In Canada there was an outbreak of HIV

In Canada there was an outbreak of HIV infection amongst injecting drug users in Vancouver.¹

Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it was safe and effective at preventing mother-to-child transmission of HIV in developing countries.² However, even with this price cut it was expected that the drug would still be far too expensive for use in many developing countries.³

The Clinton Administration refused to lift a ten-year ban on using federal funds for needle exchange programmes

In some countries HIV positive people were returning to work, having recovered their health as a result of combination antiretroviral drug treatment. However, some people began to be affected by quite severe side effects of the drugs. The emergence of negative reactions - which included a kind of fat redistribution called lipodystrophy - cast doubt on the long term safety of combination therapy. The reasons why lipodystrophy appeared in some people taking anti-HIV drugs were unknown. Some reports linked the syndrome to drug regimens that contained protease inhibitors.⁴

"While fat disappears from some areas, for unknown reasons it redistributes to build up in others. The back of the neck resembles a buffalo hump. Breasts enlarge. A woman may have to buy a bra that is two sizes larger that the last one. The abdomen swells producing a sometimes painful pot belly that is dubbed 'a protease paunch'. A woman may look pregnant when she is not. Exercise may not work it off."⁵

In April, the Clinton Administration refused to lift a ten-year ban on using federal funds for needle exchange programmes, despite concluding for the first time that such exchanges prevent the spread of HIV and do not encourage drug use. Leaders in the fight against AIDS condemned the unexpected decision, which was announced by Health and Human Services Secretary Donna Shalala. During her speech Shalala quoted NIH director Varmus as saying:

"An exhaustive review of the science indicates that needle exchange programmes can be an effective component of the global effort to end the AIDS epidemic. Recent findings have strengthened the scientific evidence that needle exchange programmes do not encourage the use of illegal drugs."

But, without explanation, Shalala said the administration had "decided that the best course at this time is to have local communities use their own dollars to fund needle exchange programmes".⁶

In the UK the London Lighthouse charity closed its residential unit.⁷

In June, the company AIDSvax started the first human trial of an AIDS vaccine using 5,000 volunteers from across the USA.

"It opened a new era in AIDS research, and led us toward the human trials. It was like being in a room that was partially lit and getting darker and darker, and suddenly the lights went on and you could see the pathway out."⁸

San Francisco started a pioneering Post Exposure Prophylaxis (PEP) program giving HIV drugs to people that might have been exposed to HIV through sexual contact or needle sharing during injecting drug use. The HIV drugs were given to people at the earliest possible time after the risk exposure.

"The treatment really is to try, in case they've been exposed to HIV, to stop the replication before it infects the cells and like a brush fire gets out of control."⁹

The company AIDSvax started the first human trial of an AIDS vaccine using 5,000 volunteers

A study found that the combination of caesarean delivery and AZT reduced the risk of HIV transmission from a mother to her baby to less than 1%. The study also found that women who took AZT but delivered their babies by natural childbirth had a higher risk (6.6%) of transmitting HIV to their babies.¹⁰

In July, the 12th International AIDS conference was held in Geneva. The challenge of this conference was not only to discuss the advantages available for the treatment of HIV, but also to conquer overwhelming pessimism. The mood of the meeting was in sharp contrast to the euphoria at the previous AIDS meeting in Vancouver two years before.

"A series of reports about new problems with anti-HIV drugs and setbacks in vaccine trials left many participants thinking that their best hope against the epidemic was the strategy they had since it began: prevention."¹¹

A French court ordered the former French prime minister Laurent Fabius to stand trial on charges of involuntary homicide for allowing HIV-tainted blood to be used in transfusions.¹²

The first case of a patient being infected with a strain of HIV resistant to the most powerful new antiretroviral drugs was reported in San Francisco in July. The mutated strain of HIV, seemingly impervious to protease inhibitors and older drugs, was found in a newly infected patient at San Francisco General Hospital.

"We may be seeing an emerging and dangerous edge to the epidemic."Dr. Frederick Hecht of the University of California at San Francisco¹³

The United Nations issued new recommendations advising that HIV positive women in developing countries should be counselled to make their own decisions about how to feed their babies. This was interpreted as a major policy shift towards endorsing the use of infant formula. At the same time the United Nations decided to conduct pilot projects in eleven developing countries to expand access to services to prevent mother-to-child transmission of HIV.¹⁴

Jonathan Mann, the first director of the Global Program on AIDS, died in the crash of Swissair flight 111, along with his wife the AIDS researcher Mary-Lou Clements-Mann.

"It was always safe for scientists and institutions to think of AIDS as a virus, a transmissible infection… but Dr. Mann structured it as a human rights issue, and a global rights issue. He really was a spiritual leader as well as scientific leader."Dr. James Curran¹⁵

Red ribbon in South Africa dedicated to Gugu Dlamini

The FDA gave approval for various new drugs including Sustiva (efavirenz), another drug in the NNRTI group.¹⁶

In South Africa, Gugu Dlamini, an AIDS activist, was beaten to death by her neighbours after revealing her HIV positive status on Zulu television. This happened just a month after Deputy President Thabo Mbeki had called for people to "break the silence about AIDS" in order to defeat the epidemic.¹⁷

"It is a terrible story. We have to treat people who have HIV with care and support, and not as if they have an illness that is evil."- Thabo Mbeki¹⁸

The 1998 World AIDS Campaign 'Young People: Force for Change' was prompted in part by the epidemic's threat to those under 25 years old, for as HIV rates rose in the general population, new infections were increasingly concentrated in the younger age groups. The campaign also had a special representative, Brazilian footballer Ronaldo.¹⁹