AIDS at 20: "The Epidemic is Just Starting"

Sabin Russell
The San Francisco Chronicle
June 5, 2001

Twenty years after doctors in Los Angeles reported the first cases of AIDS, the devastating epidemic that followed in the United States is becoming a footnote to a larger story of global catastrophe.

Since June 5, 1981, when University of California at Los Angeles immunologist Michael Gottlieb and colleagues described five cases of rare pneumonia among gay men, AIDS has killed nearly 450,000 Americans—including 18,600 in San Francisco alone.

Yet two decades into the epidemic, the outbreak of AIDS in America turned out to be just a foreshock, an early warning of a worldwide pandemic the likes of which have not been seen since the Black Death of the Middle Ages.

HIV, a tiny virus that destroys key blood cells of the human immune system, is only beginning its worldwide rampage.

"Relatively speaking, this is still a new disease,'' said Helene Gayle, director of HIV prevention for the federal Centers for Disease Control and Prevention in Atlanta. "And it's going to get worse before it gets better. Clearly, the global dimensions of this disease are staggering.''

22 Million Already Dead

The epidemic is relentlessly expanding. Twenty-two million already are dead. Thirty-six million are believed to be infected. In sub-Saharan Africa alone, 25 million are living with HIV. Six million are infected in India and Southeast Asia. AIDS rates in the Caribbean are the highest outside Africa, and the disease is making inroads in Latin America, China, and the nations of the former Soviet Union.

AIDS is leaving a legacy of orphans. According to the United Nations, there are 13 million AIDS orphans in the world today, 95 percent of them in Africa.

One year ago, President Clinton declared HIV to be a threat to national security. On June 25, the United Nations will convene an unprecedented special session of the General Assembly on AIDS.

Public health experts have been documenting the global spread of HIV since the early 1980s, but for years the world paid scant attention. That changed last July, when the 13th International AIDS Conference took place in Durban, South Africa, where more people are living with HIV than any other nation on Earth.

"Durban was instrumental in bringing this issue into the open and showing the inequity of the situation,'' said Anne-Valerie Kaninda, medical adviser for Doctors Without Borders. "Ninety-five percent of the people with HIV live in the developing world and do not have access to treatments.''

Doctors Without Borders was among a handful of activist organizations that began a campaign to slash the price of AIDS drugs for impoverished nations hard-hit by the epidemic. A year's supply of AIDS drugs in the United States costs $12,000 to $15,000, impossibly out of reach for people in nations where annual health spending is only a few dollars per person.

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