“I’m sorry. Your test result is positive.”
These words, delivered with a heavy heart by health professionals, were once a harbinger of despair. Thirty or forty years ago, a positive diagnosis of HIV felt like a death sentence, shrouded in stigma and fear. In that era where knowledge of HIV treatment was scarce, and misconceptions ran rampant, those two chilly sentences transformed lives overnight, casting shadows over futures once filled with hope.
Fast forward to today, and much has changed. While HIV remains a significant global public health challenge, advancements in treatment and understanding have transformed its impact. The WHO estimates 42.3 million lives have been lost to the disease, and a cure is still out of reach. However, remarkable advancements in treatment and a deeper understanding of how HIV progresses have turned it into a manageable chronic condition, enabling those living with HIV to lead long, healthy lives.
You might be wondering: how has HIV treatment evolved from the early days of the epidemic to the advanced options available today? Well, take a closer look.
How It All Started
The first reported case of AIDS was in 1981. Just three years later, Dr. Françoise Barré-Sinoussi (who won a Nobel prize for this work) and her colleagues at the Pasteur Institute in France discovered a retrovirus — later named human immunodeficiency virus (HIV) — was the cause of AIDS (Acquired Immunodeficiency Syndrome).
During this time, fear and misinformation fueled a growing stigma around the disease, turning it into a global concern. At some point, the Centers for Disease Control and Prevention (CDC) in the United States published a case definition that suggested AIDS was prevalent among certain gender groups, particularly homosexual men, further perpetuating misconceptions.
AZT: The World’s First Drug for HIV Treatment
In 1987, the US Food and Drug Administration (FDA) approved the first antiretroviral drug, AZT (azidothymidine), for treating AIDS. Originally developed for cancer treatment, AZT was found to block crucial enzymes needed for HIV replication, effectively slowing the virus’ progression. The success of AZT was short-lived as its severe side effects outweighed its benefits, leaving its users with severe anemia and other health complications.
Between 1991 and 1994, three other drugs — Hivid (ddC, zalcitabine), Videx (ddI, didanosine), and Zerit (d4T, stavudine) — were approved and used in combination therapies to extend life expectancy. And, while they certainly helped, they proved even more toxic than AZT and required complex dosing schedules.
The Birth of The Red Ribbon
The red ribbon was created in the early ‘90s by a group called Visual AIDS as a response to the growing AIDS crisis. Inspired by the yellow ribbons that signaling support for soldiers during the Gulf War, they chose red to represent blood and passion — symbolizing both the pain of loss and love for those living with HIV. The ribbon quickly gained recognition, and today, it has become a global symbol of AIDS awareness.
The AIDS Cocktail
With the discovery that HIV was the virus that caused AIDS, and the understanding that HIV could mutate and become resistant to a single medication, the “AIDS cocktail,” later known as highly active antiretroviral therapy (HAART), was introduced in the mid-’90s.
This groundbreaking therapy combined several antiretroviral drugs that targeted different stages of the HIV life cycle. It was so effective that it led to dramatic improvements in the health of people living with HIV. Viral loads dropped to very low levels, preserving immune function and reducing the risk of transmission — whether through sex, sharing infected needles, or from mother to child during pregnancy, birth, and breastfeeding.
HAART transformed HIV from a fatal disease into a manageable chronic condition. Between 1996 and 1997 alone, AIDS-related deaths in the United States dropped by 47% due to these advancements.
An Ambitious Target to End the AIDS Epidemic
In 2013, the Joint United Nations Programme on HIV and AIDS (UNAIDS) launched its ambitious "90-90-90" targets aimed at ending the epidemic by 2020. These targets aimed for 90% of people living with HIV to know their status, 90% of those diagnosed to receive sustained antiretroviral therapy, and 90% to achieve viral suppression by 2020.
This initiative called for global collaboration among governments, NGOs, communities, and public figures. The response was further amplified by campaigns focused on prevention methods such as condom use, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and events like World AIDS Day, all working to raise awareness and dismantle the stigma surrounding HIV.
Advances in HIV Treatment
Today, advances in HIV treatment have led to new and much more tolerable therapies for treating HIV. Some of the early treatment regimens were complicated, requiring patients to take more than 30 pills a day. Today, modern HAART regimens often consist of a single-tablet combination that offers improvements in safety and convenience.
Other recent innovations include long-acting injectable ARV therapy like Lenacapavir, which showed even better efficacy and greater adherence rates among patients who struggle with daily pills. These advancements reflect not just improvements in pharmacology but also a deeper understanding of patient needs
The Future: How Close Are We to a Cure?
While current treatments allow individuals with HIV to live long, healthy lives, researchers remain dedicated to finding a cure. Innovative approaches, such as gene therapy, are being explored to target and eliminate HIV at its source. Techniques like CRISPR/Cas9 hold immense potential by editing genes within immune cells to bolster their ability to combat the virus effectively.
Simultaneously, clinical trials are making strides toward developing safe and effective HIV vaccines that could provide lasting immunity against the virus. These efforts reflect a global commitment not only to not just manage HIV but potentially eradicate it.
A Success Story for Global Health
The journey of HIV treatment is a testament to human resilience and collective progress. From the early days marked by fear, stigma, and misinformation to today's advanced treatment options, the fight against HIV has evolved into a powerful narrative of hope and solidarity. The red ribbon remains a powerful symbol throughout this journey as —a reminder of those lost but also an emblem of hope for millions living with HIV today.
Despite significant advancements, challenges remain — particularly in ensuring equitable access to life-saving antiviral therapies in low- and middle-income countries. Beyond medical breakthroughs, this journey has fostered greater compassion and understanding for those living with HIV/AIDS, uniting the global community in unprecedented ways.
As we commemorate World Aids Day and continue to strive toward creating awareness and ending AIDS as a public health threat by 2030, it is crucial that we maintain our commitment to demand equitable access for all individuals living with HIV/AIDS across the world.