In January it was reported that some people with AIDS

In January it was reported that some people with AIDS already had resistance to the drug Zidovudine (AZT) even though they themselves had never taken the drug.

"Some of the patients may have gotten the virus from other patients who have been taking AZT and who are now transmitting the resistant virus."

Researchers said there was an urgent need to develop new drugs to combat the epidemic.¹

On January 6th the Russian ballet star Rudolf Nureyev died. His doctor said that "he died from a cardiac complication following a cruel illness", but it was widely reported that he had died from AIDS.^{2 3} He was buried in his evening clothes with his medals and his favourite beret.⁴

During January, 116 new cases of AIDS were reported in the UK, bringing the cumulative total to 7,045. One in 6 of these new cases were acquired through heterosexual intercourse.⁵

HIV-positive Romanian children

In Romania, despite the progress made since the overthrow of the Causescu regime, the number of children infected with HIV had increased. There were an estimated 98,000 infected orphans.⁶

China had reported one thousand cases of HIV infection, mostly in injecting drug users, but it was believed that this greatly understated the scale of the country's HIV epidemic.^{7 8} The Ministry of Health in China announced that soon only approved government blood donation centres would be able to collect and sell blood.⁹

In February the tennis player Arthur Ashe died, less than a year after announcing that he had been infected with HIV.¹⁰

In March, the House of Representatives in the USA voted overwhelmingly to retain the ban on the entry into the country of HIV positive people. ¹¹

In South Africa, the National Health Department reported that the number of recorded HIV infections had grown by 60% in the previous two years and was expected to double in 1993. A survey of women attending health clinics indicated that nationally some 322,000 people were infected.¹²

A video of Princess Diana speaking at an AIDS conference in 1993.

Princess Diana continued her HIV/AIDS advocacy work and spoke at the opening address of the 2nd International Conference on HIV in Children and Mothers in Edinburgh.

"By the year two thousand, only seven years from now - even the most conservative estimates predict there will be more than thirty million people worldwide with HIV - equivalent to more than half the population of the United Kingdom".Diana - Princess of Wales, 1993

In the UK in March, there were a large number of rather hysterical stories in the British press about the fact that a number of doctors in England had continued to practise medicine whilst knowing they were infected with HIV.¹³ The UK government responded by issuing new guidelines, according to which health care workers who believed that they had been exposed to HIV had to seek medical advice and testing. ¹⁴

Meanwhile scientists had found that HIV 'hides out' in lymph nodes and similar tissue early in the course of infection.¹⁵

“The virus lies concealed for a decade or so, quietly seeding the destruction of the immune system, the researchers found. The finding resoundingly solves a mystery of AIDS: where does the virus secrete itself during the decade or so after an initial infection when patients feel well and little virus can be detected in their blood?”¹⁶

In early April the ministers of health and finance from 39 countries met in Riga, Latvia, and launched an initiative to contain the spread of HIV in Central and Eastern European countries.¹⁷ During the Eighties, many countries of Central and Eastern Europe, the newly independent states, and the Russian Federation had introduced large-scale screening for HIV infection, with in excess of 20 million tests being carried out in the Russian Federation during 1993. One aspect of the Riga initiative was a refocusing of testing policies away from this mass screening and towards voluntary testing.¹⁸

A video of Dr R.P. Brettle talking in 1993 about AIDS treatment and the results of the Concorde trial.

The preliminary results were published of the large Anglo-French clinical trial of AZT known as Concorde.¹⁹ The results were interpreted as meaning that AZT was not after all a useful therapy for HIV positive people who had not developed symptoms.²⁰

In the UK the radio DJ and comedian Kenny Everett announced that he was HIV positive, as did Holly Johnson, former lead singer with the group Frankie goes to Hollywood.^{21 22}

The World Bank reviewed it activities against AIDS in Africa, and decided that AIDS should not dominate its agenda on population, health and nutrition issues. The World Bank believed that AIDS would have little demographic effect but recognised that it was a serious threat to health and economic development. With reference to blood screening, it was argued that this was costly and "might not be cost-effective under all circumstances".²³

The ninth International AIDS meeting was held in Berlin, Germany. The general feeling of the meeting was one of disappointment. The message conveyed by the people who attended was once again to put more money and effort into effective prevention of HIV and AIDS.

“Dr. James W. Curran, who heads the AIDS Programme at the Centers for Disease Control and Prevention in Atlanta, said he left the meeting 'dispirited by the relentless assault of the virus'.”²⁴

At the beginning of the year the CDC had expanded the US definition of AIDS to include people with other opportunistic infections, as well as HIV infected adults with a CD4 count of less than 200. The expert epidemiology group of the European Centre for the Epidemiological Monitoring of AIDS together with the WHO's Regional Office for Europe accepted the inclusion of the additional indicator diseases but not the CD4 cell count criteria. European data collection on this basis began on July 1st.²⁵

In mid-1993 six United Nations organizations, including the WHO, began to seek agreement on forming a novel joint and cosponsored UN programme on HIV/AIDS.²⁶

By this time it had been realised that HIV was also spreading rapidly in the Asia and Pacific regions, home to more than half the world's population, where more than 700,000 people were already believed to be infected.²⁷

A video of Dr. Brettle talking in 1993 about combination therapy.

The drug 3TC was authorised by the FDA in the USA and the Federal Health Protection Branch in Canada, to be used in "compassionate" therapy in people who had not responded to other AIDS treatment or who are not eligible for clinical trials.²⁸ Those patients who had developed a resistance to AZT were offered didanosine (ddI) and dideoxycytidine (ddC) - drugs that had been extensively studied. A number of trials were underway comparing the effectiveness of taking AZT on its own and in combination with ddI and ddC.²⁹

Despite the years of litigation and number of newspaper accounts of the infection of haemophiliacs and transfusion recipients, no formal investigation of what had happened in Germany was undertaken until the 'scandal' of October 1993. In October, the failure of a small German blood supply company called UB Plasma to screen blood and plasma for HIV was made public. The company's misconduct was discovered by the Federal Health Office by chance, as a result of routine examination of positive HIV test results.³⁰ The Federal Government also admitted that officials had covered up 373 cases of HIV-contaminated blood in the 1980s.³¹

On World AIDS Day, 1st December, Benetton in collaboration with ACT UP Paris placed a giant condom (22 metres high and 3.5 wide) on the obelisk in Place de la Concorde in Central Paris in an effort to waken the world to the reality of the disease. A symbolic monument to HIV prevention, it appeared on the covers of newspapers worldwide.³²

At the end of 1993 the estimated number of AIDS cases worldwide was 2.5 million