The HIV epidemic: social and historical perspectives

Because I have lectured about this subject I have a lot of graphics, but I'll try to keep it reasonable. The first report of what turned out to be AIDS was published in CDC's Morbidity and Mortality Weekly Report on June 5, 1981. It reported on five cases of Pneumocystis carinii pneumonia in young men in California. This is a microbe that only causes disease in people with weakened immune systems.  After at first calling the mystery disease Gay Related Immunodeficiency Disease, or GRID, epidemiologists quickly renamed it Acquired immune Deficiency Syndrome,  or AIDS. It was particularly prevalent among gay men in the U.S., but it soon became evident that you didn't have to be gay to get AIDS and that in fact, in Africa, it was prevalent among heterosexual men and women. 

 

It would be three more years before a retrovirus was identified as the cause of AIDS. It was discovered independently in two laboratories in the U.S. and one in France. The discoverers argued about what to call it and who was first, but eventually to share the credit and call it Human Immunodeficiency Virus, HIV. Unfortunately, knowing the cause didn't lead to a vaccine, and didn't lead to any effective treatment until 1996, another 13 years. In the meantime the disease wreaked devastation, particularly in gay communities in North America and Europe, and widely in sub-Saharan Africa. 

 

HIV infection is strongly associated with social and economic disadvantage. Skipping over a lot of history, here is the global distribution in a recent year. (I happen to have this graphic that's a couple of years old, but it hasn't changed much.)

 

 

 

Of course, this isn't adjusted for population size, so here is the prevalence map.

 

 

You can see that the geographic distribution is highly variable. Within the U.S. it is also highly variable.

 

 

 And it varies just as strongly within a single city, in this case New York.

And finally, within the U.S., the prevalence varies strongly by certain demographic characteristics. This is a little hard to read but the orange bar at the left is Black race, and the little bar second to right is white.

 

 

 

So why is this? Stay tuned  and I will explain.