Today, HIV (human immunodeficiency virus) remains one of the largest pandemics in the world. HIV is the same virus that can lead to AIDS (acquired immunodeficiency syndrome).

Researchers found the earliest case of HIV in a blood sample of a man from the Democratic Republic of Congo. It’s said that the most common form of the virus spread from chimpanzees to humans sometime before 1931, most likely during “bush meat trading.” While hunting chimpanzees, hunters would have come in contact with animal blood.

Before the 1980s, researchers estimate that about 100,000 to 300,000 people were living with HIV. The earliest case in North America was confirmed in 1968, in Robert Rayford, a 16-year-old who never left the Midwest and never received a blood transfusion. This suggests that HIV and AIDS may have been present in the United States before 1966.

But before AIDS was identified, the disease presented with other immunodeficiency conditions like Pneumocystic jirovecii pneumonia (PCP) and Kaposi sarcoma (KS). A year after scientists identified AIDS, they discovered the cause: HIV.

Originally people believed that only certain people were at risk for HIV. Media named them the “four-H club”:

  • hemophiliacs, who received contaminated blood transfusions
  • homosexual men, who reported higher incidences of the disease
  • heroin users, and people who used drugs via injection
  • Haitians or people of Haitian origin, many cases of AIDS were reported in Haiti

But then, researchers studied how the disease spread. By 1984, they found that:

  • Females could get HIV through sex.
  • There were 3,064 diagnosed cases of AIDS in the United States.
  • Of those 3,064 cases, 1,292 people died.

The National Cancer Institute identified HIV as the cause of AIDS.

The number of cases continued to grow as the CDC refined their case definition, and scientists learned more about the virus.

By 1995, complications from AIDS was the leading cause of death for adults 25 to 44 years old. About 50,000 Americans died of AIDS-related causes. African-Americans made up 49 percent of AIDS-related deaths.

But death rates began to decline after multidrug therapy became widely available. The number of deaths has since dropped from 38,780 in 1996 to 14,499 in 2000.

Azidothymidine, also known as zidovudine, was introduced in 1987 as the first treatment for HIV. Scientists also developed treatments to reduce mother to child transmission.

In 1997, highly active antiretroviral therapy (HAART) became the new treatment standard. It caused a 47 percent decline in death rates.

The Food and Drug Administration (FDA) approved the first rapid HIV diagnostic test kit in November 2002. The test kit allowed hospitals to provide results with 99.6 percent accuracy in 20 minutes.

Also in 2003, the CDC reported that 40,000 new transmissions occurred each year. More than half of those transmissions came from people who didn’t know they had contracted the virus. It was later discovered the number was closer to 56,300 people living with HIV. This number remains roughly the same since the late 1990s.

The World Health Organization set a goal to bring treatment to 3 million people by 2005. By 2010, about 5.25 million people had treatment, and 1.2 million people would start treatment.

Current treatment

The FDA approved Combivir in 1997. Combivir combines two drugs into a single medication, making HIV medications easier to take.

Researchers continued to create new formulations and combinations to improve treatment outcome. By 2010, there were up to 20 different treatment options and generic drugs, which helped lower costs. The FDA continues to approve HIV medical products, regulating:

  • product approval
  • warnings
  • safety regulations
  • label updates

As of 2017, studies have shown that a person living with HIV who is on regular antiretroviral therapy that reduces the virus to undetectable levels in the blood is NOT able to transmit HIV to a partner during sex. The current consensus among medical professionals is that “undetectable = untransmittable.”

Stigma in the early years

When the first few cases of AIDS emerged, people believed the disease was only contracted by men who had sex with men. The CDC called this “infection GRIDS,” or gay-related immunodeficiency syndrome. Shortly after, the CDC published a case definition calling the disease AIDS.

Public response was negative in the early years of the epidemic. In 1983, a doctor in New York was threatened with eviction, leading to the first AIDS discrimination lawsuit.

Bathhouses across the country closed due to high-risk sexual activity. Some schools also barred children with HIV from attending.

In 1987, the United States placed a travel ban on visitors and immigrants with HIV. President Obama lifted this ban in 2010.

The United States government resisted funding needle exchange programs (NEPs) due to the war on drugs. NEPs were shown to be effective at reducing HIV transmission. Some believe that this resistance accounts for 4,400 to 9,700 avoidable transmissions.

Government support

Throughout the years, the government continues to fund HIV- and AIDS-related:

  • systems of care
  • counseling
  • testing services
  • treatment
  • studies and research

In 1985, President Ronald Reagan called research for AIDS “a top priority” for his administration. President Clinton hosted the first White House Conference on HIV and AIDS, and called for a vaccine research center. This center later opened in 1999.

Pop culture opens up conversations about HIV

Actor Rock Hudson was the first major public figure to acknowledge he had AIDS. After he died in 1985, he left $250,000 to set up an AIDS foundation. Elizabeth Taylor was the national chairperson until her death in 2011. Princess Diana also made international headlines after she shook hands with someone with HIV.

Pop culture icon Freddie Mercury, singer for the band Queen, also passed away from AIDS-related illnesses in 1991. Since then many other celebrities have revealed that they’re HIV-positive. More recently, Charlie Sheen announced his status on national television.

In 1995, the National Association of People with AIDS founded National HIV Testing Day. Organizations, conventions, and communities continue to fight the stigmas attached to this infection.

Following the politics of blood bans

Prior to the epidemic, U.S. blood banks did not screen for HIV. When they started doing so in 1985, men who had sex with men were banned from donating blood. In December 2015, the FDA lifted some of its restrictions. Current policy says that donors can give blood if they have not had sexual contact with another man for at least one year.

In July 2012, the FDA approved pre-exposure prophylaxis (PrEP). PrEP is a medication shown to lower the risk of contracting HIV from sexual activity or needle use. The treatment requires taking the medication on a daily basis.

Doctors recommend PrEP for people who are in a relationship with someone who has HIV. The US Preventive Services Task Force recommends it for all people at increased risk of HIV.

People who may benefit from PrEP include:

  • people in a non-monogamous relationship with a partner who is HIV-negative (PrEP reduces the risk of transmitting HIV to a partner)
  • people who have had anal sex without a condom or who have contracted a sexually transmitted disease (STD) in the past 6 months
  • people who have sex with men and women
  • people who have injected drugs, have been in drug treatment, or shared needles in the past 6 months
  • people who regularly have different sexual partners of unknown HIV status, especially if they inject drugs

PrEP is shown to reduce the risk for HIV infection by greater than 90 percent.