First known case of human HIV infection
A blood sample is taken in 1959 from a man living in Leopoldville, Belgian Congo, now Kinshasa, Democratic Republic of Congo (formerly Zaire). For decades, the sample is stored away in a freezer. In 1998, after sophisticated testing is developed for HIV, the blood sample from 1959 is tested and confirmed as positive for HIV.
Norwegian sailor dies
A Norwegian sailor who had traveled throughout the world -- including a long trip through West Africa in 1961, as well as a two-day stay in Kenya in 1964 -- dies of immune deficiency in 1966. His wife and their daughter, who is born the following year, in 1967, also die of immune deficiency.
Blood tests later reveal the family all tested positive for the group O subtype of HIV, which is mostly found in West Africa, indicating that the man had likely been infected during his 1961 voyage.
Danish doctor dies
Dr. Grethe Rath, a Danish surgeon working in Zaire, dies after suffering from a series of infections, including a rare pneumonia known as Pneumocystis carinii.
Greek fisherman dies
The fisherman, who had commercially fished Lake Tanganyika in Zaire, is treated in Antwerp, Belgium, by Dr. Peter Piot. "He had died with something very unusual, with the disseminated cryptococcal meningitis; in other words, an infection with a fungus that is very rare," Piot recalls. Piot keeps samples of the fisherman's blood and tissues, and later it is confirmed that the man was infected with HIV.
Epidemic becomes visible in Haiti
Between June 1979 and November 1981, doctors in Haiti diagnose 12 cases of Kaposi's sarcoma (KS), a rare skin cancer usually found in older Eastern European men. The cancer is new and puzzling to doctors: No cases had been seen in the city between 1968 and 1977.
In 1982, 13 doctors form the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) to research the new disease in Haiti.
New disease found in drug users
During the summer, Dr. Gerald Friedland, a physician in the Bronx, begins to see patients with Pneumocystis pneumonia. These cases differ from those seen in Los Angeles because Friedland's patients are not gay men, but instead injection drug users sharing needles in New York's "shooting galleries," where people go to rent needles and syringes. Says Friedland, "You could not construct a social system better designed to transmit a blood-borne disease."
At the same time, pediatric immunologist Dr. Arye Rubenstein is seeing in his Bronx clinic children of drug addicts presenting immune suppression symptoms.
No helper T-cells in Los Angeles man
Dr. Michael Gottlieb of the University of California, Los Angeles treats a gay man suffering from Pneumocystis pneumonia. Upon closer inspection, he and colleagues discover the man has no CD4 T-cells, also known as helper T-cells because of their role in directing the immune system's response to infection.
Gottlieb and colleagues note four additional cases of the rare pneumonia in gay men and alert the Centers for Disease Control (CDC), which publishes a notice in its Morbidity and Mortality Weekly Report (MMWR) on June 5, 1981. This is the first publication dealing with what would come to be known as AIDS. By the time the report is published, 250,000 Americans are already infected.
The CDC is also getting reports of an increase in cases of Kaposi's sarcoma, a rare skin cancer formerly found almost exclusively in older men of Eastern European descent. The agency forms a task force, led by Dr. Jim Curran, to study the mysterious cases.
First AIDS fund-raiser held
After reading in The New York Times about a mysterious disease affecting gay men, gay activist Larry Kramer, holds a meeting of concerned people in his apartment. Within a year, they form the Gay Men's Health Crisis (GMHC), the first AIDS activist organization.
European doctors note immune deficiency
After reading the reports of the new immune deficiency disease in the CDC's Morbidity and Mortality Weekly Report (MMWR), Dr. Willy Rozenbaum of Paris' Claude Bernard Hospital recognizes similar symptoms in a gay male. He also recalls, however, treating heterosexual patients for Pneumocystis pneumonia.
At the same time, Dr. Peter Piot, who is working at the Institute of Tropical Medicine in Antwerp, Belgium, recognizes similar symptoms in some of his patients. "We started thinking, well, that sounds really like the Central Africans that we're seeing in our hospital, but we have women, so it can't be only gay men," he recalls. "It's different, but what is this?"
Report of disease in Haitians
Miami physician Dr. Margaret Fischl sees Pneumocystis pneumonia and Kaposi's sarcoma in her patients -- not gay men, but recent Haitian immigrants. After reading the CDC's June 5, 1981, Morbidity and Mortality Weekly Report, Fischl calls the CDC to report her patients. "Their first comment back to me was they didn't believe me," Fischl recalls. "... They were concerned that something else was going on."
In July 1982, the CDC publishes a notice in the MMWR of 34 cases of the new disease among male and female Haitians living in five states. An accompanying editorial says, "It is not clear whether this outbreak is related to similar outbreaks among homosexual males, IV drug abusers, and others, but the clinical and immunologic pictures appear quite similar.
Reports of pneumonia in hemophiliacs
The CDC's Morbidity and Mortality Weekly Report publishes a case study of three heterosexual males, all of whom are hemophiliacs suffering from Pneumocystis pneumonia. Hemophiliacs are treated with a clotting factor known as Factor VIII, made from the pooled plasma of thousands of donors. A virus is the only particle small enough to survive the filtering process used to make the concentrate.
"The impact of that report was tremendous," explains Dr. Jim Curran, who was heading the CDC's task force investigating the new disease. "Almost immediately, people became convinced that this syndrome was caused by a virus that could be transmitted through the blood supply."
Report of a transfusion-related case
Dr. Arthur Amman, a San Francisco pediatrician, treats a 20-month-old who had received multiple blood transfusions and is suffering from immune deficiency problems. The Health Department is able to trace the blood donations and finds that one of the 19 individuals who had donated blood to the infant had already died of AIDS.
Amman reports this case in the CDC's Morbidity and Mortality Weekly Report. An editorial note suggests: "The etiology of AIDS remains unknown, but its reported occurrence among homosexual men, intravenous drug abusers, and persons with hemophilia A (1) suggests it may be caused by an infectious agent transmitted sexually or through exposure to blood or blood products. If the infant's illness described in this report is AIDS, its occurrence following receipt of blood products from a known AIDS case adds support to the infectious-agent hypothesis."
First hearings held on new disease
At hearings in Los Angeles, Rep. Henry Waxman (D-Calif.) launches the first investigation into what is being called gay-related immunodeficiency syndrome (GRID). The CDC estimates tens of thousands of people could be affected by the new disease.
CDC precautions for health workers issued
Noting that there has not yet been a case in which AIDS was transmitted to a health care worker, the CDC nonetheless suggests that when treating people with AIDS, personnel take precautions similar to those used with hepatitis B patients.
AIDS is named
The CDC convenes a meeting of scientists, blood industry executives, gay activists, hemophiliacs and others to develop guidelines for screening the blood supply. With activists anxious about stigma, industry executives concerned with business and scientists unclear on what exactly is going on, the group decides to adopt a "wait and see" attitude.
One accomplishment: The new disease is given a name -- acquired immunodeficiency syndrome (AIDS).
The Shanti Project receives grant
San Francisco appropriates $450,000 for the Shanti Project, an AIDS clinic in the city that provides support and education. Along with other community organizations, it develops the "San Francisco model of care," which emphasizes home- and community-based services by relying on an extensive network of volunteers.
Evidence of a retrovirus
In January, Dr. Francoise Barre Sinoussi, a researcher at virologist Luc Montagnier's lab at the Pasteur Institute in Paris, finds evidence of the enzyme reverse transcriptase (RT) in lymph node tissue taken from an AIDS patient. RT's presence could only mean one thing: that AIDS was being caused by a retrovirus -- a virus whose genome consists of RNA rather than DNA. When it infects a cell, a retrovirus uses reverse transcriptase to convert its RNA into DNA, which can then hijack the cell's machinery to produce more viruses. Barre-Sinoussi's discovery is the strongest evidence to date that AIDS is caused by an infectious virus.
Later that summer, Pasteur Institute researchers capture the first image of the virus via an electron microscope photograph, confirming that AIDS is caused by a previously unknown virus, which they name LAV (lymphadenopathy virus).
Reports of heterosexual infection
In its Morbidity and Mortality Weekly Report, the CDC describes two cases of females who had no other risk factors except that they had been having sex with infected males. An accompanying editorial note says: "Epidemiologic observations increasingly suggest that AIDS is caused by an infectious agent. The description of a cluster of sexually related AIDS patients among homosexual males in southern California suggested that such an agent could be transmitted sexually or through other intimate contact. ... The present report supports the infectious-agent hypothesis and the possibility that transmission of the putative 'AIDS agent' may occur among both heterosexual and male homosexual couples."
CDC tries to quell fears
As fear of the new disease grows, the CDC tries to calm the public in a note in its Morbidity and Mortality Weekly Report: "The vast majority of cases continue to occur among persons in the major identified risk categories. The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends, relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk."
Blood donation guidelines published
In January, the CDC convenes a meeting with blood industry executives, public health officials and gay and hemophilia activists to talk about how to protect the blood supply. Suggestions to exclude high-risk donors are met with resistance: Gay activists express concern about discrimination and stigma, while blood industry executives feel the evidence is weak that the blood supply is tainted and don't want to face the financial losses from implementing a new screening policy.
"I pounded the table and yelled at them, asking them how many people they wanted to kill," recalls former CDC epidemiologist Dr. Don Francis. "... I just said: 'Just tell us the number. You want 10 dead? You want 20 dead? You want 100 dead?'"
Though screening guidelines are published in March, safeguards for the blood supply are not implemented for another two years, until a blood test is developed after HIV is identified. In the meantime, 35,000 Americans become infected from contaminated blood and blood products.
Margaret Heckler named health secretary
In March, former Rep. Margaret Heckler (R-Mass.) becomes President Reagan's secretary of health and human services. She tells FRONTLINE that AIDS was her "number one priority," but that she believed increasing the budgets of the public health organizations responding to the crisis was unnecessary. "Throwing money at the problem was exactly the kind of philosophy that President Reagan would have hated and was not authorized," she explains. "... We were placing the emphasis on those who could provide the answers. In a peculiar case, this was not a problem that money could solve; it was a problem that the scientists could solve, and so one had to balance the various segments of the AIDS dilemma."
"The Denver Principles" published
A nonprofit advocacy group, the National Association of People with AIDS (NAPWA), releases a mission statement calling for a humane response to the crisis: "We condemn attempts to label us as 'victims,' a term which implies defeat, and we are only occasionally 'patients,' a term which implies passivity, helplessness, and dependence upon the care of others. We are 'People With AIDS.'" The statement includes a list of recommendations for health care providers and others on how to treat people with AIDS. The list becomes known as "The Denver Principles."
AIDS Medical Foundation formed
Founded to spur coordination and educational outreach among the medical community, the group is formed by Dr. Mathilde Krim, a cancer researcher at New York's Memorial Sloan-Kettering Cancer Center. It is the precursor to the American Foundation for AIDS Research (amfAR), which is founded two years later.
"1,112 and Counting"
Gay activist and co-founder of Gay Men's Health Crisis Larry Kramer writes a seminal article on the new disease killing gay men. It appears in the New York Native, a gay newspaper. "If this article doesn't scare the s*** out of you, we're in real trouble," he begins. "If this article doesn't rouse you to anger, fury, rage, and action, gay men may have no future on this earth. Our continued existence depends on just how angry you can get."
The international implications
Representatives gather at World Health Organization (WHO) headquarters in Geneva for the first meeting to discuss the international implications of the new disease. By this point, AIDS has been found in several dozen countries. Delegates from the Soviet Union insist that AIDS will not be found within the Eastern bloc. Much of the conversation centers around the blood supply, as several European countries had already banned importing blood or blood products from the United States.
Study in Zaire
Hearing about Congolese patients coming to Belgium for treatment, CDC epidemiologist Dr. Joseph McCormick realizes the problem may be more extensive there than anyone realizes. He heads a team, which includes Dr. Peter Piot, that travels to Kinshasa for a six-week study and confirms infection in 38 patients, some of whom are severely ill, indicating they are in an advanced stage of infection.
The team's major discovery is that there is an equal number of infections in women and men, further evidence that the disease could be heterosexually transmitted. "This changed the landscape of AIDS forever, because this showed us that everybody ... was susceptible to AIDS," McCormick explains. "This was not something special to people who practiced a gay lifestyle. This was something that could affect anyone."
A blood test
In addition to isolating the virus, virologist Dr. Robert Gallo of the National Cancer Institute develops a blood test to screen for infection. Known as the ELISA test, it gains wide use starting in 1985, and reveals that the extent of infection was worse than anyone thought. "[I]t was like an iceberg, and we were only seeing the tip of the iceberg," recalls Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases.
Many activists voice concern about confidentiality and civil rights issues once a test is developed. "If you get tested, this is America, and we have all of these computers, and we have all of this information sharing, so will your employer find out? Will your insurer find out? ... Will this knowledge be kept private?" asks Cleve Jones.
Others question the benefit of getting tested when no treatment was available. "When the HIV test came out, my partner and I debated what to do," recalls Dr. Chris Beyrer, director of the Johns Hopkins Fogarty International Center's AIDS International Training and Research Program. "We decided not to get tested and instead just to really be very, very monogamous, committed to each other and extremely safe, and be absolutely religious about condom use."
Announcement of the virus
On April 23, Health and Human Services Secretary Margaret Heckler announces at a press conference that American virologist Dr. Robert Gallo of the National Cancer Institute has isolated the virus that causes AIDS. Four years earlier, Gallo had isolated the family of retroviruses that cause leukemia, called HTLVI and HTLVII. Gallo is convinced that the AIDS virus is part of the same family, and he names it HTLVIII.
It is later determined that Gallo's virus is improbably similar to the virus discovered in 1983 by the French researchers, who had sent him a sample of their culture, and is likely the same virus. At the press conference, Heckler gives Gallo sole credit for the discovery. A scientific dispute between the two teams festers for almost a decade, until an out-of-court financial settlement gives each team credit for its work.
A third scientist, Dr. Jay Levy at the University of San Francisco, also isolates a retrovirus, which he names ARV (AIDS-associated retrovirus). In 1986, a compromise name is settled upon: human immunodeficiency virus, or HIV.
Once the virus is discovered, new discoveries occur at a rapid pace: Scientists begin to sequence the virus's genome and learn that it targets a specific cell in the immune system, the CD4 T-cell.
CDC funding request
On the day that Secretary of Health and Human Services Margaret Heckler tells Congress, "I have to say that, in the AIDS situation, I really don't think there is another dollar that would make a difference, because the attempt is all out to find the answer," the CDC's Dr. Don Francis sends a very different message to his superior Dr. Walter Dowdle:
"This disease is not going to go away," he writes. "... The inadequate funding to date has seriously restricted our work and has presumably deepened the invasion of this disease into the American population. In addition, the time wasted pursuing money from Washington has cast an air of despair over AIDS workers throughout the country."
Bathhouses close in San Francisco
After a protracted political battle, Dr. Merv Silverman, director of San Francisco's Department of Public Health, orders the city's bathhouses closed. The bathhouses, where gay men could go to relax or have sex, were considered an important symbol of community and sexual freedom, and many gay men did not support their closure. "It goes back to the reality of the lives that we were living as incredibly sexually repressed people," explains activist Cleve Jones. "I still believe that it is the behavior that spreads the disease, not the location where you're engaging in the behavior."
After Silverman's order, the 14 bathhouses sue to reopen. A judge rules that they can stay open if they hire monitors and expel anyone engaging in high-risk sexual activity. They would remain open for years into the epidemic.
Potential vaccine approaches
Dr. Don Francis and Dr. John Petricciani publish an article in the New England Journal of Medicine outlining potential vaccine approaches. They suggest that a recombinant approach, in which researchers genetically engineer a vaccine using part of the virus, is the safest way to proceed.
Reagan mentions AIDS
At a press conference, the president is asked whether he would send his child to school with a child who had AIDS. "I'm glad I'm not faced with that problem today, and I can well understand the plight of the parents and how they feel about it," he responds. "... On the other hand, I can understand the problem of the parents. It is true that some medical sources had said that this cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, 'This we know for a fact, that it is safe.' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it."
Prior to the press conference, Reagan's staff had prepared a briefing paper advising sympathy for parents and children and emphasizing that casual contact with a person with AIDS posed no danger. But John Roberts -- then a young White House lawyer and now the Supreme Court chief justice -- reviewed the paper and sent a memo: "I would not like to see the president reassuring the public on this point. ... We should assume that AIDS can be transmitted through casual or routine contact until it's demonstrated that it definitely cannot be."
Report critical of funding published
In response to a request from Congress, a report, "Review of the Public Health Service's Response to AIDS," is prepared by the Office of Technological Assessment, a nonpartisan office designed to analyze complicated scientific issues. The report outlines the state of scientific knowledge, but, more significantly, is highly critical of the lack of federal support for research, in particular from the Department of Health and Human Services.
"... [I]ndividual PHS [Public Health Service] agencies have consistently asked DHHS to request particular sums from Congress; the Department has submitted requests for amounts smaller than those suggested by the agencies; and Congress typically has appropriated amounts greater than those requested by the Department," the authors write. "... Of greater impact than holding general funding of PHS agencies about even or decreasing it have been budget requests for decreases in personnel ceilings. At critical times, several of the PHS agencies have actually experienced decreases in personnel."
Project Inform formed
After watching desperate friends and acquaintances self-medicate with alternative therapies and black-market drugs from Mexico, Martin Delaney, forms Project Inform to share information and accelerate advances in treatment for people living with HIV.
The American Federation for AIDS Research (amfAR) is formed by Dr. Mathilde Krim and Dr. Michael Gottlieb to unify AIDS nonprofits on the East and West Coasts. Actress Elizabeth Taylor becomes national chairman, and actor Rock Hudson gives the organization $250,000.
The Normal Heart opens
The Normal Heart, written by Larry Kramer, is a play depicting the early years of the AIDS epidemic and the founding of Gay Men's Health Crisis, the first AIDS activist organization.
Rock Hudson dies of AIDS
News of the actor's disease breaks in July, when he is visiting Paris for experimental treatment. After returning to the U.S., Hudson allows his doctors to publicly confirm his AIDS diagnosis. He dies in Los Angeles in October.
"I think this was the first huge American celebrity, and worldwide celebrity, diagnosed with the disease," recalls Dr. Jim Curran, who was then leading the CDC's AIDS task force. "... It became a People magazine story rather than a New England Journal of Medicine story, and it was very important from the point of view of public awareness."
Ryan White denied entry into school
Ryan White, a hemophiliac teenager who had contracted AIDS through contaminated blood products, is barred from attending school in Kokomo, Ind., in the summer of 1985. After a protracted court battle, he is finally allowed to attend classes, but his family is ultimately forced to move to nearby Cicero after a bullet is fired into their home.
White is embraced by the public as a symbol of the disease, and he and his mother, Jeanne, take advantage of media attention to educate the public about AIDS. He dies in 1990. His funeral, attended by Elton John, Michael Jackson, First Lady Barbara Bush and 1,500 others, is broadcast on national television.
First International AIDS Conference held
The bulk of the conference, organized by the CDC and held in Atlanta, is dedicated to understanding the science of AIDS. Several scientists present research estimating huge AIDS prevalence in Africa; for example, infections among 66 percent of children in certain areas of Uganda and among 88 percent of Kenyan female prostitutes. Dr. Max Essex, from Harvard's School of Public Health, presents data suggesting that the origins of AIDS can be traced to the African green monkey.
The prevalence estimates are later discovered to be hugely inflated, tainted by false positive results in people who had been exposed to malaria. The political ramifications are enormous. Many African leaders resent that the continent is considered the source of the problem, and other policy-makers are skeptical of future projections because of the inaccuracy of the initial estimates.
A treatment breakthrough
Early clinical results of a trial led by Dr. Margaret Fischl shows zidovudine, or AZT, slows the progression to AIDS as patients' immune systems regenerate. Only one of the 145 patients receiving AZT in the trial dies, while there are 16 deaths of the 137 patients receiving a placebo. The study's monitors recommend stopping the trial immediately and rapidly approving the drug for wider distribution.
AZT had been developed with public money in the 1960s as a possible cancer treatment, and the government gives the use patent to Burroughs Wellcome, the pharmaceutical company that sponsored the trial. Burroughs Wellcome prices the drug at as much as $10,000 for a year's supply.
Ultimately, AZT, which is approved by the Food and Drug Administration in March 1987, is not the miracle drug researchers had hoped for. For some individuals it has debilitating side effects that lead them to stop taking it; furthermore, after a certain point, the virus mutates and develops resistance to the drug.
Second International AIDS Conference held
In Paris, scientists from a biotech company called Genentech announce that they have successfully tested a vaccine in the lab. The Genentech vaccine incorporates the gp120 protein on HIV's surface, the idea being that the gp120 would stimulate an immune response. The vaccine produces HIV antibodies in guinea pigs.
Also at the conference, Dr. Jim Curran of the CDC predicts 300,000 cases of AIDS worldwide by 1991.
New virus discovered
A second type of HIV is discovered almost simultaneously by the labs of Dr. Max Essex at Harvard's School of Public Health and Dr. Luc Montagnier of the Pasteur Institute in Paris. Both find the virus, eventually named HIV-2, in West Africans, but the American and French groups come to different conclusions about the virus's danger: Essex thinks the virus is the missing link between chimp viruses and HIV and that it is relatively harmless to humans, while Montagnier believes the new virus is highly lethal.
It turns out that Essex's sample likely had been contaminated in his lab, and Montagnier is credited with the discovery of HIV-2. He is, however, wrong about its lethality: HIV-2 appears to be both less virulent and less infectious than HIV-1, which makes up the bulk of the world's infections.
Surgeon General's report released
Surgeon General C. Everett Koop releases a report urging parents and schools to have a "frank and open conversation" about AIDS with children and teenagers. "Adolescents and pre-adolescents are those whose behavior we wish to especially influence because of their vulnerability when they are exploring their own sexuality (heterosexual and homosexual) and perhaps experimenting with drugs," he writes. "Teenagers often consider themselves immortal, and these young people may be putting themselves at great risk." The report dispels myths that the virus could be spread by mosquitoes and recommends that the U.S. not pursue mandatory testing or quarantines.
Many are surprised that Koop, an evangelical Christian working for a conservative administration, would write and release such a candid report. "I must confess that we were worried about what that report would say, and overwhelmingly pleased by the frankness, conciseness and clarity with which he spoke," recalls Dr. Jim Curran of the CDC. Koop actually drafted the report himself in his basement with the involvement of only a few close aides.
The racial breakdown
In its Morbidity and Mortality Weekly Report (MMWR), the CDC analyzes reported AIDS cases and finds that the incidence rate for blacks and Hispanics is three times as high as that of whites. Among the cases diagnosed between June 1981 and August 1986, 25 percent are in blacks, who make up 12 percent of the population at the time, and 14 percent are in Hispanics, who make up 6 percent of the population. Among children, the disparity is even higher: 58 percent of cases are in blacks, and 22 percent are in Hispanics.
Needle exchange programs started
Angered by those who said drug addicts couldn't change their behavior -- and despite state and city laws prohibiting the possession of needles without a prescription -- Jon Parker, a former addict, starts the first needle exchange in the U.S. in New Haven, Conn., to combat the spread of HIV among injection drug users.
WHO starts AIDS program
The World Health Organization's Global Program on AIDS is started by Dr. Jonathan Mann, who had directed a CDC study of AIDS in Zaire. Mann grows the organization from nothing to a $100 million program with a staff of 250. He travels the world, meeting with world leaders and grassroots activists, to sound the alarm and get governments' attention, as well as to link AIDS with human rights.
Paper suggests HIV does not cause AIDS
Dr. Peter Duesberg, a respected biologist at the University of California, Berkeley, publishes a paper in Perspectives in Cancer Research suggesting that HIV is not the cause of AIDS, because a virus cannot cause a syndrome. Though his theories are not accepted by most of the scientific community, his work will attract the attention of South Africa's President Thabo Mbeki in the late 1990s.
First vaccine trials
The first two AIDS vaccine clinical trials are approved. Both are recombinant approaches. The first, made by Microgenesis, is made using an insect protein; the second, by Bristol-Myers, is made using HIV's gp120 protein, delivered in a vaccinia virus, the same virus used for the smallpox vaccine.
Congress passes the Helms amendment
Angered by an explicit safe-sex brochure developed by Gay Men's Heath Crisis, Sen. Jesse Helms (R-N.C.) calls for an amendment banning federal funds for any educational materials that "promote or encourage homosexual sexual activities." The policy is still in effect today.
Reagan delivers speech about AIDS
In April, the president gives his first major speech on AIDS at the College of Physicians in Philadelphia. He defends his administration's spending and endorses educating students. "Let's be honest with ourselves: AIDS information cannot be what some call 'value-neutral.' After all, when it comes to preventing AIDS, don't medicine and morality teach the same lessons?"
At the request of actress and American Foundation for AIDS Research National Chairman Elizabeth Taylor, Reagan agrees to speak again at an amfAR fundraiser at the end of May. Reagan aide Landon Parvin writes the speech, and amfAR Director Merv Silverman advises. Parvin tells FRONTLINE that the speech was subject to an intense back-and-forth political debate within the White House. "It really didn't make much sense to have White House staff second-guessing a medical doctor, but that happened," he says.
At the dinner, Reagan announces the creation of a national commission and calls for education efforts and compassion. "There's no reason for those who carry the AIDS virus to wear a scarlet 'A,'" he says. But toward the end he is booed after calling for "routine testing" and denying residence to HIV-positive immigrants. The speech's positive messages are lost in the ensuing political arguments and reactions.
Toward the end of his presidency, Reagan reversed the government's previous legal position and mandated that all AIDS patients - symptomatic or asymptomatic - would now be protected against discrimination by entities receiving federal assistance. It was one of the recommendations that had been made by Reagan's special commission on AIDS.
ACT UP fights pharmaceutical industry
The AIDS Coalition to Unleash Power (ACT UP) is formed by Larry Kramer, and others to protest the high cost of AZT and the government's slow approval of other drugs. ACT UP's first protest is outside Wall Street. More than 200 demonstrators shut down traffic.
Family's house burned down
Americans rally around the Ray family, whose Arcadia, Fla., house is burned down by arsonists after a judge rules that the family's three hemophiliac sons, who had all acquired AIDS from tainted blood products, should be allowed to attend school. Ricky Ray dies of AIDS in 1992, and his brother Robert dies in 2000.
AIDS Quilt displayed in D.C.
Inspired by participants at a San Francisco march holding up homemade signs bearing the names of friends and family members who had died of AIDS, activist Cleve Jones decides to organize panels for what would become the AIDS Memorial Quilt. "I thought, what a perfect symbol; what a warm, comforting, middle-class, middle-American, traditional-family-values symbol to attach to this disease that's killing homosexuals and IV drug users and Haitian immigrants, and maybe, just maybe, we could apply those traditional family values to my family," he recalls.
Displayed on the National Mall as part of the National March on Washington for Gay and Lesbian Rights, the Quilt measures 150 feet by 470 feet and includes 1,920 panels honoring individuals who had died of AIDS. Half a million people visit the Quilt in its first weekend on the Mall, and in the spring of 1988, it tours the U.S. By the end of the tour, $500,000 has been raised for AIDS charities, and the Quilt has tripled in size to 6,000 panels. It would be displayed again on the Mall in 1988, 1989, 1992 and 1996.
And the Band Played On published
Written by former San Francisco Chronicle reporter Randy Shilts, the book is the first major chronicle of the AIDS epidemic. It engenders controversy because of its depiction of Gaetan Dugas, a promiscuous Canadian flight attendant who died of AIDS in March 1984 and who was at the center of a CDC cluster study detailed in the book. Shilts' description of Dugas as "Patient Zero" leads many to wrongly believe that Dugas is responsible for spreading AIDS in the U.S.
CIA report on AIDS in Africa
The CIA produces a secret report that predicts millions of African deaths each year from AIDS. "Despite the lack of widespread scientific research, the reporting confirms that this deadly epidemic is spreading out of control in Sub-Saharan Africa," the authors write. "... The long-range impact of AIDS will be devastating. Heavily infected countries will suffer irreplaceable population losses in those groups most essential to their future development: midlevel economic and political managers, agrarian and urban workers, and military personnel."
The report also examines how Africa's AIDS problems impact the Soviet bloc and details how the USSR spread disinformation that the U.S. had developed AIDS as a biological weapon.
TASO formed in Uganda
Along with 15 colleagues, Dr. Noerine Kaleeba, whose husband died of AIDS, founds The AIDS Support Organization (TASO) to educate the population about the disease and battle the stigma against it in Uganda. The country's new leader, President Yoweri Museveni, implements a national prevention campaign known as the ABC model, which stands for Abstain, Be Faithful and Use Condoms.
A warning for Asia
Dr. John Dwyer, an Australian AIDS researcher, suggests at a conference in Manila, the Philippines, that Asia could be on the brink of an African-sized epidemic. At the time, Asia reports 208 cases, as compared to more than 45,000 cases in the U.S., more than 7,000 cases in Europe and more than 6,000 cases in Africa.
Jonas Salk attempts an AIDS vaccine
Nobel Prize winner Dr. Jonas Salk develops an AIDS vaccine using killed bits of HIV, an approach similar to his polio vaccine.
AIDS brochure mailed to all households
"Understanding AIDS," a shorter version of the Surgeon General's 1986 AIDS report, is mailed to every U.S. household.
Protesters shut down FDA
Roughly 1,000 protesters effectively shut down the Food and Drug Administration building by blocking its entrances. Within a week, the FDA changes its procedures to allow drugs that show promise while still in clinical trials to move to the marketplace and the general population more quickly -- a process known as "fast tracking" or "parallel track."
Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID), tells FRONTLINE that the protesters had an important effect on his thinking. "After a little while, I began to get beyond the rhetoric and theater of the demonstrations and the smoke bombs, to really listen to what it is that they were saying," he explains, "and it became clear to me, quite quickly, that most of what they said made absolute sense, was very logical and needed to be paid attention to. ... Interacting with the constituencies was probably one of the most important things that I had done in my professional career."
Global Summit in London
Representatives from 148 nations -- including 117 health ministers -- are brought together by WHO's Global Program on AIDS (GPA), marking the first time the world's health ministers gather to meet on a specific disease. GPA head Jonathan Mann divides the world into three broad groups: Pattern I countries (those in North America, Western Europe, Australia, New Zealand and some areas of South America), where the epidemic is primarily spread through homosexual sex and intravenous drug use; Pattern II countries (mostly in Africa), where the epidemic is primarily spread through heterosexual sex, mother-to-child transmission and tainted blood products; and Pattern III countries (those in Asia, the Middle East and Eastern Europe), where the virus is present but hasn't yet spread much. Mann expresses the most worry about Pattern III countries.
At the summit, leaders endorse education efforts, prevention programs and destigmatizing the disease. They do not, however, address hot-button issues such as immigration policy or quarantines, which Cuba implements in January 1988.
Children infected in USSR
Though there had been sporadic cases of HIV in the country, the first concentrated outbreak occurs among children in the remote town of Elista. A man who had traveled to the Congo in the early 1980s infects his wife and unborn daughter, and the disease is spread by Soviet doctors and nurses reusing needles in the pediatric ward because of a needle shortage. Similar outbreaks occur in other towns. Eventually, more than 250 children are infected in hospitals in Elista, Volgograd and Rostov, shocking the nation.
New information about the virus
Using a newly available tool, Dr. David Ho and virologist Dr. George Shaw independently measure the amount of virus in an HIV-positive person's blood. The tests show that, contrary to the belief that HIV lays dormant for a period of time, there are millions of virus particles coursing through the blood, even in the earliest weeks of infection, when the person does not show any symptoms of AIDS. This discovery will have implications for the way scientists think about treatment options.
A new drug
After promising results are shown in Phase I clinical trials, the FDA allows didanosine, known as ddI, to be available to patients for whom AZT is ineffective or too toxic. Like AZT, ddI blocks HIV from replicating, though the virus eventually develops resistance and overcomes the drug. The FDA formally approves ddI in 1991.
Nationwide "Day Without Art"
On Dec. 1, nearly 600 art institutions mark the second annual AIDS Awareness Day by joining the "Day Without Art," organized by the activist group Visual AIDS. Some close their doors, dim the lights, shroud the art and/or hold memorials. The Metropolitan Museum of Art removes Pablo Picasso's Portrait of Gertrude Stein and the Art Institute of Chicago removes Edward Hopper's Nighthawks for the day.
Noted choreographer Alvin Ailey dies of AIDS the same day. Photographer Robert Mapplethorpe, who in 1988 had taken a series of self-portraits showing how the disease had ravaged him, had died earlier in the year.
AZT approved for use in children
Until now, the FDA had allowed doctors to prescribe AZT to children for compassionate reasons. It now gives official approval once studies show that the drug is safe for children, although they suffer the same side effects as adults. It's the first time an AIDS drug is approved for use in children aged three months to 12 years.
President Bush signs Ryan White CARE Act
Named for the hemophiliac boy who had campaigned against discrimination and who died in April, the Ryan White Comprehensive AIDS Resources Emergency Act authorizes $4.4 billion over five years for health care and support services in the 16 cities hardest hit by AIDS: Atlanta; Boston; Chicago; Dallas; Fort Lauderdale, Fla.; Houston; Jersey City, N.J.; Los Angeles; Miami; Newark, N.J.; New York; Philadelphia; San Diego; San Francisco; San Juan, Puerto Rico; and Washington, D.C.
Reagan's mea culpa
A statement from former President Reagan is delivered at a Pediatric AIDS Foundation dinner. In it he says, "We can all learn and grow in our lives, and I've learned that all kinds of people can get AIDS, even children."
"A 'Manhattan Project' for AIDS"
In July, activist Larry Kramer, publishes an op-ed in The New York Times arguing for "an all-out effort by the federal government" to respond to the epidemic. "It is beyond comprehension," he writes, "why, in a presumably civilized country, in the modern era, such a continuing, extraordinary destruction of life is being attended to so tentatively, so meekly and in such a cowardly fashion."
Woman infected by dentist
Kimberly Bergalis is the first known person to have contracted HIV from a health care professional. Four of the dentist's other patients will also develop the same strain of AIDS, although the CDC never determines the precise means by which the disease was transmitted to Bergalis or the others. Bergalis launches a controversial, and ultimately unsuccessful, campaign for mandatory testing of health care workers. She dies in 1991.
Internat'l AIDS Conference in San Francisco
The conference is boycotted by many foreign health officials and scientists because of U.S. policy barring entrance to foreigners with HIV/AIDS. The international conference scheduled to be held in Boston in 1992 is ultimately moved to Amsterdam.
Jonathan Mann quits WHO
Dr. Jonathan Mann resigns as head of WHO's Global Program on AIDS after clashing with new WHO Director-General Hiroshi Nakajima, who reportedly resents Mann's high profile and limits his budget and travel. In the years after Mann's resignation, the GPA's staff drops to four people from a high of more than 250, essentially leaving a vacuum on the international stage until UNAIDS (Joint United Nations Programme on HIV/AIDS) is formed in 1996.
Several years later, in 1998, Mann and his wife, AIDS vaccine researcher Dr. Mary Lou Clements-Mann, will die in a Swissair plane crash on their way to a UNAIDS conference in Geneva.
Infection rates in South Africa
In 1990, the year Nelson Mandela is released from prison, nearly 1 percent of South Africa's population is infected with HIV. For the next four years, the apartheid government and the African National Congress are consumed with the transfer of power; in that political vacuum, the chance to stem the epidemic is missed.
More concerns about Eastern Europe
Hundreds of babies and children in Romanian orphanages are found to be infected with AIDS following the fall of dictator Nicolae Ceausescu. Dr. Jonathan Mann, head of the World Health Organization's Global Program on AIDS, calls Eastern Europe the "new frontier for the AIDS epidemic."
AIDS red ribbon campaign begins
At the Tony Awards, entertainers wear red ribbons to symbolize AIDS awareness. In ensuing years, the ribbon becomes a ubiquitous symbol of the epidemic.
"Where Have All the Ribbons Gone?" In this article, Laura Engle recounts the history of the AIDS ribbon and other symbols of HIV/AIDS.
Magic Johnson announces infection
Basketball player Magic Johnson discloses at a press conference that he has contracted HIV. "I will now become a spokesman for the HIV virus because I want people, young people, to realize they can practice safe sex," he says. "And, you know, sometimes you're a little naive about it, and you think it could never happen to you. You only thought it could happen to, you know, other people and so on and on. And it has happened."
"When Magic Johnson made the announcement he was HIV positive, it had a major impact in our community, and it had a major impact with young people who are now 25," recalls activist Pernessa Seele. "As a matter of fact, I was just speaking with someone in the store just last week, and this is a brother who's working, and he was behind the counter, and he's now 25 years old. He was saying, 'I remember, I think I was like 15 when Magic Johnson announced, and I have used a condom ever since.' It was so impactful for him and his generation."
Rock star Freddie Mercury dies of AIDS
Mercury, lead singer of the band Queen, releases a statement the day before his death: "Following enormous conjecture in the press, I wish to confirm that I have been tested HIV positive and have AIDS. I felt it correct to keep this information private to date in order to protect the privacy of those around me. However, the time has now come for my friends and fans around the world to know the truth, and I hope everyone will join with me, my doctors and all those worldwide in the fight against this terrible disease."
More concerns about Asia
After a trip to the Philippines, Thailand and India, Rep. Jim McDermott (D-Wash.) writes an op-ed piece in The Washington Post suggesting Asia is the "sleeping giant" of the AIDS pandemic. "AIDS must become a concern not only for every health department but for our State Department as well," he writes. "All of our development efforts in the Third World will become meaningless if the economy and labor force of developing nations are destroyed by this disease. Let us not look back in another 10 years and wonder how, amply warned, we allowed a worldwide human disaster to erupt."
"Global Disaster" predicted
A classified U.S. intelligence report, "The Global AIDS Disaster," predicts with uncanny accuracy how AIDS threatens the world. With chapter headings titled "A time bomb for the 1990s," "AIDS is now global," "AIDS in Africa getting worse" and "Grim future," the report predicts 45 million global infections by the year 2000.
A vaccine success?
Researcher Ron Desrosiers at Harvard injects six rhesus monkeys with a strain of simian immunodeficiency virus (SIV) he engineers by removing one gene. He injects a control group of 12 monkeys with the same strain of the virus, but with the missing gene intact. After two years, the six monkeys that had received the strain missing the gene are healthy with normal CD4 counts and low levels of virus in their blood, while all the monkeys in the control group become sick or die.
Desrosiers then injects four of the healthy monkeys and four from the control group with the intact virus. The monkeys that had received the genetically engineered virus remain healthy, even when Desrosiers repeats the experiment using a 100-times-stronger dose of the intact virus.
Desrosiers' experiment seems to show a promising vaccine approach, but many researchers are wary of injecting a live virus into humans. Desrosiers' results are later called into question when, in 1994, Dr. Ruth Ruprecht shows data from experiments in which she gave newborn monkeys a later version of Desrosiers' vaccine, and all develop AIDS from the vaccine.
Third antiretroviral drug approved
Zalcitabine, known as ddC, is approved by the FDA to be used in conjunction with AZT. Manufactured by Hoffman-La Roche, ddC is approved eight months after the company applies for a license.
Change in definition of AIDS
The CDC changes the definition of AIDS to expand the list of opportunistic infections that affect HIV-positive individuals, particularly those specific to women and IV drug users.
Phase II vaccine trials begin
Two separate Phase II trials of vaccines made from the gp120 protein, found on HIV's surface, begin.
Bill Clinton elected president
During his campaign, Clinton promises to provide new leadership on AIDS. By 1992, 200,000 Americans had died and more than 1.5 million were already infected with HIV.
HIV-positive individuals address conventions
In July, two HIV-positive individuals -- Bob Hattoy, a gay adviser to the Clinton campaign, and Elizabeth Glaser, a heterosexual mother infected during a blood transfusion -- address the 1992 Democratic National Convention. "We are part of the American family, and Mr. President, your family has AIDS,'' Hattoy says to the crowd. "And we're dying, and you're doing nothing about it.''
The following month, Mary Fisher, an HIV-positive mother from Florida, speaks at the GOP convention. "Tonight, I represent an AIDS community whose members have been reluctantly drafted from every segment of American society," she says. "Though I am white and a mother, I am one with a black infant struggling with tubes in a Philadelphia hospital. Though I am female and contracted this disease in marriage and enjoy the warm support of my family, I am one with the lonely gay man sheltering a flickering candle from the cold wind of his family's rejection."
Arthur Ashe announcement
Tennis player Arthur Ashe learned in 1988 that he had contracted HIV; it was believed he received tainted blood products during heart surgery in 1979 or 1983. Ashe decides to go public after being contacted by a USA Today reporter who had received a tip about his illness. He will die in February 1993 at age 49.
Doubts surface about gp120 vaccines
Researchers at Duke University, the biotech firm Chiron and Walter Reed Army Institute of Research all raise doubts about the efficacy of the gp120 vaccine approach. Each independently confirms that the gp120 vaccines, while effective in the lab, are powerless when challenged by new, real-world virus isolates taken directly from AIDS patients.
Federal study conducted on needle exchange
A CDC-funded study of needle exchange programs in the U.S., Canada and Europe finds that the programs are effective in helping to prevent the spread of HIV and concludes that the federal government should fund such programs.
Angels in America and Philadelphia honored
Tony Kushner's play about homosexuality and AIDS in the 1980s wins the Pulitzer Prize in April and the Tony Award in June. That same year, Tom Hanks wins an Academy Award for best actor in Philadelphia for his portrayal of an HIV-positive lawyer, fired from his job because of his illness.
AZT reduces mother-to-child transmission
A study in the New England Journal of Medicine finds that only 8.3 percent of children born to HIV-positive mothers who had been given AZT were born infected, as opposed to 25.5 percent of babies born to HIV-positive mothers who were given a placebo. The finding sparks a debate over whether HIV tests should be required of pregnant women.
Turning point in vaccine research
In June, the National Institutes of Health (NIH) AIDS Research Advisory Committee meets to decide whether to fund large-scale Phase III trials of Genentech's gp120 vaccine. Press accounts the previous month had wrongly indicated that the vaccine had infected volunteers in Phase II trials. (The vaccine could not cause the infection because it contained no live virus.)
Activists argue that funding the trials would divert funds from treatment research. After a contentious hearing, the committee decides not to fund the Phase III trial even though a subcommittee had recommended moving forward. The announcement dampens enthusiasm for vaccine research, and Genentech abandons its HIV vaccine research entirely.
Global AIDS Action Network founded
The group, GAAN, is founded by gay activist Paul Boneberg. Its mission is to involve U.S. activists in the global AIDS epidemic.
MTV cast member with AIDS
AIDS educator and gay activist Pedro Zamora is featured on The Real World, a popular reality series. The 22-year-old dies of AIDS on Nov. 11, one day after the season finale. President Clinton releases a statement, saying, "Pedro was particularly instrumental in reaching out to his own generation, where AIDS is striking hard. Through his work with MTV, he taught young people that the 'real world' includes AIDS and that each of us has the responsibility to protect ourselves and our loved ones."
Nelson Mandela elected president
Though HIV infection rates are doubling every year, Mandela barely mentions the word "AIDS" in public appearances. His health minister, Dr. Nkosazana Suma, puts together a musical, Serafina II, with AIDS awareness themes, but the production is a high-profile disaster. South Africa is on its way to becoming home to the world's largest epidemic.
A treatment breakthrough
Independently, Dr. David Ho of the Aaron Diamond AIDS Research Center and Dr. George M. Shaw of the University of Alabama at Birmingham discover that from the moment of infection, the immune system is engaged in a pitched battle with HIV. By giving new drugs called protease inhibitors to AIDS patients, both doctors learn that within two weeks, the virus becomes resistant to the drugs. They then measure virus reproduction rates and find that between 100 million and 1 billion new virus particles are produced daily. They also learn that T-cells are reproducing at a rate of 1 billion per day. This battle between the immune system and HIV could go on for 10 years or more before the virus begins to win and a person experiences the opportunistic infections associated with AIDS.
FDA approves first protease inhibitor
The drug saquinavir is approved in record time -- 98 days after the FDA receives an application from Hoffman-LaRoche, Inc. Protease inhibitors target an enzyme, protease, that acts like a pair of scissors to cut off a protein HIV needs in order to replicate. As the name implies, protease inhibitors prevent the enzyme from doing its job, and in collaboration with other drugs, they help slow virus reproduction.
International vaccine effort begins
The Rockefeller Foundation launches the International AIDS Vaccine Initiative (IAVI) to try to accelerate the development of a vaccine by helping raise funds, bridging the gap between public- and private-sector projects, and serving as a clearinghouse for news and information.
AIDS is top killer of young Americans
The CDC announces the disease is the number one cause of death for Americans between age 25 and 44. By 1996, it would no longer be the leading cause of death for all Americans in this age group, but would rank first among African Americans and third among women aged 25 to 44.
Rapper Eazy-E dies of AIDS
A member of the seminal gangsta rap group N.W.A., Eazy-E (nee Eric Wright) issues a statement to warn "all my homeboys and their kin" the week before he dies at age 31. "I've learned in the last week that this thing is real, and it doesn't discriminate. It affects everyone," he says. Officials at Los Angeles' Cedars-Sinai Medical Center report that the hospital received a record number of phone calls after Eazy's announcement.
The AIDS cocktail unveiled
The 11th International AIDS Conference in Vancouver showcases the development and effectiveness of highly active antiretroviral therapy (HAART), which becomes known as the AIDS cocktail. The treatment, developed by Dr. David Ho and others, involves several highly toxic drugs administered several times per day and leads to dramatic improvement in AIDS patients. But the conference immediately raises questions about access to the expensive therapy -- which costs $20,000 per year -- for the 90 percent of HIV-infected people living in developing nations. William W. Dodge IV is patient number nine in the study.
Time's Man of the Year
Dr. David Ho is named "Man of the Year" by Time magazine for his work in developing the AIDS cocktail.
Brazil provides free drugs
Although Brazil's constitution guarantees access to free health care, the government refuses to make expensive antiretroviral drugs available to its estimated 500,000 citizens living with HIV/AIDS. Nair Soares de Brito, a schoolteacher dying from AIDS, sues, and a judge rules she must get the drugs immediately. The government passes a law guaranteeing universal free access to the cocktail in September, and distribution begins in October.
Dr. Peter Piot is asked to head the new agency, which is designed to coordinate all of the U.N.'s AIDS efforts and to fill the vacuum left by the WHO's now-defunct Global Program on AIDS. "I felt that the top priority was exactly to put AIDS on the political agenda," Piot tells FRONTLINE. "It has to be on the agenda of presidents, of prime ministers, if it's a national emergency, a matter of national survival."
Clinton announces vaccine commitment
At a commencement speech at Morgan State University in Baltimore, President Clinton commits the United States to developing an AIDS vaccine by 2007.
AIDS-related deaths decline dramatically
Largely due to the development of highly active antiretroviral therapy (HAART), also known as the AIDS cocktail, AIDS-related deaths in the U.S. decline by more than 40 percent.
South Africa passes Medicines Act
The law encourages pharmacists to offer generics; establishes a national pricing committee to evaluate fair prices; enables the government to introduce "compulsory licensing," or the ability to manufacture drugs locally; and allows "parallel importation," or the ability to purchase drugs from the country selling them at the lowest price.
By early 1998, about 40 pharmaceutical companies have sued South Africa, and in February of that year, the Office of the U.S. Trade Representative, responding to industry pressure, places the country on a watch list.
VaxGen begins Phase III trials
After the NIH declines to fund large-scale trials of Genentech's gp120 vaccine in June 1994, Dr. Don Francis, who had left the CDC to run Genentech's AIDS vaccine-testing program, raises the funds to spin off the AIDS vaccine division into a new company, VaxGen. The company privately raises the funds for Phase III trials -- to date, the only Phase III trials of an AIDS vaccine. It hopes the vaccine will protect 45 percent to 65 percent of participants.
In 2003, the company releases disappointing results which show that overall, the vaccine reduced the rate of HIV infection by only 3.8 percent, a statistically insignificant number.
Clinton refuses to fund needle exchange
As Secretary of Health and Human Services Donna Shalala prepares to announce a lift on the ban against federal funding for needle exchange programs, she receives a call telling her that President Clinton, at the urging of drug czar Gen. Barry McCaffrey, won't rescind the ban. The decision is applauded by conservatives, who don't want to send a message endorsing drug use, but is denounced by activists and the scientific community, who argue that overwhelming evidence shows the programs reduce the spread of HIV and do not encourage drug abuse.
Years later, Clinton tells FRONTLINE that he didn't lift the ban because he faced "overwhelming" opposition. "It was overwhelming in Congress, and it was overwhelming within the Drug Control Office of the administration, and it simply would have been reversed in Congress if I'd done it," he says. "Politically, the country wasn't ready for it."
Minority AIDS initiative created
At the urging of African American leaders and the Congressional Black Caucus, and alarmed by the rising proportion of AIDS cases in black and Latino communities, the Clinton administration authorizes $156 million for prevention, care and education campaigns targeting those communities.
Congress authorizes hemophilia fund
The Ricky Ray Hemophilia Relief Fund Act, named for one of the three HIV-positive brothers whose Arcadia, Fla., home was burned down by arsonists in 1987, authorizes payments to hemophiliacs who contracted HIV from the blood supply between 1982 and 1987. The fund, which closes out in October 2005, pays out more than $559 million to 7,171 eligible individuals and survivors.
Treatment Action Campaign launched
In South Africa, on Dec. 10, International Human Rights Day, about 15 people gather on the steps of Cape Town's St. George's Cathedral to demand drugs for South Africans living with HIV. By day's end, they collect more than 1,000 signatures from South Africans, many of whom were until then unaware treatment for HIV/AIDS existed. The petition calls for the government to introduce free AZT for pregnant women, and the Treatment Access Campaign is born.
Health GAP Coalition formed
Dr. Alan Berkman and ACT UP activist Bob Lederer form the Health GAP (Global Access Project) Coalition to coordinate organizations dedicated to fighting global AIDS. The group focuses on making antiretroviral drugs accessible and fights to reform international trade policies -- to win debt cancellation for poor countries and to encourage multinationals to provide treatment to their workers.
Internat'l AIDS Conference in Geneva
UNAIDS presents the first set of authoritative surveillance numbers, backed by Harvard, the World Health Organization, the U.S. Census Bureau and others. The numbers show that over the previous three years, HIV infection rates had doubled in 27 countries. There are 8 million AIDS orphans, and 16,000 people are becoming infected each day. With the new credible numbers, UNAIDS head Dr. Peter Piot is able to link economic and security considerations to the pandemic. He fights to get AIDS on the agenda of the G7, the World Economic Forum and elsewhere.
Price cut for AZT
Responding to pressure from activists and the international community, Glaxo Wellcome announces it will cut the price of AZT, which helps prevent mother-to-child transmission by as much as 75 percent for the developing world. At the time, about 1,500 HIV-infected babies are born every day, but even with the discount the prices are still exorbitantly high and out of reach for the world's poorest countries.
New data about HIV's origins
Researcher Beatrice Hahn of the University of Alabama at Birmingham presents new data suggesting that HIV-1 originated in a subspecies of chimpanzees, Pan troglodytes troglodytes, found in West Central Africa. Examining four of these chimps, who were infected with simian immunodeficiency virus, or SIV, Hahn finds that three were infected with a strain of SIV whose genetic material closely resembles HIV-1.
Clinton changes policy
At a World Trade Organization meeting in Seattle, Clinton announces that the U.S. will not level punitive trade sanctions against any sub-Saharan African country that wants to pursue parallel licenses or produce generic drugs. In May 2000, he signs an executive order "broadening the agreement to include all sub-Saharan African countries."
Activists trail Al Gore
At his 2000 campaign kickoff announcement in Carthage, Tenn., Vice President Al Gore is targeted by 18 activists wearing T-shirts that read "Gore's Greed Kills." They want to make antiretroviral drugs accessible in Africa. A few days later, The New York Times runs an editorial supporting the position. The activists follow Gore on the campaign trail, protesting at his events.
The "Amsterdam Statement" issued
At a conference on increasing global access to lifesaving drugs, the activist groups Health Action International, Doctors Without Borders (Medecins Sans Frontieres) and Ralph Nader's Consumer Project on Technology issue a statement calling for balancing the intellectual property rights of patent holders with the rights of citizens to access essential medicines. The statement, which becomes known as the "Amsterdam Statement," reads:
"In the developing world, a lucrative or 'viable' market for lifesaving drugs simply does not exist. But clearly what does exist is need. The market has failed both to provide equitably priced medicines and to ensure research and development for infectious disease. This lack of affordable medicines and research and development for neglected diseases is causing avoidable human suffering. Market forces alone will not address this need: political action is demanded."
A new president in South Africa
Thabo Mbeki takes office, promising African solutions for African problems like AIDS. By this point, one in five South Africans has HIV. As deputy president, he had been Mandela's point person on the disease, but soon after becoming president, Mbeki delivers a speech questioning whether HIV causes AIDS -- a theory, discredited for years, espoused by so-called AIDS denialists.
Mbeki asks the denialists to serve on an advisory panel, and based on their advice, he bans AZT and other antiretrovirals, claiming their effects are too toxic.
AIDS becomes Africa's number one killer
The presidents of Namibia, Nigeria, Botswana and Kenya all publicly address the AIDS epidemics in their countries, though not all of them follow up with concrete action.
George W. Bush elected president
Soon after taking office, the Bush administration is lobbied by economist Jeffrey Sachs, U.N. Secretary-General Kofi Annan and others proposing the idea of a global fund to provide treatment for AIDS and other infectious diseases in the world's poorest countries. Some administration officials are skeptical at first that the distribution and implementation of treatment regimens in Africa is practical.
U.N. Security Council debates AIDS
U.S. Ambassador to the United Nations Richard Holbrooke proposes to U.N. Secretary-General Kofi Annan that the Security Council address HIV and AIDS after visiting Africa and witnessing the continent's burgeoning crisis. The meeting marks the first time the Security Council has convened on a health issue.
"That was a breakthrough because it opened so many doors," explains UNAIDS head Dr. Peter Piot. "Presidents, prime ministers say, 'Ooh, it was debated in the Security Council. This must be a serious problem,' which was ridiculous, but I literally got that kind of reaction."
Mbeki letter to world leaders
In April, South Africa's president sends a five-page letter explaining his views on AIDS to President Clinton, U.N. Secretary-General Kofi Annan and others. "[A]s Africans, we have to deal with this uniquely African catastrophe," he writes. "... It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical." Mbeki also defends the AIDS denialists: "Not long ago, in our own country, people were killed, tortured, imprisoned and prohibited from being quoted in private and in public because the established authority believed that their views were dangerous and discredited. We are now being asked to do precisely the same thing that the racist apartheid tyranny we opposed did, because, it is said, there exists a scientific view that is supported by the majority, against which dissent is prohibited."
The letter is leaked to The Washington Post, infuriating and embarrassing Mbeki. The following month he holds an AIDS conference in South Africa and gives the denialists equal time.
Internat'l AIDS Conference in Durban
The 13th International AIDS Conference, held in Durban, South Africa, exposes many Western scientists to the scale of Africa's AIDS problem for the first time. President Thabo Mbeki speaks at the opening session and restates his belief that poverty, not a virus, is at the root of AIDS.
At the conference, economist Jeffrey Sachs floats the idea of a "global fund" that would buy the drugs at cost and make them available for free to the world's poorest countries.
Accelerating Access Initiative formed
The AAI is formed by five pharmaceutical companies, UNAIDS, WHO, the World Bank, UNICEF and the U.N. Population Fund to provide deeply discounted drugs to the least developed countries. "I met with the chairman and CEOs of five pharmaceutical industry [companies] twice, urging them to reduce the price of medication," recalls U.N. Secretary-General Kofi Annan. "Yes, they were determined to protect the intellectual property, but as I told them then, if you insist only on intellectual property and you do not take any measures to ensure that the poor have access to affordable medication, the whole regime is going to come under serious pressure."
The program, however, is hampered by distribution problems, and the companies negotiate separate rates for each country, which they refuse to reveal publicly.
Bono lobbies Sen. Jesse Helms
Rock star Bono, whose work for debt relief for Africa led him to AIDS activism, meets with Sen. Jesse Helms (R-N.C.), who had consistently opposed AIDS funding on moral grounds. "Jesse Helms is a tough guy; that's well known," Bono tells FRONTLINE. "But he's also rigorous from his point of view, and our argument is rational and considered, even on the scriptural front, even with considerable backup. You know, Christ only speaks of judgment once, and oddly enough, it's in regard to the poor. I think it's Matthew 23. It's the famous lines: 'I was naked and you clothed me. I was a prisoner and you visited me.' ... That's a very powerful piece of Scripture, and he was very moved. Even emotionally, he kind of welled up."
"He respected what Bono was telling him, and he was willing to listen to a rock star," recounts the evangelical leader Franklin Graham. "And Sen. Helms changed his position. [From] opposing funding for HIV/AIDS, he became an advocate for funding."
Indian pharmaceutical company cuts prices
Cipla, a Bombay-based pharmaceutical company, strikes a deal with Doctors Without Borders to provide a year's worth of antiretroviral drugs for $350 per patient -- compared to the $10,000-to-$15,000-per-patient yearly prices in the United States and Europe. Cipla stipulates that the drugs be free to patients.
The Doha declaration
The World Trade Organization (WTO) issues a ruling, which becomes known as the Doha declaration, that gives poor countries the right to use compulsory licensing and other trade mechanisms to access generic drugs for domestic use in cases of public health emergencies.
Kofi Annan proposes Global Fund
At an African summit on AIDS and other infectious diseases, U.N. Secretary-General Kofi Annan proposes the Global Fund to Fight AIDS, Tuberculosis and Malaria. In May, President George W. Bush announces the first contribution to the new fund -- $200 million, a significant figure, though much less than had been asked for.
"The U.S. was our first major donor, the first country even before the existence of the Global Fund to say, 'This is a good idea, this is the kind of mechanism we need, and here's a large amount of money on the table to help it get up and running,'" recalls Richard Feachem, the head of the Global Fund.
Rapid test approved by FDA
The new OraQuick HIV test, a finger-prick test made by OraSure, can return results in 20 minutes, as compared to the two weeks it previously took for results to be processed. (Public health officials estimated nearly 8,000 HIV-positive people each year did not return to find out their status.)
In January 2003, the Department of Health and Human Services approves a waiver allowing the test to be administered outside of hospitals, in doctors' offices, mobile testing units and counseling centers.
Evangelical Christians meet in Washington
Evangelist Franklin Graham, holds a closed-door meeting of evangelical Christians at a Washington hotel. With Bush administration and other Republican officials in the audience, he lays out his vision of a Christian missionary response to AIDS. "We need leadership," he says. "The church of Jesus Christ needs to provide the leadership in this crisis. The infection rate is increasing -- 40 million people. ... We need an army of men and women who are willing to go into this battle."
At the same meeting, Sen. Jesse Helms (R-N.C.) apologizes for his prior opposition to AIDS spending and outreach. "I'm ashamed I have done so little [on AIDS]. ... I will do better than I have done in the past, and I will work together with you."
HIV-positive Muppet joins Sesame Street
An HIV-positive character named Kami, the Tswana word for "acceptance," joins the cast of Takalani Sesame, South Africa's version of Sesame Street.
Internat'l AIDS Conference in Barcelona
The 14th International AIDS Conference is dominated by the issue of getting treatment to the world's poorest countries.
The "next wave" of AIDS
The U.S. National Intelligence Council releases a report naming five countries of strategic importance with large populations at risk of HIV infection as the "next-wave" countries. The five nations -- Ethiopia, Nigeria, India, China and Russia -- make up 40 percent of the world's population and are estimated to be in the early to middle stages of their HIV/AIDS epidemics. None of their governments have prioritized stemming the disease.
New kind of drug approved
The FDA approves Fuzeon, the first of a new class of drugs called fusion inhibitors designed to block HIV's ability to penetrate its target, the immune system's CD4 T-cells.
Bush announces $15 billion plan
In his State of the Union address, while Americans wait for news about the impeding war with Iraq, President Bush announces a five-year, $15 billion plan for AIDS prevention, treatment and care. "AIDS can be prevented," the president says. "Antiretroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year -- which places a tremendous possibility within our grasp. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many."
The President's Emergency Plan for AIDS Relief (PEPFAR) targets 15 countries, mostly in Africa and the Caribbean. Of the $15 billion, $1 billion is to be given to the Global Fund, which targets 130 countries. Critics argue that the plan doesn't address the problem in some of the "next-wave" countries, including China, India and Russia, but the Bush administration responds that it is focusing on countries that don't have the resources to help themselves and where the problem is the worst. Randall Tobias, the former CEO of Eli Lilly, is named to head the program.
3 x 5 initiative begins
The World Health Organization and UNAIDS announce their 3 x 5 initiative on World AIDS Day 2003. The goal is to get 3 million people in developing countries on antiretroviral treatment by the end of 2005. It becomes clear that the target will not be met by June 2005, when the drugs are getting to 1 million of the 6 million who need it. But progress is made in individual countries: By 2005, Botswana, Swaziland and Malawi all have at least 50 percent of their HIV-infected population on treatment.
China addresses AIDS
Shaken by an outbreak of the deadly infectious virus known as SARS (Severe Acute Respiratory Syndrome), China's leadership begins to address AIDS, which it had ignored for years. Dr. David Ho persuades several deputy ministers to attend a conference on AIDS at which former President Clinton speaks. When an HIV-positive individual in the audience asks a question, Clinton invites him onstage. "Just on instinct I said, 'Come up here,' because I knew it was being televised nationally," Clinton recalls. "He came up on the stage, and I put my arm around him and hugged him and shook his hand, and I took him over and introduced him to the vice ministers. And the Chinese showed the whole thing on television. ... Within 10 days, the prime minister had 10 AIDS activists in his office."
China quickly implements a prevention and treatment campaign, sending doctors to the most affected provinces, teaching sex workers to use condoms, counseling and giving free methadone to drug addicts, and promising free antiretrovirals.
Call for global AIDS vaccine initiative
More than 20 leading AIDS researchers and public health officials publish a paper in Science calling for "a more efficient and integrated HIV vaccine research enterprise" modeled on the Human Genome Project. The idea is endorsed by G8 leaders in 2004, and the Bill & Melinda Gates Foundation provides much of the funding and administrative support.
In February 2005, the Global HIV Vaccine Enterprise releases a six-part scientific strategic plan, which recommends standardized specifications for laboratory and manufacturing processes; shared regulatory and intellectual property guidelines; and the pursuit of a vaccine that produces cellular immunity and elicits antibody responses.
HIV outbreak in porn industry
Four actors contract HIV from onscreen unprotected sex; more than 50 performers are quarantined, and the adult film industry virtually shuts down for more than a month. The incident sparks debate over whether actors should be required to practice safe sex onscreen. In September, the state of California fines two adult film companies $30,000 each under a state law that requires employers to protect workers from exposure to blood or bodily fluids.
South Africa starts to distribute drugs
In 2002, the country's highest court had unanimously ruled that the government could not deny AIDS treatment to its citizens, ordering it to provide antiretroviral drugs immediately to pregnant women. Widespread distribution does not occur until 2004, shortly before national elections.
Brazil turns down U.S. money
After applying for aid from the President's Emergency Fund for AIDS Relief (PEPFAR), Brazil learns that under U.S. law, recipients of government funds are required to oppose prostitution and sex trafficking. "Prostitutes are our partners," Dr. Pedro Chequer, director of Brazil's National AIDS Programme, tells FRONTLINE. "We could never exclude such an important group. Today it's prostitutes; tomorrow it may be homosexuals." In protest, Brazil rejects more than $40 million in funding.
A new class of drugs?
At the 13th Conference on Retroviruses and Opportunistic Infections (CROI), researchers from the pharmaceutical companies Merck and Gilead present promising data on a new class of drugs, integrase inhibitors, which stop the enzyme integrase that allows HIV's DNA to be incorporated into the T-cell's DNA. Merck, whose development is further along, hopes to have its drug on the market by 2007.
New data on origins
In late May, Dr. Beatrice Hahn of the University of Alabama, Birmingham, and colleagues announce that they have traced the origins of the "M" strain of HIV-1, which is responsible for 90 percent of worldwide infections, to a specific family of chimpanzees, known as Pan troglodytes troglodytes, who live in southern Cameroon.