Just three years after smallpox was eradicated, a new epidemic caught the attention of the medical community. The US Centers for Disease Control published a study of five mysterious Los Angeles deaths in June 1981. This is recognized as the date that Acquired Immune Deficiency Syndrome (AIDS) became a known disease. 2
Human Immunodeficiency Virus (HIV), the virus that causes AIDS, has actually been a human pathogen since about 1920. The HIV virus first evolved in Central African chimpanzees. It was most likely transmitted to a small number of Africans who hunted and butchered chimps. AIDS took hold as an epidemic along the Congo River. It seems to have made its way to Europe and the Americas by the 1960s. Due to its long latency period and a relatively slow spread, it avoided widespread detection through the 1970s. 3
Some research suggests that the spread of AIDS was also ironically accelerated by the end of the smallpox era! The smallpox vaccine appears to have offered some degree of immunity to HIV. 4 HIV silently spread around the world at the very moment that smallpox was dying out and its vaccine was decreasingly necessary.
We often associate AIDS with America in the 1980s, because that is when it experienced its first major outbreak and caused immediate public alarm. There is anecdotal evidence, at least, that it dampened the sexual revolution. 5 However, the global pandemic was just getting started in 1990. After its magnification in American gay communities, HIV spread much more quickly worldwide. The rate of new infections peaked in 1997, and annual deaths peaked in 2005 – hundreds of times deadlier than 20 years earlier. 6
HIV is a retrovirus, meaning that it infects its host with a nasty trick called reverse transcription. A retrovirus is made of RNA. After infecting a victim, HIV reverse-transcribes itself into six genes, and then incorporates itself into the host’s own DNA! All subsequent copies of the victim’s infected cells also contain the new genes, which make copies of the original retrovirus during normal human transcription. 7 HIV is also especially nefarious because it attacks the immune system itself. When the viral count becomes high enough, it begins to seriously compromise the immune system, the condition that is known as AIDS. In that condition, the victim is susceptible to all manner of infectious agents.
Two effective lines of pharmaceutical treatment are now available. “AIDS cocktails” are so named as combinations of two or more antiviral medications. They have proven highly effective at lowering viral counts and mitigating AIDS symptoms in many HIV+ patients. A handful of patients have been cured completely 8 or functionally (without further need of medicine). 9 Gilead released a pre-exposure preventive (PrEP) pill in 2004. PrEP treatment greatly reduces the risk of new infections. 10 Now there is a sense that the epidemic is coming under control in the First World. However, PrEP and AIDS cocktails are too expensive for most people without insurance. 11 AIDS is still a bad crisis in poorer countries, where these medications are unaffordable and where education and women’s rights are still sorely lacking.
To date, the HIV virus has infected about 70 million people worldwide, approximately half of whom have died of AIDS. 12 Though transmission and death rates are on the decline, it is still one of the leading causes of preventable death in the world. Making a full cycle, AIDS is once again most severe in poor African countries.
B. The LGBT Movement
Gay rights is one of the most emotionally divisive issues in modern culture. AIDS played a key role in rallying emotions on both sides. Before AIDS, it was not only possible, but apparently common, for gay men to keep their sexual identities private, even from their families, for their entire lives. When a young gay man contracted AIDS, his family had to confront it with him, often in a wrenchingly emotional medical battle. The disease impacted a large number of families, who had to seriously reevaluate their image of homosexuality. This marked the beginning of widespread support for gay rights among the population at large. 13
Since the 1990s, at least two significant trends have followed. First, open homosexuality has become increasingly common, to the point of being perfectly ordinary in urban life and the entertainment industry. Second, gay pride has evolved into a full-fledged civil rights movement. A movement is afoot to add sexual orientation as a legally “protected class” in the US, entitled to the same anti-discriminatory protection as race, gender, or religion. The US military and Boy Scouts are two institutions that have famously rescinded such discrimination voluntarily.
While AIDS made the gay male community much more visible, women have always been part of the gay rights movement. To reflect increasing inclusivity, the term “LGB” (lesbian / gay / bisexual) came into favor in the 1980s, now usually with a “T” for “transsexual” and sometimes a “Q” for “queer”. 1 LGBT issues have become a linchpin of identity politics, with strong leftist encouragement to protect rights across the sexual spectrum.
By far the central thrust of the civil rights movement has been the quest for gay marriage, and this is a worldwide battle. In 1989, Denmark became the first country to grant a civil union, a quasi-marriage for same-sex couples. 14 Since then, a complex variety of gay marriages and civil unions have been legalized in several jurisdictions around the world. After Northern Europe, South America has surprisingly emerged as one of the most progressive regions. Where civil union or same-sex marriage is legal, it generally provides same-sex couples with the same rights as traditional couples, such as adoption, inheritance rights, medical benefits, and tax breaks.
Conservative pushback has been considerable. With a small minority and an obvious reproductive handicap, homosexuality had no chance of ever evolving as a mainstream lifestyle. Homophobia never needed a rational basis to persist, because it had never been seriously challenged before. Religious opponents justify their position with a few verses of scripture, or sometimes with alarmist accusations: AIDS is God’s punishment on gay men 15 , or homosexual men “recruit” boys with molestation. 16 These may be after-the-fact justifications for the underlying psychology of sexual prejudice and resistance to change. 17 Some oppositional leaders express the fear that LGBT rights come at the expense of religious liberty. 18 Public attitudes toward gay rights are split by region 19 and by generation. 20 At present trend rates, principled opposition to rights such as same-sex marriage will mostly die out in “western” cultures this century. On the other extreme, there are no LGBT rights to speak of in many African and southern Asian states. 21
The outbreak of the HIV virus just happened to coincide with the development of genetic engineering. Smallpox was eliminated in the 1970s with a relatively simple vaccine, a solution full of smallpox-like viruses that stimulated the body to develop immunity to the real thing. Vaccines have been known to medicine for centuries without any deep understanding of how they work. Researchers combat AIDS, on the other hand, with thorough molecular knowledge of what HIV is and how it functions. In fact, HIV research was foundational for much of today’s genetic science 22, including the record-breaking rapid development of COVID-19 tests and treatments. 23
The chemistry of genes has been understood only since the 1950s. By the 1980s, scientists were able to actually “read” or sequence portions of DNA. Genome sequencing started modestly, with viruses and bacteria. It progressed rapidly to plants and animals. The most ambitious project of all, the human genome project, produced a readout of the entire human genome by 2000.
Identifying the location and function of thousands of genes has revolutionized medicine. Many human traits and disorders have been traced to particular genes. It is now possible to take genetic tests to identify susceptibility to cancers and diseases.
Across the human genome, 99.9% of the genetic code is universal, with the small remainder unique to each person. The identification and analysis of this 0.1% variation is known as DNA fingerprinting. This has become another powerful technique, with applications in criminal and disaster investigations and paternity tests. As with many contemporary issues, the ability to genetically identify individuals with a high degree of reliability has double-edged implications for security and privacy.
By comparing the genetic similarities and differences between two individuals, it is possible to ascertain when they last shared a common ancestor. The more recently they diverged, the more similar their genomes are. This kind of analysis can provide reliable information about evolutionary pre-history, and it underlies much of the knowledge presented in this book.
Once the code of life can be read, it can also be rewritten. Genetic engineering began with the creation of recombinant DNA in the 1970s. This technique inserts one or two genes into a pre-existing, living strand of DNA. Such “gene splicing” experiments demonstrate convincingly how inter-related all life on Earth really is. DNA can be combined from sources as disparate as humans and yeast. They fit together as if they were long lost soul mates. Though the public imagination is gripped by science-fiction fantasies of half-goat / half-men, in practice genetic chimera are less exotic. Practical examples include pest-resistant plants and bacteria that can produce insulin.
By the 1990s, gene splicing advanced to human medical applications, gene therapy. For example, a healthy gene can be patched into the DNA of someone born with a genetic defect. Gene therapy is medically difficult, but has already had success treating blindness 24 , hemophilia 25 , leukemia 26 , and even the effects of aging (in mice) 27 . The first “designer babies” were born in 2018, twin girls engineered at conception to be immune to their father’s HIV. 28
Now here’s the strangest irony of all. Gene therapy requires the use of a vector, a small piece of genetic material, to carry the healthy gene into the host cells. The vector is often a virus. Since the HIV retrovirus is especially adept at infecting cells and grafting a copy of itself into DNA, it is actually a prime candidate for this purpose. Indeed, a modified form of HIV has been used successfully as a vector for gene therapy to cure a fatal brain disease! 29 Yes, humans are finally exploiting a virus to serve our own purposes – turnabout is fair play.
Along with computer technology, genetics is one of the pillars of 21st century science. The potential is staggering, as we await better biofuels, cloned tissue for safe transplants, and even synthetic meat. The pace of commercialization is steady but slow, limited not just by science and technology but also by legal and ethical regulations. Public attitudes are divided by religion, but people are generally more comfortable experimenting with computer code than with the code of life. 30
- AIDS ribbon photo © Digitalpress, licensed to Scot Fagerland, https://www.dreamstime.com/stock-photo-aids-awareness-red-ribbon-symbol-solidarity-people-hiv-austrian-parliament-image41027213 (accessed, saved, and archived 5/30/20). ↩
- Pepin, Jacque, The Origins of AIDS, Cambridge Press, 2011, p. 1 ↩
- This paragraph based on Pepin, Jacques, The Origins of AIDS, Cambridge University Press, 2011. ↩
- Raymond S. Weinstein et al., “Significantly reduced CCR5-tropic HIV-1 replication in vitro in cells from subjects previously immunized with Vaccinia Virus”, BMC Immunology 22:23 (5/18/2010), http://www.biomedcentral.com/1471-2172/11/23/abstract (accessed and saved 2/03/19). ↩
- Nordheimer, Jon, “With AIDS about, heterosexuals are rethinking casual sex,” New York Times, 3/22/1986, http://www.nytimes.com/1986/03/22/us/with-aids-about-heterosexuals-are-rethinking-casual-sex.html?pagewanted=all, accessed 6/08/2013. ↩
- Raw data at AIDSInfo Online Database, www.AIDSinfoOnline.org. Summarized by Max Roser and Hannah Ritchie, “HIV / AIDS”, Our World in Data (2014 – 2018), https://ourworldindata.org/hiv-aids (accessed and saved 2/03/19). ↩
- Shors, Teri (2008). Understanding Viruses. Jones and Bartlett Publishers. ISBN 0-7637-2932-9 , pp. 48 – 50 ↩
- Gero Hütter et al., “Long-Term Control of HIV by CCR5 Delta32/Delta32 Stem-Cell Transplantation”, N Engl J Med 360:692-698 (2/12/2009), https://www.nejm.org/doi/full/10.1056/NEJMoa0802905#t=article (accessed and saved 2/07/19). ↩
- Asier Sáez-Cirión et al., “Post-Treatment HIV-1 Controllers with a Long-Term Virological Remission after the Interruption of Early Initiated Antiretroviral Therapy ANRS VISCONTI Study”, PLOS Pathogens 9(3), https://doi.org/10.1371/journal.ppat.1003211 (accessed and saved 2/07/19). ↩
- Peter L. Anderson et al., “Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men”, Science Translational Medicine 4(151) (9/12/2012), https://stm.sciencemag.org/content/4/151/151ra125 (accessed and saved 12/30/20). ↩
- Rochelle P. Walensky and A. David Paltiel, “PrEP School: A Field Manual for the Battle Over HIV Prevention Drug Pricing”, Health Affairs (8/29/2019), https://www.healthaffairs.org/do/10.1377/hblog20190826.11005/full/#:~:text=For%20many%20PrEP%2Deligible%20individuals,is%20the%20most%20insurmountable%20obstacle. (accessed, saved, and archived 12/30/20). ↩
- “Global Health Observatory (GHO) data: HIV/AIDS”, World Health Organization, https://www.who.int/gho/hiv/en/ (accessed and saved 2/03/19). ↩
- See e.g. Jacki Lyden and Hank Plante, “Amid Daily Struggles, Gay Rights Movement Embraces Watershed Moments”, National Public Radio (2/09/13), http://www.npr.org/templates/transcript/transcript.php?storyId=171585896 (accessed and saved 2/03/19). ↩
- “The Danish Registered Partnership Act”, D/341- H- ML Act No. 372 (6/01/1989), http://www.qrd.org/qrd/world/europe/denmark/registered.partnership.act.with.amendments (accessed and saved 2/03/19). ↩
- Israel B. Olaore and Augusta Y. Olaore, “Is HIV/AIDS a consequence or divine judgment? Implications for faith-based social services. A Nigerian faith-based university’s study”, Journal of Social Aspects of HIV/AIDS 11(1):20-25 (5/12/2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272139/ (accessed and saved 2/03/19). ↩
- Evelyn Schlatter and Robert Steinback, “10 Anti-Gay Myths Debunked”, The Intelligence Report (2/27/2011), https://www.splcenter.org/fighting-hate/intelligence-report/2011/10-anti-gay-myths-debunked (accessed and saved 2/03/19). ↩
- Jojanneke van der Toorn et al., “In Defense of Tadition: Religiosity, Conservatism, and Opposition to Same-Sex Marriage in North America”, Pers Soc Psychol Bull 43(10):1455 (7/22/2017), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665159/ (accessed and saved 2/03/19). ↩
- Bryan Fischer, “Focal Point”, American Family Radio (7/20/2011), quoted by Kyle Mantyla in “Fischer: Gay Rights and Religious Liberty Cannot Coexist”, Right Wing Watch (7/20/2011), http://www.rightwingwatch.org/post/fischer-gay-rights-and-religious-liberty-cannot-coexist/ (accessed and saved 2/03/19). ↩
- “Attitudes to same-sex relationships around the world”, The Economist (11/02/2017), https://www.economist.com/graphic-detail/2017/11/02/attitudes-to-same-sex-relationships-around-the-world (accessed and saved 2/04/19). ↩
- “Same-Sex Marriage Detailed Tables, 2017”, Pew Research Center (6/26/2017), www.people-press.org/2017/06/26/same-sex-marriage-detailed-tables-2017/ (accessed and saved 2/04/19). ↩
- “Maps: Sexual Orientation Laws”, ILGA (Oct., 2017), https://ilga.org/maps-sexual-orientation-laws (accessed and saved 2/04/19). ↩
- Eben Kirksey, “The Man Who Smelled Like Rancid Creamed Corn to Usher In a New Scientific Era”, The Atlantic (12/19/2018), https://www.theatlantic.com/health/archive/2018/12/hiv-aids-genetic-engineering/578560/ (accessed and saved 2/04/19). ↩
- James H. McMahon et al., “Leveraging the advances in HIV for COVID-19”, The Lancet 396(10256):943-944 (10/03/2020), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32012-2/fulltext (accessed and saved 12/30/20). ↩
- Jean Bennett et al., “AAV2 Gene Therapy Readministration in Three Adults with Congenital Blindness”, Science Translational Medicine 4(120):120 ff (2/08/2012), http://stm.sciencemag.org/content/4/120/120ra15.abstract (paysite accessed 2/05/19). ↩
- Amit C. Nathwani et al., “Adenovirus-Associated Virus Vector-Mediated Gene Transfer in Hemophilia B”, N Engl J Med 365:2357-65 (12/22/2011), https://www.nejm.org/doi/full/10.1056/NEJMoa1108046 (accessed and saved 2/05/19). ↩
- David L. Porter et al., “Chimeric Antigen Receptor-Modified T Cells in Chronic Lymphoid Leukemia”, N Engl J Med 365:725-33 (8/25/2011), https://www.nejm.org/doi/full/10.1056/NEJMoa1103849 (accessed and saved 2/05/19). ↩
- Bruno Bernardes de Jesus et al., “Telomerase gene therapy in adult and old mice delays aging and increases longevity without increasing cancer”, EMBO Mol Med 4, 691-704 (5/15/2012), http://embomolmed.embopress.org/content/4/8/691 (accessed and saved 2/06/19). ↩
- He Jiankui, “About Lulu and Nana: Twin Girls Born Healthy After Gene Surgery As Single-Cell Embryos”, The He Lab (11/25/2018), https://www.youtube.com/watch?v=th0vnOmFltc&app=desktop (Accessed 2/06/19, before Jiankui published results). ↩
- Nathalie Cartier et al., “Hematopoietic stem cell gene therapy with a lentiviral vector in X-linked adrenoleukodystrophy”, Science 326(5954):818-23 (11/06/2009), https://www.ncbi.nlm.nih.gov/pubmed/19892975 (accessed 2/08/19). ↩
- Cary Funk, Brian Kennedy, and Elizabeth Sciupae, “U.S. Public Wary of Biomedical Technologies to ‘Enhance’ Human Abilities”, Pew Research Center (7/26/2016), http://www.pewresearch.org/science/2016/07/26/u-s-public-opinion-on-the-future-use-of-gene-editing/ (accessed and saved 2/07/19). ↩
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