JOHANNESBURG, South Africa - It began quietly, when a statistical anomaly pointed to a mysterious syndrome that attacked the immune systems of gay men in California. No one imagined 25 years ago that AIDS would become the deadliest epidemic in history.

Since June 5, 1981, HIV, the virus that causes AIDS, has killed more than 25 million people, infected 40 million others and left a legacy of unspeakable loss, hardship, fear and despair.

Its spread was hastened by ignorance, prejudice, denial and the freedoms of the sexual revolution. Along the way from oddity to pandemic, AIDS changed they way people live and love.

Slowed but unchecked, the epidemic's relentless march has established footholds in the world's most populous countries. Advances in medicine and prevention that have made the disease manageable in the developed world haven't reach the rest.

In the worst case, sub-Saharan Africa, it has been devastating. And the next 25 years of AIDS promise to be deadlier than the first.

AIDS could kill 31 million people in India and 18 million in China by 2025, according to projections by U.N. population researchers. By then in Africa, where AIDS likely began and where the virus has wrought the most devastation, researchers said the toll could reach 100 million.

"It is the worst and deadliest epidemic that humankind has ever experienced," Mark Stirling, the director of East and Southern Africa for UNAIDS, said in an interview.

More effective medicines, better access to treatment and improved prevention in the last few years have started to lower the grim projections. But even if new infections stopped immediately, additional African deaths alone would exceed 40 million, Stirling said.

"We will be grappling with AIDS for the next 10, 20, 30, 50 years," he said.

Efforts to find an effective vaccine have failed dismally, so far. The International AIDS Vaccine Initiative says 30 are being tested in small-scale trials. More money and more efforts are being poured into prevention campaigns but the efforts are uneven. Success varies widely from region to region, country to country.

Still, science offers some promise. In highly developed countries, cocktails of powerful antiretroviral drugs have largely altered the AIDS prognosis from certain death to a manageable chronic illness.

There is great hope that current AIDS drugs might prevent high-risk people from becoming infected. One of these, tenofovir, is being tested in several countries. Plans are to test it as well with a second drug, emtricitabine or FTC.

But nothing can be stated with certainty until clinical trials are complete, said Anthony Fauci, a leading AIDS researcher and infectious diseases chief at the U.S. National Institutes of Health.

And then there is the risk that treatment will create a resistant strain or, as some critics claim, cause people to lower their guard and have more unprotected sex.

Medicine offers less hope in the developing world where most victims are desperately poor with little or no access to the medical care needed to administer and monitor AIDS drugs. Globally, just 1 in 5 HIV patients get the drugs they need, according to a recent report by UNAIDS, the body leading the worldwide battle against the disease.

Stirling said that despite the advances, the toll over the next 25 years will go far beyond the 34 million thought to have died from the Black Death in 14th century Europe or the 20 to 40 million who perished in the 1918 Spanish flu epidemic.

Almost two-thirds of those infected with HIV live in sub-Saharan Africa where poverty, ignorance and negligent political leadership extended the epidemic's reach and hindered efforts to contain it. In South Africa, the president once questioned the link between HIV and AIDS and the health minister urged use of garlic and the African potato to fight AIDS, instead of effective treatments.

AIDS is the leading cause of death in Africa, which has accounted for nearly half of all global AIDS deaths. The epidemic is still growing and its peak could be a decade or more away.

In at least seven countries, the U.N. estimates that AIDS has reduced life expectancy to 40 years or less. In Botswana, which has the world's highest infection rate, a child born today can expect to live less than 30 years.

"Particularly in southern Africa, we may have to apply a new notion, and that is of `underdeveloping' nations. These are nations which, because of the AIDS epidemic, are going backwards," Peter Piot, the director of UNAIDS, said in a speech in Washington in March.

Later, at a meeting in Abuja, Nigeria, last month, Piot cited encouraging news including a sharp fall in new infections in some African countries. There also has been an eightfold increase in the number of Africans benefiting from antiretroviral treatment, he said.

But, he warned, "the crisis of AIDS continues and is getting worse and any slackening of our efforts would jeopardize the hard-won gains of each and every one of us."

Besides the personal suffering of the infected and their families, the epidemic already has had devastating consequences for African education systems, industry, agriculture and economies in general. The impact is magnified because AIDS weakens and kills many young adults, people in their most productive years.

So many farmers and farmworkers have died of AIDS that the U.N. has invented the term "new variant famine." It means that because of AIDS, the continent will experience persistent famine for generations instead of the usual cycles of hunger tied to variable weather.

Africa's misery hangs like a sword over Asia, Eastern Europe and the Caribbean.

Researchers don't expect the infection rates to rival those in Africa. But Asia's population is so big that even low infection rates could easily translate into tens of millions of deaths.

Although fewer than 1 percent of its people are infected, India has topped South Africa as the country with the most infections, 5.7 million to 5.5 million, according to UNAIDS.

The astonishing numbers have grown from a humble beginning.

Nobody knows for sure when or where, but the AIDS epidemic is thought to have begun in the primeval forests of West Africa when a virus lurking in the blood of a monkey or a chimpanzee made the leap from one species to another, infecting a hunter.

Researchers have found HIV in a blood sample collected in 1959 from a man in Kinshasa, Congo. Genetic analysis of his blood suggested the HIV infection stemmed from a single virus in the late 1940s or early 1950s.

For decades at least, the early human infections went unnoticed on a continent where life routinely is harsh, short and cheap.

Then, on June 5, 1981, the Centers for Disease Control in Atlanta reported five young actively homosexual men in Los Angeles had a new, mysterious and as yet unnamed illness that attacked the immune system and caused a type of pneumonia. A month later, it reported an odd surge among homosexual men in the number of cases of Karposi Sarcoma, a rare cancer now linked to AIDS.

In the early days of the epidemic, just the mention of AIDS elicited snickers and jokes. Few saw it as a major threat. It was the "Gay Plague," and for some, divine retribution for a lifestyle Christian fundamentalists and other conservatives consider deviant and sinful.

When heterosexuals began to contract the disease through blood transfusions and other medical procedures, they were often portrayed as "innocent" victims of a disease spread by the immoral and licentious behavior of others.

The initial reactions and prejudices associated with AIDS slowed the early response to the epidemic and limited the funding. Too much time, money and effort was spent on the wrong priorities, Stirling aid.

"Over the last 25 years, the one real weakness was the search for the magic bullet. There is no quick and simple fix," he said. "But with the recent successes we are starting to see the end of epidemic."

"There is evidence to suggest we are at the tipping point," said Stirling.

The pace of change over the last couple of years suggests the number of new infections can be reduced by 50 to 60 percent by 2020 — if the momentum continues.

"It is surely possible, it is doable," Stirling said.


---------

Not much can be said except for a

Devestating. Someone I worked with, a devout Catholic (relevant or not, I dunno) made the statement last week that "if we weren't so tolerant of gay people, AIDS would never have existed."

I couldn't figure how all these African children fit into that theory. I wonder how bad it'll have to be before we really start to see it for what it is. It's hard to imagine, at any point in human history, a disease with such massively destructive statistics not being the primo concern of the day for all human kind.

Well, if people lived by the ideal of having only one sexual partner, then yes, the epidemic would be extremely localized and the impact much less. Homosexuality isn't the issue, but one can't argue that unfaithful partners and people having unprotected sex with multiple partners has had a major impact in this.

I'm not so sure if it was Clinton himself, or the guy hosting the forum, one of them said: "What we're trying to do here is end AIDS."

I can't stand this shit...

You're gonna hafta expound. I'm not following your outrage.

In the darkest corner of my mind i think it would be a good idea to just exterminate all aidetics.

My friend's dad had a pretty good, though very un-PC, idea of a way to possibly attempt to isolate the AIDS virus and attempt to stop the spread of it. Ok, for every confirmed person who gets infected w/ AIDS (or HIV, don't wanna ignore that as if it is any less important), you put a symbol on them or put a barcode of them (ok, yes, the Nazis did something similar to this but this is actually for a good cause) to show others that they have AIDS. This doesn't necessarily mean that people will stop sharing needles w/ them (through drugs, not medical stuff) or having sex with them because some people are extremely/dangerously ignorant so over possibly a few decades, if we could isolate these people into one country or vast mass of land for them to live until they eventually died, overtime, hopefully, the virus will stop spreading.

Oh and did anyone see 'The Age Of AIDS' documentary that was shown on PBS this week? VERY good. Made me angry, sad, depressed and a little hopeful all at the same time. Oh and now I know why attempting to get Jesse Helms out of office was such a big deal to Pearl Jam.

That's a pretty fucking stupid idea, and very degrading.

Because they're not gonna end AIDS. It's going to continue to get worse, continue to explode, and continue to cost lives.

That idea is just about as cool as AIDS.

well said...that idea is pretty degrading...

So, you can't stand that he said "end" instead of "try to fight" or "slow down?"

Or would you have preferred he said, "we can't stop AIDS, so I'll let anyone making the mistake of unprotected sex die with complete lack of hope, and the eight of us that are left will focus on making abortion illegal."??

B, look. Clearly, AIDS is never going to stop. So we should just accept it and stop wasting money trying to help people.

DUH.

God damn Democrats, all caring about people!!

I don't know why you said the second sentence. But you hit the nail on the head in the first sentence.

I watched the whole thing, and it really struck me because right after that Clinton went on to describe how there's so few children (like 10,000) worldwide receiving medical treatment for AIDS. He continued that they'd like to get 10,000 more this year, and 10,000 more next year. And I just felt like banging my head on the desk. I wish I was there to ask. "So what is it Mr. Clinton? Do you want to END AIDS? Or do you just want to do a little bit here, or a little bit there?"

There's something else that really pissed me off and that's the non-commitment by the world to it. Nobody wants to agree to anything because they're so afraid they're gonna have to pay more money than they want. Well Jesus. What's goal here then... What's even more troubling is that we can't even come out and make on honest estimate on what the financial burden would be to end the spread, and give humane lives to the people that already have it.

It just really bugs me when the word end is used to describe these massive problems. Because again, I don't think it does it justice. I think it's cause for people to lose perspective on just how bad these problems really are. If Clinton came out and said, "Hey look, we got 30,000,000 people right now, and it's gonna be 50,000,000 if we don't do something right now. It's gonna cost over a trillion dollars RIGHT NOW just to keep the number from growing, it's gonna cost another trillion to END it, and another trillion to give adequate treatment to these people. It's a lot, I know, but that's the frightening reality of what we're dealing with."

It would have so much more impact on everyday people that aren't effected by it.

It's like we all have this gang of ruffians living in the shitty end of town and their slowly growing in numbers, but we'd rather pretend that they'll kill themselves off instead of addressing the problem head on.

i think the problem with AIDS though is there are different strains that go about doing the same thing through different avenues, so you find a way to stop it one way, there's still X amount of ways it can still travel

i definately think diseases such as AIDS, Cancer and others are natures way of keeping population in check, and if we do wipe these diseases out, there will only be others to take their place

Yeah, good point

In the United States, and I'd be willing to bet many other places, an individual with TB can be forcibly hospitalized and forced to complete a treatment regimine if they have failed to follow through on medications before. That certainly is degrading, but at some point you have to put the well being of the society above the freedoms of the individual, or at least thats the line most governments take. Obviously the key thing is at what point does an infected person pose an unacceptable threat to public health.

thank you simpleschoolboy. This was the way I thought of the situation as kind of a 'worst case scenario'.