25 Years of AIDS and HIV: Denial and the Global Epidemic 1999-2004

On June 5, 1981, the CDC introduced the world to the disease the eventually became known as AIDS. This is the third article in a series that looks back at some of the major milestones of the past 25 years. Parts 1-3 of this series can be found in the January, April-May and June-July 2006 editions of Survival News_._

Jeff Graham

Just as much of the 1990s concerned the "changing face of AIDS," the turn of the century brought about a major shift in focus from the domestic AIDS crisis in the United States to realizing the full global implications of a world-wide pandemic. Although leaders in the United States and other western countries had paid lip service to the global epidemic since the mid-80s, no significant effort had ever been focused on easing the suffering of the vast majority of people living with HIV who lived in impoverished countries in Africa, Asia and Latin America. In 1999, activists threw down the gauntlet by strategically disrupting then Vice President Al Gore's announcement that he would be running for president.

Activists continued to shadow Gore in the early months of his campaign, eventually forcing the Clinton administration to announce plans to create a U.S. response to the growing international epidemic. Unfortunately, with an estimated 2.6 million people already dead from AIDS and an additional 33 million people infected with HIV, many would argue that the U.S. response was far too little, too late.

By early 2000, it seemed as though things might be turning around. The Clinton administration had begun to focus on the global epidemic, and many U.S.-based AIDS organizations were reaching out to their colleagues around the world with offers of support. Yet these efforts would soon be thwarted by a surprise influence from so-called AIDS denialists. This loosely organized group of people have been followers of the widely discredited claims of Dr. Peter Duesberg that HIV is a harmless virus and that AIDS as a disease doesn't really exist.

While these claims have been around since the late 1980s and have gained new adherent every few years, no one could have foreseen the devastating impact these denialists would have on the fight against AIDS in South Africa. South African President Thebo Mbeki appears to be someone who does his own internet research. He stumbled across some websites run by the denialists and felt that these folks were exposing an actual cover-up. As a result, rather than using the momentum of the growing international fight against AIDS to bring resources to South Africa, he convened a panel of "experts" to debate whether or not HIV and AIDS was a serious problem in South Africa. It was estimated that as many as 25% of the adult population in South Africa was already infected with HIV.

By the time the 2000 World AIDS Conference was held in Durban, South Africa, there had already been outbreaks of violence as people living with HIV in that country demanded their government recognize their needs and formulate a plan for providing medications to all in need. Unfortunately, their struggle continues today.

At the turn of the century, Chinese officials also reversed their previous position that AIDS was not an issue in their country and announced that the epidemic was spreading so quickly that within a few short years, the rates of infection and mortality could easily surpass that of sub-Saharan Africa. Although the Chinese epidemic is very similar to the epidemic in other parts of the world, with injection drug users and their sex partners, sex workers and gay and bisexual men at the highest risk, one of the main reasons for the media attention to the Chinese epidemic was the story of the Henan Province. In this part of China, HIV spread rapidly through the general population due to the practices of plasma donation centers. The widespread selling of blood at centers that did not use sterilized equipment or clean needles led to an epidemic in this region alone that some estimate infected as many as one million people.

2001 saw the development of new global efforts to address the AIDS pandemic. First was the United Nations General Assembly Special Session on HIV/AIDS. This gathering of political, medical and activist leaders from around the world held great promise. Committed to reigning in the pandemic while it was still possible to accomplish, the delegates set relatively firm timetables for action and aggressive goals to mark their success. These global efforts were soon to be institutionalized by the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This new international relief efforts promised that for the first time there would be a global plan in place to stem the transmission of HIV and provide desperately needed medications to the estimated 90% of people living with HIV/AIDS around the globe who did not have access to them.

Unfortunately, political pressures began to weaken the ability of the Global Fund to collect the donations necessary to accomplish their goals. By 2003, the Bush administration made the strategic decision to create their own global initiative called the President's Emergency Plan for AIDS Relief or PEPFAR. This new initiative sought to focus not on ending the global epidemic through global action; rather it hoped to slow the epidemic by focusing attention and resources on 14 specific countries. It was hoped that through such directed action, best practices could be developed and used in further global relief efforts.

From the very beginning, PEPFAR has been mired in controversy. While many of its projects have brought great relief to people living with AIDS, many of its prevention efforts have come under attack for pandering to conservative religious organizations who do not believe in the effectiveness of condom distribution or needle exchange.

Jeff Graham is AIDS Survival Project's Senior Director of Advocacy and Communications. jgraham@aidssurvivalproject.org.