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Understanding AIDS

In 1981, the first cases of patients with the disease that was to become known as AIDS, were identified in hospitals in New York and San Francisco. By late 1983, the cause of AIDS — the human immunodeficiency virus (HIV) had been identified. Significant numbers of cases had been reported from central Africa. In southern Africa, where I lived and worked, we had seen only sporadic occurrences — mainly among gay white men. However by 1987, HIV-infected men were identified in the workforce serving the mines industries and farms of South Africa. Armed with knowledge of labour migration and the potential for the spread of this disease, I wrote and presented my first (highly speculative) paper on AIDS at the first ‘Global Impact of AIDS’ conference held in the Barbican Centre in London.

By 1994, it was clear that the southern African epidemic was going to be horrendous. In Swaziland, the prevalence among anti-natal clinic attenders, who were a bellwether for infections, rose from 3.9% in 1992 to 16.1% in 1994. This peaked to an unbelievable 42.6% in 2004. Similar patterns were seen across the region. The prevalence was highest among younger people, who aged between 25 and 39.

I quickly realised the task for academics was to understand the causes and consequences of this disease. In particular, we needed to warn of its potential social, political, and economic impacts. Because of the long term nature of the disease, it was clear that academics had to ‘cry wolf’ long and loud. AIDS generally only emerges after a prolonged period during which a person’s immune system battles the virus. It is, like climate change, a long wave event. Those who understood this had to reach policymakers, politicians, and persuade them to take action. The tools we had to do this were, and continue to be, limited. Research and writing; talking to whatever audience will have us; and educating and influencing students.

I deployed all these strategies to the best of my ability. From 1992, I co-ran short courses on ‘Planning for the Impact of AIDS’ in countries from the Philippines to the United Kingdom via South Africa, Ukraine, and other locations. I set up and raised money for research projects, and brought in students and research assistants. I published widely. Books and articles flowed. Did they make any difference? I believe so, but it is hard to measure.

In 2005 while preparing an article which asked ‘Is AIDS a Darwinian event’, I came across the Very Short Introductions (VSI) series. I decided I had to write a VSI on HIV and AIDS. Following their acceptance of the proposal, there was the painfully slow writing process, peer review of an early version, and meticulous editing and production. Ultimately, the first edition of the HIV and AIDS VSI appeared in 2008. By 2015, it was apparent that a second edition of the HIV and AIDS VSI was needed.

We can’t ignore the most serious epidemic of the past 100 years, and if nothing else, we should learn from it.

AIDS is a fast moving epidemic and some of the data and assertions were immediately out of date. For example, the book failed to foresee the massive expansion in treatment. In 2008, there were 28.9 million people living with HIV, and a mere 770 000 were receiving anti-retroviral drugs. By 2015, there were 36.7 million people infected with HIV, but 17 million were on treatment. Of course, the current thinking is that everyone who is infected should be on treatment. Unfortunately, there is a long way to go for this to become a reality. The level of funding that the disease has received, especially from international donors, was exceptionally generous.

The election of Donald Trump in the United States and the vote where 52% of Britons said they should leave the European Union in the Brexit poll, will have consequences for the epidemic. These countries are the main international donors and have led the fight against the epidemic. It is unclear if global support will continue.

AIDS is no longer at the top of the global agenda; not even for health, where two outbreaks — Ebola and Zika, have caught the attention of the world. Environmental challenges and inequality are going to be high on the international agendas. Who is to say this is wrong, because ultimately these challenges have created fertile ground for the spread of HIV and other diseases. Despite this, we can’t ignore the most serious epidemic of the past 100 years, and if nothing else, we should learn from it.

Featured image credit: microscope slide research by PublicDomainPictures. Public domain via Pixabay

Recent Comments

  1. Alex Flett

    I think Alan, who has been a doughty fighter in the “battle” against the virus is correct in his worry as to the potential revitalisation of HIV because of the recent political events. Even before these,I sensed the possible resurge because of two things 1) is complacency, and 2) the winding down of cultural events which had AIDS Awareness as their central function. At the last International Conference I was staggered at the lack of Cultural actions when the previous Durban Conference in 2000 was full of such events, getting the message into the various cultures in Southern Africa by engaging artists, Visual, Theatre, Dance, Music etc., with the Conference. As a visual artist AIDS Awareness has been at the centre of my work since 2000, through exhibitions and workshops. Because of frustration with the lack of understanding of the value of the Arts in helping keep the transmission rates at bay, I have this past year exhibited work which has no direct link to the virus, for the first time in 16 years. To give an example of how powerful the Arts can be, in 2009 during a workshop in Gaborone I had one student who was over 70 years of age and who walked for an entire day out of the Kalahari to come to the workshop. When she went back, she was not only going back with a painting, she was going back with an image which spoke loudly about what she had learned, and as an elder of her village and tribe would be listened to in respect of viral transmission. Importantly, she was listened to in a way which neither a scientific colleague from the IAS, or I as an artist would be listened to if we were to go into that piece of the Kalahari. Other workshops I have led have seen artists/students from communities all across Southern Africa go back to these communities and have spoken to their communities in a manner which no matter how hard we work, we cannot do. Artists are vital in translating AIDS Awareness into their home communities, something which our colleagues in the scientific community seem unable to understand. I was asked to engage with the cultural section of the HIV “battle” by Dr Leive Fransen of the European Union precisely because there were grumblings form scientists in northern Europe and the USA as to why there should be a cultural section of a Conference. There has been no serious cultural organisation in the Conferences since Bangkok in 2004. And I suspect that the actions of Act up Paris and their 15 minutes of fame by redecorating the Pharma stands gave the excuse for giving up on a Cultural Director and Cultural Team. Twelve years later at the second Durban Conference the lack of Culture (I had a show of the works from the 2000 Conference in the town itself) meant that the Conference was just another bland corporate style Conference, and when I saw the flattery of around Price Harry and …… I was staggered at it because what teenager in South Africa is going to actually be interested in them? With one well known hip hop start willing to perform for nothing and the cricket ground as a venue, and the involvement of the TV companies, every teenager in South Africa could have been turned on to AIDS Awareness. A spoiled Royal and a fat little white man with a bad rug on his head just didn’t cut the mustard. What a waste. The advances in retro viral drugs however welcome has created a complacency amongst young which is incredibly dangerous. So incredibly bad was the general organisation of that 2016 Conference that they failed to inform delegates of the peculiarities of the electrical plug system in South Africa. These tells me that the organisers were in four and five star hotels where they could access connectivity for their iphones etc, but everyone else struggled to get their electronic machinery charged up. There were no mechanisms inside the Conference Centre to help in this, and generally it seems that Durban was not in the slightest bit interested in the importance of the Conference as a means of informing people, but as a means of making money for the city. The Conference organisers were so far removed from the reality of the situation, they were, not to put to fine a point of it, in cloud cuckoo land. At present, in those areas of the wold who can afford not just the drugs, but the means of distribution. So it is easy to be complacent about the position of the numbers for whom this is available and think that there is no need to keep up a system of cultural education in AIDS Awareness. And my fear is that such an attitude is going to backfire on those who are most at risk.

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