Quite simply, HIV was probably a mutation of an African monkeys virus. The presence of related retroviruses in African monkeys and apesand the close relationship of HIV to a Chimpanzee Immunodeficiency virus all suggest that Central Africa may have been the site of evolution of HIV.Some people think that there are other possible origins of HIV. One of these is the suggestion that HIV was a deliberate or accidental productof biological warfare research. That's not possible, since the technology and the basic knowledge that would have been necessary to create such a virus had not been developed in 1975, when the epidemicbegan to grow.
We really don't know that either! However, a reasonable (but neither provable yet comforting) scenario is this:
- HIV infection existed at low levels for a long period of time in small tribal communities in Africa. The pool of available, uninfected individuals in such a community is simply too small. In addition, especially in small communities, sexually transmitted diseases seldom become epidemic. Multiple sexual partners would not be accepted in such communities, so transmission would be limited.
- Urbanization of this region of the world, particularly under British and French colonialism, brought young African males to the cities for education and to participate in the professions. The more relaxed morals of the urban setting bring the availability of multiple sexual partners and prostitution. In fact, prostitution was evidently created deliberately in certain circumstances to solve the problems of the separation of the urban professional men from their tribal families. Such events could furnish a a greater spread of HIV, enough to possibly create a 'base' of HIV positive individuals for future expansion.
- Western approaches to health care in urban Africa, including the extensive use of blood transfusions for the treatment of Malaria and the frequent use and reuse of hypodermics for everything from immunizations and antibiotics to vitamin injections (a common practice in Central Africa) would contribute to the growth of this epidemic.
- With urbanization came increased air travel and increased contact with other parts of the world and with other societies: government supported exchange programs in education, policy development, agriculture, and the arts; increasing economic and business ties; all possible conduits for an infective virus that is not visible in the early years after infection, although fully capable of being transmitted.
- When the virus arrived in Europe and in the United States, it was joined with two "cultural epidemics" that were instrumental in the rapid growth of the disease: the so-called sexual liberation movement, and the dramatic increase in recreational and addictive drug use. Multiple sexual partners and injection drug use (IDU) with shared needles are the two main ways to get this virus.
- As a final ecological twist, the virus arrived in America just as the sexual liberation shifted from the heterosexual to the homosexual community. As is often true, the disenfranchised are the last to receive the "benefits" of any societal change. So members of the gay community were the last to experience the open sexual freedom that occured in the twentieth century. The timing could not have been worse!
The growing gay liberation movement was especially visible and open in large coastal cities such as Los Angeles, San Francisco, New York, and Miami, with new "bath houses" opening almost monthly in the late 70's. The bath houses offered the gay community the opportunity for open and often excessive sexual activity.
The intense sexual activity of the bath houses was certainly one of the determinants of the epidemic in the United States. It diverted what was (and is) elsewhere in the world a heterosexual epidemic to one that was primarily (at first) a homosexual one in this country. (World wide, 75% of all HIV transmission is heterosexual.) The social and political consequences of that unusual beginning have significantly altered forever this country's response to the AIDS crisis. Since most of the early PWA's (persons with AIDS) were gay or were injection drug users in this country, it was unfortunately easy for some in our society to view the epidemic as a consequence of their socially unaccepted activities. This country's strange and complex preoccupation with sex and drugs again took its toll and the HIV epidemic took off at an unbelievable rate as governments, health care professionals, and the public in general closed its ears and eyes to the pleading of those public health officials who recognized that this was to be an epidemic for all life styles, all races, and all ages.