History
In January, the Centers for Disease Control and Prevention (CDC) reported that, for the first time, the rate of AIDS diagnoses among black and Hispanic gay men had overtaken that among white gay men in the U.S. Statistics showed that African Americans comprised 57% of all new HIV infections, even though they made up just 13% of the U.S. population.50 In order to publicise the importance of HIV testing for African Americans, reverend Jesse Jackson publicly took an oral HIV test.51
UK national statistics revealed that 1999 had been the first year in which the number of newly diagnosed HIV infections probably acquired through heterosexual sex was higher than the number probably acquired through sex between men.52
Preliminary studies presented at the 7th Conference on Retroviruses and Opportunistic Infections showed that, in some cases, temporarily stopping HIV drug therapy might not lead to increased levels of virus or the development of drug resistance.53 This later became known as the structured treatment interruption or drug holiday.
In February, the trial started of Bulgarian health workers charged in Libya with deliberately infecting children with HIV. The Bulgarian medics - five nurses and an anaesthetist - were detained in 1998 after almost 400 children were given infected blood at a hospital in Benghazi, Libya's second largest city. Eight Libyans and a Palestinian were also charged.54
A more definitive study was published about the risk of transmitting HIV through oral sex. Although earlier studies had identified oral sex as a means of transmitting HIV, the new study was designed to find out the extent of HIV transmission through oral sex among men who have sex with men. The research suggested that oral sex accounted for about 7% of cases.55
"I think it reinforces what we've said already - which is that condoms should be used for whatever type of sex you have."Dr. Robert Janssen, Director of the Division of HIV/AIDS prevention at the CDC56
Early in the year the South African government made a decision to invite a panel of experts to pursue debate on questions relating to HIV/AIDS.57 In March it was reported that South African President Thabo Mbeki had consulted two American 'dissident' researchers to discuss their claim that HIV was not the cause of AIDS.58
Israel lost one of its most successful singers, Ofra Haza, from what was believed to be an AIDS-related complication. Following her death there was a considerable increase in demand for helplines and anonymous HIV testing.
"Nevertheless, her death has brought the whole issue of AIDS out into the open in Israel. This can only be a good thing for a country which has seven openly HIV positive people - including myself - out of an estimated 10,000."Aviram Germanovitch, Director of the Israeli AIDS Task Force59
In April, President Mbeki sent a letter to world leaders explaining his views on HIV/AIDS. In this letter Mbeki argued, amongst other things, that since HIV is spread mostly through heterosexual contact in Africa, the continent's problems are unique.
"Accordingly, as Africans, we have to deal with this uniquely African catastrophe... It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV-AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical."60
In Botswana, as many as one in four adults and four of every ten pregnant women were estimated to be infected with HIV.61 The president of Botswana, Festus Mogae, announced that new contributions from donors including $50 million donated by the Bill and Melinda Gates Foundation would allow his country to provide antiretroviral therapy to all HIV-infected pregnant women and children born with the virus.62
The Clinton Administration formally declared HIV/AIDS to be a threat to U.S national security. The United States government believed that the global spread of AIDS was reaching catastrophic dimensions that could topple foreign governments, spark ethnic wars and undo decades of work building free-market democracies abroad. It was the first time the National Security Council was involved in fighting an infectious disease.63
"We shouldn't pretend that we can give injections and work our way out of this. We have to change behaviour, attitudes, and it has to be done in an organized, disciplined, systematic way."Bill Clinton64
Later in the year, the U.S. Institute of Medicine released a report that sharply criticised the Clinton Administration for failure to develop a comprehensive and effective plan to combat the disease in the United States.65
In May, at the opening of the first meeting of the presidential advisory panel on AIDS in South Africa, President Mbeki offered his first detailed explanation of why he had consulted the two American 'dissident' AIDS researchers. He also explained why the 33-member presidential AIDS advisory panel contained people who believed that HIV caused AIDS and others who did not.
"We were looking for answers because all the information that has been communicated points to the reality that we are faced with a catastrophe, and you can't respond to a catastrophe merely by saying I will do what is routine."66
Five pharmaceutical companies offered to negotiate steep reductions in the prices of AIDS drugs for Africa and other poor regions.67 A couple of months later the United States offered sub-Saharan African nations loans to finance the purchase of AIDS drugs and medical services.68 The offer was not seen as very helpful and was rejected by many African nations.69
"Making drugs affordable is the solution rather than offering loans that have interest."70
According to the latest UNAIDS report, there were 34.3 million people infected with HIV worldwide, of whom 1.3 million were children under the age of 15. It was predicted that AIDS would cause early death in as many as half of the teenagers living in the hardest hit countries of southern Africa, causing population imbalances. In particular, it was predicted that two thirds of 15 year-old children in Botswana would die of AIDS before they reached 50.71
Almost four million people were estimated to be living with HIV in India. This meant that the country had the second largest HIV population in the world: only South Africa had more people living with HIV.72
In July, the 13th International AIDS Conference was held in Durban, South Africa. This was the first time that such a conference was held in a developing country or in Africa.73 Nkosi Johnson, an eleven year old HIV-positive boy, gave a speech in the opening ceremony of the conference and called for the government to give AZT to pregnant HIV-positive women.74
Mbeki used his opening address at the conference to stress the role of poverty in explaining the problems faced by Africa and compared the campaign against AIDS with the struggle against apartheid.75
"As I listened and heard the whole story told about our own country, it seemed to me you could not blame everything on a single virus."76
To counter the comments made by president Mbeki, over 5,000 scientists around the world signed the 'Durban Declaration' affirming that HIV is the cause of AIDS.77
Nelson Mandela, South Africa's former president, closed the AIDS conference with a call for action to combine efforts and save people.78
"History will judge us harshly if we fail to do so now, and right now."
At the conference, preliminary findings were reported from nonoxynol-9 studies in Africa and Thailand. Scientists had hoped that nonxynol-9 would prove to be the first effective 'microbicide' that could reduce the risk of HIV transmission during sex, but the findings were quite the opposite. Women at high risk of HIV infection were warned not to use the spermicide nonoxynol-9 because the studies suggested it might increase the risk of transmission.79
"If you use nonoxynol-9, you are either wasting your money or possibly wasting your life."Dr. Joseph Perriens80
For some people these were not surprising findings, since the toxic effects of nonoxynol-9 had been reported since 1989.81
There were few other noteworthy scientific findings reported at the conference.
In September, the first phase of a new vaccine trial was launched in Oxford. The trials were sponsored by the International AIDS Vaccine Initiative.82 The research into an AIDS vaccine was criticised by the World Bank for focusing on a vaccine that could be marketed in western countries, despite the fact that more than 90% of HIV infections were in the developing world.83
It was reported that the number of people living with HIV in Brazil was less than half that once predicted by health experts, and the number of AIDS deaths had plummeted by as much as fifty per cent since the introduction of combination antiretroviral therapy in 1996. The country's HIV prevention and treatment programmes were seen as a model for other resource-poor countries to emulate.
"It makes a lot of sense to look at what Brazil is doing... Something they're doing is working."Mbulelo Rakwena, South Africa's ambassador to Brazil -84
Treatment provision remained non-existent in South Africa, and President Mbeki stated in an interview with the Time Magazine that he did not think that HIV alone caused AIDS.
"Clearly there is such a thing as acquired immune deficiency. The question you have to ask is what produces this deficiency. A whole variety of things can cause the immune system to collapse… But the notion that immune deficiency is only acquired from a single virus cannot be sustained. Once you say immune deficiency is acquired from that virus your response will be antiviral drugs. But if you accept that there can be a variety of reasons, including poverty and the many diseases that afflict Africans, then you can have a more comprehensive treatment response."85
In October, President Mbeki announced his withdrawal from the scientific and public debate on the causes of AIDS after admitting that he had created confusion in South Africa.86
There has been a lot of confusion about what Mbeki said and did not say during the year.87 It is clear that over a period of some months, particularly in April and in September, Mbeki led many people to think that either 1) he does not believe that HIV causes AIDS or 2) he does not believe that HIV causes AIDS on its own.
It would seem that Mbeki may have believed that immune deficiency is caused by a collection of factors such as poverty, nutrition and contaminated water as well as HIV, rather than just HIV on its own:
"You cannot attribute immune deficiency solely and exclusively to a virus."88
It is true that poverty related factors such as malnutrition will hasten the onset of AIDS in people who are HIV-positive. Therefore, it is also true that provision of food will slow down the progression of HIV. However improved nutrition is not enough in itself to permanently keep people healthy. History provides evidence of this.
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