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The term "unprecedented" may have been overused in the description of the Coronavirus 2019 (COVID-19) pandemic, but it's a natural response to how the virus has influenced the livelihood, state of mind, and priority of fear in the world's population.

With an estimated 257 million infections and almost 5.2 million deaths worldwide, never before has a disease like Covid-19 been so little understood and so greatly feared. That is apart from one previous worldwide pandemic - HIV/AIDS.

On 5th June 1981, the US Center For Disease Control first documented the existence of a syndrome of severe immune deficiency in five gay men in Los Angeles.

Here we are four decades later and more than 70 million people have been infected with the HIV virus worldwide and about 35 million people have died. The only good news is that AIDS-related deaths have been reduced by 60% since the peak in 2004. In 2019, around 690,000 people died from AIDS-related illnesses worldwide, compared to 1.7 million people in 2004 and 1.1 million people in 2010.

The vast majority of people with HIV are in low- and middle-income countries. In 2019, there were 20.7 million people with HIV (54%) in eastern and southern Africa, 4.9 million (13%) in western and central Africa, 5.8 million (15%) in Asia and the Pacific, and 2.2 million (6%) in Western and Central Europe and North America.

It's thought a growing complacency over safer sex practices is to blame for the increase. The Public Health Laboratory Service (PHLS), who keep UK HIV/AIDS statistics, said that that the figures were worrying, as it demonstrated that too many people were ignoring the advice of experts and engaging in unprotected sex.

Across the Atlantic HIV infection amongst black US gays is of epidemic proportions, comparable with those of Botswana. And young white gay men in the states are also ignoring safe sex messages: "For some people, AIDS has become a manageable, chronic disease due to access to more effective drug treatments," said AIDS campaigner Tim McFeeley.
"While this is good news, it has perhaps led to a sense of complacency about the disease within our community, particularly in young people who do not remember the early stages of the epidemic." Here in the UK there's real concern that we could see a big rise in full-blown AIDS in future years and not just in the gay community.
As of the end of 2019, 25.4 million people with HIV (67%) were accessing antiretroviral therapy (ART) globally. That means 12.6 million people are still waiting. HIV treatment access is key to the global effort to end AIDS as a public health threat. People with HIV who are aware of their status, take ART daily as prescribed, and get and keep an undetectable viral load can live long, healthy lives and have effectively no risk of sexually transmitting HIV to their HIV-negative partners.

There were approximately 38 million people across the globe with HIV/AIDS in 2019. Of these, 36.2 million were adults and 1.8 million were children less than 15 years old. An estimated 1.7 million individuals worldwide acquired HIV in 2019, marking a 23% decline in new HIV infections since 2010.

In 2019, it was estimated that there are 105,200 people living with HIV in the UK. 94% of these people are diagnosed, and therefore know that they have HIV. This means that around 1 in 16 people living with HIV in the UK do not know that they have the virus.
In November 2021 the NHS begun to offer a new long-acting injectable drug to 13,000 people living with the virus to help keep it at bay. Charities have hailed the "incredible news" saying it offers an alternative to taking daily antiretroviral drugs to keep the virus at very low levels without the side-effects that the pills have. These two new injectable drugs, Cabotegravir and Rilpivirine, are given to patients every two months. They keep the number of virus particles in the blood - also known as the viral load - so low that it cannot be detected or transmitted between people.
It's a major step forward in the gight against HIV but the epidemic is far from beaten. Dr Barry Evans of the PHLS says "Many of those being diagnosed are people who were infected some years ago but who are now only coming forward for testing." A former US AIDS czar Sandra Thurman calls the disease "an epidemic the likes of which humankind has never seen."

There is no room for complacency. Countries need to live up to their commitment to end the AIDS epidemic as a public health threat by 2030 - a target included in the 2030 Agenda for Sustainable Development adopted by the United Nations General Assembly in September 2015. The immediate challenge is to reach the Fast-Track targets for 2020, as HIV-related deaths are still unacceptably high. The 2020 targets include reducing the number of people dying from HIV-related causes to fewer than 500,000. Based on current estimates, this provides an opportunity to prevent almost 300 000 deaths per year.

The number of people living with HIV aged over 50 has been increasing. Worldwide, about 4.2 million people with HIV are aged 50 years or older. The majority (2.5 million) are in low-and middle-income countries where more than 12% of adults living with HIV are 50 years or older. In high-income countries, around one third of adults living with HIV are 50 years or older. In the UK it is one quarter (25%).

In these next pages we trace the history of AIDS and how it's cut a swathe through the our community.

ICEBERGS AND TOMBSTONES

CONDOMS AND COCKTAILS

See OutReach for a full listing of HIV and AIDS resources and advice organisations
Photos:UNICEF/Sattlberger,AVERT,UNAIDS/Neeleman

 

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