HIV/AIDS: 30 Years Later

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On June 5, 1981, the CDC announced that a relatively rare form of pneumonia had been detected among a small group of young gay men in Los Angeles. The disease was later found to be linked to AIDS. In the three decades since then, millions more people have been infected with HIV. Today, 33 million worldwide are estimated to be living with HIV/AIDS.

From the moment the epidemic made its first, devastating appearance, the question of stigma has been a critical part of the story. It’s a key determinant in the spread of the disease, says SPH epidemiologist James Koopman. “Whether you’re talking about drug use and intravenous exchange or homosexuality, there’s been a big emphasis on stigma,” he says, adding that in all too many instances, the stigma associated with HIV/AIDS has led to the denial of people’s basic human rights. More features on:

  • TB: the most common opportunistic infection for HIV and the leading cause of HIV-related deaths.
  • HIV and unemployment: a vicious cycle.
  • Shift: from a focus on prevention to a growing concern with the capacity of health systems.

VIDEO on progress and current concerns: SPH researcher Rachel Snow, adjunct lecturer Eve Mokotoff, and an HIV patient look back at the disease's first three decades and focus on the future priorities.


Tourism and HIV

Outside of sub-Saharan Africa, the Caribbean has the highest rates of HIV in the world. The Dominican Republic—where Mark Padilla, an assistant professor of health behavior and health education, conducts research on the confluence of tourism, sexuality, and health—has a one-percent HIV-prevalence rate. But among certain vulnerable populations, that rate is considerably higher. Padilla is at work on three studies aimed at clarifying what’s driving the spread of the HIV in the Dominican Republic and how policymakers can slow the epidemic:


In a study funded by the U.S. National Institutes of Health, Padilla is trying to untangle the complex relationship among tourism environments, alcohol consumption, and HIV risk. Through interviews with Dominicans who work in tourist enclaves, Padilla and his research team have found that the tourism industry in general promotes alcohol consumption (including binge drinking) among both tourists and locals who live and work in tourist environments. The reason? Businesses realize that sex and eroticism draw clients to consumption locations, even if those locations aren’t officially prostitution sites. “Client-tourists want to meet locals who are potentially available for sexual/erotic interactions,” Padilla says. To attract locals, businesses therefore distribute free alcohol-consumption coupons. This “synergy between the sex economy and the alcohol economy,” he adds, is a factor in the spread of HIV.


In order to reduce the spread of HIV among vulnerable populations, countries need policymakers who are committed to allowing HIV-prevention measures to be implemented in tourist environments. But this doesn’t always happen. Padilla and his research team are trying to find out why, and what, if anything, can be done to address the problem. They’ve talked to Dominican policymakers from an array of sectors—government, civil society, private tourism—and gotten mixed responses.

Some policymakers have mentioned the “fragility” of the tourism industry and the need to safeguard it by downplaying the threat of HIV. Others have said they believe HIV prevention is important, and they recognize its connection to tourism. Padilla and his team are disseminating their findings among policymakers, and the process is generating fruitful debate about how to tackle the problem.


Near the popular resort town of Punta Cana, on the southeastern coast of the Dominican Republic, there’s been a recent spike in HIV rates among transgendered people who reside in the area. Padilla and his colleagues are conducting an ethnographic study aimed at understanding the social and physical conditions that may be causing the spike. They’ve found that the transgendered community experiences extremely high rates of violence and abuse. “Many are kicked out of their homes and have no place to live,” Padilla says. “HIV is often an outcome of violence against these people.” <

2 Reader Comments

Jun 06, 2011 at 11:57 AM Posted By Leslie Stainton

Editor's note: The figures shown in the graph were taken from and and are widely accepted by the HIV/AIDS research community. The discrepancy in numbers reflects the impossibility of verifying with exactitude the number of people who have contracted and/or died from HIV/AIDS since 1986. According to SPH Professor Rachel Snow, "The best of the crude estimates we have from mathematical modelers is that something in the range of 20+ million people have probably died from HIV/AIDS." The number of individuals currently living with HIV is estimated to be somewhere between 32 and 35 million, Snow says.

May 23, 2011 at 10:52 AM Posted By Paula Tavrow, PhD

This was a wonderful issue. However, the graph on HIV/AIDS on p. 35 is a mess. First, the graph show that there have been 60M people infected with HIV since the start of the epidemic, with 30 M deaths. Yet it also states that there are now 33.3 M people living with HIV. This does not compute. Simple arithmetic would mean that 30 M people are now living with HIV, if the previous two figures are correct. But even worse is that the figure doesn't show anything properly from a graphical point of view. Graphs are intended to depict data in visual ways to make it more understandable and memorable. This does neither. It would have been far better to just have a table with numbers. This is misleading and hard to follow.

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