Losing the war on AIDS

Abstract

I n 1978, physicians in New York, San Francisco, and Los Angeles began to see unusual opportunistic infections, such as Pneumocystis carinii pneumonia and cerebral tuberculosis, in intravenous drug users and homosexual men. Then a large number of Kaposi’s sarcoma cases suddenly appeared in these same risk groups. By 1981, it became widely recognized that a new epidemic, caused by a sexually transmitted, blood borne disease, had begun. Denial has characterized the AIDS epidemic from the onset. Blood banks in the United States drew the erroneous conclusion that the ‘‘types of people’’ who were getting AIDS, namely homosexuals, would not donate blood at community blood centers in large numbers. Between 1982 and 1985, blood banks did not screen for high-risk behavior, which would have excluded many infected individuals. During this time period, between 18,000 and 28,000 individuals were infected with HIV as a result of blood transfusions. Meanwhile, Hispanic gay men in San Francisco felt that AIDS was an Anglo’s disease. White gay men felt that it was a disease of people who went to bathhouses. Totalitarian regimes, such as China, Saudi Arabia, and Iraq, consistently denied that AIDS even existed in their countries. Only when confronted with overwhelming numbers of infected individuals have those countries acknowledged the extent of the disease. South Africa never acknowledged the presence of HIV/AIDS until the fall of the apartheid government in the mid-1990s. Azidothymidine, the first antiretroviral agent, was developed in 1987 by BurroughsWellcome (later GlaxoWellcome, later GlaxoSmithKline). We now know that one drug alone is not powerful enough. Only with the introduction of protease inhibitors in 1995, and the combination of protease inhibitors