Timeline: Moments in the history of HIV
The first cases of what would later become known as AIDS are reported in mostly gay men in the United States. In the following year the condition will be given the name GRID (Gay-related immune deficiency) and later the name AIDS (Acquired Immune Deficiency Syndrome). Later the origins of HIV would be traced back to 1920s Zambia.
The first cases of people dying because of AIDS are reported in South Africa. The first known case of a South African contracting HIV occurred in 1981.
The activist organisation ACT-UP (AIDS Coalition to Unleash Power) is founded in New York City. In the years that followed ACT-UP would play a critical role in pressuring the US government, regulators and pharmaceutical companies to respond to the HIV epidemic with greater urgency and later make the drugs more accessible and affordable.
Triple drug therapy (using three ARVs together) is found to be effective in suppressing the virus. For those who can afford the treatment, this changes an HIV diagnosis from a death sentence into a chronic disease. The first ARV, AZT was registered in 1987, but treatment with only one ARV did not work for very long since the virus would quickly develop resistance to the drug.
The first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV-positive. It was estimated that there were between 74,000 and 6,500,135 people in South Africa living with HIV.
The Department of Health awarded a R14.27-million contract to produce a sequel to the musical, Sarafina!, about AIDS, in order to reach young people. The project was dogged by controversy, and was finally shelved in 1996.
In early 1997, Mbeki as Deputy President of South Africa pushed for a new anti-AIDS drug Virodene that was said to be less expensive than antiretroviral triple therapy. A group of AIDS patients who had been treated with Virodene were invited to testify before the Cabinet and these testimonies were mainly positive.
At first the South African Medicines Control Council denied a licence for Virodene but the drug was later legalised. the MCC however declared Virodene unfit for human consumption as it later became clear the drug posed a severe health hazard.
The Treatment Action Campaign (TAC) is founded on the steps of St George’s Cathedral in Cape Town to campaign for access to AIDS treatment for people in South Africa. Over the next decade TAC would become world-renowned for its struggle for HIV treatment and their work continue until this day.
Thabo Mbeki becomes President of South Africa and Manto Tshabalala-Msimang becomes Minister of Health. Mbeki would controversially go on to question whether HIV causes AIDS with the minister his enforcer. Tshabalala-Msimang cast a lot of doubt on whether ARVs were toxic, causing a lot of people to shun the drugs and dying. Tshabalala-Msimang was a big promoter of the unproven value of olive oil, garlic, lemon and beetroot to boost the immune system giving platforms to all kinds of quacks.
On October the 28th, Mbeki gave a speech to the National Council of Provinces in which he touched upon the issue of HIV/AIDS, and especially whether his government should distribute ARV drugs. He argued that they shouldn’t be so quick to do so because of their adverse effects, and recommended that the members of the council read the information on the Internet on the topic.
Eleven-year-old Nkosi Johnson speaks at the opening of the International AIDS Conference in Durban urging government to make HIV treatment available to pregnant women. Johnson would pass away a year later from an AIDS-related illness. The 2000 conference is seen by many as a turning point in the global HIV response.
As part of its so-called defiance campaign, the TAC illegally imports the drug fluconazole from Thailand. Fluconazole is an important drug for treating HIV-related opportunistic infections, specifically painful thrush. At the time fluconazole was dramatically cheaper in Thailand than in South Africa. The campaign is later named after TAC volunteer Christopher Moraka, who died of AIDS in 2001 while campaigning for access to the drug. In response to the campaign, the pharmaceutical company Pfizer agrees to donate fluconazole to the South African government.
Mbeki convened a panel of 33 scientists whom he referred to as “experts”, of whom about half were AIDS denialists such as Peter Duesberg and Harvey Bialy. The panel, known as the “Presidential Advisory Panel on AIDS,” also included AIDS researchers who supported the scientific consensus that HIV causes AIDS, and was split about evenly between the two groups.
Parks Mankahlana, who served as spokesperson both for Nelson Mandela in the first post-apartheid government and for President Thabo Mbeki, died August 24 at the age of 36. Although he was credited with expanding press access after decades of restrictions, Mankahlana became a lightning rod for controversy during debates about AIDS dissenters, when he said that the Durban Declaration affirming that HIV causes AIDS belonged “in the trash.” The cause of death still remains unknown, despite calls to the government to confirm or deny rumours of AIDS.
The South African government successfully defended against a legal action brought by transnational pharmaceutical companies in April 2001 of a law that would allow cheaper locally produced medicines, including anti-retrovirals, although the government’s roll-out of anti-retrovirals remained generally slow.
A landmark Constitutional Court judgment in the so-called TAC case orders that the government must provide pregnant women living with HIV with the ARV Nevirapine to protect their babies from HIV infection.
In a hugely symbolic moment, Former President Nelson Mandela puts on the TAC’s iconic “HIV POSITIVE” T-shirt when visiting a Doctors without Borders clinic in Cape Town. 2002 is the year that Mandela starts clearly distancing himself from the AIDS denialist policies of Mbeki and Tshabalala-Msimang.
The South African Cabinet approves an HIV treatment plan that provides for antiretroviral treatment in the public sector. Many delays would however follow before treatment became widely available and the programme would only really take off years later. This was mainly due to Tshabalala-Msimang dragging her feet.
The Competition Commission refers the so-called Hazel Tau case to the Competition tribunal. The case involves three ARVs that the TAC alleged were excessively priced. Soon after the companies involved agree to grant licenses to generic manufacturers, thus opening up the competition that would lead to the price reductions that made the growth of the ARV programme possible.
Nelson Mandela’s son Makgatho, passed away from AIDS in 2005. After Makgatho’s death, Madiba made a public announcement that his son had been HIV-positive. Madiba said: “Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like tuberculosis, like cancer, is always to come out and say somebody has died because of HIV/AIDS, and people will stop regarding it as something extraordinary.” He then started numerous HIV/Aids campaigns such as the 46664 foundation, which focused on “supporting projects in South Africa and sub-Saharan Africa where the needs of those infected and affected by HIV/AIDS are currently greatest.”
Activists cause a stir by trashing South Africa’s stand at the International AIDS Conference in Toronto. At the time Health Minister Manto Tshabalala-Msimang was promoting beetroot, garlic and African potato as alternative treatments for HIV and the stand had been decorated with vegetables.
“Shall I repeat garlic, shall I talk about beetroot, shall I talk about lemon… these delay the development of HIV to Aids-defining conditions, and that’s the truth.” Health Minister Manto Tshabalala-Msimang said in debate on her department’s budget vote.
In late 2006, Tshabalala-Msimang fell ill, after which the country’s deputy health minister, Nozizwe Madlala-Routledge, assumed leadership over South Africa’s health policies after being summoned to do so by deputy president Phumzile Mlambo-Ngcuka. While she was at the helm of South Africa’s health policies from then until she was fired next August, she attempted to reverse Mbeki’s AIDS denialist policies by describing the number of South Africans waiting for ARV drugs as a “serious violation of human rights.” She was also one of the principal authors of the country’s aggressively anti-AIDS health plan, which was adopted that December.
On August 9, 2007, despite ongoing calls to fire Tshabalala-Msimang, Mbeki instead fired Madlala-Routledge, South Africa’s then-deputy health minister and a long-time critic of his AIDS policies. The stated reason was that she had attended a conference without his permission, but critics argued this was merely an excuse for Mbeki to rid himself of a politician who was willing to criticise his policies.
In a landmark court case brought by the TAC and the South African Medical Association, the Western Cape High Court orders vitamin salesman Matthias Rath to stop promoting his vitamin supplements as a treatment for AIDS and finds that Rath has been conducting unlawful clinical trials and should stop doing so. The case is a victory for the scientific governance of medicine over the AIDS quackery that flourished under AIDS denialism.
The KwaZulu-Natal Department of Health threatens disciplinary action against Dr Colin Pfaff for providing pregnant women living with HIV with dual antiretroviral therapy to prevent transmission to their babies. Pfaff is one of many courageous healthcare workers – too many to mention here – who resisted state-sponsored AIDS denialism and placed their patients first – often at significant personal cost.
President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang are replaced by President Kgalema Motlanthe (and later Jacob Zuma) and Health Minister Barbara Hogan. If there is a moment where state-sponsored AIDS denialism finally ended, this is it.
It is reported that HIV has been “cured” for the first time in a man called Timothy Ray Brown (also known as the Berlin patient). Unfortunately the “cure” is extremely risky and not a viable option for anyone who does not also have a very specific kind of cancer. Brown received a stem cell transplant as part of treatment for leukaemia. The stem cells happened to come from a person who had natural immunity to HIV and it is this natural immunity that “cured” Brown. Read him tell his story here.
On February 7, 2008, research by Nicoli Nattrass estimated that the failure of Mbeki’s administration to provide ARV drugs until 2006 was responsible for about 343,000 deaths. Later that year, a study by Pride Chigwedere et al., published in the December 2008 issue of the Journal of Acquired Immune Deficiency Syndromes, estimated that Mbeki’s HIV/AIDS policies were responsible for “more than 330,000” deaths.
Dr Aaron Motsoaledi replaces Barbara Hogan as Minister of Health. He would stay in the position until 2019 and oversee the massive expansion of South Africa’s HIV treatment programme.
The standard first line treatment of HIV in the public sector is updated to include the ARV tenofovir . Tenofovir replaced d4T, a drug that was associated with much more severe and stigmatising side effects.
Evidence begins to accumulate that people who are not HIV-positive can protect themselves from HIV infection by taking a pill that contains two ARVs. In the years that follow a number of trials confirm the efficacy of so-called oral PrEP (Pre-exposure prophylaxis in pill form). Initial optimism over a gel to prevent HIV infection (microbicide) dissipates when the gel performs poorly in follow-up trials. A vaginal ring containing an ARV would later perform relatively well in trials – but not as well as oral PrEP.
Fixed-dose combination ARV therapy is introduced in the public sector, meaning that most patients have to take only one pill once a day, as opposed to multiple pills.
Findings of the landmark START trial is published, resolving one of the most important questions in HIV treatment. START found that it is better for your health to start ARV treatment as soon as possible, rather than waiting for your immune system to show signs of deterioration before starting treatment. Prior to START, treatment was generally only recommended for people with compromised immune systems (CD4 cell counts below certain thresholds).
It is announced that dolutegravir, a highly effective ARV with few side effects, will become available in the public sector in South Africa. Some studies indicate that dolutegravir plus just one other ARV might be effective, overturning the idea that at least three different ARVs are needed. ARV therapy also continues to involve with the development of long-acting injections, that may in future replace pills for some people.
South Africa is set to meet the first and the third of the UNAIDS 90-90-90 targets for 2020 – with over 90% of people living with HIV in the country estimated to know their status and with around 90% of people on treatment having undetectable viral loads. South Africa however continues to fall short on the second 90, with only in the region of 70% of people with a positive HIV diagnosis taking treatment.
While HIV can be treated successfully, treatment is life-long and we still have no realistic cure. As we enter 2020 the search for a cure or an effective vaccine is gathering momentum with a number of promising scientific leads and a number of important trials in progress.
For a fascinating in-depth timeline of the epidemic in the United States see this US government page.
For a good overview of the South African epidemic up until 2014 see this article in the South African Medical Journal.