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After 40 years of AIDS, progress has been made but major problems remain

Four decades ago this past week, the first ever cases of the HIV/AIDS epidemic were publicly noted, and hardly noticed. But soon after, cases exploded around the world. It's estimated that roughly 35 million people have died from AIDS in the years since. William Brangham reports and speaks with two people deeply immersed in the issue for a look back at the epidemic and the best way forward.

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  • Judy Woodruff:

    Four decades ago this past week, the first ever cases of the HIV/AIDS epidemic were publicly noted and hardly noticed.

    The Centers for Disease Control published a weekly report then, noting that five gay men in Los Angeles were sick with an unusual pneumonia-like infection. Two had died. By the end of that year, the CDC counted 270 confirmed cases of — quote — "severe immune deficiency," the disease that later became known as AIDS, caused by the infection of HIV.

    Cases exploded around the world. It's estimated that about 35 million people have died from AIDS in the years since.

    William Brangham looks now at the progress made against this virus and the major problems that remain.

  • William Brangham:

    In the 1980s and early '90s, the AIDS epidemic was marked by two kinds of images. One, we saw in public, activists taking to the streets demanding not only action, but basic recognition that AIDS was real. President Reagan's administration often ignored the crisis. Reagan himself didn't publicly mention it for years.

    But the other was in private, in homes and in hospitals, patients, many of them gay men, wasting away from AIDS. The LGBTQ community lost a staggering number of friends and loved ones to the virus. With no medications or vaccine, contracting HIV back then was often a death sentence, a sentence shrouded with a thick blanket of stigma and denial.

    By the late '80s and early '90s, some small improvements. As well-known Americans tested positive and came forward, attitudes began to shift. And then in the late 1980s came the first antiretroviral drugs to treat HIV infection. A decade later, combination of drugs proved the virus could not just be slowed, but suppressed.

    This huge shift meant people could survive, with HIV becoming a chronic, but not fatal condition. But, for years, those drugs were expensive and not available to people in sub-Saharan Africa. Millions died before new programs were launched to make those drugs more affordable and more widely available.

    Salim Abdool Karim runs one of South Africa's leading HIV research centers.

  • Salim Abdool Karim:

    It is not that we don't know what to do. It is a challenge of trying to do what we know works and to do it at a scale where it can really make a difference.

  • William Brangham:

    HIV treatment has undoubtedly saved millions. Nearly 38 million around the world today, more than 1.2 million in the U.S., are living with HIV; 27 million of them get that treatment.

    But AIDS still takes its toll. Nearly 700,000 people died last year, and millions still don't get the lifesaving access they need.

    So, for a look back at this epidemic and a look at the best way forward, we turn to two people deeply immersed in all of this.

    Chris Collins is the president and CEO of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria. And the Reverend Robert Newells is director of national programs at the Black AIDS Institute, an African American-led research and advocacy group focused on ending HIV in Black communities.

    Gentlemen, thank you both very much for being here on this anniversary.

    Chris Collins, to you first.

    I grew up in San Francisco in the '80s. I lived in New York in the '90s. I have very distinct memories of this epidemic. For people who don't remember, can you just give us a snapshot of what it was like back then?

  • Chris Collins:

    It was absolutely terrifying and tragic.

    I mean, I came out as gay a year before the MMWR was released. And as soon as that happened, all of the…

  • William Brangham:

    This was when the CDC first signaled that HIV was here.

  • Chris Collins:

    That's right.

    And, pretty soon, everybody I knew was scared, worried for themselves, worried for all of their friends. It was a mystery then of what was going on. And we saw our government not responding adequately to it. So it was a time of a great deal of fear, but also frustration and anger.

  • William Brangham:

    And, Reverend Newells, the same question to you.

    Do you have an early memory of this epidemic that you could share with us?

  • Robert Newells:

    Sure.

    I grew up in Oakland just across the bay from San Francisco. But I was 10 years old 40 years ago. And what I remember was seeing white gay men on television suffering from this new disease, but, in my community, it was really a secret. We didn't die of AIDS in those days. We died of pneumonia or cancer, so it was that stigma that kept people quiet about it.

    So I really didn't see it as a Black disease at that time.

  • William Brangham:

    And we certainly now how that has changed since then.

    Chris Collins, as I mentioned in the introduction, so much progress has been made. We have drugs that treat HIV. We have drugs that prevent HIV, so great success on one hand, and yet still a lot of faltering going on globally.

  • Chris Collins:

    Well, that's right. I mean, the progress has been incredible, in terms of where the science has taken us, and just the mobilization that has been global to demand equity and scale up of things that work for people.

    But we're falling short in a lot of ways, as you say. There's about a 10 million-person treatment gap right now between the number of people living with HIV and those that are on treatment. And we're seeing increases in HIV infections in some parts of the world.

    And now, also, because of neglect all over the world of marginalized people, people who are marginalized in their own societies, such as gay men and other men who have sex with men,sex workers, people who inject drugs, trans people, others, you're seeing now an increasing share of infections are among those key population groups, those marginalized groups.

    And governments all over the world are criminalizing their behavior. Societies are — make them outcast, and that makes them more vulnerable and makes it very tough for them to access services. So we have got to turn that around if we're going to begin to end this epidemic.

  • William Brangham:

    And, Reverend Newells, we know that, here in the United States, that once HIV/AIDS sort of dropped off the front page, a lot of Americans thought, OK, we're done with that.

    But as your work certainly is a testament to, there is still a pocket where we have not figured out how to solve this in the U.S. Can you tell us a little bit about where HIV is still prevalent in America?

  • Robert Newells:

    Sure.

    In Black and brown communities, much like everyone has talked about with the COVID pandemic, HIV and AIDS is still really prevalent among Black same-gender-loving men, Latino same-gender-loving men, and Black trans women specifically, and cisgender black women.

    So, I think — and in the Deep South, because that's where most Black people in this country live, the HIV epidemic seems to be center in big urban areas. There is a big problem in rural areas as well that looks like it looks in sub-Saharan Africa.

  • William Brangham:

    And, Chris Collins, with regards to those particular populations, you often hear this term that they're hard to reach.

    But I have heard many activists say it's not about hard to reach. It's that we know what works. It's just a function of finding the political will to do better. Do you agree with that assessment?

  • Chris Collins:

    Absolutely.

    I mean, it is not easy to bring down HIV infection mortality rates, but we do know what to do. It's not rocket science. Communities around the world have actually dramatically driven down HIV incidence and mortality when they have gone to scale and reached everybody at risk.

    But what we have got in the United States now, really, if you look at the map of HIV incidence, it's a map of policy failure and the impact of racism in our in our society. It doesn't have to be that way. Line up the states with some of the highest HIV incidents against states that didn't take the Medicaid waiver for Obamacare, for example, you will see the impact of policy, failure of health systems to be scaled so that they can reach everybody.

    That plays out in more severe HIV epidemics. We can turn this around, but it's going to take political commitment and the investment.

  • William Brangham:

    Reverend Newells, you touched on this earlier, but I wonder if you could talk a bit more about the issue of stigma, because that seems to be still such a big impediment to getting people to care and getting good care to people.

  • Robert Newells:

    Sure, stigma, both individualized stigma, community stigma, family stigma, faith-based stigma, can prevent folks from, A, getting tested to even find out what your status is, and then, B,getting treatment.

    It's not always all about access. Access is a big deal. But access doesn't mean uptake. And so, if you feel stigmatized by going to get treatment or services, then the access doesn't really matter. You're not going to uptake those services.

  • William Brangham:

    So, Chris Collins, the COVID pandemic has certainly shown us how a virus loose anywhere in the world can be a threat to everybody.

    Going forward, with regards to the fight against HIV, what do you think we ought to be doing? What are the next most important steps to take?

  • Chris Collins:

    Well, we need to make sure we're reaching everybody.

    One of the priorities that came out of the high-level meeting that the United Nations just had was to say, we have really got to work with governments around the world and get rid of negative laws that criminalize people's behavior and that marginalize them in communities. Doing that and getting tailored services to those populations is going to be essential.

    We have got to increase investment. This is another thing the U.N. called for this week. We're underinvesting in ending HIV. We could bring this epidemic to near an end, but we have been underinvesting for decades now.

  • William Brangham:

    Reverend Newells, same question to you.

    What do you — do you think we have it within our power to end the HIV epidemic?

  • Robert Newells:

    We absolutely have it within our power.

    I think some of the lessons we take from the COVID experience that we have all shared is that the messenger really does matter. If you're trying to reach folks that you're not used to reaching, you're not going to be successful.

    So, we have to invest in Black leadership, Black folks reaching Black folks. The messenger matters when addressing medical mistrust, the history of that, and the lived present-day experience that folks have with medical racism. Like, those are things that contribute to this pandemic. And those are the things that we have to hit head on if we're going to end it for everyone by 2030, as the U.N. would like to do.

  • William Brangham:

    All right, Reverend Robert Newells and Chris Collins, thank you both for joining us on this anniversary. Good to talk with you.

  • Chris Collins:

    Thank you.

  • Robert Newells:

    Thank you.

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