AIDS Care

ISSN: 0954-0121 (Print) 1360-0451 (Online) Journal homepage: http://www.tandfonline.com/loi/caic20

AIDS–ten years on J. Elford , R. Bor , L. Sherr & G. Hart To cite this article: J. Elford , R. Bor , L. Sherr & G. Hart (1991) AIDS–ten years on, AIDS Care, 3:3, 235-238, DOI: 10.1080/09540129108253068 To link to this article: http://dx.doi.org/10.1080/09540129108253068

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Date: 10 November 2015, At: 09:08

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AIDS CARE, VOL. 3, NO. 3,1991

EDITORIAL

AIDS-ten years on J. ELFORD, R. BOR,L. SHERR’& G. HART^ Downloaded by [NUS National University of Singapore] at 09:08 10 November 2015



Royal Free Hospital School of Medicine, St. Mary’s Hospital G. University College & Middlesex School of Medicine, London, UK

It is now ten years since AIDS was first described in the medical literature. On June 5 1981 the US Centers for Disease Control (CDC) reported five cases of a rare pneumonia among young gay men in Los Angeles. A month later came reports from New York, Los Angeles and San Francisco of another 10 cases of pneumocystis carinii pneumonia as well as 26 cases of Kaposi’s sarcoma. By the end of August a further 70 patients, mostly young white men, had been reported in CDC’s Morbidity and Mortality Weekly Report (MMWR) taking the US total past the hundred mark. A decade later the global total of AIDS cases exceeds 300,000 and, to quote Larry Kramer, we are still counting. The early MMWR reports make fascinating reading ten years on. Like pieces of a jigsaw puzle, they fell into place with remarkable speed. There were just 3 MMWR entries concerning this new disease in 1981. June, ‘Pneumocystis pneumonia-Los Angeles’, July, ‘Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men-New York City and California’ and at the end of August a ‘Follow-up on Kaposi’s sarcoma and pneumocystic pneumonia’. Immunosuppression was suspected but the cause was not known. Physicians were alerted for these presenting symptoms in homosexual men. And there the matter rested until May 1982. ‘Persistent, generalized lymphadenopathy among homosexual men’ was rapidly followed in June by a report on diffuse, undifferentiated non-Hodgkins lymphoma among male homosexuals plus an ‘Update on Kaposi’s sarcoma and opportunistic infections in previously healthy persons’. By now 355 cases of KS and opportunistic infections had been reported in the USA and not just among gay men; 41 were heterosexual men and 13 heterosexual women. About two-thirds of the heterosexual patients were drug-users. Compared with the gay men, the heterosexual patients were more likely to be black or Hispanic. June 1982 saw the publication of an intriguing report on a cluster of Kaposi’s sarcoma and pneumocystis carinii pneumonia among gay men living in Los Angeles and Orange Counties, California. Nine patients with KS or PCP had all had ‘sexual contact’ with other patients within five years of the onset of their symptoms. The report suggested that their immunosuppression could be the result of a sexually transmitted infectious agent, yet to be identified. With hindsight the investigators probably asked the wrong questions about risk but came up with the right answer all the same. Infection probably occurred more than five

Address for Correspondence: Dr J. Elford, Department of Public Health and Primary Care, Royal Free Hospital School of Medicine, Pond Street, London NW3 2QG, UK.

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years before the onset of symptoms and ‘sexual contact’ was a nebulous measure of risk without more precise information on the type of sexual activity. The pace began to quicken in July with reports of opportunistic infections and Kaposi’s sarcoma among Haitians living in the United States and pneumocystis pneumonia among haemophiliacs. The clinical and immunological picture among the 34 Haitian patients was similar to that already seen in gay men and drug users. As was the case for the three haemophiliacs even though they were heterosexual men with no history of injecting drugs. While the cause of the immunosuppression was still unknown this report raised the possibility of an infectious agent being transmitted through blood products. Another piece of the jigsaw fell into place. A new term entered our vocabulary in September 1982 with the publication of an ‘Update on acquired immune deficiency syndrome (AIDS)’. The first case definition of AIDS had emerged. A pedant might argue that we have to wait another year before marking the tenth anniversary of ‘AIDS’. November 1982 saw the publication of precautions for clinical and laboratory staff in contact with AIDS patients. Close parallels were drawn between the modes of transmission of hepatitis B and the postulated infectious agent causing AIDS; infection through casual contact seemed unlikely. Health care staff were advised to take extra precautions with AIDS patients and those with apparently increased risk (homosexual men, injecting drug users, haemophiliacs and Haitians). These recommendations seem a world apart from the universal precautions now being adopted for infection control at work. We had to wait until just before Christmas 1982 for the remaining pieces of the jigsaw to appear. On December 10th came a report from California that AIDS may be associated with blood transfusions. An infant of 20-months developed unexplained cellular immunodeficiency and opportunistic infection after multiple transfusions. Soon after birth the infant had received blood products from 19 donors, including platelets derived from the blood of a man subsequently found to have AIDS. At 7 months the child became ill, dying just over a year later. If this was AIDS it strengthened the hypothesis of an infectious agent transmitted either sexually or in blood and blood products. A week later, on December 17th, unexplained immunodeficiency and opportunistic infections were reported in four children, all under the age of 2 years, living in New York, New Jersey and California. The MMWR editor noted that if indeed the infants did have AIDS then exposure to the putative agent must have occurred very early. “Transmission of an ‘agent’ from mother to child, either in utero or shortly after birth, could account for the early onset of immunodeficiency in these infants”. A mere eighteen months after the first report of PCP in young gay men living in Los Angeles the jigsaw was all but complete. Early in 1983 AIDS was reported among prison inmates in New York and New Jersey while in March the MMWR published guidelines on AIDS prevention. Acknowledging that the cause of AIDS remained unknown it recommended that “sexual contact should be avoided with persons known or suspected to have AIDS’. No sex rather than safer sex was the order of the day. A 1983 report in Science was the first to describe the much sought after virus while in March of that year a letter in the Lancet brought to our attention the presence of AIDS in Africa. The jigsaw took on a global dimension. Were those first two years simply a period of calm epidemiological surveillance? Far from it. In September 1983, the editor of MMWR wrote that AIDS cases had been classified into risk groups for epidemiological purposes. However, the close association of certain groups with the disease had been misconstrued by some to mean that they were likely to transmit the disease through non-intimate contact. This view, the editor continued, was not

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AIDS-TEN

YEARS ON

237

justified by available data. Nonetheless, it had been used unfairly as a basis for discrimination. This was early recognition by CDC Atlanta that AIDS was as much a social and political problem as it was medical. And has remained so. We learned about the clinical, epidemiological, psychosocial and political dimensions of HIV and AIDS in a remarkably short length of time. Yet could anyone fully anticipate the far-reaching consequences of the emerging pandemic? HIV and AIDS have now been reported in almost every country of the world. They have affected people far beyond the epidemiological boundaries originally created by CDC. And the impact of HIV and AIDS has not simply been on physical health but also on psychological, social, economic and political well-being. HIV and AIDS remind us that health must always be studied in its social context. And, in turn,the psychosocial dimensions of health and illness should inform the clinical agenda. To mark the first ten years of AIDS, we have invited a number of scholars to contribute review papers in their chosen field. Inevitably we have not been able to cover all the psychosocial aspects of HIV and AIDS in this special edition of AIDS Care. Nonetheless, the papers published here reflect the diversity of research in this area. Behaviour change, drugs, the worried well, children and adolescents are described in these review papers. Interventions, risk reduction, the role of nongovernmental organizations and HIV/AIDS in Haiti are also included. And an original research paper from Brazil on the low occupational risk of HIV supports the epidemiological data gathered in the USA and Europe during the first decade. We are immensely grateful to all those who contributed review papers to this edition of AIDS Care. Working to a tight deadline, they gathered material from disparate sources to provide an overview of the first decade of AIDS. Reading these papers allows us to pause and reflect on the ten years that have passed since that first MMWR report in June 1981. Looking back over the last decade may guide us in formulating priorities for the years to come. From the papers published here, it is clear to us that tackling inequalities and discrimination should be placed high on the agenda alongside the development of new therapies.

References BARRE-SINOUSSI, F., CHERMANN, J.C., REY,F. et al. (1983) Isolation of T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS), Science, 220, pp. 868-871. CENTERS FOR DISEASE CONTROL(1981) Pneumocystis pneumonia-Los Angeles, Morbidity and Monality Weekly Report, 30, pp. 250-252. CENTERSFOR DISEASECONTROL(1981) Kaposi's sarcoma and pneumocystis pneumonia among homosexual men-New York City and California, Morbidity and Monality Weekly Report, 30, pp. 305-308. CENTERSFOR DISEASECONTROL (1981) Follow-up on Kaposi's sarcoma and pneumocystis pneumonia, Morbidity and Monaliry Weekly Report, 30, pp. 409-410. CENTERSFOR DISEASECONTROL(1982) Persistent, generalized lymphadenopathy among homosexual males, Morbidity and Mmaliry Weekly Repm, 31, pp. 249-251. CENTERSFOR DISEASECONTROL(1982) Update on Kaposi's sarcoma and opportunistic infection in previously healthy persons-United States, Morbidity and Mmaliry Weekly Repon, 31, pp. 294-301. CENTERS POR DISEASECONTROL (1982) A cluster of Kaposi's sarcoma and pneumocystis carinii pneumonia among homosexual male residents of Los Angeles and Orange Counties, California, Morbidity and Monality Weekly Repon, 31, pp. 305-307. CENTERSFOR DISEASECONTROL(1982) Opportunistic infections and Kaposi's sarcoma among Haitians in the United States, Morbidity and M m l i t y Weekly Report, 31, pp. 353-361. CENTERSFOR DISEASE CONTROL(1982) Pneumocystis carinii pneumonia among persons with hemophilia A, Morbidiry and Mortality Weekly Report, 31, pp. 365-367. CENTERSFOR DISEASECONTROL(1982) Update on acquired immune deficiency syndrome (AIDS)-United States, Morbidity and Mortaliry Weekly Report, 31, pp. 507-514.

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CENTERSFOR DISEASECONTROL(1982) Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs, Morbidity and Mortality Weekly Report, 31, pp. 577-580. CENTERSFOR DISEASECONTROL (1982) Update on acquired immune deficiency syndrome (AIDS) among patients with hemophilia A, Morbidity and Mortality Weekly Report, 31, pp. 644-652. CENTERSFOR DISEASECONTROL(1982) Possible transfusion-associated acquired immune deficiency syndrome (AIDS)-California, Morbidity and Mortality Weekly Report, 31, pp. 652-654. CENTERS FOR DISEASECONTROL (1982) Unexplained immunodeficiency and opportunistic infections in infants-New York, New Jersey, California, Morbidity and Mortality Weekly Report, 31, pp. 665-667. CENTERSFOR DISEASECONTROL (1983) Acquired immune deficiency syndrome (AIDS) in prison inmates-New York, New Jersey, Morbidity and Mortality Weekly Report, 31, pp. 700-701. CENTERSFOR DISEASECONTROL(1983) Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations, Morbidity and Mortality Weekly Report, 32, pp. 101-103. CENTERSFOR DISEASECONTROL(1983) Update: acquired immunodeficiency syndrome (AIDS)-United States, Morbidity and Mortality Weekly Report, 32, pp. 465-467. CLUMECK, N., MASCART-LEMONE, F., DE MAUBEUGE, J., BRENEZ,K., MARCELIS,L. Acquired immune deficiency syndrome in black Africans, Lancet, 1983; i: 642.

AIDS--ten years on.

AIDS Care ISSN: 0954-0121 (Print) 1360-0451 (Online) Journal homepage: http://www.tandfonline.com/loi/caic20 AIDS–ten years on J. Elford , R. Bor ,...
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