World AIDS Day 2019: Theme, History and Facts about HIV and AIDS

World AIDS Day is taking place on December 1 to raise awareness around HIV and AIDS, and to support the 37.9 million people around the world living with the virus.

This year's theme will be "Ending the HIV/AIDS Epidemic: Community by Community," highlighting the role of communities in preventing, treating and supporting people with HIV.

"I believe in communities," UNAIDS executive director Winnie Byanyima said in a statement. "Communities make change happen."

"With communities in the lead and governments living up to their promises, we will end AIDS."

This year marks the 21st World AIDS Day since its establishment in 1988, when James W. Bunn and Thomas Netter—two public health officers at the World Health Organization's Global Program on AIDS in Geneva—co-founded the day in an effort to destigmatize the disease.

"There was a lot that people felt they did not know about the epidemic and they were afraid," Bunn told NPR in a 2011 interview. "In those days people were being fired from their job. They were being denied Social Security benefits. They were being ostracized by their families. They were being evicted from their homes because they were sick and dying."

Today, people can show their support for people living with HIV and AIDS by donning a red ribbon.

What is the difference between HIV and AIDS?

HIV stands for human immunodeficiency virus, a condition that weakens the immune system against infections and certain cancers by destroying or impairing the body's immune cells.

If an HIV-positive person does not receive treatment, they could be susceptible to diseases and infections a person with a functioning immune system would be able to fight off, including—but not limited to—tuberculosis and cryptococcal meningitis.

AIDS, which stands for acquired immune deficiency syndrome, is the most advanced stage of HIV and can develop any time between two and 15 years after infection if the person is not taking proper medication.

To qualify as AIDS, one of more than 20 life-threatening cancers or so-called "opportunistic infections" (such as Kaposi sarcoma, Non-Hodgkin lymphoma and cervical cancer) must be present, according to the WHO.

One important difference between the two is that HIV can be passed on from one person to another, while AIDS cannot.

Where did HIV come from?

HIV can be traced to chimpanzees in Central Africa—most likely, Kinshasa, the capital of the Democratic Republic of the Congo (DRC), says Avert, an international HIV and AIDS charity based in the U.K. Scientists believe it is a mutation of simian immunodeficiency virus (SIV)—a condition found in monkeys and apes—that was passed onto humans when hunters looking for bush meat came into contact with infected blood.

The theory is backed up by the fact that there are different strains of HIV (M, N, O, and P), suggesting slightly different forms of the virus emerged after multiple contact with SIV-carrying primates.

While scientists may not have identified the virus that caused AIDS until 1984, the jump from chimpanzee to human may have taken place much earlier and as far back as the late 1800s, according to the U.S. Centers for Disease Prevention and Control (CDC). The first confirmed case of HIV is from a sample of blood that was taken in 1957 and belonged to a man in Kinshasa.

From Kinshasa it spread through roads, railways and a burgeoning sex trade to other parts of the DRC and, by the 1960s, to Haiti. Many Haitians had been working in the DRC and it is thought that it is through them that HIV first traveled across the Atlantic to the Caribbean.

Who was the first person in the U.S. to die from HIV?

AIDS was not formally recognized until the early 1980s, when University of California, Los Angeles (UCLA) physician Michael Gottlieb put a name to a devastating illness affecting gay men living in Los Angeles. However, the first AIDS-related deaths in the U.S. are thought to have occurred much earlier.

On May 15, 1969, a gay black teenager died of a then-unknown illness in St Louis, Missouri. Before his death, 16 year old Robert Rayford had developed Kaposi sarcoma lesions and other AIDS related symptoms. However, it was not until 1987 that an autopsy revealed Rayford carried the virus and he is now believed to be the first person to have died from AIDS in the U.S.

It is not known who gave Rayford the disease but scientists now suspect that the virus entered and re-entered the U.S. several times, subsiding if there was not a large enough population for it to spread.

Recently, scientists have traced an unknown patient zero to early 1970s New York. It is thought the virus entered the U.S. from the Caribbean, gaining a foothold in New York before spreading to the rest of the country.

How many people are diagnosed each year?

Worldwide, approximately 1.7 million people were newly infected with HIV last year. That includes 37,832 people in the U.S and associated territories.

In East and Southern Africa, where 7 percent of the population aged 15 to 49 are HIV-positive, there were 800,000 new infections in 2018.

HIV-1 Group M is the strain responsible for most of these.

How many people in the U.S. live with HIV?

According to government data, there are around 1.1 million people living with HIV in the U.S. today. Approximately 1 in 7 (or 15 percent) are unaware that they are infected.

Florida, Georgia and Louisiana are the states with the highest rates of infection per 100,000 people, the CDC reveals. As many 46 percent of people who are HIV-positive people live in Southern states.

However, the number of people newly diagnosed is decreasing. Overall, the number of people in the U.S. being diagnosed with HIV decreased around 9 percent between 2010 and 2016.

How can it be contracted—and how can it not be contracted?

HIV is transmitted from one person to another through bodily fluids, including blood, breast milk and semen.

In the U.S., two-thirds of new diagnoses in 2018 were because of male-to-male intercourse. Around a quarter were caused by heterosexual intercourse and 7 percent were caused by drug injections using infected needles.

There are plenty of myths about how you can contract HIV. You cannot get AIDS from a toilet seat. Despite urban legends stating otherwise, HIV cannot be passed on to another person through hugging, shaking hands or sharing objects and/or food. As the CDC makes clear, the virus is not present in saliva (or tears or sweat) so unless both people have bleeding gums, it is not possible to get HIV from kissing.

Can HIV be cured?

No—but it can be effectively managed.

According to the WHO, around 32 million people have died of AIDS. Fortunately, with the right treatment, an HIV-positive status is not a death sentence.

The average life expectancy in the U.S. for people without HIV is 76 years for men and 81 years for women. According to WebMD, a 20 year old who began antiretroviral treatment in 2008 and manages to maintain a low viral load can expect to live to around 78.

According to the WHO, 62 percent of people have received treatment and more than half (53 percent) have achieved HIV suppression so that there is effectively no risk of passing the virus on to others.

But what about Timothy Ray Brown?

Timothy Ray Brown is a patient in Berlin who was apparently cured of HIV after undergoing a rigorous treatment to cure his acute myeloid leukemia.

The process effectively wiped out his immune system with large quantities of radiation or chemotherapy, and replaced it with stem cells from a donor.

The same treatment has been performed more recently in a London patient, who like Brown received donor cells from a person with two copies of a gene mutation affecting the CCR5 receptor—a mutation that effectively renders the person immune to HIV.

However, while testing might suggest the patients are in remission, experts have been careful about bandying around the word "cured." What's more, it can only be used to people who are HIV-positive and have acute myeloid leukemia.