AS MEDICAL SCIENCE presses forward to find a cure for HIV—and as we mark the thirtieth anniversary of the discovery of HIV as the cause of AIDS—it’s useful in the compressed timeframe known as “AIDS time” to recall one of the most pivotal moments of the now-33-year-long AIDS epidemic

THE FIRST GAY PERSON I ever met was also the first lover who died of AIDS. Tom was an ebullient bon vivant who loved to cook, built his own clavichord, and snuck me into the Episcopal church where he was the organist to play Bach works till dawn. Unbeknownst to us when we met in 1980 (my freshman year of college), HIV was silently insinuating itself into the bloodstream of men and women around the globe. It sprung into the public’s attention in 1981 after physicians published a report on an unusual outbreak of Pneumocystic pneumonia (PCP) affecting five previously healthy young gay men in Los Angeles with weakened immune systems. …

EVEN IN THE FIRST DECADE of the now three-decade-long HIV/Aids plague, there was already talk about ‘the changing face’ of the epidemic. …

While it’s true that the proportion of minorities with HIV has risen over the years, the fact is that, since AIDS was first reported among a group of gay men in 1981, gay and bisexual men of all colors continue to account for by far the largest number of those infected with HIV, those at risk for infection, and those living with untreated HIV. Like it or not, HIV/Aids in America is still a profoundly “gay” disease. …

AS WE ENTER the fourth decade of AIDS, the crisis continues largely unabated. About 1.1 million Americans live with hiv/aids, as do 33 million people around the world. Every year, about 56,000 more Americans are newly infected; roughly half are gay men and half are African American. While the overall HIV incidence in the U.S. remains flat, infections among gay and bisexual men are increasing-the only risk group for which this is the case. Infections are increasing especially among young black gay men.

Globally, 2.7 million people were newly infected in 2008, down from a peak of 3.5 million in 1997. Despite this progress, for every two HIV-positive people who get into treatment globally, another five are newly infected. Most of the 33 million people living with HIV around the world don’t have access to anti-retrovirals (ARVs), the HIV medications that revolutionized treatment in the mid-1990’s, and are not likely to any time soon. In sub-Saharan Africa, where most of these people live, access to something as basic as palliative care (pain medication) is often beyond reach.

On a more positive note …

THE CREATION of new drugs to treat HIV/AIDS has just about run its course. The next generation of therapies will involve modulating the body’s own immune system to better control the infection, and modifying its cells to make them more resistant to continued assault by the virus. The most advanced example of this line of research was recently presented at the Conference on Retroviruses and Opportunistic Infections, held in Boston. It is the world’s premier meeting on HIV science.

The study involved just six patients, but it demonstrated the proof of concept that it is possible to change the DNA of a person’s CD4+T cells so that they no longer express the CCR5 molecule that the virus uses to enter cells. The modified immune cells can be put back into a patient and they appear to thrive for at least three months and counting. Just how long they might last and how well they function has yet to be determined.

IN THE PERIOD of the first reports of the new syndrome of immune deficiency (1981 to 1985), before we were certain about the primary role of HIV in the epidemic, sides were taken about putative cause(s), and about what the future held for the epidemic, gay sexual life, and the gay community in general. The range of viewpoints fell into several discernible camps.