*I Included the Part 1 Discussion Guide and My AIDS Notes at the End*

AIDS Assignment Week 1:Tanya Staton

*I included the Part 1 discussion guide and my AIDS notes at the end*

AIDS Synopsis Outline:

1. Distribution of AIDS

1. Frequency:

1. In summer of 1981 CDC had recorded 100 new cases that mostly appeared in gay lifestyles.
2. In 1999 1 in 5 South Africans had the disease.
3. In the late 90’s new infections remained stable, but 80% of new cases were among minorities.

1. Pattern

1. Originally seen in gay men and drug users now in hemophiliacs, women, babies
2. Virus seen in almost every country with South Africa having the most cases
3. 1 confirmed case in 1981 now 40 million cases in 2006

1. Determinants:

1. Unsure of cause of virus in the beginning
2. When hemophiliacs started getting the disease scientists concluded that it was a virus because particle was small enough to get through filter.
3. Believed to be a HTLV virus discovered the virus originated from chimpanzees.

1. Health related states or events

1. Disease States:

1. Low t-helper cell count, pneumocystis, Kaposi sarcoma

1. Conditions associated with health:

1. Sexual activity, drug use, blood transfusion, mother to baby

1. Descriptive Epidemiology

1. Person:

1. Gay men, IV drug users, hemophiliacs, mother to baby transmission, heterosexual couples, Haitians

1. Place:

1. Probably originated in the Congo
2. Seen in larger cities where gay lifestyle thrives and drugs available
3. Bath houses, addiction clinics
4. All over the world: South Africa has most cases

1. Time:

1. First case in 1959
2. Incubation period before symptoms vary: disease can lie dormant
3. 40 million affected can potentially rise to 40 million more

1. Clinical criteria:

1. People becoming sick and dying because no treatment available
2. Ho trying to figure out why the virus lies dormant

1. Analytical Epidemiology

1. Why

1. Not sure why virus was occurring

1. How

1. Virus believed to have spread from chimpanzees to human more than likely from meat consumption and unclean sanitation practices when handling the carcass.
2. Virus replicated and RNA changed multiple times before eventually infecting humans

1. Testing Hypothesis

1. Tried to regrow virus
2. Using clean needles and condoms would prevent spread of virus
3. Tried using AZT to cure, worked for a while but virus adapted
4. Came up with triple cocktail and drugs worked to prolong life

1. Other roles of Epidemiology

1. Identifying where greatest risk is

1. Gay & drug users
2. Now South Africa so programs being directed there
3. Uganda was a problem, but leader helped get under control
4. China and Russia

1. Evaluating the effectiveness of preventive programs

1. President Musevini of Uganda started preventive program: started Abstain, be faithful and use condom (ABC) program. Uganda became first country to get AIDS under control.
2. Needle exchange program reduced infections in drug users
3. Testing blood and blood products reduced cases in hemophiliacs

1. Assisting in carrying out Public Health Programs

1. Bono backed AIDS and Christin faith: spoke with Helms about providing assistance
2. Clinton tripled funds to help with AIDS research.
3. NIH went to white house to help develop a plan for AIDS

1. Communicating Public health information

1. TASO formed to educate preventive programs
2. Cleave Jones created AIDS quilt to draw national attention
3. Wall Street strike to lower cost of drugs

Positives/Negatives & Strengths/Weakness

There were many negatives and weakness that occurred when AIDS was emerging. The biggest weakness was the way most political leaders chose to deal with the situation. Instead of protecting their country they ignored the problem. Reagan actually claimed it “was a disease that scientists could handle” (pbs.org). He even cut the budget. The way Ryan White and other hemophiliacs were treated is also a negative. There were many Black American churches that opposed helping with AIDS patients. They claimed that helping them was “Bad Bible” (pbs.org). A huge negative was how drug companies kept prices extremely high instead of lowering the cost to save lives (pbs.org).

There were many positives and strengths over the last 25 years in regards to the AIDS pandemic though. I think a major positive was the way the CDC, NIH and WHO all worked together to help find a way to control the virus (pbs.org). There were also people like Graham who considered the crisis as a great opportunity to spread to Christian faith while helping the infected (pbs.org). Activists proved that progress can happen if they work together to make their voice heard. The AIDS quilt is a great example (pbs.org). Blood donation guidelines were set which are still used today. Another strength AIDS brought was it bonded countries on a global scale. Countries leaned on each other for support for new drugs, possibility of a cure and for funds.

MPH 510

Age of AIDS – Part One

Discussion Notes

PURPOSES/USES/ROLES/ACTIVITIES OF EPIDEMIOLOGY/EPIDEMIOLOGISTS:

1. Identifying risk factors for disease, injury, and death

• Noticed trend that gay men were dying of pneumocystis and Kaposi Sarcoma
• CDC evaluated the disease more than published first official publication (then called GRID) in June 1981 edition of MMWR.

1. Describing the natural history of disease

• Discovered the first confirmed death of AIDS from man in Congo in 1959
• Realizing that the transmission event took place from animal to human in the 1930s probably.
• Discovering the disease was a virus after blood units contaminated: virus can only pass through filter.

1. Identifying individuals and populations at greatest risk for disease

• First appearing in Gay community so calling the new disease GRID in the U.S.
• Soon noticed increase in IV drug users from needle sharing.
• Hemophiliacs discovered to becoming infected from contaminated blood and blood products.

1. Identifying where the public health problem is greatest

• Appearing in cities where gay population is prevalent: New York, Los Angeles
• Noticed an increase of HIV infections among Haitian decent in South Florida.
• Bulk of HIV cases are in Africa

1. Monitoring diseases and other health-related events over time

• Epidemiologists realized that the mode of transmission was blood borne.
• Ruling out that casual contact was not a transmission route.

1. Additional activities

• Activists boycotting Wall Street to drive the prices of HIV prescription drugs down.
• Cleave Jones created quilt project to draw national attention and support in 1987.

1. Evaluating the efficacy and effectiveness of prevention and treatment programs

• Condoms distributed to brothels in Thailand: lead to 90% decrease in sex workers over next decade.

• Programs set up for needle exchange programs in Britain: saw a decrease in cases.

1. Providing information useful in health planning and decision making for establishing health programs with appropriate priorities

• Pamphlets circulated in New York about the importance of safe sex in gay population: Congress later ruled to ban material in Helms law.

1. Assisting in carrying out public health programs

• Mann at WHO lead global program to work on justice
• Mann helped established AIDS programs in 100 countries
• Elizabeth Taylor convinces president to give speech on AIDS, although he was not very informed on the subject matter.

1. Being a resource person

• Joe McCormick flying CDC research team to Congo to look for patients with similar symptoms.
• BeautriceHann discovering the virus originated from a chimpanzee.
• Dr. Gallea isolating retrovirus from leukemia virus

1. Communicating public health information

• President Uganda preached tolerance: Proved to be one of the first countries that prevention works and number of cases decline.
• Thailand Prime Minister required HIV broadcasting on the radio every hour
• TASO taught preventive methods on how to avoid infection in 1987 by Dr. Kaleeba.

AIDS Notes Section 1:

Part 1: A Deadly New Disease

• 150x smaller than wbc
• January 1981- 21 gay man lost 30lbs, fever, lung infection, initial cases mystery, had pneumocystis.
• blood sample had hardly any t-helper cells which means hardly any immune cells
• couldn't do much for early cases
• CDC- best known for epidemiology,
• Jim Current looked back for other cases of pneumocystis
• June 1981 MMWR published first official publication
• Paul Volberoug, MD – 22 yr old male, Kaposi sarcoma.
• Stigma and isolation associated with HIV
• Summer CDC had 100 new cases, that mostly appeared in large city center of gay lifestyles
• Called GRID 1st (gay related immune deficiency)
• Also drug related
• Cases seen in South Florida seen in women and men but Haitian descent

Part 2: The Spread Escalates

• Drug users starting to have symptoms not just gays
• would rent needles- so blood borne exploded
• addiction clinics boomed with patients
• fear everywhere within the city
• rejection & discrimination starts to set in: support systems get lost
• Socially unacceptable: as politician the government became an issue as to what to do with it
• Conservatives "against nature, pay the price, violate laws of god"
• 1981- Children's hospital of San Francisco HIV seen in baby: associated with blood transfusion
• Panic within hemophilia community
• factor 8 pooled from many donors: multiple lots contaminated
• CDC now knew had to be a virus because only particle small enough to get through filter
• Blood bankers resistant because no test and would face huge financial risk & screening would discriminate.
• 2 more years before safeguards put in place for screening
• 35000 contaminated from blood products

Part 3: Politics & Tracking

• Epidemic had begun in 1st part of Reagan administration
• Margaret Heckler HHS secretary looking to scientists for aids
• CDC said budget cuts limited research
• Problem scientists could solve
• problem: where did disease come from
• Joe McCormick flew CDC team to Congo to look for patients with similar symptoms
• Alarmed raised when realized that general population could be infected
• Epidemic already: Sect of Health Edward Brandt didn't make sense because focus had been on gays
• In Africa realized disease had been circulating for some time
• Who took disease out of Congo?
• Speculated Haitians did and immigrated after their independence
• Porte Prince started first AIDS clinic
• Convinced that gay brought to Haiti
• Press released Haitians risk group & goods would not be allowed to be sold in the US
• Bath house community feeder: come & have multiple partners
• Great fear if government closed bath houses what would be next
• Bath houses fostering death and disease not liberation

Part 4: Scientific Breakthroughs

• NIH trying to identify viral agent
• couldn't see or grow yet
• Dr. Robert Gallea: 4 yrs earlier isolated retrovirus for leukemia
• Convinced HTLV related to Aids virus
• January 1983 biopsy sent to Passer institute: cultured and checked regularly
• needed to keep t-cells alive so fed virus with additionally wbc
• 3 weeks teamed isolated new virus
• Summer 1983 French researchers first saw HIV in electron microscope
• virus passed on to 70 million people
• 10 years to discover that it originated from a chimpanzee virus in Africa
• Process of hunting encountered blood-blood contact from preparing meat
• Virus adapted and evolved
• family tree of retroviruses:
• 1930's speculated the transmission event took place from animal to human
• BeautriceHann: discovered origin in chimpanzee
• medical campaigns for pox virus so might have led to transmission and adaption's
• 1959 first confirmed death of AIDS in Congo
• April 1984: Heckler press conference to help develop blood test
• Ashamed that US presented as a US discovery: French US dispute for more than a decade
• Thought could develop a vaccine within 2 years
• serologic test confirmed that HIV positive but symptom free
• mid 1980s number deaths doubling every year

Part 5: A Death gives AIDS a Face

• Government still focusing AIDS as gay problem mainly because activists to fight were gay men
• Rock Hudson rumors spreading very sick
• Went to Paris to receive treatment because had been doing trials since 1983
• denied AIDS rumors
• Finally gave permission to announce he had AIDS
• 90 days he died after Doris day appearance
• Frightening that disease happening to a lot of people
• A lot of ignorance: denied healthcare, losing apartments, wearing gloves
• people afraid to get tested because who will know results
• parents forced hemophilia boy to quit school: Ryan White
• Family Florida home burned down because hemophilia with AIDS
• Nixon should of dispelled the fears
• September 1985 Nixon had to dispel fears and told no danger from casual contact
• Instead of ensuring not casual he said "medicine has not proved it is safe"
• Public Health officials CDC gave pressed briefings to try and calm fears
• Government still putting faith in science
• Immune parts not reactive because virus hides behind sugar, and proteins that are foreign are hidden behind this sugar

Part 6: Lessons of Leadership

• 2 million affected: majority in Africa
• Uganda had highest incidence in mid 1980s
• Stigma because sexually transmitted and sex is taboo
• WHO in Geneva working on cure
• prejudice associated with disease and have to stop
• Mann asked to lead global program to work on justice
• established AIDS programs in over 100 countries
• not just medical disease but also a social disorder
• president Uganda preached tolerance
• TASO groups offered instruction on how to avoid
• positive people and families that exude hope
• Uganda one of first countries that prevention could work and numbers could decline
• Thailand prisoners infected because heroin prevalent and many needles shared
• Amnesty granted to prisoners so AIDS spread fast
• 1 in 10 tested positive in military
• Thailand prime minister changed where radio broadcaster must have HIV information every hour on air
• condoms distrusted to brothels: "called crash helmet:
• 90% decline among sex workers next decade
• People felt better because of government constant education about aids
• helped that churched back the condom "Proved good leadership and great common sense things can happen"

Part 7: Setbacks

• Nixon and Thacher view of AIDS completely different
• Britain mainly iv drug use main transmission
• British government trying to establish needle requirements, but does that mean government supports drugs??
• programs to set up needle exchanges to prevent transmission
• US activists ran into trouble about clean needles
• 40% HIV infections are drug related
• no needle exchange will receive public funding
• Conservatives upset with promotion and pushed ban to eliminate material to educate gays
• Helms law to ban still in affect: Politics driving force in spread of disease
• AZT started to help patients re-build immune system
• AZT developed with public money
• charged highest pharmaceutical ever 10k a year
• Burroughs Welcome: act up activist group went o protest
• Activists boycott wall street to finally drive price down
• FDA greatest demonstration: 1k almost all with HIV "seize control" to help develop new medications
• Wanted access to new drugs biggest concern
• AZT not cure it seemed to be because as long it could replicate resistance developed

Part 8: At the Brink

• 1987 AIDS quilt on display: 40,000 already died
• Cleave Jones created quilt project to draw national attention
• Reagan spoke at AIDS research benefit: Elizabeth Taylor invited
• realized how "clueless" Regan really was
• White house staff 2nd guessing a medical doctor
• education is critical to clearing up fears
• demonstration inside because claimed immigrants needed to tested
• did not talk about condoms/abstinence
• August 1990 finally governed research funding: Called Ryan White care act
• CIA predicted AIDS time bomb for global: predicted 45 million infections by year 2000
• 250 employees working on AIDs at height now down to 4

Section 2

Part 1: Political Indifference

• Before first case 250,000 Americans already had it
• Because of stigma/shame world leaders un-willing to accept fact that HIV is real issue
• South Africa largely been free from AIDS but foreign come to work mines
• Live in Hostel and mine workers come to have sex with women: no clue about AIDS so no condom use
• 1990 Mandela released from prison and 1% already HIV +
• Heterosexual African epidemic
• Activists met resistance because outsiders coming in and trying to tell how to behave (especially whites)
• Mostly women dying who were infected by husbands who worked in mines
• New government having challenges so HIV not really focused on
• Babies being infected childbirth/breast feeding
• Discriminated on HIV status so people being turned away from treatment to allow for better prognosis cases
• May 1994 activists hoped he would make time for AIDS
• Deputy took on AIDS effort, but activists tried to get Mandela involved.
• In 5 years South African president he barely mentioned AIDS
• South Africa epidemic becoming World’s largest

Part 2: A radical new treatment

• Clinton said he would help AIDs when ran from presidency
• “virus do not discriminate” –Clinton
• AIDS already killed 200,000 another 1.5 million infected
• One world one hope campaign started
• Triple funds for research
• David Ho trying to figure out why did the virus lie dormant
• Discovered never was, but replicated by billions every day and mutated
• HIV developed drug resistance if given one at time so tried to use multiple drugs
• 3 drugs being used: protease inhibitors was one of them
• Dodge a clinical trial patient: given anti-viral therapy that were incredibly toxic
• Very toxic but viral load un-detectable
• 1996 researchers announced results to world: called triple cocktail
• New drug allowed HIV to longer be a death
• 16000 a year for drug cost
• South Africa could definitely not afford drugs
• 1996 20 million infected with HIV
• United Nations agency developed to fight epidemic

Part 3: Struggle to Get the Drugs