FILE PHOTO: AIDS activist and author Larry Kramer poses for a portrait in his apartment in New York, U.S., June 24, 2019…
FILE PHOTO: AIDS activist and author Larry Kramer poses for a portrait in his apartment in New York, U.S., June 24, 2019. Picture taken June 24, 2019. REUTERS/Lucas Jackson/File Photo

AIDS activist Larry Kramer used to wear an oversized rectangular turquoise ring on his left finger, tinged with variations of green.  A turquoise band circled a second finger.  Two large turquoise rings decorated his other hand.

When Kramer first moved to New York in the 1970s, a fortune teller told him he "must always wear something turquoise to look after your health."  He trusted the superstition, surviving hepatitis B and a liver transplant — and battling an HIV infection for more than 30 years.

"God knows how," Kramer told VOA in his final interview before he died of pneumonia on May 27, less than a month before his 85th birthday.

Turquoise's health benefits are unproven, but a revolutionary generation of antiviral drugs, the first of which was studied and approved 25 years ago, kept Kramer and millions of other HIV-positive people alive for decades.

Before that success though, the search for an effective treatment took well over a decade and triggered some of the fiercest confrontations between Americans and their government during that period.

Drug cocktail broke virus' deadly grip, saved countless lives

Trail blazer

Kramer pioneered AIDS activism in America, demanding funds to research and find treatments for a mysterious disease that emerged in 1981 and would eventually be traced to the human immunodeficiency virus, or HIV, which most often is transmitted sexually. Sufferers accused the U.S. government of disinterest in combating a disease that was primarily killing gay men, a widely ostracized group.

"Ronald Reagan, who was president," Kramer recalled, "never even said the word AIDS" until his second term in office.

By the end of 1986, more than 16,000 Americans with AIDS had died.  In 1987, Kramer started ACT UP, the first group to stage loud and boisterous protests over an epidemic for which no effective treatments had emerged.

FILE - Demonstrators from the organization ACT UP, angry with the federal government's response to the AIDS crisis, protest in front of the headquarters of the Food and Drug Administration in Rockville, Md., Oct. 11, 1988.

Silence = Death

What would prove to be ACT UP's most consequential clash came on October 11, 1988, when the group shut down the headquarters of the U.S. Food and Drug Administration, the agency that approves and regulates medications in America.  ACT UP blocked roads to the complex outside Washington, as participants lay on the ground in front of the building with mock tombstones, some reading, "RIP Killed by the FDA." Activists hung a banner above the entranceway with ACT UP's motto: Silence = Death.

Richard Klein, who served as the FDA's liaison with the AIDS community at the time, called ACT UP's protest "a great wake-up call for the FDA."

In a recent VOA interview, Klein recalled "very heady days" as tensions boiled over between AIDS activists and federal officials. And he notes that changes did come about. Activists were added to FDA advisory committees as patient representatives.  Patient access was expanded for experimental drug studies, many of which were fast-tracked and revamped. Trial subjects in placebo groups whose health deteriorated were reassigned to groups receiving the drug or drugs being tested.

"It took people who were dying to really make the point of 'We don't want to die in these clinical trials,'" Klein said.

Yet AIDS patients continued to die — 300,000 in the United States by 1995. Ending the plague was by no means a given.

The most commonly prescribed drug at the time, azidothymidine or AZT, was developed in the 1960s and approved for AIDS treatment in 1987. AZT did initially slow the deterioration of patients' immune systems. Inevitably, however, the HIV virus became resistant to the medication and the deadly progression of AIDS would resume.

New class of drugs

Fourteen years into the epidemic, 1995 saw a breakthrough. In June of that year, the FDA authorized a study of saquinavir, the first of a new category of drugs called protease inhibitors designed to prevent the HIV virus from replicating,

"This new class was seen as a way to possibly overcome the virus resistance issues," Klein said. 

Saquinavir proved ineffective by itself. But, when combined with AZT and another anti-viral medication, the resulting "drug cocktail" brought about an increase in AIDS patients' white blood cell counts, a clear indication that their immune systems had begun to recover. Critically, the HIV virus did not develop resistance to the cocktail.

Fewer than four months after receiving the heartening results, the FDA gave its fastest-ever drug approval to saquinavir as part of combination treatment for HIV/AIDS .  

"It completely transformed the lives of HIV infected individuals," National Institutes of Health Director Anthony Fauci told VOA in a recent interview.

Fauci, who is currently leading NIH's battle against COVID-19, presided over much of the U.S. government's response to AIDS from 1984 onward. He noted that the arrival of protease inhibitors marked "the first time we had highly, highly effective drugs against HIV."

Richard Klein, who worked for more than 41 years with the U.S. Food and Drug Administration, said activists who served on FDA advisory committees, as seen here, forced the agency to change policies that laid the groundwork for future epidemics.

Ending a feud 

Beyond physical healing, the advent of life-saving drugs allowed for the eventual transformation of a stormy public feud into a friendship.  

At the height of the AIDS epidemic, Larry Kramer branded Fauci, who was the face of the government's efforts to combat HIV, an "incompetent idiot" and a "murderer." Over time, the two men grew to respect and appreciate each other. 

Kramer called Fauci a "friend" in his interview with VOA. Writing for Time magazine after Kramer's death, Fauci lauded his activism, adding, "I will miss a lot about Larry, but I think his warmth most of all." 

Protease inhibitor drugs saved countless people after 1995, including Kevin Taylor, who shared his story with VOA. The 57-year-old Richmond, Virginia, man is still living with HIV, 35 years after he tested positive for the virus and doctors told him to get his affairs in order in anticipation of an early death. 

Taylor says HIV medications gave him a new lease on life: "Not necessarily to be cured, but to least have some kind of life as opposed to just living in the shadows waiting for your end to come."  

Drugs keep HIV at bay, reducing viral loads to undetectable levels for many. In recent years, the same drugs have proven effective in preventing HIV infections when taken prophylactically by those at high risk for contracting the virus. 

Despite these advances, there is no cure and no effective vaccine for HIV/AIDS.