PEPFAR at 20-Looking Back and Looking Ahead.

This Viewpoint looks at PEPFAR (the United States President's Emergency Plan for AIDS Relief) from its inception to today, including successes and goals for the future to help care for people worldwide living with HIV.

Past and future of HIV infection. A document based on expert opinion / Pasado y futuro de la infección por VIH. Un documento basado en la opinión de expertos

HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection. (AU)

La infección por VIH cumple ahora casi 40 años de existencia. En este tiempo, junto a la catástrofe y la tragedia que ha supuesto, ha representado también la capacidad de la sociedad moderna de asumir un reto de esta magnitud y de transformar, gracias al tratamiento antirretroviral, una enfermedad mayoritariamente letal en una enfermedad crónica, compatible con una vida personal y de relación prácticamente normales. Este aniversario parecía un momento idóneo para pararse a reflexionar sobre el futuro de la infección VIH, los retos que todavía quedan por abordar y las perspectivas para el inmediato futuro. Esa reflexión tiene que ir más allá de planteamientos meramente técnicos, de profesionales especializados, para abordar aspectos sociales y éticos. Por este motivo, la Fundación de Ciencias de la Salud convocó a un grupo de expertos en distintos aspectos de esta infección para discutir una serie de preguntas que parecieron pertinentes a todos los convocados. Cada pregunta era expuesta por uno de los participantes y discutida por el grupo. El documento que ofrecemos es el resultado de esa reflexión. (AU)

[Therapeutic activism and health democracy: lessons from the fight against AIDS]. / Activisme thérapeutique et démocratie en santé : les leçons de la lutte contre le sida.

The "great AIDS patient revolt" had a major impact on the world of health care in Western countries. It is considered to be one of the social factors that led to the emergence of the notion of health democracy at the turn of the century. A look back at a historic struggle.

1984-Discovery of the First Anti-HIV Drug, Suramin.

In 2021, we commemorate the 40th anniversary of the identification of the disease AIDS, the acquired immune deficiency syndrome, a name that for the first time in history was launched in 1981 [...].

The model crisis, or how to have critical promiscuity in the time of Covid-19.

During the past forty years, statistical modelling and simulation have come to frame perceptions of epidemic disease and to determine public health interventions that might limit or suppress the transmission of the causative agent. The influence of such formulaic disease modelling has pervaded public health policy and practice during the Covid-19 pandemic. The critical vocabulary of epidemiology, and now popular debate, thus includes R0, the basic reproduction number of the virus, 'flattening the curve', and epidemic 'waves'. How did this happen? What are the consequences of framing and foreseeing the pandemic in these modes? Focusing on historical and contemporary disease responses, primarily in Britain, I explore the emergence of statistical modelling as a 'crisis technology', a reductive mechanism for making rapid decisions or judgments under uncertain biological constraint. I consider how Covid-19 might be configured or assembled otherwise, constituted as a more heterogeneous object of knowledge, a different and more encompassing moment of truth - not simply as a measured telos directing us to a new normal. Drawing on earlier critical engagements with the AIDS pandemic, inquiries into how to have 'theory' and 'promiscuity' in a crisis, I seek to open up a space for greater ecological, sociological, and cultural complexity in the biopolitics of modelling, thereby attempting to validate a role for critique in the Covid-19 crisis.

The Role of Dermatologists in the Early HIV/AIDS Epidemic: A Historical Review for the 40th Anniversary of HIV/AIDS.

In 1981, the HIV/AIDS epidemic was first recognized in young gay men presenting with opportunistic infections and Kaposi sarcoma. Over the past 40 years, there has been an unparalleled and hugely successful effort on the part of physicians, scientists, public health experts, community activists, and grassroots organizations to study, treat, and prevent HIV/AIDS. Yet the role of dermatologists in the investigation of HIV/AIDS and in the treatment of infected patients has largely been neglected in the historical literature. It is important to revisit dermatologists' historic contributions and problematic biases during this epidemic and honor the legacy of the dermatologists who were instrumental in treating and advocating for patients affected by HIV/AIDS.

Covid-19 in Historical Context: Creating a Practical Past.

Decades ago, in his foundational essay on the early days of the AIDS crisis, medical historian Charles Rosenberg wrote, "epidemics start at a moment in time, proceed on a stage limited in space and duration, following a plot line of increasing revelatory tension, move to a crisis of individual and collective character, then drift toward closure." In the course of epidemics, societies grappled with sudden and unexpected mortality and also returned to fundamental questions about core social values. "Epidemics," Rosenberg wrote, "have always provided occasion for retrospective moral judgment" (Rosenberg 1989, pp. 2, 9). Following Rosenberg's observations, this essay places COVID-19 in the context of epidemic history to examine common issues faced during health crises-moral, political, social, and individual. Each disease crisis unfolds in its own time and place. Yet, despite specific contexts, we can see patterns and recurring concerns in the history of pandemics: (1) pandemics and disease crises in the past, along with public health responses to them, have had implications for civil liberties and government authority; (2) disease crises have acted as a sort of stress test on society, revealing, amplifying or widening existing social fissures and health disparities; (3) pandemics have forced people to cope with uncertain knowledge about the origin and nature of disease, the best sources of therapies, and what the future will hold after the crisis. While historians are not prognosticators, understanding past experience offers new perspectives for the present. The essay concludes by identifying aspects of history relevant to the road ahead.

Criação e implantação do Centro de Testagem e Aconselhamento para o Vírus da Imunodeficiência Humana em Nova Iguaçu: contribuições de Enfermagem / Creation and implementation of the Testing and Counseling Center for the Human Immunodeficiency Virus in Nova Iguaçu: contributions from Nursing

Trata-se de um estudo histórico-social, de abordagem qualitativa, na perspectiva da História do Tempo Presente, cujo cenário foi o Centro de Testagem e Aconselhamento do município de Nova Iguaçu. As fontes históricas diretas escritas constituíram-se de Manuais, projeto de criação do CTA de Nova Iguaçu, relação nominal da equipe de profissionais, fôlder de eventos científicos, entre outros; as fontes diretas orais constaram de 11 entrevistas; as fontes indiretas foram artigos científicos e livros sobre o tema. Esta pesquisa tem como objeto de estudo: a atuação do enfermeiro no processo de criação e implantação do Centro de Testagem e Aconselhamento (CTA) para HIV/Aids, do município Nova Iguaçu. O marco inicial é o ano de 1995, quando tiveram início as atividades do CTA/NI. Nesse mesmo ano, foi publicada a Portaria n.o 931, de 1995, que designava um enfermeiro como Gerente Técnico da Unidade de Gerenciamento Municipal do Programa de DST/Aids, no município do estudo. O marco final é o ano de 1996, mediante a consolidação do CTA, com atendimento expressivo de usuários nesse curto período ‒ ou seja, 851 atendimentos de julho de 1995 a dezembro de 1996. Os objetivos da Tese foram: Descrever o processo de criação do Centro de Testagem e Aconselhamento no município de Nova Iguaçu; Analisar as estratégias ou lutas simbólicas empreendidas pelo enfermeiro no processo de criação do Centro de Testagem e Aconselhamento, no município de Nova Iguaçu; Discutir os efeitos simbólicos para os enfermeiros que atuaram nas ações de prevenção, controle e tratamento do HIV/Aids no Centro de Testagem e Aconselhamento, no município de Nova Iguaçu. Os resultados: no Brasil, em meados do século XX, o aparecimento da Aids considerada ‒ nova doença no campo da saúde ‒, causou um grande impacto na sociedade em função da alta mortalidade e do estigma ao doente. No sentido de minimizar os efeitos da epidemia, algumas iniciativas foram implementadas pelas autoridades de saúde, à época, como a criação do Centro de Testagem e Aconselhamento, em âmbito nacional. pesquisa evidenciou que, para a criação do Centro de Testagem e Aconselhamento para HIV/Aids de Nova Iguaçu, houve um grande investimento por parte do enfermeiro, designado Gerente Técnico da Unidade de Gerenciamento de DST/Aids. Iniciado em 1995, tal Centro alinhou-se com a Política de Saúde nacional, com a elaboração do Projeto de Criação do COAS/CTA, a escolha do local adequado para funcionamento do Centro, a composição da equipe de saúde, a capacitação dos profissionais visando um novo fazer, além da realização de cursos e eventos científicos, com a divulgação de conhecimentos sobre a temática. Foi possível concluir que o enfermeiro, apoiado por uma aliança pactuada com o Secretário de Saúde do Município de Nova Iguaçu, em atender às exigências para o controle da epidemia, na região, contribuiu para que o CTA atendesse aos critérios e objetivos determinados pelo Programa Nacional de Controle de DST/Aids. Dessa forma, o enfermeiro se destacou, empreendendo eficazes estratégias, e alcançou resultados significativos nas ações de prevenção, diagnóstico e tratamento do HIV/Aids. À medida que participava desse investimento, transformava-se em porta-voz legítimo de um discurso autorizado no campo da infectologia em Nova Iguaçu. Assim, a incorporação de um novo serviço reconfigurou o habitus profissional nas ações para o controle da epidemia, evidenciando sua importância enquanto integrantes da equipe de saúde e com ganhos simbólicos para a enfermagem.

This is a historical-social study, with a qualitative approach, from the perspective of the History of the Present Time, whose setting was the Testing and Counseling Center (TCC) in the city of Nova Iguaçu. The direct written historical sources consisted of Manuals, the creation project of the TCC of Nova Iguaçu, nominal list of the team of professionals, folder of scientific events, among others; direct oral sources consisted of 11 interviews; indirect sources were scientific articles and books on the subject. This research has as its object of study: the role of nurses in the process of creation and implementation of the Testing and Counseling Center (TCC) for HIV/AIDS, in the municipality of Nova Iguaçu. The initial milestone is the year 1995, when the activities of the TCC/NI began. In that same year, Ordinance No. 931, of 1995, was published, which designated a nurse as Technical Manager of the Municipal Management Unit of the STD/AIDS Program in the municipality of the study. The final milestone is the year 1996, through the consolidation of the TCC, with expressive service to users in this short period ‒ that is, 851 assistances from July 1995 to December 1996. The objectives of the Thesis were: Describe the process of creating the Testing and Counseling Center in the municipality of Nova Iguaçu; To analyze the strategies or symbolic struggles undertaken by nurses in the process of creating the Testing and Counseling Center, in the city of Nova Iguaçu; Discuss the symbolic effects for nurses who worked in the actions of prevention, control and treatment of HIV/AIDS at the Testing and Counseling Center, in the city of Nova Iguaçu. The results: in Brazil, in the mid-twentieth century, the emergence of AIDS, considered a new disease in the health field, caused a great impact on society due to the high mortality and stigma to the patient. In order to minimize the effects of the epidemic, some initiatives were implemented by the health authorities at the time, such as the creation of the Testing and Counseling Center, nationwide. The research showed that, for the creation of the HIV/AIDS Testing and Counseling Center in Nova Iguaçu, there was a large investment by the nurse, designated as Technical Manager othe STD/AIDS Management Unit. Beginning in 1995, this Center aligned itself with the national Health Policy, with the elaboration of the OSSC/TCC Creation Project, the choice of the appropriate place for the Center to function, the composition of the health team, the training of professionals aiming a new task, in addition to holding courses and scientific events, with the dissemination of knowledge on the subject. It was possible to conclude that the nurse, supported by an alliance agreed with the Secretary of Health of the Municipality of Nova Iguaçu, in meeting the requirements for the control of the epidemic in the region, contributed to the TCC meeting the criteria and objectives determined by the National Program of STD/AIDS Control. Thus, the nurse stood out, undertaking effective strategies, and achieved significant results in HIV/AIDS prevention, diagnosis and treatment actions. As he participated in this investment, he became the legitimate spokesperson for an authorized discourse in the field of infectious diseases in Nova Iguaçu. Thus, the incorporation of a new service reconfigured the professional habitus in actions to control the epidemic, highlighting their importance as members of the health team and with symbolic gains for nursing.

Disputas pela significação no discurso do HIV/aids: um percurso na ciência, na literatura, na militância LGBTI e nos canais do YouTube / Disputes for meaning in the discourse of HIV/AIDS: a journey in science, literature, LGBTI activism and YouTube channels / Disputas por el significado en el discurso del VIH/SIDA: un viaje en ciencia, literatura, activismo LGBTI y canales de YouTube

Este artigo trabalha na perspectiva histórica e na revisão bibliográfica de autores que analisam os recursos da linguagem, como a metáfora, para perceber a construção discursiva do HIV/aids na medicina, na mídia, no campo literário, na militância LGBTI e nos relatos em canais no YouTube de pessoas vivendo com HIV. O objetivo é utilizar as análises da terminologia e da história de luta pela significação de termos associados à doença e ao vírus em cada período. Dessa forma, verificamos que as representações iniciais sobre a condição clínica relacionada à culpa e ao julgamento moral de grupos, já vulneráveis antes da epidemia, não foram totalmente superadas no discurso. Observamos ainda os esforços, ao longo desses 40 anos, no campo da ciência para reduzir o estigma e a discriminação a partir da palavra.

This article works in the historical perspective and in the bibliographic review of authors who analyze language resources, such as the metaphor, to understand the discursive construction of HIV/AIDS in medicine, in the media, in the literary field, in LGBTI activism and in reports on YouTube channels of people living with HIV. The objective is to use the analysis of terminology and history of struggle for the meaning of terms associated with the disease and the virus in each period. We found that the initial representations about the clinical condition related to guilt and the moral judgment of groups, already vulnerable before the epidemic, were not completely overcome in the discourse. We also observe the efforts, over these 40 years, in the field of science to reduce stigma and discrimination based on words.

Este artículo trabaja en la perspectiva histórica y en la revisión bibliográfica de autores que analizan recursos del lenguaje, como la metáfora, para comprender la construcción discursiva del VIH/SIDA en la medicina, en los medios de comunicación, en el campo literario, en el activismo LGBTI y en canales de YouTube de personas que viven con el VIH. El objetivo es utilizar el análisis de la terminología y la historia de las luchas por el significado de los términos asociados a la enfermedad y al virus en cada período. Así, encontramos que las representaciones iniciales sobre el cuadro clínico relacionado con la culpa y el juicio moral de grupos, ya vulnerables antes de la epidemia, no fueron superadas por completo en el discurso. También hemos visto esfuerzos, durante estos 40 años, en el campo de la ciencia para reducir el estigma y la discriminación basados en las palabras.

Timeline: HIV.

The human immunodeficiency virus, the lentivirus that causes AIDS, is responsible for the most prevalent epidemic in the history of mankind. Here in this Timeline, we have attempted to illustrate a short history of HIV-1, from its identification in landmark papers published by Robert Gallo, Myron Essex, and Luc Montagnier, to the numerous drug and vaccine trials as well as the stride toward a possible cure. Even today, a vaccine and cure against HIV-1 remains elusive. In spite of this, in the space of 30 years, from the time when being HIV positive meant an instant death sentence, to today where millions of HIV positive people are living normal lives, the progress we have made in such a short period of time should be celebrated. To view this Timeline, open or download the PDF.

Public health heritage and policy: HIV and AIDS in museums and archives.

In the last five years there has been a resurgence of scholarly research and museum exhibitions on the history of HIV and AIDS. This work has called into question some of the conventions of archiving and interpreting the history of the pandemic. It is increasingly clear that a narrow range of materials have been saved. As historians and curators turn to these holdings for analysis and exhibition, they find they inadequately represent the impact of AIDS across diverse groups as well as the range of local, national, international responses. This essay considers some of the factors that shape collection of the material culture, particularly the heritage of public health, and the consequences for our understanding of lessons from the past.

Public health heritage and policy: HIV and AIDS in museums and archives / Herança e política de saúde pública: HIV e aids em museus e arquivos

Abstract In the last five years there has been a resurgence of scholarly research and museum exhibitions on the history of HIV and AIDS. This work has called into question some of the conventions of archiving and interpreting the history of the pandemic. It is increasingly clear that a narrow range of materials have been saved. As historians and curators turn to these holdings for analysis and exhibition, they find they inadequately represent the impact of AIDS across diverse groups as well as the range of local, national, international responses. This essay considers some of the factors that shape collection of the material culture, particularly the heritage of public health, and the consequences for our understanding of lessons from the past.

Resumo Nos últimos cinco anos, retomaram-se as pesquisas acadêmicas e exposições museológicas sobre a história do HIV e da aids. Este trabalho questiona algumas das convenções de arquivamento e interpretação da história da pandemia. Fica cada vez mais claro que foi preservada uma pequena amostra de materiais. À medida que historiadores e curadores recorrem a esse patrimônio para análise e exposição, descobrem que representam de maneira inadequada o impacto da aids em diversos grupos, bem como o escopo das respostas locais, nacionais e internacionais. Este artigo considera alguns dos fatores que influenciam a coleção de cultura material, em particular o legado da saúde pública e as consequências de nossa compreensão das lições do passado.