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NOVA: Rx for Survival

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11.04.05
Politics and Economy:
Global Health: America's Response
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AIDS Policy Timeline

As the HIV/AIDS epidemic hits the 25 year mark it is possible to chart important changes through a timeline. Much has altered — the locus of the disease, the sufferers, the dollars spent worldwide, and ideas of the best way to treat the disease and combat its spread. Today, in the United States, this debatecenters on the strategies of The President's Emergency Fund for AIDS Relief — over matters of condoms and abstinence and overseas funding.

1981U.S. Centers for Disease Control and Prevention (CDC) reports first cases of rare pneumonia in young gay men, later diagnosed as AIDS-related; also issues report on highly unusual occurrence of rare skin cancer, Kaposi's Sarcoma, among young gay men.
NEW YORK TIMES publishes first news story on AIDS.
1982CDC scientists name what had previously been called "Gay cancer," or more formally, GRID, (Gay Related Immuno Deficiency) AIDS (Acquired Immune Deficiency Syndrome). CDC names four risk factors: male homosexuality, intravenous drug abuse, Haitian origin and hemophilia A.
Center for Disease Control says sexual contact or infected blood could transmit AIDS
U.S. begins formal tracking of all AIDS cases
First U.S. Congressional hearings held on HIV/AIDS.
Gay Men's Health Crisis, (GMHC) established in New York City.
1983 The U.S. Public Health Service issues recommendations for preventing transmission of HIV through sexual contact and blood transfusions.
The Orphan Drug Act is signed into U.S. law, providing incentives to drug companies to develop therapies for rare diseases.
U.S. CDC adds female sexual partners of men with AIDS as fifth risk group
People living with AIDS (PWAs) issue The Denver Principles.
1984HIV, the virus, isolated by Luc Montagnier of the Pasteur Institute and Robert Gallo of the National Cancer Institute; later named the Human Immunodeficiency Virus (HIV).
CDC states that abstention from intravenous drug use and reduction of needle-sharing "should also be effective in preventing transmission of the virus."
1985 First International AIDS Conference held in Atlanta. Hosted by U.S. Department of Health and Human Services (DHHS) and the World Health Organization (WHO).
FDA approved first enzyme linked immunosorbant assay (ELISA) test kit to screen for antibodies to HIV.
Project Inform founded to advocate for faster government approval of HIV drugs.
The U.S. Public Health Service issues first recommendations for preventing transmission of HIV from mother to child.
American Foundation for AIDS Research (amfAR) is founded by Co-Chairs Mathilde Krim and Michael S. Gottlieb, and National Chair Elizabeth Taylor.
Pentagon announces that it will begin testing all new recruits for HIV infection and will reject those who are positive.
1986 Ronald Reagan mentions AIDS on Feb. 6, 1986, vowing in a letter to Congress to make AIDS a priority.
Institute of Medicine report calls for a national education campaign and creation of National Commission on AIDS.
U.S. Surgeon General Koop issues "Surgeon General's Report on AIDS", calling for education and condom use.
National Academy of Science issues report critical of the U.S. response to "national health crisis;" calls for a $2 billion investment.
Robert Wood Johnson Foundation creates "AIDS Health Services Program", providing funding to hard hit U.S. cities; program is precursor to Ryan White CARE Act.
1987FDA approved AZT - the first drug approved for the treatment of AIDS.
FDA publishes regulations which require screening all blood and plasma collected in the U.S. for HIV antibodies.
FDA revised its strategy for the regulation of condoms by strengthening its inspection of condom manufacturers and repackers, strengthening its sampling and testing of domestic and imported condoms in commercial distribution, and providing guidance on labeling of condoms for the prevention of AIDS.
The AIDS Drug Assistance Program (ADAP) is initiated to ensure the availability of medications to un- or under-insured PWAs.
Global Programme on AIDS launched by the World Health Organization.
President Reagan establishes the Presidential Commission on HIV (Watkins Commission).
U.S. adds HIV as a "dangerous contagious disease" to its immigration exclusion list; mandates testing of all applicants.
U.S. CDC holds its first National Conference on HIV and communities of color.
U.S. FDA creates new class of experimental drugs, Treatment Investigational New Drugs (INDs), which accelerates drug approval by two to three years.
U.S. Congress approves $30 million in emergency funding to states for AZT.
U.S. Congress adopts Helms Amendment banning use of federal funds for AIDS education materials that "promote or encourage, directly or indirectly, homosexual activities," often referred to as the "no promo homo" policy.
U.S. CDC launches first AIDS-related public service announcements, "America Responds to AIDS".
1988FDA implemented new regulations designed to make promising therapies available sooner. Subpart E of the IND regulations established procedures designed to expedite development, evaluation, and marketing of new therapies intended to treat patients with life-threatening and severely-debilitating diseases.
World AIDS Day first declared by World Health Organization (WHO) on December 1.
The U.S. Health Omnibus Programs Extension (HOPE) Act of 1988 authorizes the use of federal funds for AIDS prevention, education, and testing.
U.S. FDA allows the importation of unapproved drugs for persons with life-threatening illnesses, including HIV/AIDS
U.S. Surgeon General and CDC mail brochure, "Understanding AIDS" to all U.S. households; first and only national mailing of its kind
U.S. National Institutes of Health (NIH) establishes Office of AIDS Research (OAR) and AIDS Clinical Trials Group (ACTG).
1989 U.S. Congress creates the National Commission on AIDS.
19906th International AIDS Conference ("AIDS in the Nineties: From Science to Policy"), San Francisco, CA. To protest U.S. immigration policy, domestic and international non-governmental groups boycott the conference.
Ryan White dies at the age of 18. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 is enacted by the U.S. Congress. The Act provides federal funds for community-based care and treatment services. Critics contend the Act is underfunded
Americans with Disabilities Act of 1990 enacted by the U.S. Congress, prohibiting discrimination against individuals with disabilities, including people living with HIV/AIDS.
American AIDS deaths pass the 100,000.
1991 CDC recommends restrictions on the practice of HIV-positive health care workers and Congress enacts law requiring states to take similar action.
Housing Opportunities for People with AIDS (HOPWA) Act of 1991 enacted, providing grants to U.S. states and local communities.
ICASO (International Council of AIDS Service Organizations) forms.
New York City Board of Education approves an HIV/AIDS initiative, which includes condom availability in high schools.
19928th International AIDS Conference ("A World United Against AIDS"), Amsterdam; would have taken place in Boston, but was moved due to U.S. immigration ban.
AIDS becomes number one cause of death for U.S. men ages 25 to 44.
A federal court strikes down "offensiveness" restrictions on AIDS education materials proposed by Senator Jesse Helms.
1993 President Clinton establishes White House Office of National AIDS Policy (ONAP).
Women's Interagency HIV Study (WIHS) and HIV Epidemiology Study (HERS) begin; both major U.S. federally-funded research studies on women and HIV/AIDS.
U.S. Congress enacts the NIH Revitalization Act, giving the OAR primary oversight of all NIH AIDS research; requires NIH and other research agencies to expand involvement of women and minorities in all research
U.S. CDC initiates HIV prevention community planning process for local distribution of federal prevention funding.
First annual "AIDSWatch" - hundreds of community members from across the U.S. converge in Washington, DC to lobby Congress for increased AIDS funding.
President Clinton signs HIV immigration exclusion policy into law.
The CDC, NIH, and FDA declare in a joint statement that condoms are "highly effective" for prevention of HIV infection.
1994U.S. Public Health Service recommends use of AZT by pregnant women to reduce perinatal transmission.
U.S. FDA approves an oral HIV test, the first non-blood based antibody test for HIV.
AIDS becomes leading cause of death for all Americans ages 25 to 44; remains so through 1995.
1995First protease inhibitor, saquinavir, approved in record time by the U.S. FDA, highly active antiretroviral therapy (HAART).
First White House Conference on HIV/AIDS.
First National HIV Testing Day created by the National Association of People with AIDS.
1996 Joint United Nations Programme on HIV/AIDS (UNAIDS) begins operations
U.S. FDA approves first non-nucleoside reverse transcriptase inhibitor (NNRTI), nevirapine.
HIV no longer leading cause of death for all Americans ages 25-44; remains leading cause of death for African Americans in this age group.
The Levine Committee, a blue ribbon advisory panel, calls for overhaul of NIH AIDS research, including stronger role for OAR and increased support for vaccine-related and investigator-initiated research.
Brazil begins national ARV distribution, first developing country to do so.
The number of new AIDS cases diagnosed in the U.S. declines for first time in history of epidemic, though experience varies by sex, race and ethnicity.
U.S. Congress reauthorizes the Ryan White CARE Act.
International AIDS Vaccine Initiative (IAVI), an NGO, forms to speed the search for an effective HIV vaccine.
1997 AIDS-related deaths in the U.S. decline by more than 40 percent compared to the prior year, largely due to HAART.
President Clinton announces goal of finding an effective vaccine in 10 years and the creation of Dale and Betty Bumpers Vaccine Research Center.
U.S. Congress enacts FDA Modernization Act of 1997, codifying accelerated approval process, and allowing dissemination of information about off-label uses of drugs.
WHO estimates that 30.6 million people are living with HIV/AIDS worldwide, more than the population of Australia.
1998Minority AIDS Initiative created in U.S., after African American leaders declare a "state of emergency" and Congressional Black Caucus (CBC) calls on the Department of Health and Human Services to do the same.
First large scale human trials (Phase III) for an HIV vaccine begin.
Ricky Ray Hemophilia Relief Fund Act of 1998 enacted by U.S. Congress, authorizing payments to hemophiliacs infected through unscreened blood-clotting agents between 1982 and 1987.
The U.S. Supreme Court in Bragdon v. Abbott rules that the Americans with Disabilities Act covers those in earlier stages of HIV disease, not just AIDS.
U.S. Department of Health and Human Services Secretary Shalala determines that needle exchange programs are effective and do not encourage the use of illegal drugs, but Clinton Administration does not lift the ban on use of federal funds for such purposes.
AIDS is now New York City's leading cause of death for women ages 25 to 44.
1999President Clinton announces "Leadership and Investment in Fighting an Epidemic" (LIFE) Initiative to address the global epidemic; leads to increased funding.
First human vaccine trial in a developing country begins in Thailand.
200013th International AIDS Conference ("Breaking the Silence"), Durban, South Africa; first to be held in a developing nation, heightens awareness of the global pandemic.
U.S. and UN Security Councils declare HIV/AIDS a security threat.
President Clinton issues Executive Order to assist developing countries in importing and producing generic forms of HIV treatments.
Millennium Development Goals, announced as part of Millennium Declaration, include reversing the spread of HIV/AIDS, malaria and TB as one of 8 key goals.
U.S. Congress reauthorizes the Ryan White CARE Act for the second time.
U.S. CDC forms Global AIDS Program (GAP).
G8 Leaders acknowledge need for additional HIV/AIDS resources during Okinawa Meeting.
UNAIDS, WHO and other global health groups announce joint initiative with five major pharmaceutical manufacturers to negotiate reduced prices for AIDS drugs in developing countries.
Global AIDS and Tuberculosis Relief Act of 2000 enacted by U.S. Congress, authorizing up to $600 million for U.S. global efforts.
President Clinton announces Millennium Vaccine Initiative, creating incentives for development and distribution of vaccines against HIV, TB and malaria.
President Clinton creates first ever Presidential Envoy for AIDS Cooperation.
U.S. Department of Health and Human Services approves first state 1115 Medicaid expansion waivers for low-income people with HIV.
New York State passes legislation decriminalizing sale and possession of syringes without prescription.
2001 United Nations General Assembly convenes first ever special session on AIDS, "UNGASS" UN Secretary-General Kofi Annan calls for a global fund, a "war chest", to fight AIDS, during African Summit on HIV/AIDS in Abuja, Nigeria
U.S. Secretary of State, Colin Powell, reaffirms U.S. statement that HIV/AIDS is a national security threat.
The World Trade Organization, announces "DOHA Agreement", to allow developing countries to buy or manufacture generic medications to meet public health crises, such as HIV/AIDS.
Generic drug manufacturers offer to produce discounted, generic forms of HIV/AIDS drugs; several major pharmaceutical manufacturers agree to offer further reduced drugs prices in developing countries.
A new study shows that 14% of individuals newly infected with HIV in the U.S. already exhibit resistance to at least one antiviral drug.
The 189 member nations of the U.N. General Assembly adopt by consensus a global blueprint for action on HIV/AIDS and Secretary General Kofi Annan calls for the creation of a $7 to $10 billion global fund to combat AIDS in the developing world.
2002 The Global Fund to Fight AIDS, Tuberculosis, and Malaria begins operations; approves first round of grants later this year.
HIV is leading cause of death worldwide, among those aged 15-59.
UNAIDS Reports that women comprise about half of all adults living with HIV/AIDS worldwide.
The Bush Administration begins promoting abstinence-only HIV prevention programs and targets programs that do otherwise for audits by the Office of the Inspector General of the Department of Health and Human Services.
The Bush Administration removes Condom Fact Sheets from the "Programs that Work" section of the HHS Website. After protests, revised Condom Fact Sheets are later reposted to the website.
2003 President Bush announces PEPFAR, the President's Emergency Plan for AIDS Relief, during the State of the Union Address; PEPFAR is a five-year, $15 billion initiative to address HIV/AIDS, tuberculosis, and malaria primarily in hard hit countries.
Activists express reservations about a provision that gives abstinence programs a third of USAID's prevention funding.
"3 by 5" Initiative announced by World Health Organization, to bring treatment to 3 million people by 2005.
The William J. Clinton Presidential Foundation secures price reductions for HIV/AIDS drugs from generic manufacturers, to benefit developing nations.
G8 Evian Summit includes special focus on HIV/AIDS, new commitments to the Global Fund announced.
2004 The Global Fund to Fight AIDS, Tuberculosis, and Malaria holds first ever "Partnership Forum", in Bangkok, Thailand.
PEPFAR, President Bush's Emergency Plan for AIDS Relief, begins first round of funding.
UNAIDS launches The Global Coalition on Women and AIDS to raise the visibility of the epidemic's impact on women and girls around the world.
2005 U.N. General Assembly High-Level Meeting on HIV/AIDS to review progress on targets set at 2001 U.N. General Assembly Special Session on HIV/AIDS (UNGASS).
The World Health Organization, UNAIDS, the United States Government, and the Global Fund to Fight AIDS, Tuberculosis and Malaria announce results of joint efforts to increase the availability of antiretroviral drugs in developing countries. An estimated 700,000 people had been reached by the end of 2004.
The U.S. Food and Drug Administration grants "Tentative Approval to Generic AIDS Drug Regimen for Potential Purchase Under the President's Emergency Plan for AIDS Relief", marking first ever approval of an HIV drug regimen manufactured by a non-U.S.-based generic pharmaceutical company.
At World Economic Forum's Annual Meeting in Davos, Switzerland, priorities include a focus on addressing HIV/AIDS in Africa and other hard hit regions of the world.
Ranbaxy becomes first Indian drug manufacturer to gain U.S. Food and Drug Administration approval to produce generic antiretroviral for PEPFAR.
THE ECONOMIST reports on September 8, 2005: "The Global Fund estimates that it needs $7.1 billion from donors to fund projects in 2006 and 2007. At its “replenishment” conference this week in London, though, it received pledges totalling $3.7 billion. The fund reckons this is just enough cash to fill this year's shortfall of roughly $350m, and to pay for the renewal of projects already under way. What it does not allow, however, are any new projects over the next two years—unless more money is forthcoming."
Jesse Helms publishes an autobiography which outlines his changed stance on HIV/AIDS.

Sources: The Kaiser Family Foundation, UNAIDS, THE ECONOMIST; WHO.

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