HIV/AIDS and the links between science and technology

Soon after the AIDS epidemic was recognized it became apparent that the world was faced with a major public health crisis. Millions of people, perhaps many millions were going to die and there were no known ways to deal with the disease. As it became apparent that HIV was a retro-virus that attacked the immune system, that it was silent for some time even after the victims could infect others, and that it was quite contagious the problems became more evident and of greater concern.

Scientific research not only identified the nature of the virus and the way that it functioned, but epidemiological research soon identified that the disease was concentrated in homosexual males, in intravenous drug users, in those who had sexual contacts with these first groups and in certain geographical areas. It became obvious that public health measures should include campaigns to promote safe sex, case finding, campaigns to reduce transmission by shared needles among intravenous drug users, prevention of HIV transmission via blood transfusions, and that these measures were of greatest urgency in places in Africa and Haiti were the epidemic was most advanced. Epidemiological techniques were quickly applied to measuring the effectiveness of these approaches.

At the time of the discovery of the epidemic, there were no pharmaceuticals available to cure viral infections, much less infections of RNA retro-viruses. Indeed, decades later there are still none. A major research program was undertaken to develop anti-retroviral drugs which was successful first in development of AZT in the early 1990s, then other agents, and later the antiviral combinations that are now in use. The development of these drugs was greatly enhanced by scientific research illuminating the nature of the virus, the cells and organs it attacked, the natural history of the disease progression in patients, and the infective mechanisms.

It was thought that it might be possible to develop a vaccine to prevent infection at least in a large percentage of those who received the vaccine. Epidemiological evidence that some people seemed to be in high risk groups and engaged in behavior that created risk who did not exhibit HIV infection added to the hope that a vaccine could be found. Of course, decades have passed in which billions of dollars have been spent to develop such a vaccine, and we still do not have one; the problem is that the traditional approaches which worked with so many viral diseases did not work in developing an effective HIV vaccine. Still the effort continues, but it continues based on a vastly increased understanding of the HIV virus, the immune system, the population dynamics of the virus in the infected individual, and the processes of immunization; all this understanding was developed by biomedical science, much of it by research specifically intended to support HIV vaccine development.

In short, there has been a very serious and well financed scientific program developed in support of the effort to develop effective technology to limit the extent of the HIV/AIDS epidemic and to ameliorate the effects of the disease in those infected. Indeed, some of the scientific evidence that has been accumulated arises directly out of efforts to develop pharmaceutical agents to detect, prevent and cure the disease. Technology development and science have been so closely intertwined as to make it difficult to draw boundaries between scientific research and technology development. Indeed, investigators have told me that they write a proposal for support for their work to emphasize basic research, applied research or technology development according to the preferences of the funding agency rather than the nature of the project which they fully intend to prosecute if funded.

This is one of a series of postings occasioned by reading Brian Arthur's book, The Nature of Technology: What it is and How it Evolves:

• Thoughts on invention on reading Brian Arthur's book
• Classification and Technology
• A Thought About Engineering and Technology
• More on Arthur's Nature of Technology
• The Nature of Technology