Early and contemporary drivers of the HIV-1 group M pandemic

HIV emerged silently taking time to spread and become visible only through geographically isolated clusters of life-threatening immunodeficiency, known as AIDS since the early 80s. The clusters of infection expanded, overlapping to evolve into a pandemic that is ongoing and almost as silent. Phylogenetic analysis places the emergence of HIV-1 group M, the subtype responsible for the pandemic, in the human population more than 100 years ago. Once established, the rate and direction of spread of HIV-1 from local, to national, to contemporary pandemic proportions have varied over time and place. The literature presents many theories on the emergence and drivers of the spread of the virus over the past century. Here, historical evidence and phylogenetic models are reviewed to seek clarity on the emergence, geographic spread and key world events that mark the progression of the HIV-1 pandemic. This narrative review places particular focus on: war (both its direct and indirect affects), trade and economic expansion, changes in sexual behaviors, and public health policy. Investigating the impact of major world events and policy on the emergence and spread of HIV-1 may aid better understanding of what influences the viruses transmission dynamic. By identifying multilateral targets that influence transmission, up-scaled efforts to effectively control, if not remove, HIV-1 from the human population become a possibility. Suggestions for revisions in HIV-1 global public health policy are discussed. Refocused efforts to tackle HIV-1 transmission and replace the need to manage the pathology of this terrible disease are both ethically and economically just.