40 Years of HIV

From October 1980 to May 1981, five young, white, previously healthy gay men were hospitalized and treated for pneumonia in Los Angeles, CA. On June 5, 1981 the Centers for Disease Control and Prevention (CDC) published an article in its Morbidity and Mortality Weekly Report (MMWR) about these five cases. This edition of the MMWR was the first official reporting of what will later become known as AIDS. This June 5, 2021 marks the 40th anniversary of the beginning of the AIDS epidemic and over the last 40 years, HIV advocates and researchers have made huge strides towards eradicating HIV and ending the epidemic.

It is important to reflect on the last four decades of the epidemic in order to recognize and celebrate how much we have accomplished. From 1981 to 2021, many scientific and technological advancements have been produced to treat HIV. In 1964, azidothymidine (AZT) was first developed to treat cancer. It was found ineffective against cancer, but in the 1980s, it was discovered to be effective in suppressing HIV replication. In March 1987, AZT became the first drug to be approved by the U.S. Food and Drug Administration (FDA) for treating AIDS. Since the discovery and development of AZT, HIV medication has evolved into antiretroviral therapy (ART). ART has transformed HIV from a fatal infection to a manageable chronic condition. During the beginning of the HIV epidemic, the life expectancy of someone who was diagnosed with AIDS was approximately a year. Now, with the development of ART, those living with HIV and adhere to ART can live long, healthy lives. Also, people living with HIV and adhere to ART can achieve an undetectable viral load and not sexually transmit HIV.

Over the last decade, biomedical HIV prevention has been at the forefront of ending the epidemic. In 2010, a randomized controlled trial found that pre-exposure prophylaxis (PrEP) reduced the risk of becoming infected with HIV among men who have sex with men (MSM). Since then, many studies found that when taken daily as prescribed, PrEP is 99% effective in reducing HIV transmission via sex. In 2012, the FDA approved the use of Truvada for PrEP. Two years ago, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians offer daily oral PrEP to all people at high risk of acquiring HIV.

We reflect to acknowledge all that we have accomplished, but reflection must also include discovering where we have fallen short and find ways to strengthen our efforts moving forward. Though there have been many scientific and technological advancements in preventing and treating HIV, these advancements are not effective if they are not reaching the people who need it most. It is imperative that the fight against HIV also includes eradicating stigma, discrimination, prejudice, and health and racial inequities. Black communities; specifically Black gay, bisexual, and other men who have sex with men (GBM); are disproportionately impacted by HIV. The reasons for the disparity are less about differences in behavior and more about Black communities experiencing poverty, lack of health insurance, limited access to affordable housing, and stigma which hinders them from accessing and having knowledge about HIV prevention and care resources and services. Health programs that address these barriers are essential in order to increase access to quality HIV prevention and care among these communities and better their health outcomes.

As we reflect on our past, we must also look towards the future. The Department of Health and Human Services (HHS)’s HIV National Strategic Plan (HIV plan)’s goal is to end the HIV epidemic in the U.S. by 2030. The HIV Plan covers 2021-2025, with a 10-year goal of reducing new HIV infections by 90% by 2030. NASTAD is committed to working toward this goal with the same commitment and dedication it has displayed over the last 30 years. The 40th anniversary of the first reported cases of AIDS falls on the same year as NASTAD’s 30th anniversary. Over the last 30 years, NASTAD has been steadfast in the fight against HIV by providing HIV prevention, care, treatment, and policy resources and services. Since its inception, it has worked to strengthen public health infrastructure and address systemic inequities in order to end the intersecting epidemics of HIV and related conditions.

From 1981 to 2021, the fight against HIV has evolved and shown huge strides of progress. We must continue the momentum and push forward in order to see a world free of HIV.