June 5th was HIV’s 30th anniversary. 30 years since the first report of the virus in the US. In that time, we’ve seen the disease turn into a massive global pandemic, killing over 30 million people.
And we have seen our future. HIV is most likely a zoonosis; the best guess is still that it spread to people from monkeys through monkeys being used as food. It spent plenty of time infecting monkeys as SIV, simian immunodeficieicy virus, and occially infecting the odd person as HIV. Our easliest recorded HIV infection was in 1959 in the DRC, and the virus’s origin may be as old as 1884.
HIV burst into pandemic 30 years later because that’s when the conditions were right. There was more human-simian interaction because of habitat destruction, for one. More importantly, a global population that was technologically and culturally perfect for the massive spread of a disease that travels through sex and drugs.
HIV is just the first infectious disease that will appear out of nowhere at just the right time; a glimpse of the infectious diseases of our future. Climate change, population growth, and new technology are changing our planet, fast. At some point, we’ll change just enough to create the conditions for the next massive infectious disease.
When we fight that infectious disease, HIV will probably be our model for the attack. We can learn from our mistakes, and copy the successes. We did a good job of rapidly expanding antiretroviral treatment, once we figure out that it could be done in the developing world. And, hey, we did develop antiretrovirals. The medical research in general has been well funded and innovative, looking at everything from vaccines to microbicides. We know a lot about HIV and how it spreads. Finally, in terms of money we established the Global Fund to Fight AIDS, TB, and Malaria which creates a moral imperative to maintain funding.
We’ve been less good at preventing the spread of HIV. When we face our next infectious disease, we’ll need to find better ways to stop its spread. Our efforts to get people to change their behavior and stop spreading HIV have been badly funded and minimally successful. With the exception of a few cases like Zimbabwe in the last ten years, and Thailand and Uganda in the 90s, we’ve seen few successes in slowing the spread of AIDS. It’s very difficult to change entrenched human behavior. We haven’t found much that’s highly effective, in part because we haven’t been trying all that hard.
Right now, after 30 years, 33.3 million people are living with HIV. About 20% of them are getting antiretroviral treatment. The global rate of infection is on the decline. I could argue we’re winning this fight, if 2010 hadn’t seen our very first cut in funding for HIV. Funding cuts haven’t pushed us backward yet, but if they keep on, they will.
Our future looks a lot like HIV. Wouldn’t it be nice if that future was a success story?