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The AIDS Epidemic and Its Spread in the for Additional Reading United States and the World © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE The OR DISTRIBUTION AIDS NOT FOR SALE OR DISTRIBUTION 1 Epidemic © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION LOOKING AHEAD © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER NOT FOR SALEJune 5,OR 2011 DISTRIBUTION marked 30 years since the Centers forNOT Disease FOR Control SALE and ORPrevention DISTRIBUTION (CDC) reported the fi rst cases of AIDS in the United States in its weekly Morbidity OUTLINE and Mortality Weekly Report (MMWR). The chronological milestone provides an opportunity to refl ect upon the status of HIV/AIDS in the world today. Since these Looking Ahead fi rst fi ve cases were reported, nearly 600,000 people have died in the United States as a result of HIV/AIDS.© Jones Worldwide, & Bartlett 30 million Learning, people LLChave died of HIV-related © JonesIntroduction & Bartlett Learning, LLC causes. There is stillNOT no vaccineFOR SALE available OR to DISTRIBUTIONprevent this viral disease. However, thereNOT TheFOR Early SALE Years OR DISTRIBUTION remains hope that this viral disease will be conquered one day. Development of anti- The First Observations virals to treat patients, along with improved HIV diagnosis methods, have increased The Breakthrough the life expectancy of U.S. patients after HIV diagnosis from 10.5 to 22.5 years. Another AIDS Virus This opening chapter introduces acquired immune deficiency syndrome (AIDS) A Pandemic by© exploringJones & the Bartlett development Learning, of its epidemic LLC in the United States and© Jonesthe world & BartlettOrigin Learning, of the AIDS LLC Epidemic andNOT by FORdescribing SALE the ORresearch DISTRIBUTION to uncover its cause. On completingNOT the chapter, FOR youSALE ORThe DISTRIBUTION Origin of HIV should be able to . The Jump to Humans Out of Africa • Understand the conditions that led public health officials to realize that an Entry into the United States epidemic of AIDS was in progress. The First Decades and • Recognize some broad features of AIDS and characterize the individuals at risk © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLCBeyond for the disease. Thirty-Plus Years of AIDS NOT FOR SALE• Summarize OR DISTRIBUTION the research leading to the isolation NOTand identification FOR SALE of ORthe AIDS DISTRIBUTION Looking Back virus. • Conceptualize the transmission of the AIDS virus from chimpanzees to humans. Review • Discuss some theories for the origin of the AIDS epidemic and its spread in the For Additional Reading United States and the world. • Note the current© magnitudeJones & ofBartlett the AIDS Learning, epidemic and LLC describe where it is likely © Jones & Bartlett Learning, LLC to spread in theNOT future. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The end of this chapter contains a Healthline Q & A section that addresses questions you may have as you read and digest the information presented. ©INTRODUCTION Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Human perception can lead to false understandings; however, when observing new patterns in the world, often all we have are our perceptions. This is the case with our early thoughts about AIDS. Physicians and scientists could not adequately © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 14881_CH01_1-26.indd 1 3/21/13 1:54 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 1.1 A fable tells of six blind men (seen here as blindfolded) invited to examine an elephant and report what they believed it to be. Each touched the elephant at a differ- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ent part and reported something NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION completely unlike the others. In the early years of the AIDS epidemic, physicians, researchers, and members of the general public saw disease in different ways, much ©as differentJones blind & menBartlett Learning, LLC © Jones & Bartlett Learning, LLC perceived theNOT elephant. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTdefine FOR and SALE describe OR AIDS DISTRIBUTION because they did not know at what theyNOT were FOR looking. SALE OR DISTRIBUTION This inability to see the “big picture” is best illustrated by the old South Asian fable about six blind men invited to examine an elephant. The first man, falling against the elephant’s side, claimed it was a wall. The second, seizing a leg, declared the elephant a tree. Another, grasping a tusk, thought the elephant was a spear. The fourth man, © Jones & Bartlettgrabbing Learning, the trunk, LLC decided he was holding a snake.© Jones The fi& fth, Bartlett touching Learning, the ear, LLC NOT FOR SALEbelieved OR DISTRIBUTION it to be a fan. The last blind man, holdingNOT the FOR tail, SALEproclaimed OR the DISTRIBUTION elephant a rope (Figure 1.1). So it was in the early 1980s with AIDS: The elephant was the disease, and the blind men were the scientists and doctors grappling with its emergence in an epidemic. Without a clear vision of AIDS, they were forced to treat the epidemic piecemeal—to © Jones & Bartlett Learning,try LLC and explain each bit of knowledge© Jones as &it cameBartlett forth. Learning, Physicians were LLC seeing patients whose immune systems were profoundly suppressed, but they had no idea what was NOT FOR SALE OR DISTRIBUTIONcausing this problem. Public healthNOT officersFOR SALE were charting OR DISTRIBUTION the course of the AIDS epidemic without knowing its cause. Manufacturers were searching out new drug therapies, but they were unsure about what they were trying to eliminate. Physicians and scientists did not really know what they were seeing and could not adequately © Jonesdescribe &what Bartlett was going Learning, on. LLC © Jones & Bartlett Learning, LLC Even though physicians and scientists could not identify the causes of what was Focus on HIV NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION There were approximately happening or completely describe all of the features of the disease, it was clear from 34.2 million people living with very early on that a large problem had been presented to public health in the United HIV in 2011. States. Physicians saw it as a medical problem, economists as a potential disaster to the healthcare system, employers as a threat to the smooth operation of their businesses, © Jones & Bartletthealthcare Learning, workers LLC as a problem requiring personal© Jones protection, & Bartlett and politicians Learning, as yet LLC NOT FOR SALEanother OR DISTRIBUTION drain on public funds. Until 1984, thereNOT was FOR no clear SALE definition OR DISTRIBUTIONof AIDS. No test was available to confirm a diagnosis and no cure was in sight. Most scientists agreed that a cure would follow only after they found a cause and understood the natural history of the disease. © Jones &2 Bartlett Learning,The LLC AIDS Epidemic © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 14881_CH01_1-26.indd 2 3/21/13 1:54 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Despite the early pessimism, however, scientists found the cause of AIDS in a shorter span of time than had been required for any previous infectious disease. So quickly was the cause of AIDS found by scientists that it highlighted the astounding advances made during the 1970s when the ongoing revolution in modern molecular biology began. These© Jones advances & Bartlettand rapid Learning,identification LLC of the cause of AIDS, how-© Jones & Bartlett Learning, LLC ever, did not prepareNOT physicians, FOR SALE scientists, OR DISTRIBUTION patients, and our society for the slow NOT FOR SALE OR DISTRIBUTION and ongoing progress made in combating AIDS. Indeed, in the early 1980s, when the cause of AIDS was identified, there was a sense that it would soon be a histori- cal side note in the annals of infectious disease. No one was prepared for what has followed. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Early Years By 1981, most observers believed that infectious diseases were largely under control in the Western world. There had been no smallpox anywhere since October 1977, and © Jones & Bartlettdiseases suchLearning, as typhoid LLC fever, polio, and whooping© cough Jones were & rarelyBartlett encountered. Learning, LLC Even childhood diseases such as measles, mumps, and rubella appeared to be relics of NOT FOR SALEthe past. OR Indeed, DISTRIBUTION the speed with which an effectiveNOT therapy FOR for Legionnaires’SALE OR DISTRIBUTIONdisease was discovered in 1976 and the success in interrupting the outbreak of toxic shock syndrome in 1978 had strengthened public confidence that scientists could defeat any epidemic. Moreover, in ©the Jones early 1980s, & Bartlett American Learning, researchers LLC had largely turned away © Jones & Bartlett Learning, LLC from the negative aspects of microorganisms and were pursuing their practical uses. For instance, bacteriaNOT had FOR become SALE mainstays OR DISTRIBUTION of genetic engineering, which was fastNOT FOR SALE OR DISTRIBUTION developing as the technology of the future. (A 1981 Time magazine article described genetic engineering as “the most powerful and awesome skill acquired by man since the splitting of the atom.”) Genetically engineered insulin was already in production.
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