A look at the AIDS epidemic through 2003
by James Denison

AIDS (acquired immune deficiency syndrome) is one of the most devastating diseases in the world and experts say that the epidemic has not yet peaked. This essay will look at the virus’ emergence, its effects, what needs to be done, as well as, the obstacles that must be overcome to successfully combat this virus which now effects all four corners of the globe.

At the time of this writing, November 2003, the latest reports from the WHO (World Health Organization) and UNAIDS, the umbrella organization of the Joint United Nations Program on HIV/AIDS, put the number of people killed by AIDS at over 20 million and the number people currently infected with the disease is at least 43 million. Two very disturbing figures that also came out in the latest reports are that 3 million people died from the disease this year, and a record number of people were infected with the disease this year, as well. The report puts the figure at 5 million new infections in 2003. That means around 14,000 people are infected with the disease every day. Yet, in rich countries AIDS is no longer a death sentence, with the advent of new combination drug therapies. But, though this new-found light of hope now shines in rich countries, there is an ever-expanding shadow of death ravaging poor countries where millions of people are dying from the disease every year.

Results have shown that educational preventative campaigns to bring awareness of the dangers of becoming infected in countries such as the United States, United Kingdom, Thailand and Brazil have proven extremely effective in slowing the spread of the disease and sometimes even reversing the trend so that less people are infected than before. However, in countries where little to no public awareness programs have been implemented, the results have been devastating. The worst hit region in the world has been sub-Saharan Africa, and the most alarming increases in infections this year come from China, India, Indonesia and Russia, all of which have had little to no public awareness programs to date. Another important reason for the spread of the disease in these regions is an issue concerning human rights, those of women, homosexuals and intravenous drug users. Also, stigmatization and discrimination against people carrying the virus has led to many infected people to not come forward and acknowledge their HIV status and get the help they need, but instead some of these people end up infecting others, and the tragedy expands exponentially.

The Origins Of A Killer

In 1999 an international team of genetic scientists traced HIV-1 (human immunodeficiency virus) to a closely related strain of virus called SIV (simian immunodeficiency virus). This virus infects chimpanzees in west-central Africa. Since chimpanzees are hunted for meat in this region, it is believed that the virus may have passed from the blood of chimpanzees into humans through superficial wounds. So deep in the heart of Africa, AIDS was spreading like wildfire decades before its effects were to be noticed in the early 1980’s in major metropolitan areas such as New York, Los Angeles and San Francisco. As a special report in the Economist noted:

The human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), is thought to have crossed from chimpanzees to humans in the late 1940’s or early 1950’s in Congo. It took several years for the virus to break out of Congo’s dense and sparsely populated jungles but, once it did, it marched with rebel armies through the continent’s numerous war zones, rode with truckers from one rest-stop brothel to the next, and eventually flew, perhaps with an air steward, to America, where it was discovered in the early 1980’s. As American homosexuals and drug injectors started to wake up to the dangers of bath-houses and needle-sharing, AIDS was already devastating Africa

The first official report that something was wrong in the United States came on June 5, 1981 in the Morbidity and Mortality Weekly Report from the Centers for Disease Control in Atlanta. In the report there was a story of a rare illness, Pneumocystis carinii pneumonia, that had killed five young gay men in Los Angeles. At the time of the report there had been no connection made yet to another unusual symptom that had already been surfacing in gay men in New York and San Francisco, that of: Karpsi’s Sarcoma. This was a cancer that usually afflicted old men from Mediterranean countries. It was not until after two years of bewildering speculation at the mounting tragedy of the “Gay Disease” or “Gay Cancer” tearing through the community that there was a causative agent identified, that came to be known as: HIV. By this time the virus had already been found to be spreading in the heterosexual population and especially among hemophiliacs in the United States and Western Europe. These were the days of the dawning of an epidemic that the world knew almost nothing about, yet much work was to be done both in medical research and public awareness to stem the spread of this devastating virus.

Desperate Times, Desperate Action

AIDS is the most political disease in the world. In the United States the virus would not be as nearly as contained as it is (i.e. there would be hundreds of thousands more AIDS deaths and perhaps millions of more people infected) if radical grassroots organizations had not taken direct action to raise awareness and put very public pressure on the government, the medical industry and the scientific community to begin to pay serious attention to the growing epidemic and its victims. The very same human rights issues of stigmatization and discrimination that faced the gay and intravenous drug using communities in the United States in the early 1980’s, are the very same issues at the burning core of the nightmare affecting sub-Saharan Africa and Asia in the year 2003. When the AIDS epidemic first broke out in New York, San Francisco and Los Angeles the response from the federal government, then headed by ultra-conservative Ronald Reagan, and local governments, such as New York City’s then mayor Kenneth Koch, there was virtually no responsive action and little to no attention given to the disease and its victims. This was because the very people affected by the virus had long been discriminated against and stigmatized by the American society at large, especially, by the mainstream population influenced by the religious right, whose roots go to the deepest levels of the American psyche all the way back to the time of the Pilgrims arriving at Plymouth Rock with their superstitious, hellfire brand of Christian fundamentalism. To be gay or an intravenous drug user was not, to say the least, widely accepted in American culture. Homosexuality was still widely held to be a perversion and, in many monotheistic circles that cast a very wide net in America, to be a sin against God. The plight of, and contempt for, intravenous drug users was held in much of the same regard. So while people in these sectors of our society watched their own die by the thousands, and witnessed unconscionable inaction by their elected leaders and medical and scientific establishments, a few very brave and visionary souls began to get angry and to organize and to develop extremely successful direct action campaigns of civil disobedience to put pressure on the necessary powers that be, to bring attention and care to a previously marginalized and disempowered segment of the population. One of the most important figures in the AIDS movement was a man named Larry Kramer who started the first AIDS activist group GMHC (Gay Men’s Health Crisis) and later the very successful ACT UP coalition (AIDS Coalition To Unleash Power). Both of these organizations were started as small groups in New York City and grew to raise awareness about the crisis on a global scale. And most importantly, these campaigns eventually educated the public about the virus and slowed the spread of the disease in the U.S. and Western Europe and achieved more resources for medical attention  to those already afflicted with the disease. In the process of this struggle, homosexuals have become a great deal more accepted into American society and have thrown off a huge load of the stigma and discrimination heaped upon them during the last 2,000 years of Christian-influenced Western Civilization, though there is still a good deal more to be done.

The success in the United States, led largely by Gay Rights activists, has yet to translate into success in combating the AIDS epidemic that is, along with extreme poverty and internecine wars, destroying societies in sub-Saharan Africa and is on the rise in Asia. Although, in Africa and Asia it is the general heterosexual population that is being decimated, the issues of human rights are still a vital and driving force that unfortunately are giving AIDS an extremely powerful upper-hand. Dr. Peter Piot, the Executive Director of UNAIDS, addressed the importance of human rights in the fight against AIDS in a recent speech given at 59th Session of the United Nations Commission on Human Rights, in Geneva, Switzerland on March 19, 2003. Here are three brief excerpts that help to shed light on the situation:

Respect, protection and fulfillment of human rights is central to the AIDS agenda, and equally, HIV/AIDS needs to be at the center of the global human rights agenda.

The goal of realizing human rights is fundamental to the global fight against AIDS. And in a world facing a terrible epidemic – one that has already spread further, faster and to more devastating effect than any other in human history – winning the fight against AIDS is a precondition for achieving rights worth enjoying.

Lack of respect for human rights continues to increase vulnerability to HIV infection of individuals and the whole society. Individuals or groups who suffer discrimination and lack of human rights protection are both more vulnerable to becoming infected and less able to cope with the burdens of HIV/AIDS. Refugees, migrants, prisoners, men who have sex with men, sex workers and injecting drug users may be more vulnerable to contracting HIV because they are often unable to realize their civil, political, economic, social and cultural rights. Further, gender inequalities spur on the spread of the epidemic and its disproportionate impact on women.

The most tragic and glaring human rights issue right now in Africa and Asia is discrimination against women.

Into The Post-Modern Heart of Darkness and Beyond

Perhaps one of the great obstacles in combating AIDS in Africa is the fear of patriarchal societies confronting issues that would empower women to make their own decisions, have a voice of their own and enjoy equal rights in ways they have yet to know. Two mutually self-defeating issues that plague the region are acute poverty and lack of education. Lack of education perpetuates superstition and taboo about sex and disease which leads to further discrimination and spread of the virus. As the "Obstacles to Prevention" section of the Economist special report points out:

Discussion of sex is often taboo. In Kenya, Christian and Islamic groups have publicly burned anti-AIDS leaflets and condoms, as a protest against what they see as the encouragement of promiscuity. A study in Thailand found that infected women were only a fifth as likely to have discussed sex openly with their partners as were uninfected women.

Myths abound. Some young African women believe that without regular infusions of sperm, they will not grow up to be beautiful. Ugandan men use this myth to seduce schoolgirls. In much of southern Africa, HIV-infected men believe that they can rid themselves of the virus by passing it on to a virgin.

Sexism. In most poor countries, it is hard for a woman to ask her partner to use a condom. Wives who insist risk being beaten up. Rape is common, especially where wars rage. Forced sex is a particularly effective means of HIV transmission, because of the extra blood.

In addition to tragedy inflicted on women looms a larger, crueler legacy, that of AIDS orphans. Because of the helplessness of women in Africa, they give birth to children and often pass the virus on to them through breast feeding. They are giving birth to victims. Victims of a disease in their bloodstream. Victims as children whose parents die from the disease. Victims of societies that are collapsing under the weight of the epidemic. Studies have shown that many of these children, who have absolutely nothing and no way to make it in the world become child prostitutes and if they are not already infected at birth, become infected and live very short lives themselves. In a report published by UNICEF this week, this year’s statistics show that there are 11 million AIDS orphans in the world today. This is 11 times higher than in 1990. The report predicts that the situation is about to get much worse. By 2010, there could be as many as 20 million AIDS orphans in sub-Saharan Africa alone.

The lack of human rights for women in sub-Saharan Africa along with the failure of certain countries to utilize comprehensive preventative programs in the 1990’s have led to the region being the hardest hit in the world. The new UNAIDS and WHO report says that 30% of people living with HIV/AIDS are living in this part of the world. South Africa has 5.3 million people with HIV – more than any other country in the world.  The report also shows that 39% of the population in Botswana is HIV positive. Sadly, two out of every three new HIV infections occur in sub-Saharan Africa. And three out of four deaths from the disease occur in this part of the world. For reasons very similar to Africa, the report reveals that there is an alarming rise of infection rates in Asian countries such as China, India and Indonesia. For any progress to be made in slowing the spread of the disease, massive resources for prevention programs and medication distribution systems to curb the death rate, especially in poor countries are needed urgently. The international community is attempting to rise to the challenge with ambitious new plans to deal with the crisis. Unfortunately, it is an unprecedented uphill battle.

“3 by 5” : The Dimensions of Hope

As grim as the new statistics are coming from UNAIDS, WHO and UNICEF, we seem, finally, to be at a turning point in combating the virus. Because the world has witnessed the horrific price of inaction or denial in sub-Saharan Africa through the 1990’s, more governments and international donor organizations are now giving in record amounts to fight the disease. For instance, this year donors and developing-country governments have put together 4.7 billion dollars, that is 23 times the total gathered in 1996. But, most of the money needed to win the fight will need to come from rich countries. Unfortunately, the current administration in power in the richest country in the world has decided to put religious fundamentalism once again as obstacle to help those dying of AIDS. Just as the dawning of the AIDS epidemic put a death sentence on gay men and intravenous drug users because they were seen as sinners against God, and therefore not worthy of help and resources from the ultra-conservative, religious right (largely influenced by the Christian Coalition) who were in power during the Reagan years, the Bush administration has brought the concept of “sin” back into the AIDS equation. Again, the results will be murderous. As the latest edition of the Economist (Nov. 29, 2003) noted in a special report:

The good news is that an increasing number of poor countries have devised plausible national plans for tackling the disease. The bad news is that some donors, particularly the largest, America, attach too many strings to their gifts. The Bush administration withholds family-planning money from groups that “promote” abortion. This causes needless trouble for reproductive health organizations, whose contribution is essential to combating AIDS. Mr. Bush is also hesitant to fund some multilateral initiatives, such a s Global Fund to Fight AIDS, Tuberculosis and Malaria. This is a shame: the Fund is good at finding out what recipient countries need, and distributes cash efficiently. If donors all gave bilaterally, recipients would have to waste time jumping through hoops.

This is a harmful and needless obstacle put into place just as the fight against AIDS is beginning to gain the necessary momentum to start to put a dent in the epidemic’s virulence. But, there are other encouraging signs starting to show. Prices for the anti-viral drug treatments for AIDS patients have begun to plummet. Since the year 2000, the prices have fallen from $10,000 per patient annually, to $300. Prices are projected to fall even further in the near future thanks to former American president Bill Clinton and his Clinton Foundation which has negotiated with four Indian drug firms to bring the price down to around $140 per year.

The most promising and ambitious project to date is being put together by UNAIDS and the WHO known as the “3 by 5” initiative. The goal is to bring anti-retroviral treatment to 3 million people by the year 2005. At the present time only 300,000 of the 5-6 million people in sub-Saharan Africa who are HIV positive have access to such treatment. The latest WHO report notes that  “At current rates of delivery less than one million people in the developing world will have access to ARV treatment by the end of 2005.”  To underscore the need for every country to lend unconditional support, Dr. Lee Jong-Wook, Director General told the BBC: “For ‘3 by 5’ to succeed, however, and for treatment access to increase further in the future the international community must continue to increase its financial and logistical support.”  The WHO report also states the need for an educational infrastructure of prevention, as well as, treatment in order to slow the spread of the virus: “There is an awareness that prevention and treatment are both necessary for controlling the spread of HIV/AIDS and that these two approaches are mutually reinforcing elements of a comprehensive response to HIV/AIDS.”

Though there appears to be some faint glimmer hope starting to shape itself on the distant horizon, there is no room for complacency or inaction. In fact, more work is needed than ever to slow the ravages of this insidious disease. It is still spiraling out of control and threatening to devastate regions beyond the African continent. So we will end this short essay with a painfully clear warning about the current state of this dire crisis with an excerpt of the most recent special report printed in this week’s Economist:

Governments everywhere should look at Africa and tremble. In some countries, more than half the population will still die of AIDS. All of Africa’s famines are now AIDS-related: hungry people lack the strength to fight off sickness, sick people lack the strength to grow food, and dead parents cannot teach their children how to farm. Other regions can avoid this, but they must act now. The rewards will come slowly; it will be years before current investments make a dent in HIV prevalence, let alone the death rate. The worst is yet to come.


Bibliography and Sources: an online resource with a wealth of information on all HIV/AIDS related topics

BBC News: “Global HIV rates at record high”  reported on November 25, 2003

The Economist: London, England
Issues used for this essay include: November 29, 2003, November 22, 2003 , July 13, 2000, December 31, 1998

The Guardian UK: London, England. “AIDS: The first 20 years (part one)”, June 3, 2001,

Positive: a film by Rosa von Praunheim in collaboration with Phil Zwickler. First Run Features NY, NY 1991

UNAIDS: “HIV/AIDS Human Rights and Law”  Speech to the 59th Session of the United Nations Commission on Human Rights in Geneva, Switzerland on March 13, 2003 by Dr. Peter Piot, Executive Director of UNAIDS. Transcript

World Health Organization: “Fact Sheet 274” on “Global AIDS treatment emergency” September 2003


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