The journey of HIV through science, struggle, activism, and hope • Spotlight

– The first cases of what would later become known as AIDS are reported in mostly gay men in the United States. In the following year, the condition will be given the name GRID (Gay-related immune deficiency) and later the name AIDS (Acquired Immune Deficiency Syndrome). Later, the origins of HIV would be traced back to 1920s in Zambia.

  1983

– In a discovery that would later win them the Nobel Prize, Dr Françoise Barré-Sinoussi and Dr Luc Montagnier identify the virus that causes AIDS. The virus will only be given the name HIV in 1986.

  1985

– The first cases of people dying because of AIDS are reported in South Africa. The first known case of a South African contracting HIV occurred in 1981.

  1987

– The activist organisation ACT-UP (AIDS Coalition to Unleash Power) is founded in New York City. In the years that followed, ACT-UP would play a critical role in pressuring the US government, regulators and pharmaceutical companies to respond to the HIV epidemic with greater urgency and later make the drugs to treat HIV more accessible and affordable.

  1990

– The first national antenatal survey to test for HIV finds that 0.8% of pregnant women in South Africa are living with the virus.

  1995

– The Department of Health awards a R14-million contract to produce a sequel to the musical, Sarafina!, about AIDS, in order to reach young people. The project was dogged by controversy and was finally shelved in 1996.

  1996

– Triple drug therapy (using three ARVs together) is found to be effective in suppressing the virus. For those who can afford the treatment, this changes an HIV diagnosis from a death sentence into a chronic disease. The first ARV, AZT was registered in 1987, but treatment with only one ARV did not work for very long since the virus would quickly develop resistance to the drug.

  1997

– Thabo Mbeki, then the Deputy President of South Africa, backs an unproven product called Virodene for the treatment of AIDS. But the Medicines Control Council eventually declares Virodene to be unfit for human consumption and blocks the use of Virodene in clinical trials since such trials would be unethical. Virodene’s main ingredient was an industrial solvent.

  1998

– The Treatment Action Campaign (TAC) is founded on the steps of St George’s Cathedral in Cape Town to campaign for access to AIDS treatment for people in South Africa. Though effective, life-saving treatment existed at the time, it was not available through the public healthcare system. Over the next decade, TAC would become world-renowned for its struggle for HIV treatment.

  1999

– Thabo Mbeki becomes President of South Africa and Manto Tshabalala-Msimang becomes Minister of Health. Both leaders reject the scientific consensus on HIV, with Mbeki famously questioning whether HIV causes AIDS. Their rejection of established science sets in motion a decade of what would become known as state sponsored “AIDS denialism”.

  2000

– Eleven-year-old Nkosi Johnson speaks at the opening of the International AIDS Conference in Durban, urging the South African government to make HIV treatment available to pregnant women. Johnson would pass away a year later from an AIDS-related illness. The 2000 conference is seen by many as a turning point in the global HIV response.

– As part of its so-called defiance campaign, the TAC illegally imports the drug fluconazole from Thailand. Fluconazole is an important drug for treating HIV-related opportunistic infections, specifically painful thrush. At the time, fluconazole was dramatically cheaper in Thailand than in South Africa. The campaign is later named after TAC volunteer Christopher Moraka, who died of AIDS in 2001 while campaigning for access to the drug. In response to the campaign, the pharmaceutical company Pfizer agrees to donate fluconazole to the South African government.

– Mbeki invites 33 “experts” to serve on a “Presidential Advisory Panel on AIDS”. The composition of the panel is widely criticised given that around half the panellists are known AIDS denialists.

  2001

– A group of multinational pharmaceutical companies under the banner of the Pharmaceutical Manufacturers Association (PMA) drops a major court case against the South African government. The PMA had challenged amendments to South Africa’s Medicines Act aimed at facilitating the increased use of generic medicines. It is widely thought that the PMA dropped the case to avoid the bad press that may have resulted from people living with HIV testifying against them in a high-profile court case.

  2002

– A landmark Constitutional Court judgment in the so-called TAC case orders that the government must provide pregnant women living with HIV with the ARV Nevirapine to protect their babies from HIV infection. Even though government would drag its feet in implementing the court’s order, the ruling sets in motion a series of events that would eventually result in the largest HIV treatment programme in the world.

– In a hugely symbolic moment, Former President Nelson Mandela puts on the TAC’s iconic “HIV POSITIVE” T-shirt when visiting a Doctors without Borders clinic in Cape Town. This is the year in which Mandela starts clearly distancing himself from the AIDS denialist policies of Mbeki and Tshabalala-Msimang.

  2003

– The South African Cabinet approves an HIV treatment plan that provides for antiretroviral treatment in the public sector. Many delays would however follow before treatment became widely available and the programme would only really take off years later, mainly due to resistance from Health Minister Manto Tshabalala-Msimang.

– The Competition Commission refers the so-called Hazel Tau case to the Competition tribunal. The case involves three ARVs that the TAC alleged were excessively priced. Soon after, the companies involved agree to grant licenses to generic manufacturers, thus opening up the competition that would lead to the massive price reductions that made the growth of South Africa’s ARV programme possible. 

  2005

– South Africa’s annual AIDS deaths peak at around 280 000. This means that more than four out of every ten deaths in 2005 are due to AIDS. One of the 280 000 is Former President Nelson Mandela’s son Makgatho. After Makgatho’s death, Mandela publicly announces that his son had been HIV-positive. He is quoted as saying: “Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like tuberculosis, like cancer, is always to come out and say somebody has died because of HIV/AIDS, and people will stop regarding it as something extraordinary.”

  2006

– Activists cause a stir by trashing South Africa’s stand at the International AIDS Conference in Toronto. At the time, Health Minister Manto Tshabalala-Msimang was promoting beetroot, garlic and African potato as alternative treatments for HIV.

– Tshabalala-Msimang falls ill in late 2006, after which the country’s deputy health minister, Nozizwe Madlala-Routledge, temporarily assumes the health leadership. Madlala-Routledge attempts to break from government’s AIDS denialist policies and plays a critical role in putting together the country’s first five-year plan to fight AIDS.

  2007

– Despite ongoing calls from activists to fire Health Minister Tshabalala-Msimang, President Thabo Mbeki instead fires Nozizwe Madlala-Routledge. Mbeki’s stated reason was that she had attended a conference without his permission, but critics argued this was merely an excuse for Mbeki to remove a politician who did not agree with his AIDS policies.

  2008

– President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang are replaced by Kgalema Motlanthe (and later Jacob Zuma) and Barbara Hogan. If there is a moment where state-sponsored AIDS denialism finally ended, this is it.

– Professor Nicoli Nattrass of the University of Cape Town estimates that the Mbeki administration’s delay in providing ARV drugs was responsible for over 300 000 avoidable deaths. Later in 2008, Harvard researchers publish similar numbers.

– In a landmark court case brought by the TAC and the South African Medical Association, the Western Cape High Court orders vitamin salesman Matthias Rath to stop promoting his vitamin supplements as a treatment for AIDS and finds that Rath has been conducting unlawful clinical trials and should stop doing so. The case is a victory for the scientific governance of medicine over the AIDS quackery that flourished under AIDS denialism.

– The KwaZulu-Natal Department of Health threatens disciplinary action against Dr Colin Pfaff for providing pregnant women living with HIV with dual antiretroviral therapy to prevent transmission to their babies. Pfaff is one of many courageous healthcare workers – too many to mention here – who resisted state-sponsored AIDS denialism and placed their patients first – often at significant personal cost.

– It is reported that HIV has been “cured” for the first time in a man called Timothy Ray Brown (also known as the Berlin patient). Unfortunately, the “cure” is extremely risky and not a viable option for anyone who does not also have a very specific kind of cancer. Brown received a stem cell transplant as part of treatment for leukaemia. The stem cells happened to come from a person who had natural immunity to HIV and it is this natural immunity that “cured” Brown. A handful of other very ill people would be cured in similar ways over the next decade or so – but a viable cure for HIV has still not been found.

  2009

– Dr Aaron Motsoaledi replaces Barbara Hogan as Minister of Health. He would stay in the position until 2019 and oversee the massive expansion of South Africa’s HIV treatment programme, helping to save many thousands of lives in the process.

  2011

– The standard first line treatment for HIV in the public sector is updated to include the ARV tenofovir. Tenofovir replaced d4T, a drug that was associated with much more severe and stigmatising side effects.

  2012

– Evidence accumulates that people who are not living with HIV can protect themselves from HIV infection by taking a pill that contains two ARVs. In the years that follow, a number of trials confirm the efficacy of oral PrEP (Pre-exposure prophylaxis in pill form). Initial optimism over a gel to prevent HIV infection (microbicide) dissipates when the gel performs poorly in follow-up trials. A vaginal ring containing an ARV would later perform relatively well in trials – but not as well as oral PrEP.

  2013

– Fixed-dose combination ARV therapy is introduced in the public sector, meaning that most patients now have to take only one pill once a day, as opposed to multiple pills.

  2015

– Findings of the landmark START trial is published, resolving one of the most important questions in HIV treatment. START found that it is better for your health to start ARV treatment as soon as possible, rather than waiting for your immune system to show signs of deterioration before starting treatment. Prior to START, treatment was generally only recommended for people with compromised immune systems (CD4 cell counts below certain thresholds).

  2025

– HIV services in many countries are severely disrupted by the abrupt withdrawal of aid from the United States. Even in South Africa, where most of the HIV response is domestically funded, experts warn that the impact is likely to be severe. Having returned as Health Minister in 2024, Dr Aaron Motsoaledi alienates many activists by downplaying the impact of aid cuts in South Africa.

– HIV, TB and related research suffer huge disruptions as most US funding for medical research in South Africa is either abruptly cut, frozen, or otherwise placed in jeopardy. The cuts are a major blow to the search for an HIV cure or vaccine.