Thirty years ago, we learned of a disease that began with a few cases and quickly transformed into an epidemic the world had not seen before. We were not exactly sure what it was, how it was spread, or how to care for people who had it. HIV & AIDS has had a dramatic impact on the world – and especially on people in low and middle income countries. Over the past 30 years, AIDS programming responses have changed due to developments in public health science, politics, economics, and organizational capacity.
As we look through the past thirty years, there have been three distinct generations of AIDS responses and programming. In the 1980s, what we refer to as the Zero Generation, there was no effective response. Little was known and little was done about HIV & AIDS. Prevention was rudimentary, treatment nonexistent, and funding limited.
By 1990, the epidemic was already showing signs of spiraling out of control. The First-Generation programs were characterized by limited funding, a focus on prevention, continued denial in many parts of the world, and—as before— essentially no treatment in low- and middle-income countries.