As one of the most complex viruses in existence today, the Human Immunodeficiency Virus (commonly referred to as HIV), is one that has represented a significant public health issue over the past several decades. Although the exact origins of the HIV virus are unknown, it is believed to have originated in the Democratic Republic of Congo, wherein it crossed species from chimpanzees to human beings in the early 20th century. HIV infection had, however, not become an epidemic until several decades later, in the mid- to late 1970s. HIV/AIDS quickly became a public health crisis, as millions around the world became infected and subsequently died as a result of AIDS. As a cure has yet to be found, and an effective vaccine has yet to be developed to combat the virus, HIV unfortunately remains a substantial threat to public health even today. The HIV virus is primarily spread via the sharing of bodily fluids, and most prominently through blood and semen. Consequently, sexual behaviors without the use of adequate protection and the sharing of needles among injection drug users are primary measures of infection that public health organizations are continuously forced to address. In more recent history, various medications have been developed that have made a significant impact in combatting the progression of HIV infection into Acquired Immunodeficiency Syndrome (AIDS), a natural and otherwise inevitable occurrence among those infected by the virus. As AIDS has been and remains entirely incurable and aggressively lethal, these medications have ultimately lessened the “epidemic” status attributed to HIV/AIDS, particularly in the West, wherein these medications are most widely accessible. Despite the advancements made in recent history, however, HIV will remain a significant public health risk until the potential for new infections is essentially eradicated.

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How to Solve the Public Health Problem of HIV
The public health crisis represented by HIV was primarily addressed via two key components: public education and the development of antiretroviral medications. In the early days of the epidemic, little was known in regards to what had caused HIV/AIDS, and how the virus was spread. A great deal of misinformation, such as the infamous myth that HIV could be spread by sharing a public toilet, had subsequently spread, furthering the need for improved public education on the issue. Perhaps the most significant piece of misinformation spread during the early years of the epidemic, however, was the myth that HIV/AIDS was a disease limited to homosexual men. As a consequence, AIDS had initially been called Gay-Related Immune Deficiency Syndrome (GRIDS), which was later changed to AIDS when this misinformation was finally corrected. As information gradually became available through research into the virus, many organizations throughout the West begun educational campaigns to both debunk the prevalent myths regarding HIV/AIDS and inform the public of how to truly prevent infection. The World Health Organization played an important role in this throughout the epidemic and into the modern day, as they have consistently raised awareness of HIV/AIDS and contributed to the important research into the virus over the years. In 2003, the organization established a goal of bringing HIV treatment to 3 million people by 2005, and had managed to surpass that goal by more than double by 2010. In 1987, the first antiretroviral drug—known as “zidovudine” or AZT—was approved by the FDA and became the first effective treatment against HIV. While still “primitive” in its treatment against HIV/AIDS, and attributed to several harsh side effects, the development and subsequent release of AZT begun the path to eliminating the HIV epidemic in the West. Since then, many other antiretroviral drugs have come to either replace or be prescribed alongside AZT in order to overwhelmingly improve treatment and limit the prevalence of serious side effects. At the time of its initial approval and release, AZT had become a significant sign of hope for those living with HIV, and coincided with other substantial educational efforts designed to address the ongoing epidemic.

Two years following the FDA’s approval of the drug, the Visual AIDS Artists Caucus launched the Red Ribbon Project to further the goal of HIV/AIDS awareness and compassion for those living with the virus. The red ribbon had subsequently become the universal symbol for HIV/AIDS, and remains so to this day. Unfortunately, the majority of these educational campaigns and other means of addressing the HIV epidemic had focused their efforts on the Western world. Still, even in the West, differences in culture and political ideology influenced vastly different outcomes. Throughout Europe, for example, the prominence of needle exchange programs contrasted greatly with countries like the U.S. which took a more hardline approach to injection drug use contributed greatly to minimizing the impacts of the HIV epidemic. Throughout much of Africa—wherein HIV/AIDS has largely retained its epidemic status through to the modern day—such efforts are far more limited and with demonstrably poor rates of success. Even in wealthier parts of the continent, such as Botswana, the attempts at education, condom distribution, and treatment for other STDs that made it easier for HIV to spread ultimately had minimal impact on minimizing the spread of HIV. Many factors contribute to this reality, with culture representing one of the most important of them, and have unfortunately allowed for HIV/AIDS to continue killing so many people even in a modern world wherein there exists medication that can allow those infected with HIV to live full lives without ever developing AIDS.

Public Health of HIV in the Future
It is rather difficult to predict the future in regards to the prevalence and status of HIV/AIDS throughout the world. While medical research on the virus continues to advance, we have yet to reach the point of finding a cure or even a viable vaccine to prevent new infections. The medications currently available for those infected with HIV are certainly remarkable in that they have eliminated the death sentence formerly attached to HIV infection. Still, they remain expensive and therefore largely inaccessible in more impoverished regions—essentially inadequate as a long-term solution. The threat of becoming exposed to and infected by HIV remains a very real and serious one, despite the advancements made throughout recent history. The use of preventative measures such as condoms and Pre-Exposure Prophylaxis (PrEP) remains vital to minimizing the spread of the virus today, and yet unfortunately still does not carry a 100% rate of success. Still, research demonstrates that the use and promotion of such preventative measures represents the best existing measure of preventing a recurrence of an HIV epidemic in the West. In parts of the world wherein HIV/AIDS remains an epidemic, promoting prevention is even more important, as is utilizing education to combat the influence of cultural and political factors that have allowed the epidemic to thrive. Going beyond simple calls for a focus on prevention, however, researchers have also largely called for addressing efforts towards those most at-risk of HIV infection. In the West, for instance, men who have sex with men are identified as being a group most at risk of acquiring HIV, alongside injection drug users. Anyone familiar with the history and the outright devastating nature of the HIV virus would agree that the demonstrably most effective approach established by research is the only meaningful way forward to ensure that a global HIV epidemic does not arise once again.

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