MG - The Historical Geography of AIDS

• HIV/Aid was first recognised in 1981
• Kaposi’s sarcoma is a disease commonly contracted by HIV patients
• A cluster of young adult males in the USA developing oral thrush in the last 1970s pointed to the fact that something was going wrong in the population
• Cause of the disease was quite unknown. People that were known to develop the disease: Intravenous drug users, men who have sex with men (MSM), haemophiliacs, blood transfusion, blood transfusion recipients, Haitian-Americans, children of mothers with AIDS
• Seemed that the virus was transferred sexually, parenteral, perinatal transmission
• 1983- Workers in Paris began to report the isolation of a novel virus from aids virus – this is now know as HIV-1
• 1884 – The same workers began to report the isolation of another virus from mainly in people from sub-Saharan Africa – this is now none as HIV-2
• HIV-2 is much less widespread

• A search was started to try and find cases of HIV infection prior to 1883
• Search approaches to finding early cases of HIV/AIDS:
• 1. Clinical symptoms of an AIDS-like disease with evidence of HIV infection
• 2. Clinical symptoms of an AIDS-like disease without evidence of HIV infection
• 3. Evidence of HIV infection in the absence of clinical information
• The first case discovered to definitely be the HIV infection was a man from Manchester in 1959 – his disease was first written as unexplained immunodeficiency disease and his tissue samples were kept
• Many patients found to have the AIDS disease were of African descent

 Plausible HIV origin hypotheses

1.     1. Zoonotic origin – HIVs originated a s infections of animals – favoured by the majority of professionals

2.     2. Non-pathogenic progenitor – HIVs recently emerged from existing non-pathogenic viruses

        3. Molecular recombination in vivo – HIVs originated from the molecular combination of two viruses concurrently infecting a single cell

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

• The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal 6 (GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES)
• Creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002
• There are major UN efforts on an annual basis to track the epidemiology of these three diseases.
• The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. 
• Globally in 2013, there were 1·8 million new HIV infections, 29·2 million prevalent HIV cases, and 1·3 million HIV deaths. 
• Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases in 2003 and 1·2 million deaths in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5%. Outside of Africa, malaria mortality has been steadily decreasing since 1990.
• Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

• Vast majority of aids cases have been HIV-1
• 1981- HIV-1 was first described
• HIV-1 is an extremely complicated virus so unlikely it could have evolved separately in 3 different continents

• HIV-2 spread

• Stage 1: Beginning in Guinea Bissau

• Stage 2: Spread through Africa to Mozambique and Angola

• Stage 3: Spread though the rest of the world, with Portugal being a major link for the spread of the disease

• Contagious diffusion

• Example: Geographical area with multiple settlements. At some point in time one settlement is infected with HIV-1. This disease will then spread to the neighbouring settlements (wave-like). Distance constraint for the disease the spread

• Hierarchical diffusion

• Spread of a virus through an ordered system. For example: Could be largest city centre at the top and smaller towns near the bottom. Or could be people in higher up positions at the top of the diagram.

• Total of 36.7 people living with HIV/AIDS in the world
• 19.4 of these people are living in eastern and southern Africa
• Around 2004 deaths from HIV begins to fall from about 2 million to 1 million in 2016 – shows improvement in treatment
• WHO HIV/AIDS Transmission Patterns (1980s/1990s) – categorized into 5 patterns (pattern 1, pattern 2, pattern 1-2, pattern 1+2, pattern 3)
• Pattern 1: America, Canada, Europe – Transmission mainly occurred through man à man transmission (very little heterosexual transmission), very male dominated epidemic in these parts of the world
• Pattern 2: Whole of sub-Saharan Africa apart from south Africa – epidemics concentrated on heterosexual transmission and mothers à babies transmission.
• Pattern 1 à 2: Late 1970s early 1980s, dominate risk groups homosexuals and drug users but then into the early 1980s this transitioned into heterosexual transmission and mothers à babies transmission
• Pattern 1+2: Only south Africa, two AIDS epidemics running in parallel, pattern 1 occurring in white population, pattern 2 occurring in black population
• Pattern 3: North Africa, middle east, south/south east Asia – delayed transmission of HIV and AIDS, very little cases reported

• HIV prevalence much higher in urban areas in Kenya. Urban: Rising from 8% (early 1990s) to 18% in late 1990s and then decreases from here. Rural: Rising from 1.5% to 8% in the late 1990s
• As you move away from major roads you see the cases of HIV decrease (Uganda)
• Trucktown hypothesis
• HIV diffuses hierarchically in the upper tiers of the urban settlement system cities à trucktown à villages. Positive truck drivers travel to the city and have sexual contact with sex workers etc, spreading the disease. Very high infection rates found in truck drivers compared to the general population. Same goes with prostitutes throughout central Africa.
• In the 1980s Uganda had some of the highest levels of AIDS in the world.
• In 1982 a new disease seemed to be occurring in south west Uganda (Kasensero, Rakai District). High level of weight loss with the disease so was called slim disease, 1984 recognised as a type of AIDS
• Uganda has its own AIDS record form – by the end of the 1980s 12.5 thousand cases had been recognised through this form system
• Bipolar distribution of AIDS activity 

• The central chimpanzee - (Pan troglodytes troglodytes)
• HIV is a type of lentivirus, which means it attacks the immune system. In a similar way, the Simian Immunodeficiency Virus (SIV) attacks the immune systems of monkeys and apes
• Research found that HIV is related to SIV and there are many similarities between the two viruses. The researchers who discovered this connection concluded that it proved chimpanzees were the source of HIV-1, and that the virus had at some point crossed species from chimps to humans.
• The same scientists then conducted more research into how SIV could have developed in the chimps. They discovered that the chimps had hunted and eaten two smaller species of monkeys (red-capped mangabeys and greater spot-nosed monkeys). These smaller monkeys infected the chimps with two different strains of SIV.
• The two different SIV strains then joined together to form a third virus (SIVcpz) that could be passed on to other chimps. This is the strain that can also infect humans

• In 1999, scientists claimed to have established the origins of the HIV, which they said was a mutation of a virus found in monkeys from West Africa. Some claim the virus was transferred to humans through the hunting and possibly eating of the chimps.
• Another controversial theory is that it was transferred through live polio vaccinations which were grown in chimp kidney cells and then given to around a million people in the Belgian Congo, Rwanda and Urundi in the late 1950s, while conspiracy theorists claim it was developed by the CIA to kill off blacks and homosexuals.