In 1982, the first cases of an unusual immune-system problem were identified among gay men in the United States, with the term AIDS (Acquired Immune Deficiency) being introduced to define what appeared to be a syndrome. In 1984, HIV (Human Immunodeficiency Virus), a retrovirus that impairs or destroys the functioning of cells of the immune system, was isolated as the cause of the progressive depletion of the immune system identified as AIDS. Four primary modes of transmission have been identified: sexual intercourse, blood transfusions, the sharing of drug needles, and mother-to-child transmission. The virus has branched into two major forms and subgroups which exist within certain populations or geographic regions, and are more prevalent with certain types of activities or behaviors (drug use and sex). There are some who question whether HIV and AIDS are connected (or even exist), though the body of scientific evidence seems solid that the two are related.

Other Factors Play A Role
What is also true is that poverty, malnutrition, lack of education and general healthcare, inequality and gender discrimination have a role to play in health matters--especially susceptibility to illness--as the more vulnerable groups lack access to health information and services, to proper nutrition, and to the financial means to afford a better overall quality of life. HIV/AIDS reinforces this ulnerability, as those infected may lose jobs and family, face intense stigma and discrimination, drop out of school to care for sick relatives, and find themselves even more impoverished and marginalized. Girls and women, sex workers, drug users, migrants, refugees, children, minority ethnic groups, prisoners, men who have sex with men often face not only marginalization but criminalization as they turn to the commercial-sex trade, or steal food to feed their families, and this makes prevention, education, care, and treatment even harder to access.

ARV treatements and beyond
The good news is that many billions of people do not yet have HIV/AIDS, and also that there are now many kinds of prevention, care, and treatment options, though these are not always accessible and available to those who need them the most. ARV (anti-retroviral therapy) treatments, condoms (male and female), vaccines research and trials, blood safety regulations and equipment, VCT (voluntary counselling and testing), microbicides ("chemical condoms"), and better ways to address mother-to-child transmission and sexually-transmitted infections (STIs), which tax the immune system and make HIV transmission during unprotected sex ten times more likely, are all in various stages of development or implementation. A new approach called ABCD (Abstain from Sexual Relations, Be Faithful to One Partner, Consistent and Correct Condom Use, and Delay having Sex) was officially endorsed by the UN General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

Currently, there are 5 to 6 million people with HIV in the developing world who need access to ARV therapy, but only 300,000 have this access. The World Health Organization has recently launched a campaign called the 3x5 Initiative, which seeks to get 3 million people on ARVs by 2005. The price of ARVs has dropped in some cases by 90%, reducing costs from $10,000 a year to $300 for some combinations of the 12 drugs now being used in ARV therapy, but challenges of scaling up local healthcare systems remain. A number of initiatives and programs are being developed and implemented to address ARV access, availability, and treatment, among them ITAC (a coalition of 40 partner organizations representing donors, governments, NGOs, international organizations, UNAIDS, the World Bank, business, and people living with HIV/AIDS), and the Accelerating Access Initiative (a public-private partnership by various UN branches and 5 major pharmaceutical companies). The WHO program works on issues related to universal access, while AAI works to scale up care and treatment in resource-poor settings. The manufacture and distribution of generic drugs adds another dimension to widescale availability and cost reductions, as do private efforts like the just-announced Clinton Foundation program to provide generic ARVs to some 2 million people in Africa and the Caribbean by 2005, at half the cost (about $140) of the lowest prices to date.

Comprehensive Healthcare
Comprehensive healthcare and support, including a focus on HIV/AIDS, ARVs, and better delivery systems are important factors in addressing the pandemic. Equally important, according to UNAIDS, are such measures as voluntary counselling and testing (VCT), prevention and treatment of TB and other illnesses, care for the sick, and a focus on HIV/AIDS prevention and education. Also important are the prevention and treatment of other sexually-transmitted diseases, family planning, good nutrition, and the development of various types of support systems, as well as respect for human rights and a reduction of the stigma associated with HIV/AIDS. Prevention and treatment, care and support should be integrated for maximum effect, and improved nutrition has been singled out in particular as essential to help ward off disease and increase stamina and longevity not only for those with HIV/AIDS, but for all community members.