Just over three decades ago, a new outbreak of opportunistic infections and Kaposi’s sarcoma was reported in a small number of homosexual men in California and New York1,2. This universally fatal disease was eventually called the acquired immunodeficiency syndrome (AIDS) due to complete loss of CD4+ T-lymphocytes. Within the first year of its description, the disease was also identified in hemophiliacs, injecting drug users, blood transfusion recipients and infants born to affected mothers. Soon thereafter a heterosexual epidemic of AIDS was revealed in Central Africa, preferentially affecting women3,4. Little did we know at that time that this small number of cases would eventually mushroom into tens of millions of affected individuals, becoming one of the greatest pandemics of modern times.
Within two years of the initial reports of AIDS, a retrovirus, later called the human immunodeficiency virus (HIV), was identified as the cause of AIDS5. Diagnostic tests were developed to protect the blood supply and to identify those infected. Additional prevention measures were implemented including risk reducing programs, counseling and testing, condom distribution, and needle exchange programs. However, HIV continued to spread, infecting 10 million individuals within the first decade of its recognition.
The second decade of AIDS was marked by further intensification of the epidemic in other areas of the world. The southern cone of Africa experienced an explosive HIV epidemic. Asia and the former Soviet Union, also noted a marked increase in the spread of HIV. However, by the mid-1990s with the discovery of highly active antiretroviral therapy, fatalities in the developed world started to decline. Use of antiretroviral drugs (ARVs) during pregnancy also resulted in a significant decline in mother to child transmission of HIV in high-income countries. However, without access to ARVs, MTCT and mortality in low and middle-income countries continued to increase to 2.4 million deaths, with over 3 million new infections in 2001, with two thirds occurring in sub-Saharan Africa6.