An unusual report in a medical journal published 25 years ago last month gave the first scientific description of the disease we now know as AIDS. Experts say that while great strides have been made in the diagnosis and treatment of this global malady, there is still widespread public ignorance about AIDS and how to prevent its spread.
In 1981, doctors for the first time identified symptoms of the virus that caused AIDS in a group of five homosexual men in California who had developed a rare form of pneumonia. Their mysterious symptoms were initially called GRID - short for gay-related immune disorder. Doctors continued to use the term GRID until the late 1980's when the name was changed to HIV, short for Human Immuno-deficiency Virus. Today, there are 40 million people in the world living with HIV and the syndrome illness it spawns, known as AIDS.
"Twenty-five years is a long time, and it's a great time of reflection in the medical community about some of the successes that have occurred in the fight against HIV/AIDS, but also about the challenges facing us in the years ahead," says Dr. Alan Greenberg, a physician and professor at the George Washington University Medical School in Washington, D.C. Dr. Greenberg has seen some of these successes first-hand at the George Washington University Hospital, where he treats AIDS patients as a volunteer physician.
Scientists developed the first AIDS treatment program in the late 1980's, but only a cocktail of drugs discovered in 1996 has been able to control the virus and prolong the life of HIV-positive individuals. Challenges remain, including finding a cure.
In the 1980s the medical community had thought it would be able to cure AIDS in just a few years. "The big disappointment is to see how difficult it has been really to control the disease and probably how difficult it will be to find a cure," says Philippe Chiliad, the medical director of the Whitman-Walker Clinic in Washington, D.C., which treats 2,000 HIV-positive patients in the nation's capital.
The Washington area has one of the highest rates of new HIV infections in the United States. The privately-funded Whitman-Walker Clinic is on the front lines of the city's fight against AIDS. The clinic opened as a gay and lesbian health center three decades ago, treating sexually transmitted diseases. After AIDS hit the gay community in the 1980s, the clinic expanded its work to HIV treatment and prevention. Today its services also include counseling, food and legal services.
The Whitman-Walker clinic offers educational programs and is supporting efforts by the Washington, D.C. government to have all city residents tested for AIDS. Dr. Chelliade says that as many as one in three HIV-positive people in Washington, D.C. don't know they carry the virus. That number is close to the national percentage.
Chelliade adds that other patients who know they are HIV positive don't get medical attention. "We need to better understand why people who are aware that they are HIV positive do not enter care," he says. "Lots of these issues, like people not getting tested, are related to issues of poverty and access to health care in general. This is the area where not a lot has been done."
Thomas Milburne was diagnosed with HIV in 1985 and has had full-blown AIDS since February 1994. He refused to get diagnosed until his body began to succumb to the virus. "I was scared because I didn't know what to expect, he says. "At that time it was sort of like: just prepare yourself to die because there weren't that many options."
Milburne says two things kept him going: a positive attitude, and the latest medications. "If you take your medication and you take care of yourself and you pay attention to what your doctors tell you, it's not the end of the world," he says. "You can deal with it and you can have a normal and happy life."
The number of HIV infections and related deaths reached a peak in the mid 1990s. The rate has dropped steadily since 1996.
Dr. Alan Greenberg of George Washington University says there is reason to be hopeful that the disease can be conquered. But he says finding a cure and eliminating AIDS will require sustained moral, political and financial commitments from governments around the world. "The scientific community has realized that without the larger support, political will and financial commitment, there is a limit to what medicine can do," Greenberg says.
Ten years ago, the international community responded to the AIDS epidemic. It formed UN-AIDS, the Joint United Nations Program on HIV/AIDS, which coordinates the global responses and resources of ten U-N system organizations. The organization works to prevent and treat AIDS in 75 countries around the world.
U.N. efforts, increased private philanthropic support for the fight against AIDS, and a steady stream of medical advances, have all helped slow the spread of the virus, and extend and improve the lives of those who have been infected. No one can say yet when, or if, AIDS will be cured. But the quest continues.