1981: AIDS diagnosed. A new fatal, infectious disease was diagnosed in 1981. Called Acquired Immunodeficiency Syndrome (AIDS), it began appearing in major cities among homosexual men and intravenous drug users. Other high-risk groups were haemophiliacs and other recipients of blood or blood products, babies born of AIDS-infected women, bisexual men, and prostitutes and their customers. AIDS was soon recognized as a worldwide health emergency: a fatal disease with no known cure that quickly became an epidemic. It was especially widespread in Africa, the apparent land of its origin.

By 1983 the virus that causes the disease had been isolated. Some medicines, notably AZT (azidothymidine), slowed the disease’s progress for a few months or more; but the spread of AIDS continued relentlessly, with more than 3,000 new cases being reported each month by 1991.

The federal government had committed more than 1.6 billion dollars to research, while the homosexual community and other special interest groups sought more federal funding and greater assistance from the health insurance industry. Educational programs on safe sexual practices, such as the use of condoms, seemed the best means of slowing the epidemic. Meanwhile, more than 70,000 persons in the United States had died from AIDS by the end of the decade.

1981: AIDS identified. A strange, new, and deadly disease made its appearance in 1980. Physicians in such large cities as Los Angeles, New York, and San Francisco noticed that homosexual men were dying from rare lung infections or from a cancer known as Kaposi’s sarcoma. By 1981 the disease was identified and given a name: AIDS, or acquired immunodeficiency syndrome.

The virus that causes AIDS, human immunodeficiency virus (HIV), was identified by Dr. Luc Montagnier of the Pasteur Institute in Paris in research done during the years 1981-84. The results of Dr. Montagnier’s studies were released in 1984. Since its discovery, AIDS has become one of the world’s major health problems. Within certain populations it has become an epidemic: male homosexuals, haemophiliacs, and intravenous drug users in the United States, for example, and heterosexual men and women in Sub-Saharan Africa. Many people were infected through blood transfusions before HIV screening was introduced. An individual infected with the virus may not show the symptoms of AIDS for several years, but the condition is eventually fatal.

The search for a successful vaccine was pursued in laboratories around the world, with no success by the early 1990s. Meanwhile, the disease continued to spread to different parts of the world. Already rife in the United States, Europe, and sub-Saharan Africa by the mid-1980s, it quickly spread to Central and East Asia. The disease also began to spread to larger portions of the heterosexual community throughout the world.

Dec. 1, 1993: AIDS awareness day. The sixth annual World AIDS Day was celebrated in many countries. The commemoration was started in 1988 by the World Health Organization. The day was partly a memorial for those who had died from AIDS (acquired immunodeficiency syndrome). Although the growth of the epidemic had peaked in the United States in the early 1990s, the disease was still spreading rapidly in Africa and parts of Asia. No cure had yet been found, nor was there a successful vaccine to protect against contracting the disease.

Dec. 1, 1993: AIDS awareness day. The sixth annual World AIDS Day was celebrated in many countries. The commemoration was started in 1988 by the World Health Organization. The day was partly a memorial for those who had died from AIDS. Although the growth of the epidemic had peaked in the United States in the early 1990s, the disease was still spreading rapidly in Africa and parts of Asia. No cure had yet been found, nor was there a successful vaccine to protect against contracting the disease.

April 7, 1994: Failure of AZT. A team of British and French medical researchers reported that AZT, a drug often used to fight AIDS, does not slow the onset of the disease in persons who have the HIV virus. Published in the journal Lancet as the Concorde Report, the document stated that AZT does prolong the lives of patients who have developed AIDS, but it does not impede the progression of HIV into full-blown AIDS. The report was based on tests conducted on HIV-infected patients in Ireland, France, and the United Kingdom.

Diseases that can be passed between people during sexual contact have plagued humankind throughout history. Until recently such a disease was called venereal disease, or VD. The preferred term now is sexually transmitted disease, or STD. The two main venereal diseases in the United States have traditionally been gonorrhoea and syphilis. Scientists now know that many other diseases can be passed during sex. More than 30 STDs have been identified.

AIDS (acquired immunodeficiency syndrome), incurable disease caused by a virus that damages the human body’s immune system; believed to be transmitted through sexual contacts, blood transfusions, or contaminated needles used for intravenous drug injections; often fatal; high percentage of victims are homosexuals or drug abusers.

The names of such STDs as acquired immunodeficiency syndrome (AIDS) and gonorrhoea are known to most people; however, other STDs such as trichomoniasis and genital candidiasis may not be as familiar. Some STDs affect only a few people or do not cause life-threatening problems. Other STDs, such as gonorrhoea and chlamydial infections, affect many people or cause severe health damage.

STDs are a major health problem throughout the world. In the United States STDs strike an estimated 20 million people each year, or an average of one person every 1.5 seconds. About one half of STD patients are under the age of 25. Nearly 2.5 million teenagers are infected with an STD each year.

Pelvic inflammatory disease (PID), general, acute inflammation of the pelvic cavity in women.

Sterility, in biology, the inability to produce offspring; one cause is the production of non functioning sex cells.

The health problems caused by STDs seem endless. The diseases can cause arthritis, sterility, nervous system damage, heart disease, and death. Women and infants suffer the most damage from STDs. For example, each year more than 1 million women suffer from pelvic inflammatory disease resulting from gonorrhoeal or chlamydial infections. About 200,000 of these women become sterile each year. More than 300,000 babies are injured or die each year from STDs.

Transmission

Mucous membrane (or mucosa), membrane that secretes mucus and lines the mouth, nose, throat, windpipe, lungs, eyelids, and the alimentary canal.

STDs are caused by a variety of organisms that include bacteria, protozoa, viruses, and very small insects such as Phthirus pubis, or pubic lice. These organisms usually live in the warm and moist parts of the body called mucous membranes. The penis, vagina, rectum, mouth, and eyes have mucous membranes. These organisms usually invade a person through the mucous membranes during sexual contact. Some STDs are passed by deep kissing or skin-to-skin contact, though these transmission methods are not common.

Anyone can get an STD regardless of age, sex, race, social class, or whether the person is heterosexual, homosexual, or bisexual. Exposure to STD organisms results from participating in certain sexual or drug-use behaviours

People with many sexual partners have the greatest risk of contracting an STD. The risk increases with each new partner. The risk is even greater if any of the partners have several sex partners.

It is virtually impossible to get an STD from such things as door knobs, toilet seats, drinking glasses, or whirlpool baths. Light and air destroy STD organisms very quickly. Some STDs such as gonorrhoea, syphilis, and genital herpes are practically always spread by sexual contact. Such diseases as AIDS, hepatitis, and pediculosis pubis, however, can sometimes be acquired through non-sexual means. AIDS and some forms of hepatitis can be acquired from infected blood in intravenous drug needles and syringes. Pubic lice can be picked up from contaminated clothing or bedding that is infected with the lice or their eggs.

Most STDs can also be passed during pregnancy or birth from an infected woman to her baby. Women can develop some infections in the vagina without having sex. It is possible but not common for those infections to be passed to others during sex. Other vaginal infections are sexually transmitted, but the woman’s sex partners may not have symptoms.

Prevention

Most people have heard some information about STDs. In recent years public awareness has increased. The media have developed greater coverage of STDs, and more schools teach about STDs. There are news items on television and in newspapers and magazines about AIDS almost daily. This increased discussion has alerted people to how widespread STDs are, to STD health dangers, and to methods of preventing STDs. Hence, many people have become more cautious.

Medical personnel and public health officials believe that education is the key to controlling the spread of STDs. STDs are dangerous. Further medical advances may bring improved modes of treatment, but avoiding infection in the first place is vital. The actions of individual persons are the most important factors in halting the spread of these diseases. Many health educators emphasize the idea that the wisest teaching approach is to motivate people to practice responsible STD-preventive behaviour, such as sexual abstinence and sexual fidelity.

Communication between partners. Among people who are mature enough to have a sexual relationship, one of the most important things to do is communicate. A person should feel free to discuss concerns about getting an STD. The conversation can be started by one partner stating that he or she cares about the health and well-being of both persons. Persons deciding to have sex with a new partner should discuss ways of protecting each other.

The disease known as AIDS is a complicated illness that may involve several phases. It is caused by a virus that can be passed from person to person. AIDS impairs the human body’s immune system the system responsible for warding off disease and leaves the victim susceptible to various infections.

AIDS was first conclusively identified in the United States in 1981, when 189 cases were reported to the Centers for Disease Control. Within a decade the disease had spread to virtually all populated areas of the world. In the United States alone there are about 65,000 new cases every year. The origin of the AIDS virus is uncertain, but it may have originated in Central Africa.

The first AIDS patients in the Americas and Europe were almost exclusively male homosexuals. Later patients included those who used unsterilised intravenous needles to inject illicit drugs; haemophiliacs (persons with a blood-clotting disorder) and others who had received blood transfusions; females whose male sexual partners had AIDS; and the children of such couples. However, since 1989, heterosexual sex was found to be the fastest growing means of transmission of the virus, with 90 percent of new cases originating from heterosexual sex.

Public awareness of the disease gradually built up as high-profile victims began to die: actor Rock Hudson (1985), clothes designer Perry Ellis (1986), choreographer Michael Bennett (1987), photographer Robert Mapplethorpe (1989), and Oscar-winning director Tony Richardson (1991). When basketball superstar Magic Johnson announced in 1991 that he had contracted the AIDS virus, the feeling spread quickly that anyone, not just particular groups of people, could be at risk. This was again confirmed as tennis legend Arthur Ashe announced in 1992 that he had been infected with the virus for several years.

The AIDS virus. American researchers initially named the virus that causes AIDS the human T-lymphotropic virus, type III or HTLV-III. After researchers discovered in the late 1980s that there were several forms of the AIDS virus, the original virus was renamed the human immunodeficiency virus type 1, or HIV-1.

The virus enters the bloodstream and destroys certain white blood cells, called T lymphocytes, that play a key role in the functioning of the immune system. The virus can also infect other types of cells in the body, including the immune-system cells known as macrophages. Unlike T lymphocytes, however, macrophages are not killed by the virus. In fact, research has suggested that macrophages may carry the AIDS virus to healthy brain cells, to the lymphatic system, and to other healthy cells in the body.

What happens after infection. Most people recently infected by the AIDS virus look and feel healthy. In some people the virus may remain inactive, and these people act as carriers, remaining apparently healthy but still able to infect others. After a few years, some people may develop AIDS-related complex, or ARC. Its symptoms may include fever, fatigue, weight loss, skin rashes, a fungal infection of the mouth known as thrush, lack of resistance to infection, and swollen lymph nodes. Sometimes the symptoms of ARC disappear, but the condition frequently goes on to become AIDS. Though it can take up to 20 years after the virus is contracted for AIDS to fully manifest itself, the average time is one to two years.

The AIDS virus causes so much damage to the immune system that the body becomes susceptible to a variety of opportunistic infections infections that are less harmful to people with normal immune systems but take advantage of the breakdown in an AIDS sufferer’s immune system to produce devastating and eventually lethal diseases. Among the most frequently occurring opportunistic infections are tuberculosis and a type of pneumonia caused by the micro-organism Pneumocystis carinii. AIDS sufferers are also more likely to develop certain tumours, particularly Kaposi’s sarcoma, a rare form of cancer. The AIDS virus may also attack the nervous system and cause brain and eye damage. The average life expectancy for an AIDS victim from the onset of symptoms is one to five years.

How AIDS is spread. AIDS is transmitted by direct contamination of the bloodstream with body fluids that contain the AIDS virus, particularly blood and semen from an HIV-infected person. The virus is usually transmitted through various forms of sexual intercourse, the transfusion of virus-contaminated blood, or the sharing of HIV-contaminated intravenous needles.

The AIDS virus cannot penetrate intact bodily surfaces, such as skin, and quickly perishes outside the human body. Consequently, AIDS is not spread by casual physical contact or by sneezing. The virus has been found in tears and saliva, but it exists there in such low concentrations that transmission from these body fluids is extremely rare. There are no known cases of AIDS transmission by insects such as mosquitoes or by domestic animals. Studies show that the virus is usually passed to an infant close to or during delivery, rather than moving across the placenta during pregnancy. Recently infected mothers can transmit the virus to their children via breast milk. The United States Congress approved guidelines recommending that health care workers who perform invasive procedures be tested for the AIDS virus but the testing and disclosure of results would be voluntary; no restrictions would be placed on those who tested positive.

There are several ways to reduce the spread of AIDS through sexual contact. These include practising abstinence no intercourse or practising safe sex. Practising safe sex means either participating only in a monogamous, or mutually exclusive, relationship in which both people are free of HIV infection, or using latex condoms whenever engaging in intercourse.

Detection and treatment. Usually, when the AIDS virus enters the bloodstream, the body’s immune system produces antibodies to battle the micro-organism Blood tests can detect these antibodies and therefore can indicate exposure to the virus. However, these tests occasionally give false readings and only begin to give accurate results within two weeks to three months after infection, during which time an infected person may pass the virus to others. Scientists do not know exactly how the AIDS virus damages the immune system, nor do they understand why the natural antibodies developed to destroy the virus are ineffective.

By 1987 the drug azidothymidine (AZT) had proved effective in slowing the reproduction of the HIV-1 virus in humans, but it is highly toxic and cannot be taken by many patients. In 1989 researchers determined that lower doses of AZT would be effective and less harmful for patients that have early symptoms of AIDS and for children with AIDS. Dideoxyinosine (DDI) was approved in the United States in 1991 for the treatment of HIV infection. This drug is a useful replacement for AZT and is used in children and other patients for whom AZT is too toxic. In 1992 zalcitabine, or DDC, became the third drug approved to treat people infected with the AIDS virus. It was, however, approved for use only in combination with AZT to treat adults with advanced HIV infection.

Several other drugs and treatments have recently been approved or become available experimentally for the treatment of P. carinii pneumonia, Kaposi’s sarcoma, and other AIDS-related conditions. Several vaccines against AIDS are being developed and tested.

BIBLIOGRAPHY FOR AIDS

Cozic, C.P., and Swisher, Karin, eds. The AIDS Crisis (Greenhaven, 1991).

Hein, Karen, and others. AIDS: Trading Fears for Facts, updated ed. (Consumer Reports Books, 1991).

Tiffany, Jennifer, and others. Talking with Kids About AIDS (Parent AIDS, 1993).