History of HIV/AIDS
There are two types of HIV:
Transmission from non-humans to humans
Research in this area is conducted using molecular phylogenetics, comparing viral genomic sequences to determine relatedness.
HIV-1 from chimpanzees and gorillas to humans
Scientists generally accept that the known strains (or groups) of
Using
HIV-2 from sooty mangabeys to humans
Similar research has been undertaken with
There are six additional known
Molecular dating studies suggest that both the epidemic groups (A and B) started to spread among humans between 1905 and 1961 (with the central estimates varying between 1932 and 1945).[21] [22]
Bushmeat practice
According to the natural transfer theory (also called "hunter theory" or "bushmeat theory"), in the "simplest and most plausible explanation for the cross-species transmission"[10] of SIV or HIV (post mutation), the virus was transmitted from an ape or monkey to a human when a hunter was cut or otherwise injured while hunting or butchering an infected animal. The resulting exposure to blood or other bodily fluids of the animal can result in SIV infection.[23] Rural Africans who were not keen to pursue agricultural practices in the jungle turned to non-domesticated animals as their primary source of meat. This over-exposure to bushmeat and malpractice of butchery increased blood-to-blood contact, which then increased the probability of transmission.[24] A recent serological survey showed that human infections by SIV are not rare in Central Africa: the percentage of people showing seroreactivity to antigens—evidence of current or past SIV infection—was 2.3% among the general population of Cameroon, 7.8% in villages where bushmeat is hunted or used, and 17.1% in the most exposed people of these villages.[25] How the SIV virus would have transformed into HIV after infection of the hunter or bushmeat handler from the ape/monkey is still a matter of debate, although natural selection would favour any viruses capable of adjusting so that they could infect and reproduce in the T cells of a human host.
Emergence
Unresolved questions about HIV origins and emergence
The discovery of the main HIV/SIV phylogenetic relationships permits explaining broad HIV
It is not yet explained why only four HIV groups (
It also remains unexplained why all epidemic HIV groups emerged in humans nearly simultaneously, and only in the 20th century, despite very old human exposure to SIV (a 2010 phylogenetic study demonstrated that SIV is at least tens of thousands of years old).[26]
Origin and epidemic emergence
Several of the theories of HIV origin accept the established knowledge of the HIV/SIV phylogenetic relationships, and also accept that
Genetic studies of the virus suggested in 2008 that the most recent common ancestor of the HIV-1 M group dates back to the
In 2014, a study conducted by scientists from the University of Oxford and the University of Leuven, in Belgium, revealed that because approximately one million people every year would flow through the prominent city of Kinshasa,[1] which served as the origin of the first known HIV cases in the 1920s,[1] passengers riding on the region's Belgian railway trains were able to spread the virus to larger areas.[1] The study also identified a roaring sex trade, rapid population growth and unsterilised needles used in health clinics as other factors which contributed to the emergence of the Africa HIV epidemic.[1]
Social changes and urbanization
Colonialism in Africa
Amit Chitnis, Diana Rawls, and Jim Moore proposed that HIV may have emerged epidemically as a result of harsh conditions, forced labor, displacement, and unsafe injection and vaccination practices associated with colonialism, particularly in French Equatorial Africa.[30] The workers in plantations, construction projects, and other colonial enterprises were supplied with bushmeat, which would have contributed to an increase in hunting and, it follows, a higher incidence of human exposure to SIV. Several historical sources support the view that bushmeat hunting indeed increased, both because of the necessity to supply workers and because firearms became more widely available.[30][31][32]
The colonial authorities also gave many
The authors proposed that HIV-1 originated in the area of French Equatorial Africa in the early 20th century (when the colonial abuses and forced labor were at their peak). Later research established that these theories were mostly correct: HIV-1 groups M and O started to spread in humans in late 19th–early 20th century.[14][15][16][17] In addition, all groups of HIV-1 descend from either SIVcpz or SIVgor from apes living to the west of the Ubangi River, either in countries that belonged to the French Equatorial Africa federation of colonies, in Equatorial Guinea (then a Spanish colony), or in Cameroon (which was a German colony between 1884 and 1916, and then fell to Allied forces in World War I, and had most of its area administered by France, in close association with French Equatorial Africa).
This theory was later dubbed "Heart of Darkness" by Jim Moore,[34] alluding to the book of the same title written by Joseph Conrad, the main focus of which is colonial abuses in equatorial Africa.
Unsterile injections
In several articles published since 2001, Preston Marx, Philip Alcabes, and Ernest Drucker proposed that HIV emerged because of rapid serial human-to-human transmission of
Central to the Marx et al. argument is the concept of adaptation by
Marx et al. reported experiments of cross-species transfer of SIV in captive monkeys (some of which made by themselves), in which the use of serial passage helped to adapt SIV to the new monkey species after passage by three or four animals.[20]
In agreement with this model is also the fact that, while both
Marx et al. proposed that unsterile injections (that is, injections where the needle or syringe is reused without sterilization or cleaning between uses), which were likely very prevalent in Africa, during both the colonial period and afterwards, provided the mechanism of serial passage that permitted HIV to adapt to humans, therefore explaining why it emerged epidemically only in the 20th century.[20][35]
Massive injections of the antibiotic era
Marx et al. emphasize the massive number of injections administered in Africa after antibiotics were introduced (around 1950) as being the most likely implicated in the origin of HIV because, by these times (roughly in the period 1950 to 1970), injection intensity in Africa was maximal. They argued that a serial passage chain of 3 or 4 transmissions between humans is an unlikely event (the probability of transmission after a needle reuse is something between 0.3% and 2%, and only a few people have an acute SIV infection at any time), and so HIV emergence may have required the very high frequency of injections of the antibiotic era.[20]
The molecular dating studies place the initial spread of the epidemic HIV groups before that time (see above).[14][15][16][17][21][22] According to Marx et al., these studies could have overestimated the age of the HIV groups, because they depend on a molecular clock assumption, may not have accounted for the effects of natural selection in the viruses, and the serial passage process alone would be associated with strong natural selection.[37][20]
Injection campaigns against sleeping sickness
David Gisselquist proposed that the mass injection campaigns to treat trypanosomiasis (sleeping sickness) in Central Africa were responsible for the emergence of HIV-1.[38] Unlike Marx et al.,[20] Gisselquist argued that the millions of unsafe injections administered during these campaigns were sufficient to spread rare HIV infections into an epidemic, and that evolution of HIV through serial passage was not essential to the emergence of the HIV epidemic in the 20th century.[38]
This theory focuses on injection campaigns that peaked in the period 1910–40, that is, around the time the
Other early injection campaigns
Jacques Pépin and Annie-Claude Labbé reviewed the colonial health reports of
The authors suggested that the very high prevalence of the
According to Pépin's 2011 book, The Origins of AIDS,[40] the virus can be traced to a central African bush hunter in 1921, with colonial medical campaigns using improperly sterilized syringe and needles playing a key role in enabling a future epidemic. Pépin concludes that AIDS spread silently in Africa for decades, fueled by urbanization and prostitution since the initial cross-species infection. Pépin also claims that the virus was brought to the Americas by a Haitian teacher returning home from Zaire in the 1960s.[41] Sex tourism and contaminated blood transfusion centers ultimately propelled AIDS to public consciousness in the 1980s and a worldwide pandemic.[40]
Genital ulcer diseases and evolution of sexual activity
João Dinis de Sousa, Viktor Müller, Philippe Lemey, and Anne-Mieke Vandamme proposed that HIV became epidemic through sexual serial transmission, in nascent colonial cities, helped by a high frequency of
Probable time interval of cross-species transfer
Sousa et al. use molecular dating techniques to estimate the time when each HIV group split from its closest SIV lineage. Each HIV group necessarily crossed to humans between this time and the time when it started to spread (the time of the MRCA), because after the MRCA certainly all lineages were already in humans, and before the split with the closest simian strain, the lineage was in a simian. HIV-1 groups M and O split from their closest SIVs around 1931 and 1915, respectively. This information, together with the datations of the HIV groups' MRCAs, mean that all HIV groups likely crossed to humans in the early 20th century.[13]
Strong genital ulcer disease incidence in nascent colonial cities
The authors reviewed colonial medical articles and archived medical reports of the countries at or near the ranges of
Therefore, the peak GUD incidences in cities have a good temporal coincidence with the period when all main HIV groups crossed to humans and started to spread.[13][14][15][16][17][21][22] In addition, the authors gathered evidence that syphilis and the other GUDs were, like injections, absent from the densely forested areas of Central and West Africa before organized colonialism socially disrupted these areas (starting in the 1880s).[13] Thus, this theory also potentially explains why HIV emerged only after the late 19th century.
Female genital mutilation
Uli Linke has argued that the practice of female genital mutilation (either or both of clitoridectomy and infibulation) is responsible for the high incidence of AIDS in Africa, since intercourse with a female who has undergone clitoridectomy is conducive to exchange of blood.[43]
Male circumcision distribution and HIV origins
Male
Sousa et al. charts reveal that male circumcision frequencies were much lower in several cities of western and central Africa in the early 20th century than they are currently. The reason is that many
The authors studied early
Computer simulations of HIV emergence
Sousa et al. then built
The main result was that
Male
One of the main advantages of this theory is stressed by the authors: "It [the theory] also offers a conceptual simplicity because it proposes as causal factors for SIV adaptation to humans and initial spread the very same factors that most promote the continued spread of HIV nowadays: promiscuous [sic] sex, particularly involving sex workers, GUD, and possibly lack of circumcision."[13]
Iatrogenic and other theories
The theories centred on the role of
Pathogenicity of SIV in non-human primates
In most non-human primate species, natural
In addition, a long-term survey of
History of spread
1959: David Carr
David Carr was an apprentice printer (usually mistakenly referred to as a sailor; Carr had served in the Navy between 1955 and 1957) from Manchester, England who died on August 31, 1959, and was for some time mistakenly reported to have died from AIDS-defining opportunistic infections (ADOIs). Following the failure of his immune system, he succumbed to pneumonia. Doctors, baffled by what he had died from, preserved 50 of his tissue samples for inspection. In 1990, the tissues were found to be HIV-positive. However, in 1992, a second test by AIDS researcher David Ho found that the strain of HIV present in the tissues was similar to those found in 1990 rather than an earlier strain (which would have mutated considerably over the course of 30 years). He concluded that the DNA samples provided actually came from a patient with AIDS in the 1990s. Upon retesting David Carr's tissues, he found no sign of the virus.[47][48][49]
1959: Congolese man
One of the earliest documented HIV-1 infections was discovered in a preserved blood sample taken in 1959 from a man from Léopoldville in the Belgian Congo.[50] However, it is unknown whether this anonymous person ever developed AIDS and died of its complications.[50]
1960: Congolese woman
A second early documented HIV-1 infection was discovered in a preserved lymph node biopsy sample taken in 1960 from a woman from Léopoldville, Belgian Congo.[17]
1966: Congolese man
A strain with a large amount of the genetic material present was dated to 1966 from a sample from a 38-year-old man.[51]
1969: Robert Rayford
In May 1969, 16-year-old African-American
1973: Ugandan children
From 1972 to 1973, researchers drew blood from 75 children in
1976: Arvid Noe
In 1975 and 1976, a Norwegian sailor, with the alias name Arvid Noe, his wife, and his seven-year-old daughter died of AIDS. The sailor had first presented symptoms in 1969, eight years after he first spent time in ports along the West African coastline. A gonorrhea infection during his first African voyage shows he was sexually active at this time. Tissue samples from the sailor and his wife were tested in 1988 and found to contain HIV-1 (Group O).[58][59]
1977: Grethe Rask
Spread to the Western Hemisphere
HIV-1 strains were once thought to have arrived in New York City from Haiti around 1971.[62][63][64] It spread from New York City to San Francisco around 1976.[62]
HIV-1 is believed to have arrived in Haiti from central Africa, possibly from the
Because of the long incubation period of HIV (up to a decade or longer) before symptoms of AIDS appear, and because of the initially low incidence, HIV was not noticed at first. By the time the first reported cases of AIDS were found in large United States cities, the prevalence of HIV infection in some communities had passed 5%.[69] Worldwide, HIV infection has spread from urban to rural areas, and has appeared in regions such as China and India.
Canadian flight attendant theory
A Canadian
Homeless people and intravenous drug users in New York
A volunteer
Julia Epstein writes in her book Altered Conditions: Disease, Medicine and Storytelling that: "As we uncover more of the early history of HIV infection, it becomes clear that by at least the 1970s the virus was already making major inroads into the immune systems of a number of diverse populations in the United States (the retrospectively diagnosed epidemic of 'junkie pneumonia' in New York City in the late 1970s for example) and had for some time been causing devastation in several countries in Africa."[74]
Anecdotal evidence suggests that so-called junkie pneumonia first began to afflict heroin addicts in New York in 1977.[75] In her book EnGendering AIDS: Deconstructing Sex, Text, and Epidemic, Tamsin Wilton writes: "People had been sickening and dying of mysterious conditions since the early 1970s, conditions that we can retrospectively diagnose as AIDS related.[76] There was, for example, a phenomenon known as 'junkie pneumonia' which spread among some populations of injecting street drug users in the 1970s, and which is now believed to have been caused by HIV infection."[76]
Melinda Cooper writes in her book Family Values: Between Neoliberalism and the New Social Conservatism: "It is plausible that these cases [of AIDS] did not come to light in the 1970s for the same reason that 'junkie pneumonia' was not recognized as the sign of an emerging infectious disease: The people in question had such precarious access to health care that news of their death was never communicated to public health authorities."[77]
An article by Pattrice Maurer in the newspaper Agenda from April 1992 explores some of the issues surrounding junkie pneumonia.[78] It starts: "In the late 1970s while the epidemic known as 'disco fever' swept through the U.S., an epidemic known as 'junkie pneumonia' raged among injection drug users in New York City." It continues: "Few people were aware that large numbers of injections drug users were inexplicably dying of pneumonia. Those few who did notice these deaths did not feel compelled to investigate the public health puzzle they posed."[78] The author's opinion is that if anyone had bothered to investigate these deaths, they would have found an immune system disorder that is now called AIDS.[78]
Steven Thrasher writes in The Guardian: "Indeed, those of us who study AIDS have long known that long before common symptoms such as Kaposi sarcoma and pneumonia were showing up among hemophiliacs and gay men, they were likely affecting homeless people who lived off society's radar, people who used IV (intravenous) drugs and those who avoided medical treatment out of fear."[73]
A chapter in The Proceedings of the World Conference of Therapeutic Communities (9th, San Francisco, California, September 1–6, 1985) gives details about serum samples that were tested for signs of HIV (then called HTLV-III/LAV) antibodies.[79] Quoting: "We have also conducted historical studies of the epidemic in New York City, using serum samples that were originally collected for other purposes. We have sera from IV drug users that go back to the middle 1960s. The first indication of HTLV-III/LAV antibody presence is in one of eleven samples from 1978 ... 29% of 40 samples in 1979 ... 44% of samples from 1980 and 52% of samples from 1982. The HTLV-III/LAV virus appears to have been introduced among IV drug users in the late 1970s in New York City."[79][80]
Anna Thompson writes on the website TheBody.com in an article dated Autumn 1993: "Many women were dying in the late '70s of pneumonia, cervical cancer, and other illnesses complicated by 'mysteriously' suppressed immune systems. Yet, it was not until 1981 that a case of AIDS in a woman was first reported by the Centers for Disease Control (CDC)."[81] She continues: "The CDC's refusal to address women's issues led to the overall perception that women do not get AIDS."[81]
In an article published in AIDS: Cultural Analysis/Cultural Activism, author
The study "HIV-1 Infection Among Intravenous Drug Users in Manhattan, New York City, from 1977 through 1987", published in February 1989, seeks to understand long term trends in the spread of HIV among intravenous drug users (IDUs).[84] AIDS surveillance data and studies which detail the number of persons who tested HIV positive in Manhattan are used to compile information deemed critical to realising the extent of the AIDS epidemic. It starts by stating that up to September 1988, IDU was the risk behaviour in 19,139 (or 26%) of the first 72,223 cases of AIDS in the US.[84] Cases among IDUs in New York City in the same period numbered 6,182 (approximately a third of national IDU cases). The study continues to outline the methodology used in the compilation of data. It says that while truly representative samples of IDUs within a community are probably impossible to obtain, samples of IDUs entering treatment provide a good source for monitoring trends. In the results section it states (quoting): "The first evidence for HIV-1 infection among IV drug users in New York is from three cases of AIDS in children born in 1977. These cases were later reported to the New York City Department of Health AIDS Surveillance Unit. These children did not receive any known transfusions prior to developing AIDS and were born to mothers known to be IV drug users."[84]
It continues to outline that the earliest known case of AIDS in an adult IDU occurred in 1979 (mixed risk) and that known cases among IDUs increased rapidly from the 8 cases in 1980 (3 mixed risk), to 31 cases in 1981, to 160 cases in 1982, and to 340 cases in 1983.[84] Statistics on the incidence of positive tests for HIV, mainly using archived samples, are: 1 out of 11 in 1978; 13 out of 50 in 1979; 8 out of 21 in 1980; 14 out of 28 between 1981 and 1983; 75 out of 137 and 38 out of 63 in 1984; 36 out of 55 in 1986 and 169 out of 294 in 1987.[84] In the comments section, it states: "The three cases in 1977 of apparent perinatal transmission (mother-to-child) from IV drug-using women strongly suggest that the introduction of HIV-1 into the IV drug-use group occurred around 1975 or 1976, or perhaps even earlier."[84] It says that without extensive samples from this period, it is not possible to be certain about the spread of HIV among IDUs, but the samples from IDUs with chronic liver disease suggest that the rates of infection were below 20% for the first 3 or 4 years after its introduction.[84]
HIV is thought to have entered the population of people using intravenous drugs in New York City in approximately 1975.[85][84] In Spring 1975, the government of New York City underwent a fiscal crisis which led to the closing of many social services, with people who used intravenous drugs living in a hostile sociopolitical and legal environment.[85] This fiscal crisis led to many agencies with health responsibilities being particularly hard hit, which in turn might have led to an increase in HIV/AIDS and Tuberculosis (TB).[86] Quoting from a 2006 American Journal of Public Health study: "Between 1974 and 1977, the Department of Health (DOH) budget (in NY) was cut by 20%, and by 1977 the department had lost 1700 staff members – 28% of its 1974 workforce. To achieve these reductions, the department closed 7 of 20 district health centers, cut $1 million from its methadone program, terminated the employment of 14 of 19 health educators, and closed 20 of 75 child health stations and 6 of 14 chest clinics (the units responsible for TB screening and diagnosis)."[86]
A study published in the
1981–1982: From GRID to AIDS
The AIDS epidemic officially began on June 5, 1981, when the U.S.
In June 1982, a report of a group of cases amongst gay men in
Activism by AIDS patients and families
During the beginning of the HIV/AIDS epidemic, it was believed that this disease mainly affected gay, white males. Due to this misconception, people of colour were provided with no information or services in order to educate and help those who were HIV positive. Fortunately, as more activists spoke out about their concerns, organizations, such as Black Coalition For AIDS Prevention and Alliance For South Asian AIDS Prevention came to be, providing their communities with services in order to enhance the lives of HIV positive individuals and to reduce the spread of HIV/AIDS. [101]
In New York City, Nathan Fain,
Also in 1982,
At the beginning of the AIDS epidemic in the 1980s, there was very little information about the disease. Because AIDS disproportionately affected stigmatized groups, such as homosexuals, people of low socioeconomic status, sex workers and addicts, there was also initially little mass media coverage when the epidemic started.[106] However, with the rise of activist groups composed of people suffering from AIDS, either directly or through a loved one, more public attention was brought to the epidemic.[107]
Identification of the virus
May 1983: LAV
In May 1983, a team of doctors at the Pasteur Institute in France including Françoise Barré-Sinoussi and Luc Montagnier reported that they had isolated a new retrovirus from lymphoid ganglions that they believed was the cause of AIDS.[108] The virus was later named lymphadenopathy-associated virus (LAV) and a sample was sent to the U.S. Centers for Disease Control, which was later passed to the National Cancer Institute (NCI).[108][109]
May 1984: HTLV-III
In May 1984 a team led by
August 1984: ARV
Dr. Jay Levy's group at the University of California, San Francisco also played a role in the discovery of HIV. He independently isolated the AIDS virus in 1983 and named it the AIDS-associated Retrovirus (ARV), publishing his findings in the journal Science in 1984.[111]
January 1985: both found to be the same
In January 1985, a number of more-detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same—indeed, it was later determined that the virus isolated by the Gallo lab was from the lymph nodes of the patient studied in the original 1983 report by Montagnier[112]—and was the etiological agent of AIDS.[113][114]
May 1986: the name HIV
In May 1986, the International Committee on Taxonomy of Viruses ruled that both names should be dropped and a new name, HIV (Human Immunodeficiency Virus), be used.[115]
Nobel
Whether Barré-Sinoussi and Montagnier deserve more credit than Gallo for the discovery of the virus that causes AIDS has been a matter of
Case definition for epidemiological surveillance
Since June 5, 1981, many definitions have been developed for epidemiological surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition.
Genetic studies
According to a study published in the
In 2010, researchers reported that SIV had infected monkeys in Bioko for at least 32,000 years. Previous to this time, it was thought that SIV infection in monkeys had happened over the past few hundred years.[120] Scientists estimated that it would take a similar amount of time before humans adapted naturally to HIV infection in the way monkeys in Africa have adapted to SIV and not suffer any harm from the infection.[121]
A 2016 Czech study of the genome of
Debunked HIV/AIDS conspiracy theories
AIDS denialism
Influence on Bolsonaro
Conspiracy theorists' influence reached a peak in 2021 with Brazilian president Jair Bolsonaro claiming that COVID vaccines can lead to AIDS. The Supreme Federal Court of Brazil ordered an investigation into Bolsonaro for falsely claiming that COVID vaccines could increase the risk of contracting AIDS.[129]
See also
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Further reading
- Shilts, Randy (1987). And the Band Played On: Politics, People, and the AIDS Epidemic. New York: St. Martin's Press. OCLC 16130075.
- Brier, Jennier (2011). Infectious Ideas: U.S. Political Responses to the AIDS Crisis. Chapel Hill: University of North Carolina Press. ISBN 978-0-8078-7211-6.
- Petro, Anthony (2015) After the Wrath of God: AIDS, Sexuality, and American Religion. Oxford University Press. After the Wrath of God: AIDS, Sexuality, and American Religion