Visual History of the World




From Prehistoric to Romanesque  Art
Gothic Art
Renaissance  Art
Baroque and Rococo Art
The Art of Asia
Neoclassicism, Romanticism  Art
Art Styles in 19th century
Art of the 20th century
Artists that Changed the World
Design and Posters
Classical Music
Literature and Philosophy

Visual History of the World
First Empires
The Ancient World
The Middle Ages
The Early Modern Period
The Modern Era
The World Wars and Interwar Period
The Contemporary World

Dictionary of Art and Artists


The Contemporary World

1945 to the present

After World War II, a new world order came into being in which two superpowers, the United States and the Soviet Union, played the leading roles. Their ideological differences led to the arms race of the Cold War and fears of a global nuclear conflict. The rest of the world was also drawn into the bipolar bloc system, and very few nations were able to remain truly non-aligned. The East-West conflict came to an end in 1990 with the collapse of the Soviet Union and the consequent downfall of the Eastern Bloc. Since that time, the world has been driven by the globalization of worldwide economic and political systems. The world has, however, remained divided: The rich nations of Europe, North America, and East Asia stand in contrast to the developing nations of the Third World.

The first moon landing made science-fiction dreams reality in the year 1969.
Space technology has made considerable progress as the search for new
possibilities of using space continues.



Africa since the Independence of its Nations

SINCE 1945


see also: United Nations member states -

Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad,
Comoros, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea,
Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Madagascar, Malawi, Mali,
Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal,
Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe


The nations of Sub-Saharan Africa that became independent after 1957 have continued to suffer the consequences of their continent's experience of colonialism. The optimism of the early years of independence soon gave way to repeated military coups, violent conflicts, and popular disillusionment with promises to end poverty and improve living conditions. Other problems faced in parts of the region include drought and famines, limited access to drinking water, and the alarming growth of HIV/AIDS since the 1980s. These problems are compounded by authoritarian and frequently corrupt regimes.


The Republic of the Congo and the Democratic Republic

Since their independence, both of these French-speaking former colonies in the Congo region have been unable to find lasting peace.


At the end of the 19th century, both Belgium and France claimed the 1 Congo region. Belgium took the territory around the capital of Leopoldvillc, while France claimed the area around Brazzaville.

After World War II, Fulbert Youlou established himself as the leader of the independence movemerit in Brazzaville. When the former French Congo became a sovereign state in i960, Youlou became its president and quickly installed a brutal regime. He was deposed in 1963, and Alphonse Massamba-Debat, introduced a socialist state. After a power struggle, Marien Ngouabi then triumphed in 1968, setting up the Congolese Workers' Party (PCT), and in 1970 proclaimed the communist People's Republic of the Congo. Following his assassination, Denis Sassou-Nguesso was appointed president by the PCT in 1979. In 1990 he established a multiparty system and introduced democratic reform. The first election in 1992 was won by the opposition, whereupon violence erupted and a three-year civil war began. Sassou-Nguesso has held power in the Republic of the Congo since his forces seized Brazzaville in 1997, although fighting continues.

The Belgian Congo, whose 2 mineral resources were exploited by Belgian mining companies, has been crisis-ridden since gaining 4 independence in 1960.

1 Traditional village huts, Belgian Congo

2 Industrial plant refining copper mined in the region of Jadotville, Zaire, 1959

4 During the ceremony marking the independence
of the Democratic Republic of Congo, King Baudoum
of Belgium (left) gives a speech; Joseph Kasavubu
(seated) is also in attendance

The leaders of the independence movement, 3 Joseph Kasavubu and 6 Patrice Lumumba, became president and prime minister of the new Democratic Republic of the Congo, whose capital was Leopoldville.

Lumumba became an international figure in the liberation movement with his demands lor a complete decolonization ol Africa. In 1960, the mineral-rich province of Katanga, led by 5 Moise Tschombe, announced its secession: a simultaneous mutiny bv the army left the government helpless.

3 Joseph Kasavubu, independence leader, 1965

6 Freedom fighters for fhe independence of Congo Patrice Lumumba in Brussels in January 1960

5 Moise Tschombe, prime
minister of the mineral-rich
Congolese province of
Katanga, 1961

The UN Security Council sent troops to oversee the disarmament of the Katangan forces. The army remained a threat and were suspected of the abduction and murder of Lumumba in January 1961.

In November 1965 General 8 Mobutu Sese Seko led a military coup. He ruled dictatorially.

Mobutu renamed the country Zaire and the capital Kinshasa, and he lavished patronage on his own clan. The corruption that enriched Mobutu and his clients was disastrous for the economy. In the earlv 1990s Mobutu began to share power by forming a coalition, bin this imported power struggles into the government.

In May 1997, while Mobutu was abroad for medical treatment, an alliance under 7 Laurent-Desire Kabila seized power.

In 1998 the country, renamed the Democratic Republic ol the Congo, became a war zone, as five neighboring states sent their own rebel fighting groups into tilt counti v. the war elided with a tentative peace in ?oo? but is tlnni'jht to haw-cost more than two million lives.

In 1998 the country, renamed the Democratic Republic of the Congo, became a war zone, as five neighboring states sent their own rebel fighting groups into the country. The war ended with a tentative peace in 2002 but is thought to have cost more than two million lives.

8 Mobutu Sese Seko, 1994

7 The Zairan rebel leader
Laurent Kabila, 1997



East Africa

While Somalia and the Sudan have experienced violence and political chaos, relatively stable political systems have emerged in 9 Tanzania and Kenya.


After 10 Tanganyika and the island of Zanzibar were granted independence from Great Britain in 1961 and 1963, they united to form Tanzania in 1964.

The first president, Julius Nyerere, stayed in office until 1985 and developed a socialist one-party system. After his resignation, Ali Hassan Mwinyi oversaw the transition to multiparty politics. Despite poverty and reliance on foreign aid, the country has remained stable under his successor Benjamin William Mkapa.

Uganda became independent in 1963. Premier 12 Milton Obote founded a socialist one-party state in 1966.

After an army coup in 1971, 9 General Idi Amin established one of Africa's bloodiest regimes: at least 200,000 people fell victim to his security forces.

10 Zebras grazing on a savanna in Tanzania

12 Premier Milton Obote during a conference in Nairobi of the Organization of African Union in the 1980s

9 General Idi Amin, who later became
known as the "Butcher of Africa"

In April 1979 he was toppled, and Obote returned to power. President Yoweni Museveni, in office since 1986, has brought some stability to the country despite the rebel groups that continue to operate in the north.

Kenyan politics were dominated by the rule of Jomo Kenyatta from independence in 1963 until his death in 1978. Under growing pressure, his successor Daniel Arap Moi permitted multiparty elections after upheavals in 1991. Moi was defeated in the 2002 elections, and his successor Mwai Kbaki has pledged to fight Kenya's major corruption problem.

In 1969 military forces under General Siad Barre seized power in Somalia. Heavy fighting with rebel groups led to the flight of Barre in 1991 and to the secession
of the Republic of Somaliland.

In 1992-1994, US and 13 UN troops intervened unsuccessfully in the civil war, and since then no central government has established effective control over the country.

In Ethiopia. Emperor Haile Selassie was overthrown by the military in 1974. Between 1977 and 1979. thousands died under the "Red Terror" regime of Mengistu Haile Mariam, who also instigated a program of forced collectivization. He was overthrown in 1991 after the secession of the provinces of Eritrea and Tigray. The country suffered a famine in 1985 that led to a major international relief effort. Following a war with neighboring Eritrea in 1999-2000, both countries have accepted mediation.

Ever since its independence in 1956, Sudan has suffered from conflicts between Muslims, Christians, and members of African faiths. A military coup in June 1989 brought to power Islamic forces, whose attempts to introduce religion into public life caused conflict with other groups.

Since 2003, a 11 campaign of ethnic cleansing and massacres against the population by government-backed Arab militias in Darfur has led to accusations of genocide.

13 In Baidoa, a Somalian child runs towards a rescue convoy; on the left, a French soldier watches closely, holding a weapon to cover the child's dash for the safety of the convoy, December 17, 1992

11 Sudanese secret police intervening
against rebels from the opposition,
October 14, 2004



AIDS in Africa

More than 25 million Africans are infected with thå human immunodeficiency virus (HIV). More than 70 percent of all HIV-infected people worldwide live in sub-Saharan Africa.

Resources for prevention and treatment are lacking, although some countries, notably Uganda, have reduced new infections through educational initiatives.

In most of Africa HIV/AIDS is the leading cause of death





byname of acquired immunodeficiency syndrome

transmissible disease of the immune system caused by the human immunodeficiency virus (HIV). HIV is a lentivirus (literally meaning “slow virus”; a member of the retrovirus family) that slowly attacks and destroys the immune system, the body’s defense against infection, leaving an individual vulnerable to a variety of other infections and certain malignancies that eventually cause death. AIDS is the final stage of HIV infection, during which time fatal infections and cancers frequently arise.

The emergence of HIV/AIDS
Details of the origin of HIV remain unclear. However, a lentivirus that is genetically similar to HIV has been found in chimpanzees and gorillas in western equatorial Africa. This virus is known as simian immunodeficiency virus (SIV), and it was once widely thought to be harmless in chimpanzees. However, in 2009 a team of researchers investigating chimpanzee populations in Africa found that SIV in fact causes AIDS-like illness in the animals. SIV-infected chimpanzees have a death rate that is 10 to 16 times higher than their uninfected counterparts. The practice of hunting, butchering, and eating the meat of chimpanzees may have allowed transmission of the virus to humans, probably in the late 19th or early 20th century. The strain of SIV found in gorillas is known as SIVgor, and it is distinct from the strain found in chimpanzees. Because primates are suspected to be the source of HIV, AIDS is considered a zoonosis, an infection that is shared by humans and other vertebrate animals.

Genetic studies of a pandemic strain of HIV, known as HIV-1 group M, have indicated that the virus emerged between 1884 and 1924 in central and western Africa. Researchers estimate that this strain of the virus began spreading throughout these areas in the late 1950s. Later, in the mid-1960s, an evolved strain called HIV-1 group M subtype B spread from Africa to Haiti. In Haiti this subtype acquired unique characteristics, presumably through the process of genetic recombination. Sometime between 1969 and 1972, the virus migrated from Haiti to the United States. The virus spread within the United States for about a decade before it was discovered in the early 1980s. The worldwide spread of HIV-1 was likely facilitated by several factors, including increasing urbanization and long-distance travel in Africa, international travel, changing sexual mores, and intravenous drug use.

In 1981 investigators in New York and California reported the first official case of AIDS. Initially, most cases of AIDS in the United States were diagnosed in homosexual men, who contracted the virus primarily through sexual contact, and in intravenous drug users, who became infected mainly by sharing contaminated hypodermic needles. In 1983 French and American researchers isolated the causative agent, HIV. (In 2008 French virologists Françoise Barré-Sinoussi and Luc Montagnier were awarded the Nobel Prize for Physiology or Medicine for their discovery of HIV.) By 1985 serological tests to detect the virus had been developed. According to the 2007 United Nations report on AIDS, an estimated 33.2 million people were living with HIV, approximately 2.5 million people were newly infected with HIV, and about 2.1 million people died of AIDS. Relative to previous years, the statistics for 2007 reflect a decrease in the annual number of new infections and deaths from AIDS and an increase in the overall number of people living with AIDS. Some 25 million people have died of the disease since 1981.

People living in sub-Saharan Africa account for about 70 percent of all infections, and in some countries of the region the prevalence of HIV infection of inhabitants exceeded 10 percent of the population. Rates of infection are lower in other parts of the world, but different subtypes of the virus have spread to Europe, India, South and Southeast Asia, Latin America, and the Caribbean. Rates of infection have leveled off somewhat in the United States and Europe. In the United States nearly one million people are living with HIV/AIDS, and half of all new infections are among African Americans. In Asia the sharpest increases in HIV infections are found in China, Indonesia, and Vietnam. Access to retroviral treatment for AIDS remains limited in some areas of the world, although more people are receiving treatment today than in the past.

Groups and subtypes of HIV
Genetic studies have led to a general classification system for HIV that is primarily based on the degree of similarity in viral gene sequence. The two major classes of HIV are HIV-1 and HIV-2. HIV-1 is divided into three groups, known as group M (main group), group O (outlier group), and group N (new group). Worldwide, HIV-1 group M causes the majority of HIV infections, and it is further subdivided into subtypes A through K, which differ in expression of viral genes, virulence, and mechanisms of transmission. In addition, some subtypes combine with one another to create recombinant subtypes. HIV-1 group M subtype B is the virus that spread from Africa to Haiti and eventually to the United States. Pandemic forms of subtype B are found in North and South America, Europe, Japan, and Australia. Subtypes A, C, and D are found in sub-Saharan Africa, although subtypes A and C are also found in Asia and some other parts of the world. Most other subtypes of group M are generally located in specific regions of Africa, South America, or Central America.

In 2009 a new strain of HIV-1 was discovered in a woman from Cameroon. The virus was closely related to a strain of SIV found in wild gorillas. Researchers placed the new virus into its own group, HIV-1 group P, because it was unique from all other types of HIV-1. It was unclear whether the newly identified virus causes disease in humans.

HIV-2 is divided into groups A through E, with subtypes A and B being the most relevant to human infection. HIV-2, which is found primarily in western Africa, can cause AIDS, but it does so more slowly than HIV-1. There is some evidence that HIV-2 may have arisen from a form of SIV that infects African green monkeys.

HIV is transmitted by the direct transfer of bodily fluids, such as blood and blood products, semen and other genital secretions, or breast milk, from an infected person to an uninfected person. The primary means of transmission worldwide is sexual contact with an infected individual. HIV frequently is spread among intravenous drug users who share needles or syringes. Prior to the development of screening procedures and heat-treating techniques that destroy HIV in blood products, transmission also occurred through contaminated blood products; many people with hemophilia contracted HIV in this way. Today the risk of contracting HIV from a blood transfusion is extremely small. In rare cases transmission to health care workers may occur by an accidental stick with a needle used to obtain blood from an infected person. The virus also can be transmitted across the placenta or through the breast milk from mother to infant; administration of antiretroviral medications to both the mother and infant around the time of birth reduces the chance that the child will be infected with HIV. HIV is not spread by coughing, sneezing, or casual contact (e.g., shaking hands). HIV is fragile and cannot survive long outside of the body. Therefore, direct transfer of bodily fluids is required for transmission. Other sexually transmitted diseases, such as syphilis, genital herpes, gonorrhea, and chlamydia, increase the risk of contracting HIV through sexual contact, probably through the genital lesions that they cause.

Life cycle of HIV
The main cellular target of HIV is a special class of white blood cells critical to the immune system known as helper T lymphocytes, or helper T cells. Helper T cells are also called CD4+ T cells because they have on their surfaces a protein called CD4. Helper T cells play a central role in normal immune responses by producing factors that activate virtually all the other immune system cells. These include B lymphocytes, which produce antibodies needed to fight infection; cytotoxic T lymphocytes, which kill cells infected with a virus; and macrophages and other effector cells, which attack invading pathogens. AIDS results from the loss of most of the helper T cells in the body.

HIV is a retrovirus, one of a unique family of viruses that consist of genetic material in the form of RNA (instead of DNA) surrounded by a lipoprotein envelope. HIV cannot replicate on its own and instead relies on the mechanisms of the host cell to produce new viral particles. HIV infects helper T cells by means of a protein embedded in its envelope called gp120. The gp120 protein binds to a molecule called CD4 on the surface of the helper T cell, an event that initiates a complex set of reactions that allow the HIV genetic information into the cell. Entry of HIV into the host cell also requires the participation of a set of cell surface proteins that normally serve as receptors for chemokines (hormone-like mediators that attract immune system cells to particular sites in the body). It appears that the binding of gp120 to CD4 exposes a region of gp120 that interacts with the chemokine receptors. This interaction triggers a conformational change that exposes a region of the viral envelope protein gp41, which inserts itself into the membrane of the host cell so that it bridges the viral envelope and the cell membrane. An additional conformational change in gp41 pulls these two membranes together, allowing fusion to occur. After fusion the viral genetic information can enter the host cell.

Once the virus has infected a T cell, HIV copies its RNA into a double-stranded DNA copy by means of the viral enzyme reverse transcriptase; this process is called reverse transcription because it violates the usual way in which genetic information is transcribed. Because reverse transcriptase lacks the “proofreading” function that most DNA synthesizing enzymes have, many mutations arise as the virus replicates, further hindering the ability of the immune system to combat the virus. These mutations allow the virus to evolve very rapidly, approximately one million times faster than the human genome evolves. This rapid evolution allows the virus to escape from antiviral immune responses and antiretroviral drugs. The next step in the virus life cycle is the integration of the viral genome into the host cell DNA. Integration occurs at essentially any accessible site in the host genome and results in the permanent acquisition of viral genes by the host cell. Under appropriate conditions these genes are transcribed into viral RNA molecules. Some viral RNA molecules are incorporated into new virus particles, while others are used as messenger RNA for the production of new viral proteins. Viral proteins assemble at the plasma membrane together with the genomic viral RNA to form a virus particle that buds from the surface of the infected cell, taking with it some of the host cell membrane that serves as the viral envelope. Embedded in this envelope are the gp120/gp41 complexes that allow attachment of the helper T cells in the next round of infection. Most infected cells die quickly (in about one day). The number of helper T cells that are lost through direct infection or other mechanisms exceeds the number of new cells produced by the immune system, eventually resulting in a decline in the number of helper T cells. Physicians follow the course of the disease by determining the number of helper T cells (CD4+ cells) in the blood. This measurement, called the CD4 count, provides a good indication of the status of the immune system. Physicians also measure the amount of virus in the bloodstream—i.e., the viral load—which provides an indication of how fast the virus is replicating and destroying helper T cells.

Genome of HIV
The genome of HIV mutates at a very high rate, and thus the virus in each infected individual is slightly different. The genetic mechanisms that underlie this individual variation have been investigated through approaches based on genome sequencing. The HIV-1 genome in 2009 was the first HIV genome to be sequenced in its entirety. Prior to this achievement, the ability of HIV RNA to fold into highly intricate structures had complicated attempts to elucidate the genomic sequence, and scientists could sequence only small segments of the genome. The HIV-1 genome is composed of 9,173 nucleotides of RNA (nucleotides are the building blocks of nucleic acids).

Sequencing revealed that variation occurs throughout the HIV genome but is especially pronounced in the gene encoding the gp120 protein. By constantly changing the structure of its predominant surface protein, the virus can avoid recognition by antibodies produced by the immune system. Sequencing also has provided useful insight into genetic factors that influence viral activity. Knowledge of these factors is expected to contribute to the development of new drugs for the treatment of AIDS.

Course of infection
The course of HIV infection involves three stages: primary HIV infection, the asymptomatic phase, and AIDS. During the first stage the transmitted HIV replicates rapidly, and some persons may experience an acute flulike illness that usually persists for one to two weeks. During this time a variety of symptoms may occur, such as fever, enlarged lymph nodes, sore throat, muscle and joint pain, rash, and malaise. Standard HIV tests, which measure antibodies to the virus, are initially negative because HIV antibodies generally do not reach detectable levels in the blood until a few weeks after the onset of the acute illness. As the immune response to the virus develops, the level of HIV in the blood decreases.

The second phase of HIV infection, the asymptomatic period, lasts an average of 10 years. During this period the virus continues to replicate, and there is a slow decrease in the CD4 count (the number of helper T cells). When the CD4 count falls to about 200 cells per microlitre of blood (in an uninfected adult it is typically about 1,000 cells per microlitre), patients begin to experience opportunistic infections—i.e., infections that arise only in individuals with a defective immune system. This is AIDS, the final stage of HIV infection. The most common opportunistic infections are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium infection, herpes simplex infection, bacterial pneumonia, toxoplasmosis, and cytomegalovirus infection. In addition, patients can develop dementia and certain cancers, including Kaposi sarcoma and lymphomas. Death ultimately results from the relentless attack of opportunistic pathogens or from the body’s inability to fight off malignancies.

A small proportion of individuals infected with HIV have survived longer than 10 years without developing AIDS. It was suspected for many years that such individuals mount a more vigorous immune response to the virus, but scientists could not explain why. Then, in 2006, a variation called a single nucleotide polymorphism, or SNP, in the HLA-G gene—human leukocyte antigen G, a gene that codes for a molecule that stimulates immune response—was identified in a subset of female prostitutes who had remained HIV-negative despite having had sexual contact with more than 500 HIV-positive men. In 2007 scientists identified three additional SNPs responsible for an estimated 15 percent of the variability in viral load and disease progression between HIV-infected individuals. Two of these SNPs are located in genes that code for HLA-B and HLA-C, molecules that are similar to HLA-G in that they specialize in pathogen recognition and immune system activation. The third SNP is located in a gene called HCP5 (HLA complex P5), an inactive retrovirus first incorporated into the human genome millions of years ago that shares similarities in DNA sequence with HIV and is thought to interfere with viral replication.

In 2009 scientists discovered that HIV is capable of rapidly mutating to escape recognition by certain HLA immune molecules. In particular, researchers identified two forms of the HLA-B gene, known as HLA-B*51 and HLA-B*27, that produced immune molecules particularly susceptible to escape by HIV. The mutation of HIV to avoid these molecules is directly correlated to the frequency at which the HLA-B*51 and HLA-B*27 genes occur within populations. For example, the percentage of HIV-infected individuals that carried mutant virus capable of escaping immune detection by HLA-B*51 and HLA-B*27 molecules was high in populations with the highest frequencies of the HLA-B*51 and HLA-B*27 genes. In contrast, in populations with the lowest frequencies of these genes, only a small percentage of HIV-infected individuals were infected with mutant virus. The ability of HIV to mutate and hence rapidly evolve to escape immune detection by the most prevalent HLA molecules is similar to the rapid adaptation and mutation of other infectious viruses such as influenza.

Diagnosis, treatment, and prevention
Tests for the disease check for antibodies to HIV, which appear from four weeks to six months after exposure. The most common test for HIV is the enzyme-linked immunosorbent assay (ELISA). If the result is positive, the test is repeated on the same blood sample. Another positive result is confirmed using a more specific test such as the Western blot. A problem with ELISA is that it produces false positive results in people who have been exposed to parasitic diseases such as malaria; this is particularly troublesome in Africa, where both AIDS and malaria are rampant. Polymerase chain reaction (PCR) tests, which screen for viral RNA and therefore allow detection of the virus after very recent exposure, and Single Use Diagnostic Screening (SUDS) are other options. Because these tests are very expensive, they are often out of reach for the majority of the population at risk for the disease. Pharmaceutical companies are developing new tests that are less expensive and that do not need refrigeration, allowing for a greater testing of the at-risk population around the world.

There is no cure for HIV infection. Efforts at prevention have focused primarily on changes in sexual behaviour such as the practice of abstinence and the use of condoms. Attempts to reduce intravenous drug use and to discourage the sharing of needles also led to a reduction in infection rates in some areas. The first vaccine to demonstrate some level of effectiveness in preventing HIV infection was RV144, which actually consisted of two different vaccines given in succession, a strategy known as “prime boost.” Each vaccine was designed to work against strains of HIV circulating in Southeast Asia. In 2009, results from a clinical trial involving more than 16,000 volunteers in Thailand revealed that RV144 reduced the risk of HIV infection by 31.2 percent in healthy men and women between ages 18 and 30.

HIV infection is treated with three classes of antiretroviral medications. Protease inhibitors, which inhibit the action of an HIV enzyme called protease, include ritonavir, saquinivir, indinavir, amprenivir, nelfinavir, and lopinavir. Nucleoside reverse transcriptase (RT) inhibitors (e.g., abacavir [ABC], zidovudine [AZT], zalcitabine [ddC], didanosine [ddI], stavudine [d4T], and lamivudine [3TC]) and non-nucleoside RT inhibitors (e.g., efavirenz, delavirdine, and nevirapine) both inhibit the action of reverse transcriptase. Each drug has unique side effects, and, in addition, treatment with combinations of these drugs leads to additional side effects including a fat-redistribution condition called lipodystrophy.

Because HIV rapidly becomes resistant to any single antiretroviral drug, combination treatment is necessary for effective suppression of the virus. Highly active antiretroviral therapy (HAART), a combination of three or more RT and protease inhibitors, has resulted in a marked drop in the mortality rate from HIV infection in the United States and other industrialized states since its introduction in 1996. Because of its high cost, HAART is generally not available in regions of the world hit hardest by the AIDS epidemic. Although HAART does not appear to eradicate HIV, it largely halts viral replication, thereby allowing the immune system to reconstitute itself. Levels of free virus in the blood become undetectable; however, the virus is still present in reservoirs, the best-known of which is a latent reservoir in a subset of helper T cells called resting memory T cells. The virus can persist in a latent state in these cells, which have a long life span due to their role in allowing the immune system to respond readily to previously encountered infections. These latently infected cells represent a major barrier to curing the infection. Patients successfully treated with HAART no longer suffer from the AIDS-associated conditions mentioned above, although severe side effects may accompany the treatment. Patients must continue to take all of the drugs without missing doses in the prescribed combination or risk developing a drug-resistant virus; viral replication resumes if HAART is discontinued.

Antiretroviral therapy is typically initiated once CD4 levels have fallen to 200 cells per microlitre of blood, which generally coincides with the establishment of symptomatic disease. In most patients, initiating treatment at this point provides maximal therapeutic effectiveness, in that it minimizes the severity of drug toxicities and thus the risk for discontinuance of treatment and development of drug resistance. However, studies have indicated that in patients with morbidity-increasing factors, such as coinfection with a hepatitis virus or unusually rapid CD4 decline or high viral load, initiating treatment earlier, when CD4 levels have declined to 350 cells per microlitre, can improve survival and delay the onset of AIDS-related diseases significantly. Other studies have indicated that beginning antiretroviral treatment in infants immediately following diagnosis, rather than waiting until symptoms appear, can reduce infant mortality and disease progression dramatically. Such studies have resulted in the consideration of treatment recommendations that are more dynamic today than in the past, thereby improving treatment outcomes for certain subsets of patients with HIV.

The identification of gene variations in HLA-B, HLA-C, HLA-G, and HCP5 has opened avenues of drug and vaccine development that had not been previously explored for HIV infection. Scientists anticipate that therapies aimed at these genes will serve as ways to boost immune response.

Robert Siliciano

Social, legal, and cultural aspects
As with any epidemic for which there is no cure, tragedy shadows the disease’s advance. From wreaking havoc on certain populations (such as the gay community in San Francisco in the 1980s) to infecting more than one-third of adults in sub-Saharan African countries such as Botswana, Swaziland, and Zimbabwe at the turn of the 21st century, AIDS has had a devastating social impact. Its collateral cultural effect has been no less far-reaching, sparking new research in medicine and complex legal debates, as well as intense competition among scientists, pharmaceutical companies, and research institutions. Since the mid-1980s, the International AIDS Society has held regular conferences at which new research and medical advances were discussed.

In order to raise public awareness, advocates promote the wearing of a loop of red ribbon to indicate their concern. Activist groups lobby governments for funding for education, research, and treatment, and support groups provide a wide range of services including medical, nursing, and hospice care, housing, psychological counseling, meals, and legal services. Those who have died of AIDS have been memorialized in the more than 44,000 panels of the AIDS Memorial Quilt, which has been displayed worldwide both to raise funds and to emphasize the human dimension of the tragedy. The United Nations designated December 1 as World AIDS Day.

Regarding access to the latest medical treatments for AIDS, the determining factors tend often to be geographic and economic. Simply put, developing nations often lack the means and funding to support the advanced treatments available in industrialized countries. On the other hand, in many developed countries specialized health care has caused the disease to be perceived as treatable or even manageable. This perception has fostered a lax attitude toward HIV prevention (such as safe sex practices or sterile needle distribution programs), which in turn has led to new increases in HIV infection rates.

Because of the magnitude of the disease in Africa, and in sub-Saharan Africa in particular, the governments of this region have tried to fight the disease in a variety of ways. Some countries have made arrangements with multinational pharmaceutical companies to make HIV drugs available in Africa at lower costs. Other countries, such as South Africa, have begun manufacturing these drugs themselves instead of importing them. Plants indigenous to Africa are also being scrutinized for their usefulness in developing various HIV treatments.

In the absence of financial resources to pay for new drug therapies, many African countries have found education to be the best defense against the disease. In Uganda, for example, songs about the disease, nationally distributed posters, and public awareness campaigns starting as early as kindergarten have all helped to stem the spread of AIDS. Prostitutes in Senegal are licensed and regularly tested for HIV, and the clergy, including Islamic religious leaders, work to inform the public about the disease. Other parts of Africa, however, have seen little progress. For example, the practice of sexually violating very young girls has developed among some HIV-positive African men because of the misguided belief that such acts will somehow cure them of the disease. In sub-Saharan Africa the stigma associated with homosexuality and the illegal nature of this sexual orientation in some countries there have discouraged gay men from seeking treatment for the disease and have severely hindered the extension of AIDS outreach programs to this population. In 2009 the incidence of AIDS among homosexual males in certain African countries was found to be alarmingly high—some 10 times higher than in the male population at large. Furthermore, many homosexual men in those areas were reportedly unaware that the disease could be transmitted from male to male. In the opinion of many, only better education can battle the damaging stereotypes, misinformation, and disturbing practices associated with AIDS.

Laws concerning HIV and AIDS typically fall into four broad categories: mandatory reporting, mandatory testing, laws against transmission, and immigration. The mandatory reporting of newly discovered HIV infections is meant to encourage early treatment. Many countries, including Canada, Switzerland, Denmark, and Germany, have enacted mandatory screening laws for HIV. Some countries, such as Estonia, require mandatory testing of prison populations (in response to explosive rates of infection among the incarcerated). Most of the United States requires some form of testing for convicted sex offenders. Other legal and international issues concern the criminalization of knowing or unknowing transmission (more prevalent in the United States and Canada) and the rights of HIV-positive individuals to immigrate to or even enter foreign countries.

In the United States some communities have fought the opening of AIDS clinics or the right of HIV-positive children to attend public schools. Several countries—notably Thailand, India, and Brazil—have challenged international drug patent laws, arguing that the societal need for up-to-date treatments supersedes the rights of pharmaceutical companies. At the start of the 21st century many Western countries were also battling the reluctance of some governments to direct public awareness campaigns at high-risk groups such as homosexuals, prostitutes, and drug users out of fear of appearing to condone their lifestyles.

For the world of art and popular culture, HIV/AIDS has been double-edged. On the one hand, AIDS removed from the artistic heritage many talented photographers, singers, actors, dancers, and writers in the world. On the other hand, as with the tragedy of war and even the horror of the Holocaust, AIDS has spurred moving works of art as well as inspiring stories of perseverance. From Paul Monette’s Love Alone, to John Corigliano’s Symphony No. 1, to the courage with which American tennis star Arthur Ashe publicly lived his final days after acquiring AIDS from a blood transfusion—these, as much as the staggering rates of infection, constitute the legacy of AIDS.

Keith Dorwick

Encyclopaedia Britannica


see also: United Nations member states -

Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad,
Comoros, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea,
Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Madagascar, Malawi, Mali,
Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal,
Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe



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