The first research on effective behavior interventions to reduce transmission of HIV among sex partners and injection drug users began in the early 1980’s. Behavior interventions, including school- based programs, peer to peer interventions, strategies that limit needle sharing, strategies that use parent-to-child communication, client-centered counseling, and personalized risk-reduction strategies, have been effective in promoting healthy behaviors that are protective for HIV (transmission). MMWR, HIV and AIDS, United States, 1981-2000).

It wasn’t until the early 1990’s, when combination anti-viral medicine became mainstream, that deaths started to fall as you can see from the following data of the percentage of people in the USA over certain time periods who were living or deceased while having AIDS: 1981-1987 4.2 % living, 95.5 % deceased (those living, of course, were soon to become deceased in the next time interval), 1988-1992 10.2% living, 89.5% deceased, 1993-1995 37.7 % living, 61.8% deceased, 1996-2000 76.9% living, 22.6% deceased.

Azidothymidine, or AZT, was the first antiretroviral drug to be released for the treatment of HIV/AIDS.” It blocks an enzyme that is essential for the virus to reproduce itself. “It inhibits the reverse transcriptase enzyme of the virus,” states Gottlieb. The virus (an RNA virus) is making a DNA copy of its RNA genome and tries to splice that DNA into the cellular DNA of a human cell. When AZT came out in 1987, we started seeing severe anemia because we were giving patients 1,200 mg a day, instead of the 600 mg that later became standard. We were doing a lot of (blood) transfusions.AZT was proof of principle that you could develop a drug that worked against HIV. And eventually, in the mid-90’s, the viral load test was developed, and the protease inhibitors came along. So, if you combined two of the nucleoside analogs, like AZT (and a sister drug) along with a protease inhibitor, you could drop the viral load to undetectable, which has now become the gold standard. An undetectable viral load means the virus is untransmissible sexually. In the early days, we worked with no viral load test or treatment, before AZT came along.”

According to Gottlieb, David Ho was first credited with providing data of the efficacy of triple therapy. “He became Time Magazine Man of the Year in 1995, as a result. I sort of knew you had to attack the virus as we had been doing with two drug therapy, starting in 1991, but we were waiting for drug companies to produce the protease inhibitors (which were in the pipeline). David apparently had a good relationship with a couple of New Jersey drug companies that were producing protease inhibitors, and he was one of the first to get access to these drugs and apply them in clinical trials. You had to attack the virus from multiple angles to get at its reverse transcriptase enzyme and get at its protease enzyme. Now, we are using integrase inhibitors as the cornerstone of treatment and protease inhibitors are old hat.” The virus continues to evolve through random mutations, some of which inevitably make them resistant to the current therapy. “Resistance can evolve spontaneously, or through non-adherence, or inadequate drug levels. The virus is mutating all the time.”

When NBA basketball superstar Magic Johnson was diagnosed with HIV infection in 1991, it seemed the country was at a breaking point. Magic was not only a hero, but, to many, close to superhuman given his athletic abilities. Because of his magnetic personality, he was also very well liked. His subsequent survival, thanks to his physicians and combination treatment, started to turn the tide on the stigma of having AIDS. In fact, in the years following, Magic seemed to be thriving. Without knowing it, Magic became perhaps the best-known example of someone living with HIV and being able to lead a normal life, giving hope to a nation.

Globally, AIDS has been even more devastating, due to lack of awareness, fear, stigma, government and public health dysfunction, and socioeconomic status of both the individual and the country. The continent of Africa has been the most affected. In 2025, World Population Review published a list of countries with the highest HIV prevalence in adults based on data from 2023. The figures are beyond disturbing:

Eswatini 27.5 % HIV prevalence in their population, Lesotho 20.5%, Botswana 19.7%, South Africa 16.6%, Mozambique 11.8%, Zimbabwe 11.7%, Namibia 11.5%, Zambia 11%, Malawi 7.6%, Uganda 5.6%

World Population Review also published a list of top 10 countries with the number of people living with HIV as of 2023:

South Africa 7.7 million people with HIV, India 2.5 million, Mozambique 2.4 million, Nigeria 2 million, Tanzania 1.7 million, Uganda 1.5 million, Kenya 1.4 million, Zimbabwe 1.3 million, Zambia 1.3 million, and Brazil 1 million.“The transmission in Africa is mostly heterosexual, in both directions. Genital lesions can predispose to easier transmission. Some people were skeptical that people in Africa could take medicine properly and that’s been disproved and there are major advances now happening in some countries.

The culture is different and in addition, there are sort of chains of transmission with men involved with multiple women and women involved with multiple men. I am involved with a foundation that works in Malawi, and we are on the way to meeting our goals of testing 90% of the population and getting 90% of those infected to have undetectable viral loads (through medication). When Colin Powell traveled to Africa we started hearing more about the devastation of AIDS in Africa.”

The earliest strains of HIV may have come out of the forests of the Congo (DRC) as humanity continues to encroach on and shrink the forest, exposing its hidden organisms to humans through direct contact with animals and other vectors and by killing and skinning animals and eating bush meat.

Clearly the epidemic is still raging and likely will be until a vaccine is developed. “The vaccine itself has been elusive, but I am confident that we will get there. It’s a worthy objective and whether it’ll take new technology, I don’t know, but I have faith that it will be developed. I think there could eventually be eradication of AIDS as a threat to mankind.