TIME health

How One Teenager Changed the Way the World Sees AIDS

Ryan White
Taro Yamasaki—The LIFE Images Collection/Getty Ryan White, 16, a hemophiliac who contracted AIDS, surrounded by mikes held out by reporters on April 21, 1988

Ryan White, who put a new face on AIDS, died 25 years ago

In 1984, when Ryan White was diagnosed with AIDS, the disease itself was still mystified medical professionals. When his name became national news, some of the only things that were well-known about it were that it was terrifying and communicable.

White — who was 18 when he died 25 years ago, on April 8, 1990 — was a hemophiliac and had acquired HIV through a blood transfusion. In and around 1985, he made headlines by trying to attend middle school in his hometown of Kokomo, Ind. Though the state’s health department declared that it was fine for him to attend school as long as he was well enough, the district superintendent decided he would have to attend class by phoning in. His parents sued in response.

As TIME remarked as the case progressed, relatively few people were directly impacted by the case: fewer than 200 school-age Americans had been diagnosed with AIDS at the time. Fear among parents, many of whom were unaware that HIV could not be transmitted through casual contact, was disproportionate.

A year later, in the fall of 1986, White started eighth grade, thanks to a court order — and, then and in the years that followed, he put a familiar face on a disease that had seemed to many Americans to be distant or foreign. The sympathetic story of a young boy who just wanted to go to school ended up helping all AIDS sufferers get a fairer shake; in 1990, for example, shortly after he died, Congress passed his namesake act, which helps Americans get medical care for the disease. As Rev. Ray Probasco, a family friend of the Whites’ who eulogized Ryan, put it:

”Not much was known about the disease back then. So very quickly a great deal of fear permeated Ryan’s community. At first, Ryan and the disease were perceived as one and the same. In time, we saw the boy and the disease, and they were not the same. It was Ryan who first humanized the disease called AIDS. He allowed us to see the boy who just wanted, more than anything else, to be like other children and to be able to go to school.

”And children began asking Ryan, ‘Are you afraid to die?’ And Ryan responded, ‘Everyone’s going to die. If I die, I know I’m going to a better place.’ I believe that God gave us [a] miracle in Ryan. He healed a wounded spirit in the world and made it whole.”

Read TIME’s original 1985 coverage of White’s attempt to attend school, here in the TIME Vault: The AIDS Issue Hits the Schools

TIME Infectious Disease

How an HIV Outbreak Hit the Heartland

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom—TIME

Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency

The number of HIV cases found in a remote Indiana county has grown to 120, according to numbers released Friday by the state’s health department, after 79 cases were confirmed there over the last few months. Ten additional cases are awaiting confirmation.

The dozens of cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000. Indiana Governor Mike Pence declared a public health emergency there in March after dozens of cases of HIV were discovered.

An outbreak of HIV may seem odd in such a remote part of the country, but it’s been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana State Department of Health.

In this area of the state, there’s relatively weak public health infrastructure to prevent the infection from spreading. Scott County is just one of five counties serviced by a single HIV testing clinic, and the county’s relative isolation from a sufficient public health system can help explain the virus’s rapid growth, says Beth Meyerson, an Indiana University health professor and co-director of the Rural Center for AIDS/STD Prevention.

“The system isn’t working and isn’t strong enough from a public health perspective,” Meyerson says.

In a 2013 study by the non-partisan organization Trust for America’s Health, Indiana ranked last in federal funding per capita from the Centers for Disease Control. The national average spent per capita was $19.54. In Indiana, $13.72 was spent on each Hoosier.

Indiana has also seen an increase in Hepatitis C in many rural communities, says Meyerson, another warning sign that HIV may be spreading. According to the U.S. Department of Health & Human Services, about 25% of people who have HIV in the U.S. are co-infected with Hepatitis C.

On Thursday, state authorities stepped in. Gov. Pence allowed local officials to start a 30-day needle-exchange program in Scott County as a way to stop the outbreak. “I do not enter this lightly,” Pence said, according to the Indianapolis Star. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs.”

MORE This Contraceptive is Linked to a Higher Risk of HIV

While dozens of cases have been reported, it’s likely that there are many more still unconfirmed. “I don’t expect these counties will remain the center of the epidemic,” Meyerson says. “I’m sure it’s going to be in other parts of southern Indiana, wherever our system is the weakest. We don’t know what we don’t know right now.”

Read next: At Least 120 Now Infected In Indiana HIV Outbreak

Listen to the most important stories of the day.

TIME HIV/AIDS

Scientists Find a Way to Block HIV from Infecting Healthy Cells

475180273
Getty Images HIV viruses infecting a human immune cell

Researchers overcome a major hurdle in developing the ultimate protection against HIV

Reporting in the journal Nature, scientists describe a new way to potentially block HIV from infiltrating healthy cells. Such interference is key to protecting people from HIV infection, but most efforts so far haven’t been successful.

This time, however, may be different. Michael Farzan, professor of infectious diseases at Scripps Research Institute, and his team used a gene therapy technique to introduce a specific HIV disruptor that acted like gum on HIV’s keys. Once stuck on the virus’s surface, the peptide complex prevents HIV from slipping into the molecular locks on healthy cells. Because the gum isn’t picky about which HIV strain it sticks to—as long as it’s HIV—the strategy works against all of the strains Farzan’s group tested in the lab, including both HIV-1 and HIV-2 versions that transmit among people, as well as simian versions that infect monkeys. In lab dishes containing the virus and human and animal cells, the disruptor managed to neutralize 100% of the virus, meaning it protected the cells from getting infected at all.

MORE: The End of AIDS

The strategy is based on what HIV experts know about how the virus infects healthy cells. HIV looks for a protein, or receptor on immune cells called CD4, which serves as the lock, and uses a specially designed portion of its own viral coat made up of three proteins as the key. Once HIV finds its target and the match is made, the virus changes its shape to better slip inside the healthy cell, where it takes over the cell’s machinery and churns out more copies of itself. Farzan’s gum, called eCD4-Ig, not only seeks out these parts of the key and renders them useless, but by glomming onto the key, also causes the virus to morph prematurely in search of its lock. Once in lock-finding mode, the virus can’t return to its previous state and therefore is no longer infectious.

The encouraging results suggest that eCD4-Ig could provide long-term protection against HIV infection, like a vaccine; in four monkeys treated with gene therapy to receive eCD4-Ig, none became infected with HIV even after several attempts to infect them with the virus. The protection also seems to be long-lasting. So far, the treated monkeys have survived more than a year despite being exposed to HIV, while untreated control monkeys have died after getting infected.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

The strategy, while promising, is still many steps away from being tested in people. Farzan used a cold virus to introduce the eCD4-Ig complex directly into the muscle of the animals, and it’s not clear whether this will be best strategy for people. Previous gene therapy methods have led to safety issues, and concerns have been raised about controlling where and how much of the introduced material gets deposited in the body. It may also be possible to give the peptide as an injection every few years to maintain its anti-HIV effect.

MORE: HIV Treatment Works, Says CDC

Farzan anticipates that if proven safe, the strategy could help both infected patients keep levels of HIV down, as well as protect uninfected, high-risk individuals from getting infected. But many more tests will need to be done before we might see those results. Four monkeys can provide valuable information, but can’t answer questions about safety and efficacy with any confidence. “Things change when we get to humans and when we get to larger numbers,” he says. “But the data in monkeys are as encouraging as one could hope.”

TIME Innovation

Five Best Ideas of the Day: February 3

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. “Even from a libertarian point of view, vaccination is a matter of rational self-interest.”

By Ben Boychuk in the Orange County Register

2. ‘Doubt everything:’ Ukrainian students are warning their Russian counterparts not to trust Putin.

By Arslan Saidov and Claire Bigg in the Guardian

3. To reach kids where they are, provide teens crisis counseling by text.

By Alice Gregory in the New Yorker

4. Is the secret to a cure for HIV lurking in dormant pools of the virus?

By Catharine Paddock in Medical News Today

5. 3D-printed ‘cool bricks’ can naturally air condition a room.

By Whitney Hipolite in 3DPrint.com

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Unlicensed Cambodian Medic Charged With Murder After Allegedly Spreading HIV

212 HIV cases were found in the community where he practiced

An unlicensed medic is being charged with murder after Cambodian medical authorities found 212 cases of HIV in the district where he had been treating patients, allegedly with contaminated equipment.

Yem Chrin treated poor patients and was believed to have healing powers, Reuters reports. However, he did not have a medical license and was allegedly delivering injections and blood transfusions using unclean equipment. Authorities tested 1,940 people in the northwestern province where Yem Chrin worked, and 212 tested positive for HIV. Some children as young as 6 years old tested positive for the virus, according to al-Jazeera.

Yem Chrin allegedly told police that he sometimes used the same syringe on two or three patients before disposing of it.

The World Health Organization and UNAIDS found that “the percentage of people that reported receiving an injection or intravenous infusion as part of their health treatment was significantly higher among the people who tested positive for HIV than the people who were HIV negative,” in the area in which Yem Chrin treated patients, Reuters reports.

The development is a setback in Cambodia’s largely successful efforts to eradicate the virus since it first spread through the country in the 1990s.

[Reuters]

TIME HIV/AIDS

African Countries Should Spend More in AIDS Response, Study Says

A mother holds the hand of her Aids stricken son in Rakai, Ugand
Getty Images

To meet AIDS eradication goals, study says funding should be re-allocated

Twelve African countries with the highest prevalence of HIV/AIDS are currently the largest recipients of international AIDS funding. But it’s now possible for many of them to make domestic spending on the disease a priority, a new study says.

As countries in sub-Saharan Africa gain better financial footing, funds from donor countries are tightening. Researchers from Harvard School of Public Health and the Results for Development Institute decided to test a couple of scenarios to see whether funding for the AIDS response could be re-allocated so African countries would finance a greater share.

Their results, published in the journal The Lancet Global Health, show that overall, the 12 countries—Botswana, Côte d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia—could provide a greater share of the costs of AIDS programs in their countries over the next five years. However, several countries will still need support from donors, even if they were to provide their maximum funds.

MORE: The End of AIDS

By looking at factors like expected growth and total government spending, and then comparing them to the countries’ AIDS needs, the researchers found that in most scenarios, AIDS expenditures for three of the upper-middle-income countries (Botswana, Namibia and South Africa) exceed their needs. In many cases, they found, these three countries could actually fund their needs solely from domestic resources. Other low-income countries like Mozambique and Ethiopia would still need to largely rely on donors.

Currently, the dozen countries are home to more than 50% of AIDS cases worldwide, as well as 56% of financial aid for the disease. They also account for 83% of funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which makes up one of the largest shares of international donations. In 2014, the United Nations program UNAIDS estimated that a “fast-tracked” response to ending the AIDS epidemic would mean we’d need $35 billion each year by 202o, but in 2012, only $19 billion was available and almost half came from international sources. To meet such goals, the researchers suggest their new funding strategy.

Almost none of the 12 countries meet possible financing benchmarks that the study authors believe to be reasonable. If the countries spent more domestically, researchers say that self-funding could increase 2.5 times and could cover 64% of future needs. That would still leave a gap of about $7.9 billion.

“Coupled with improved resource tracking, such metrics could enhance transparency and accountability for efficient use of money and maximize the effect of available funding to prevent HIV infections and save lives,” the study authors conclude. Sharing the financial burden of AIDS more equitably may be one strategy for eradicating the disease faster.

TIME China

Chinese Officials Investigate Land Grabs by ‘AIDS Demolition Team’

"Leave your homes, or we will give you AIDS"

Chinese authorities are investigating allegations that a team charged with demolishing homes for new developments has been threatening residents with HIV/AIDS if they refuse to leave.

A crew of workers dubbed the “AIDS demolition team” in China’s northeastern Henan province is accused of telling residents they will infect them with AIDS if they resist moving out, Reuters reports, citing state media. The allegations combine two pernicious problems in China: a widespread misunderstanding and fear of AIDS and land grabs from poor homeowners who have few recourses for redress.

The government in Nanyang, a city of over 10 million in Henan, confirmed to state media that the team exists but said it is unaffiliated with the government.

“It is not yet known whether the team really included AIDS patients or just used the disease as a threat,” the government said, adding that it will investigate the workers.

Earlier this month, hundreds of people in Sichuan province signed a petition seeking to throw an HIV-positive eight-year-old boy out of their village. Beijing has promised to ensure the child receives medical treatment, an education and a living allowance.

[Reuters]

TIME health

Until 2014, This Man Was TIME’s Only Medical Person of the Year

TIME 1996: Dr. David Ho

For 2014, the Ebola Fighters have been selected. In 1996, the Man of the Year was AIDS researcher Dr. David Ho

“Some ages are defined by their epidemics,” wrote Philip Elmer-De Witt in TIME’s 1996 Man of the Year issue. The 14th century was the time of the bubonic plague. The 16th brought smallpox to the new world. In the early 20th century, influenza rampaged. “Today,” he wrote back then, “we live in the shadow of AIDS–the terrifyingly modern epidemic that travels by jet and zeros in on the body’s own disease-fighting immune system.”

The idea that a virus or bacterium can change the world — and that the men and women who fight them can too — is no less true now than it was then. On Wednesday, TIME announced that the Ebola Fighters have been named the Person of the Year for 2014.

As TIME’s Editor Nancy Gibbs notes, this year’s Ebola outbreak has brought forward heroes while raising the question of how the world can turn their personal sacrifices into new ways to fight the virus, to respond to epidemics and to care for those who need it most.

And though AIDS and Ebola remain two of the most frightening diseases on earth, looking back at 1996’s Man of the Year cover story can bring at least a little hope that those questions stand a chance of being answered. (There were theoretical medical researchers included in the 1960 Men of the Year issue, honoring U.S. scientists, but their work as doctors was not the focus of the story; Dr. Ho is the only Man of the Year prior to 2014 selected specifically for his work with a disease.) At the time, AIDS was a death sentence — but Ho, by successfully lowering the virus count in patients who received a combination of new and powerful drugs when they’d only just been infected, helped change the way the medical community looked at HIV and AIDS.

Nearly two decades later, though an AIDS vaccine is still not a reality, progress has been substantial. AIDS researchers have found their answers to many of the questions Ebola fighters face today. Treatment protocols are well established (if not applied equally all over the world). Survival is no longer miraculous. It’s possible to prevent transmission. And, just this winter, TIME took a look at the state of AIDS in San Francisco and found that, against what would have once seemed impossible odds, the city has the elimination of the disease in its sights.

Dr. Ho continues to direct the Aaron Diamond AIDS Research Center; in 2010, TIME profiled him again and found that he was still pioneering new ways of treating the disease. That tireless work by Ho and his colleagues is one of the reasons AIDS is no longer a defining disease of our time — and if he demonstrates that devotion and dedication can make a difference, that’s just one more reason to honor the Ebola fighters.

Read the full story about Dr. David Ho, here in the TIME Vault: Man of the Year, Dr. David Ho

TIME health

How the Mystery of AIDS Created Dangerous Myths

SIDA
Michel Setboun—Gamma-Rapho / Getty Images Microscope view of HIV, 1985

Dec. 10, 1981: The New England Journal of Medicine publishes a series of articles about a new disease that appears to target gay men

The early days of the AIDS epidemic were dangerous not just because a killer virus was sweeping across America, but because the mysterious syndrome spawned its own damaging myths.

On this day, Dec. 10, in 1981, the New England Journal of Medicine published three landmark articles and an editorial attempting to make sense of the deadly immune deficiency, which had been identified a scant six months earlier. By December, according to the BBC, the condition had been found in 180 Americans and killed 75, nearly all of them gay men.

Doctor Michael Gottlieb was among the first to recognize the chilling threat the crisis posed. When the epidemic began, 33 years ago, Gottlieb himself was 33 and an assistant professor of immunology at the UCLA Medical Center, eagerly searching for interesting “teaching cases,” according to a profile in the American Journal of Public Health.

One case that caught his attention was a harbinger of the devastation to come: a young gay man with an array of serious health problems more common to organ transplant patients than otherwise robust young people. Gottlieb and his fellow immunologists found that the man had virtually none of the “helper” cells that fight infection. After coming across several similar cases, the doctor suspected that some new, unknown virus was responsible. He told the editor of the New England Journal of Medicine that it might be “a bigger story than Legionnaire’s disease.”

To warn the medical community, Gottlieb put out his preliminary findings in the weekly report issued by the U.S. Centers for Disease Control and Prevention. By the time the journal article came out in December, other doctors from around the country had reported similar cases and were hunting for a cause.

One early theory pegged the spread of the disease — which the CDC named AIDS — to a club drug called “poppers,” although the correlation quickly broke down. New evidence that the virus was transmitted through bodily fluids emerged when heterosexual drug users began reporting symptoms, apparently after sharing dirty needles.

By then, however, hysteria over the agonizing illness had led to a proliferation of myths about its transmission. Those myths lingered long after they were disproved, adding another layer of stigma for the syndrome’s victims.

For example, in 1988 — by which time AIDS was well enough understood to make such claims preposterous — a sensationalistic book, Crisis: Heterosexual Behavior in the Age of AIDS, stirred new panic with old assertions about how the syndrome was spread. According to TIME’s review of the book, the authors suggested that contracting AIDS was as easy as using the toilet after someone with the virus, being bitten by the same mosquito or even getting to second base. This last was meant as a literal warning to baseball players, not a metaphor for heavy petting: a player could catch the virus by sliding onto the base “if, by chance, an infected player has bled onto it,” the book warned.

When confused — and terrified — callers jammed AIDS hotlines, one epidemiologist fumed, “This is the AIDS equivalent of shouting ‘Fire!’ in a crowded theater.”

Read more about the early search for the HIV virus, here in TIME’s archives: Hunting for the Hidden Killers

TIME portfolio

The Best Pictures of the Week: Nov. 28 – Dec. 5.

From ousted Egyptian President Hosni Mubarak’s acquittal to protests over Eric Garner’s chokehold death verdict and the launch of NASA’s unmanned exploration spacecraft Orion to the White House’s Christmas decorations, TIME presents the best pictures of the week.

Your browser is out of date. Please update your browser at http://update.microsoft.com