1. Learning from the Early HIV/AIDS Epidemic Harold W. Jaffe, MD Centers for Disease Control and Prevention Atlanta, GA

2. 1981

3. The End of Infectious Diseases? “ Even with my great personal loyalties to infectious disease, I cannot conceive of the need for 309 more infectious-disease experts unless they spend their time culturing each other.” - Robert G. Petersdorf, “The Doctors’ Dilemma” (1978) N Engl J Med 1978;299:628

4. The End of Infectious Diseases? “ Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky” - Albert Camus, “The Plague” (1947)

5. Primary and Secondary Syphilis United States, 1969-1980 MMWR. Sept 11, 1981

9. The First 1,000 Reported AIDS Cases Distribution by Risk Group Risk group*Percent of cases Homosexual/bisexual men72.7 IV drug users15.5 Haitians 5.0 Hemophiliacs 0.7 Others 6.1 * Hierarchy of mutually exclusive risk groups J Infect Dis 1983;148:339-45

10. MMWR Publications December 1982 – January 1983 Update on Acquired Immune Deficiency Syndrome (AIDS) among Patients with Hemophilia A (12/10/82) Possible Transfusion-Associated Acquired Immune Deficiency Syndrome (AIDS) – California (12/10/82) Unexplained Immunodeficiency and Opportunistic Infections in Infants – New York, New Jersey, California (12/17/82) Immunodeficiency among Female Sexual Partners of Males with Acquired Immune Deficiency Syndrome (AIDS) – New York (1/7/83)

11. Ryan White

12. The Ray Brothers

13. HIV Infection in Nonsexual Household Contacts of 39 Patients with AIDS or AIDS-related complex New York City, 1984-5 Contact groupNo. screenedNo. infected Children <6 yrs.211* Children 6-18 yrs.470 Adults330 Total1011 *5-year-old born to mother with AIDS N Engl J Med 1986;314:344-9

15. Public Information

18. Belle Glade, Florida “AIDS in Belle Glade may be a sign of things to come in the US. because there are hundreds of other poverty-stricken, mosquito breeding towns.” Dr. Mark Whiteside, Ottawa Citizen, April 17, 1986

19. A Community Survey of HIV Infection Belle Glade, Florida, 1985-6 HIV prevalence in randomly selected persons –Adults: 28/877 (3.2%) –Children: 0/138 No household clusters (except sex partners) No infected adults over age 60 No association with antibodies to arboviruses Infections associated with Haitian origin, low income, sex with IDU, STD treatment history Science 1988;239:193-7

20. Understanding AIDS 1988 Brochure

21. Heterosexual AIDS

22. Trends in Condom Use by 9 th through 12 th Grade Students, YRBSS, 1991-2011

23. Occupationally Acquired HIV The Lancet, December 15, 1984

24. “AIDS: What the Government Isn't Telling You”  “Aerosolized blood can pass through a mask like BBs through a tennis net.”  “…[I] face a 49% risk of becoming HIV-positive in the next five years.”  “Why do I have to take care of a patient with a concealed weapon, AIDS”… [without knowing the results of their blood test] Lorraine Day, Chief, Orthopedic Surgery, San Francisco General Hospital

25. HIV Serosurvey of Orthopedic Surgeons, March 1991  87% of participants reported a blood-skin contact and 39% a percutaneous injury in the previous month  2 (0.06%) of 3420 participants tested HIV seropositive  Both reported non- occupational risk factors

26. Reducing the Risk of Occupationally Acquired HIV “Universal Precautions” to prevent exposure to potentially infectious body fluids Safe disposal of used needles Development of safer medical devices Post-exposure prophylaxis with ARVs

27. Occupationally Acquired HIV Infections in Health Care Personnel* United States, 1985-2013 *Documented seroconversion temporally related to a specific exposure to a known HIV-infected source MMWR 2015;63:1295

28. AIDS Activism

29. Activism and the FDA AZT approved for use 2 years after publication of in vitro studies Treatment IND to make experimental drugs available to persons with serious illnesses outside of the clinical trial context New regulations to expedite review of drugs designed to treat life-threatening or seriously debilitating diseases

30. Mortality and HAART Use Over Time HIV Outpatient Study, CDC, 1994-2003 Patients on HAART Deaths per 100 PY

31. Treating HIV/AIDS in the Developing World “[Africans] do not know what watches and clocks are. They do not use western means for telling time. They use the sun. These drugs have to be administered during a certain sequence of time during the day and when you say take it at 10:00, people will say what do you mean by 10:00?” - Andrew Natsios, USAID Administrator, 2001

32. The President’s Emergency Plan for AIDS Relief Announced January 28, 2003 15 focus countries Goals: − Treat 2 million HIV- infected people − Prevent 7 million new HIV infections − Provide care for 10 million HIV-infected people and AIDS orphans Overall budget for global AIDS: $15 billion over 5 years ($10 billion new money)

34. A Tale of Two Viruses Human Immunodeficiency Virus Ebola Virus

35. Emerging Infections “As the HIV disease pandemic surely should have taught us, in the context of infectious diseases, there is nowhere in the world from which we are remote and no one from whom we are now disconnected.” - IOM, 1992

37. . H. D. Marston et al., Sci Transl Med 2014;6:253ps10 Published by AAAS

38. The Viruses HIVEbola virus FamilyRetroviridaeFiloviridae Animal hostChimpanzees Gorillas Bats (?) DistributionGlobalAfrica Latent infectionYesNo TransmissionSexual, Transfusion/IDU Perinatal Direct contact with blood/body fluids

39. The Diseases AIDSEVD Ave. incubation10 years8-10 days Case-fatality rate>90%~50% CasesMillionsThousands TreatmentARVsSupportive VaccineNoneIn clinical trials

40. HIV/AIDS and the Media Kaiser Family Foundation. Supplement to March/April 2004 issue of Columbia Journalism Review

41. Ebola and the Media

43. New York Times, January 8, 2015

44. Learning from the Early HIV/AIDS Epidemic “…we might try to explain the phenomenon of the plague, but, above all, should learn what it had to teach us. ” - Albert Camus, “The Plague” (1947)