Words by Science & Technology Editor, Madeleine Veasey

I recently watched the series ‘It’s A Sin’ on Netflix, starring Olly Alexander of the band Years&Years. It follows a group of young queer men living through the 80’s HIV/AIDS crisis in the UK. Thankfully, science has come a long way in 40 years, and those living with HIV and AIDS can enjoy a long and fulfilling life. It hasn’t always been this way though; an AIDs diagnosis was once a death sentence, killing hundreds of thousands of people globally. So, how close are we to curing this relentless illness that disproportionately affects LGBTQ+ individuals?

Circa 1981, tales of a new disease some were calling ‘gay cancer’ began circulating America, and eventually these stories made their way over to the United Kingdom. Initially there was little panic, and it was labelled ‘fear-mongering’, a tactic in retaliation of the LGBT movement of the 70’s. Unfortunately, the rumours held some truth; gay men were getting very sick and dying from a mysterious illness. Medical professionals had little knowledge of its cause or how to prevent it, causing harmful speculation and prejudice to become rampant. The first 14 cases in Britain (1983) were all amongst men, most of them gay. AIDS was originally given the name GRID- Gay Related Immune Deficiency. As time went on, some women, drug users and people receiving blood treatments also became infected. Education was spread throughout LGBT communities and charities, but less so

amongst the medical profession. The stigma against the virus and those afflicted created a barrier in developing effective treatments. Nurses and doctors would wear multiple layers of protective clothing, place patients in isolation and burn their bedding after their deaths. The press particularly demonised gay men and their ‘lifestyle’, whilst individuals with Haemophilia receiving infected blood treatments were seen as the real, ‘pure’ victims. Entering the late 80s, AIDS became one of the largest topics of conversation across the country. Scientists had come as far as discovering that the virus was transmitted through bodily fluids such as blood and semen, and not casual contact or saliva. However, this did not stop the stigma against HIV carriers being ‘dirty’ or ‘dangerous’ to be around; some people lost their jobs, and many lost the support of their friends and family. In 1987, Princess Diana was pictured at the opening of a specialist HIV ward, shaking hands with patients without gloves or protective coverings. This was a pertinent moment in dispelling myths and rumours about the nature of the illness and its transmission.

The virus we know as HIV (human immunodeficiency virus) was not discovered as the cause of AIDS until 1983/84. It was found that the virus was damaging immune cells, making infected individuals highly susceptible to various other infections and weakening their ability to fight them off. Soon after, antibody tests were created. This was a huge step forward, as now those who were asymptomatic and in the early stages of the virus could be identified. The number of known HIV carriers increased dramatically and continued to rise over the coming years. In 1987, there was a breakthrough in a drug trial. The FDA had approved the use of AZT, formerly a failed cancer drug, to treat HIV. In a controversial trial, they gave 150 participants drug treatment and the other 150 placebo sugar pills. The drug treated group only had 1 death in 16-weeks, compared to 19 fatalities in the control group. There were various methodological issues with the trial and many side-effects of the drug (intestinal bleeding, liver problems, low blood cell count), but out of pure desperation the drug was deemed a success and fast tracked for approval. Similar drugs were developed in the years that followed, all known as nucleoside reverse transcriptase inhibitors (NRTIs). These drugs stop HIV cells from copying and multiplying. It wasn’t until the 90s that new classes of Antiretrovirals became available, and combination therapy (called highly active antiretroviral therapy, or HAART) became the standard approach for treatment. Initially this involved taking many medications daily, but in time many of these drugs have been combined into singular pill form. In 2010, a study found that a daily dose of antiretrovirals could protect healthy individuals from getting infected. This is known as pre-exposure prophylaxis, or PrEP. An individual exposed to HIV taking PrEP correctly will not contract the virus.

Nearly 1 million people still die from HIV/AIDS every year, and it is still the leading cause of death in some areas of Sub-Saharan Africa; 1 in 4 fatalities were caused by HIV in South Africa in 2019 (Roser and Ritchie, 2018). Impoverished areas are less likely to have access to adequate healthcare and sex-education, as-well as an increased prevalence of sex work and sexual violence, which can exasperate the spread of HIV. One study found 38% of all new cases of HIV in South Africa were amongst young people aged 15-24, particularly young women (Zuma et. al, 2022). Insistences of early sexual encounters (prior to 15) and large age-disparities between young people and their partners were determinants of HIV prevalence.

It is important to note that HIV can affect anyone, regardless of sexuality, ethnicity, and gender. Although HIV prevalence is highest in women in Sub-Saharan Africa, it is higher in men in most other countries. Individuals in communities with high rates of HIV are most at risk, and there are preventative measures that can reduce the risk of infection (education and correct use of condoms, for example). It’s not only spread through sex, either; sharing needles and being birthed/breastfeed by an HIV positive individual can also infect you. Taboo and discriminatory attitudes towards the disease have slowed global government responses and fuelled discriminatory attitudes towards high-risk groups.

It’s not all bad, though; Global deaths from AIDS has halved in the last decade (Roser and Ritchie, 2018). HIV remains a chronic illness as it can hide in cells throughout the body (called the HIV reservoir), which are not affected by drug treatments- the virus is never fully eradicated. Compelling research published in 2020 found a class of drug called IAP inhibitors (Inhibitors of Apoptosis) push these reservoirs out of hiding in some animal models, meaning they can be targeted and removed with other medications and treatments (Nixon et. al, 2020). This research could be revolutionary in the push towards a cure to HIV and AIDS, although there is still a long way to go until then. Living with HIV/AIDS in the modern world is largely manageable and many live a long, prosperous life.

Photo credit: freepix.com

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