In June, 1981, a Morbidity and Mortality Weekly Report (MMWR) article briefly described five cases of Pneumocystis pneumonia among homosexual men in Los Angeles (CA, USA). This case series, which provides the first description of what came to be known as AIDS, takes just a minute or so to read but was the first tremor of a seismic upheaval in global health that continues to reverberate four decades on.

Since the beginning of the epidemic, the Lancet journals have been committed to publishing and disseminating the latest knowledge of HIV and clinical advances in the management of HIV. Our commitment to the subject continues to this day. In this issue of The Lancet HIV, and online across the Lancet titles, we mark the 40th anniversary of the MMWR report by reflecting on the enormous strides made in the knowledge of the disease, care for those infected, and the impact of HIV and AIDS on the world, and consider the challenges now and for the future. We have gathered this new content together in an online resource, alongside some of the key historical papers published in the journals.

Intelligent study, the best science, diligent data gathering, and deft communication by researchers have been key to advances in the understanding of HIV and the response to the pandemic, never more so than in the earliest days. At the Lancet journals, we are proud to have been able to play a part. In September, 1981, a case series by Kenneth Hymes and colleagues in The Lancet described Kaposi's sarcoma in a group of young homosexual men in New York (NY, USA) and suggested that a sexually transmissible disease might have a role in the pathogenesis of the rare cancer. The flurry of early reports of disease from North America and Europe, although causing international concern, belied the true scale of the problem globally that was about to be revealed. In 1984, The Lancet published papers from Philippe Van De Perre and colleagues and Peter Piot and colleagues describing cases of the newly named AIDS in Rwanda and Zaire (now the Democratic Republic of Congo)—early data that represented merely the tip of an iceberg. The scale of the HIV/AIDS pandemic in sub-Saharan Africa shocked the world.

Societal perceptions and attitudes towards HIV/AIDS too have vastly improved. In this issue, Tamara Taggart and colleagues review the evolution of public health messaging since the beginning of the HIV pandemic 40 years ago. Fear-based messaging in the early years of the epidemic has transformed to positive messaging around ending HIV, living healthy with HIV, and U=U. As with every aspect of advances in the HIV response, involvement of people living with HIV and key populations has been vital to success.

But the job is far from done and the epidemic continues to evolve. Targets for disease control have not been met; huge disparities in access to treatment and prevention create regions and populations in which HIV incidence or mortality remain high or are even increasing. Keeping in mind the UNAIDS target to end HIV/AIDS as a public health threat by 2030, key figures in the HIV response expose the huge challenges for the next 10 years in a Feature in this issue. Stigma and discrimination, particularly among key populations, the ageing population with HIV, and adolescent girls and young women with HIV are just some of the priorities going forward.

In the 40 years since that first case series, HIV/AIDS has changed the world. Not least, the HIV response has helped to reveal the global disparities in access to health care, has shaped health systems, and has created a model for the involvement of people affected by or at risk of a disease in the design of programmes to address it. These lessons have never been more important than in the past 18 months. Many people who have dedicated their lives and work to HIV have been at the forefront of the study of SARS-CoV-2 and the response to COVID-19—and the remarkable pace of progress in addressing this new challenge is in no small part due to the knowledge, compassion, and resilience developed in the HIV response. In this year, when so much attention has been diverted to the COVID pandemic, we take this opportunity to reaffirm the Lancet group's commitment to HIV/AIDS.

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DOI: https://doi.org/10.1016/S2352-3018(21)00104-1

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40 years since the first published descriptions of disease caused by HIV, Talha Burki talks to some of the leading figures in the fight against HIV/AIDS about what must be achieved in the next decade.

Full-Text PDF Messaging matters: achieving equity in the HIV response through public health communication

Public health messages shape how the world understands the HIV epidemic. Considerable inequalities remain in HIV care continuum indicators by subpopulation and geography (eg, highest infection and mortality burden among men who have sex with men and people who live in sub-Saharan Africa). Health equity-focused approaches are necessary in this next decade to close gaps in the HIV epidemic. Between 1981 and 1989, HIV messages triggered fear and victim blaming, and highlighted behaviours of a few marginalised groups as deviant.

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