30 Years of AIDS: Honoring the Past, Looking Toward the Future

June 5, 2011, marked the passing of 30 years since AIDS was first recognized as a public health concern in a 1981 article published in a Morbidity and Mortality Weekly Report1 about a handful of gay men in several large cities who contracted rare infections. Several had died. A year later, the disease had a name—acquired immunodeficiency syndrome, or AIDS—and was on its way to becoming a global pandemic. Today, the disease has claimed approximately 25 million lives worldwide.2

In the United States, more than 600,000 people have died of AIDS as of June 3, 2011, most of them gay men and people of color.3,4 At least 20 percent of the more than 1.1 million people living with HIV in the United States are unaware of their status, fueling the number of HIV infections that occur annually.5,6,7

Despite the losses and continued challenges, the AIDS epidemic has led to innovations in prevention, treatment, and care and new approaches with Federal, State, and local collaboration that enabled communities to cope with the epidemic in ways that met their specific needs. These innovations helped mitigate the impact of the epidemic since it began. The following examples illustrate how the effort to fight the HIV/AIDS epidemic has been like that of no other public health crisis.

• Establishment of and investment in community agencies, across the Nation. Community-based organizations and gay activists helped develop the first support and care protocols for AIDS patients and were integral to initiating HRSA's first AIDS Service Demonstration Grants. Today, a national network of HIV/AIDS clinics and other agencies are providing comprehensive care to people living with HIV/AIDS.
• Increased training for service providers. In 1987 the AIDS Education and Training Centers were launched to increase the number of providers able—and willing—to treat people living with HIV/AIDS.
• Development of AIDS drugs, starting with AZT (zidovudine) in 1986 and then highly active antiretroviral therapy (HAART) in 1995, which has dramatically reduced AIDS mortality. In 1994, thanks to the ACTG-076 study, AZT was also found to decrease the spread of HIV from pregnant or nursing mothers to infants, and HRSA quickly disseminated the study findings and provisions for administering HAART in HRSA-funded health care programs.
• Technical advances. Recognizing the importance of not only technological advances but also patient access to care, HRSA expanded earlier HIV/AIDS medication assistance under the AIDS Drug Assistance Program on the heels of HAART's development, providing $52 million dollars in 1995 toward getting people the medications they needed. ADAP funding has grown tremendously since then, although needs still exist.
• Federal intervention. The Ryan White HIV/AIDS Program, established in 1990, bolstered the local response to HIV/AIDS nationwide and helped link hundreds of thousands of people living with and affected by HIV/AIDS to core medical and support services. An integrated health system, the Program will be further bolstered by the implementation of the Patient Protection and Affordable Care Act (Pub.L. 111–148) in 2014 and the positive outcomes as a result of the ongoing rollout of the National HIV/AIDS Strategy.8,9,10,11
• Basic research. Recent advancements in research on microbicides, pre- and post-exposure prophylaxis, HIV vaccines, and stem-cell transplants could yield additional treatments in the near future.12,13