A Global Health Crisis Revisited

Two former leaders of the CDC explain how the early efforts to respond to AIDS have redefined global health.

Watch a full recording of the Feb. 6 Think Global event.

By Alicia Banks

Published February 8, 2024, last updated on February 12, 2024 under Around DGHI

In the early 1980s, many Americans had only a vague conception of AIDS, believing the emerging disease to be something that affected just gay men. Then, a 20-month-old child was diagnosed with AIDS after receiving a blood transfusion.  

“The American public was thrown into a panic now that anyone could get AIDS,” recalled Kevin De Cock, M.D., the former director of the U.S. Centers for Disease Control and Prevention (CDC) office in Kenya, during a Think Global event on Feb. 6 at the Duke Global Health Institute. “AIDS was seen as a problem of marginalized groups. It was easy to ignore. The American mainstream media, up until that point, paid little attention to AIDS.” 

The case marked one of many pivotal moments in the early history of AIDS, as scientists and policymakers scrambled to understand and control the epidemic. De Cock was one of them, working on the frontlines of the CDC’s AIDS response. Along with former CDC colleagues James Curran, M.D., and Harold Jaffe, M.D., he has documented that history in a new book, Dispatches From the AIDS Pandemic: A Public Health Story.

De Cock and Curran shared highlights from the book during the DGHI event, tracking the scientific effort to understand the disease and develop prevention and treatment strategies. DGHI Director Chris Beyrer, M.D., who has conducted research on HIV and AIDS for the past three decades, moderated the discussion. 

That history contains many significant successes, most notably the development of therapies that turned AIDS from a nearly always fatal disease to one that can be successfully managed with medications. But it is also an unfinished struggle: As of 2022, approximately 39 million people live with HIV globally and more than 40 million have died from AIDS-related illnesses through the years, according to a report from UNAIDS.  

De Cock and Curran said the effort to respond to AIDS transformed global and public health. Before the emergence of AIDS, the U.S. CDC did little work internationally, they said. But the spread of AIDS across sub-Saharan Africa demanded a new, more collaborative approach across borders and health systems.  

“Initially, people thought, ‘We can’t provide therapy for people in developing countries because it’s beyond the scope of public health,’” said Curran, dean emeritus of the Rollins School of Public Health at Emory University. “The idea of what not only needed to be done, but what could be done was changed with AIDS. It changed public health, the CDC and global health.” 

Curran said the effort to control AIDS also demonstrated the interdependency of prevention and treatment, as adherence to effective treatment has become an essential part of preventing others from being infected. 

Nwora Lance Okeke, M.D., associate director for data and implementation science at the Duke Center for AIDS Research, turned the discussion toward the current state of progress against AIDS, noting the uncertain future of the President’s Emergency Plan for AIDS Relief (PEPFAR). The program, which has been credited with saving more than 25 million lives across the globe since 2003, has not been reauthorized by the U.S. Congress. 

While the United Nations announced in 2016 a commitment to end the AIDS epidemic by 2030, the panelists expressed skepticism that AIDS could be wiped out entirely. De Cock reminded the audience that without proper funding, HIV will find refuge across the globe in vulnerable populations such as sex workers and those who share needles during drug use. 

Curran also noted that when public health officials say a disease can be eliminated, it often results in reduction in resources to fight it. “It’s the funding that gets eliminated,” he said. 

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