So let’s start at the beginning, where did HIV/AIDS come from?
The HIV-1 virus has caused an international epidemic that started in the late 70’s.
We are almost certain that the virus is a result of the Simian Immunodeficiency virus (SIV) crossing the barrier from chimpanzee to human. Study of an isolated island known as Bioko Island suggests that the Simian Immunodeficiency Virus has been present in monkeys and apes for at least 32,000 years – most likely even longer than that.
It is thought that the SIV virus was prevalent among wildlife in Africa since the early 1920’s. Regardless of this it is documented that that transition from SIV to HIV happened at around late 1940 to early 1950, in the Democratic Republic of Congo.
The first documented case of HIV-1 came to light when a patient in Kinsahasa, Democratic Republic of Congo, died of “suspicious causes”. Analysis of his blood sample later showed that the HIV-1 virus was presented.
To this day it’s still not known exactly how the patient contracted the virus but the Hunter Theory is the most widely agreed upon and probable explanation. Primates are and were regularly hunted for bush meat in West and Central Africa. Consumption of bushmeat is understood to be the cause of Once in contact with the SIV infected blood, the virus would have mutated and become what we know to be the HIV virus.
In 1981 the USA reported the first recognised cases of AIDS in both California and New York. It was reported that Men who have sex with Men (MSM**) were falling ill with very obscure and relatively rare cases of Pneumonia (Pneumocystis jirovecii) and Cancer (Kaposi’s sarcoma). Very soon after cases were detected in injecting drug users, heterosexual men and women and passed from mother to child via breastfeeding, all still in the USA.
By 1982 the UK had experienced its first AIDs related death, from which the Terrance Higgins Trust was formed and still operates to this day. By 1984 over 100 cases of AIDS had been reported in the UK and via the conjoined efforts of France and America the virus which is now known as HIV, was identified as the cause of AIDS.
When HIV-1 hit the western world it was referred to by a number of names, some of which were extremely derogatory, specifically to the gay community (Gay-related immune deficiency). Eventually the disease became recognised as AIDS or Acquired Immunodeficiency Disease.
We now understand that AIDS is not a separate disease to the HIV-1 virus. AIDS is a stage of the virus, the very latest stage that one’s body can get to – as defined by the CD4 count, but we’ll save that for a later date.
From 1981 until 1983 scientists absolutely failed to identify both the virus and the nature of the virus, which was causing this state referred to as AIDS. Failing to identify both of these things, meant that authorities and the public went uneducated on the facts about the HIV virus and how it was contracted.
The inability of the authorities to educate both the public and themselves on the crucial facts of what was causing this state of AIDS meant that the epidemic unfolded rapidly.
The lack of knowledge proved devastating to any efforts made to prevent the spread of HIV-1. Rumours speculated far, wide and fast about how “AIDS” was spread. Ideas included sharing drinking cups, cutlery, kissing, mosquitos, touching and even sharing the same breathing space as a HIV+ person.
We now know that HIV is transmitted by what can be defined as intimate contact. Intimate contact can be extended to sexual intercourse – between both hetero and homosexual couples – sharing needles, breast feeding and blood to wound transmission. To top this off, a person can be infected for up to 10 years before symptoms begin to prevail – hence the desperate need to now be regularly tested for HIV.
To understand the impact that the failure to identify and understand HIV within a certain time and lack of understanding during this period, had on the spread of HIV, consider; In 2000 the World Health Organisation estimated that somewhere between 15-20% of new HIV infections were the result of blood transfusions using untested or ill-screened donor blood. Initially authorities and charities opted not to properly screen donors due to extra expense and again, lack of knowledge – There have been reports of this problem still persisting today.
There are currently 36.7 million people estimated to be HIV positive. 25.5 Million People in Sub-Saharan Africa and 11.6 Million in the Western World. If we only consider the Western population, that’s 2.32 million people living with HIV today, as a result of ineffective screening of blood donors.
The HIV epidemic came hand-in-hand with extreme panic. The fear associated with this epidemic stems from the long-standing lack of knowledge of the virus and a number of false beliefs.
Remembering that the only observable stage of HIV-1, at this point in time, was AIDS, the virus was strongly associated by everyone with death. The length of time taken to understand the virus and its development process allowed this perception to persist for a number of years and ultimately ingrain the association – an association that we now know to be false.
The spread was witnessed largely within the LGBT community, African community, drug users and sex workers. This caused society to create a link between the then perceived inappropriate behaviours and inferior social groups, thus strengthening the stigma surrounding the virus.
The sub-groups at the largest risk of contracting HIV varies between continents. In both Europe and North America the demographic at largest risk is/was the male gay community (MSM) – with 1 in 20 men thought to be HIV-1 positive. The second largest at risk demographic is African heterosexuals, with estimates standing at around 1 in 56 men currently HIV positive and 1 in 22 women.
The spread was also witnessed largely within drug users and sex-workers, allowing society to create a link between then perceived inappropriate behaviours and social groups and thus strengthening the stigma surrounding the virus.
With the gay community being at largest risk of contracting HIV in the UK, the fear that was associated with this unfamiliar virus was promptly attached to the already “inferior” demographic and the stigmatisation followed almost instantly.
Gay men were not at risk of becoming HIV-1 positive due to the fact that they identify as gay. There are both social and biological answers to why they are at highest risk of exposure.
Put simply, HIV is 18 times more likely to be transmitted via anal sex than vaginal sex – this is consistent between both men and women.
The lining of the rectum is very fragile, meaning that during intercourse it is highly likely to tear and thus expose blood vessels. The cells that line the rectum are more susceptible to HIV than the cells that line the vagina. In addition to this, both seamen and rectal mucosa carry more HIV than vaginal fluid. Overall this puts anyone that’s engaging in anal intercourse, with a HIV positive male, 18 times more likely to contract HIV than someone engaging in vaginal intercourse with a HIV positive male.
The obvious, really. Vaginal intercourse is not an option for gay men. Ignorance surrounding HIV and STDs in general meant that oftentimes condoms would not be used – after all, no one was going to get pregnant.
We’ll recall that the first recorded death from AIDS in the UK came in 1981, but this isn’t to say that this was the first case of a person carrying the HIV virus.
The nature of the virus means that it can lay dormant for as long as 10 years before any symptoms begin to show, by which time it’s likely that the individual will have reached the end stage of the virus, then and now recognised as AIDS. What does this mean? A huge amount of unaware HIV positive people engaging in unprotected intercourse.
We are aware that the gay community is somewhat smaller than the heterosexual community. On the highest end of the scale experts predict that 10% of the population is gay, that’s including females. This tells us that the “choice” of frequent sexual or life-long partners is and was significantly smaller for MSM, thus increasing the likelihood of exposure to HIV-1 infection.
On top of all of this, the 80s were a period of social rebellion and celebration for the LGBT community, following the 1969 Stone Wall demonstrations and the formation of the Gay Liberation Front. For the gay community this meant living life, as, how, when and where they wanted and with whomever they wanted.
The unfortunate reality is that the nature of the HIV-1 virus means that it is significantly more risky for the gay community. It just so happened that it was discovered within the Western World at a point of identity celebration and scientific ignorance, leading to the consequences of panic, ignorence and an all-round epidemic.
We have come along way since the first reported case and HIV is no longer a death sentence, for instance the PrEP drug and the vast amounts of advice on how to travel safely when you have an immunodeficiency condition.
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