Ten pivotal moments in the HIV epidemic

It’s World AIDS Day – all over the world people will be involved in acts of solidarity, remembrance and awareness raising for the HIV epidemic and the people it affects. World AIDS Day was first marked in 1988 but the history of the epidemic goes back much further.

The HIV epidemic has changed the world, it has affected millions of people around the world and the scale of the global response has been unprecedented – with grassroots activism, global resources and political commitment mobilised.

The story of the epidemic encompasses the extremes of human existence: ranging from scientific breakthroughs, celebrity confessions, drug consumption, human rights, births, and, deaths.

Here we’ve chosen ten pivotal events from the history of the HIV epidemic you should know about:

1. First case 1959

The earliest verified case of HIV dates back to 1959. It was discovered in a retrospective analysis of a blood sample taken from an unnamed man living in Leopoldville (now Kinshasa), in the Democratic Republic of the  Congo. This is by no means the first case of HIV – there are numerous prior cases of likely HIV infections, based on symptoms and AIDS-defining illnesses – but it is the earliest verified instance.

2. Project SIDA 1984 -1997

Much of our current understanding of HIV and AIDS is based on research findings from Project SIDA. The brain child of Peter Piot and Joseph McCormick, Project SIDA began after the pair visited Kinshasa in 1983 to investigate a surge in cases of Kaposi’s sarcoma and cryptococcal meningitis. One of the biggest HIV and AIDS research projects of its time, the research proved that AIDS could be acquired sexually, through blood transfusions, and – crucially – that it could affect anyone and everyone.

3. Princess Diana’s handshake

In 1987, stigma against people living with HIV was widespread in the UK and beyond. Despite efforts to inform the public on the ways HIV can be transmitted, many still feared touching people with HIV and AIDS. The photos of the Princess Diana shaking hands with a person openly living with HIV were shown around the world and significantly helped to shift some of the stigma and negative attitudes – which were largely based on fear and ignorance.

4. “No condom-no sex”

Thailand’s "100% Condom Use Campaign" – the slogan “No condom-no sex” – is arguably one of the most effective government-initiated HIV control programmes in history. In 1991, 97% of Thailand’s HIV infections came from encounters with sex workers. The campaign collaborated with sex businesses, commercial sex workers and local authorities to encourage 100% condom use in every commercial sex encounter, supplying millions of free condoms. Within five years, condom use increased from 15% to more than 90% of commercial sex encounters.

5. HAART raises life expectancy

Before 1996, an HIV diagnosis left people with few options; there was no known cure or effective treatment. The introduction of highly active antiretroviral therapy (HAART) was a major breakthrough and gave hope to millions of people living with HIV around the world. Those who had access to HAART saw their life expectancy increase by an average of 15 years, which was completely unheard of at the time.

6. Treatment activism

Activism has been a huge part of the story of HIV. Founded in 1998, Treatment Action Campaign (TAC) soon became one of the most important voices advocating for treatment access across the developing world and beyond. Established in South Africa to challenge the view that HIV is a death sentence and raise public awareness and understanding of HIV treatments, TAC succeeded in holding the government to account and challenged pharmaceutical companies to make treatment more affordable.

7. Denial

TAC faced an uphill struggle under the presidency of Thabo Mbeki who questioned the link between HIV and AIDS against all medical evidence. This led to years of denial and delay in rolling out treatment programmes in the face of the country’s exploding HIV epidemic. In 2008, Harvard researchers estimated that 330,000 people have died unnecessarily during this period due to government inaction.

8. The search for a cure

There is as yet no cure for HIV, but the case known as the Berlin patient is seen by many as providing a basis from which to work towards one. In 2007, American Timothy Ray Brown had been living with HIV for 11 years, taking antiretroviral medication to suppress the virus, when he developed leukaemia (unrelated to his HIV infection). His doctor in Berlin used a bone marrow donor with a known genetic mutation which gave him resistance to HIV infection by blocking the attachment of HIV to cells. Despite discontinuing his antiretroviral therapy, levels of HIV in his blood rapidly fell to undetectable levels, his CD4 count increased, and researchers have still not detected HIV in his blood or in various biopsies since. It's thought that a combination of chemotherapy destroying his own immune system, a transplant from a naturally resistant donor, and his new immune system, all helped rid his body of HIV. Brown is the only individual who is considered to have a 'sterilizing cure', meaning he no longer harbours the HIV virus within his body, as opposed to a functional cure when someone still harbours the virus within their body but does not need to take antiretroviral treatment.

9. PrEP works

In 2010, iPrEx (Pre-exposure Prophylaxis Initiative) proved that taking PrEP provides protection against HIV. In the trial, gay men at high risk of HIV were either given a daily pill containing HIV drugs or a placebo. The HIV infection rate was 44% lower in the group given PrEP. Moreover, for those men who managed to take the pill daily, the infection rate was 73% lower. These results have paved the way for PrEP as an HIV prevention method for those most at risk.

10. Treatment for all

Last year the World Health Organization published new guidelines recommending that anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible. This ‘treat-all’ recommendation responded to findings from clinical trials confirming that early use of antiretrovirals keeps people living with HIV healthier and reduces the risk of transmitting the virus to others. As of June 2016 more than 18 million people living with HIV have access to life-saving antiretroviral treatment.

This is by no means a definitive list. Our new interactive online timeline will let you read, see, hear and explore other events and how things have changed over the past four decades of the HIV epidemic.