In the early 1980s, a mysterious new illness emerged in the Western world. It soon became clear that it was a sexually transmitted infection, for which there were initially no tests, protection methods or treatments.

A medical mystery

In its weekly bulletin on 5 June 1981, the CDC – the US public health agency – shared a curious phenomenon with the public: in the last nine months, five young, gay men in Los Angeles had presented with a rare form of pneumonia, which is usually a symptom of severe immunodeficiency. The emergence of the syndrome left medical experts scratching their heads: how were healthy young men suffering such weakened immune systems?

In 1983, French virologists Luc Montagnier and Françoise Barré-Sinoussi isolated the unknown virus at Institut Pasteur in Paris, for which they would eventually receive the Nobel Prize in Medicine in 2008. The virus was given the name “HIV” (human immunodeficiency virus). However, it would be another 15 years before the discovery of an effective drug combination to treat the virus.

Silence = Death

A growing number of people, most of them young, died of AIDS within a very short time frame. Many of the victims were homosexuals (AIDS was known colloquially as the “gay plague”) and drug users. The media published shocking images of the victims, while public health agencies, doctors, politicians and prevention experts sought to educate themselves on the “correct” approach to the epidemic.

“Silence = Death” was an early slogan drawing attention to the virus – and the failure of politicians to respond to it. Activists used powerful images and spectacular awareness-raising campaigns to rouse the silent majority out of their state of indifference towards the minorities on the front line of the epidemic. By emboldening others and putting pressure on doctors, politicians and society as a whole, their efforts were essential in speeding up the response to HIV. Around the globe, the fight against HIV brought together people from all walks of life. Their solidarity ensured that those infected with and killed by AIDS were not forgotten, while also raising awareness of the virus and promoting empathy for the victims.

The creation of support structures

How do you motivate and empower all members of a society to protect themselves from HIV and not ostracise those who are already infected? It’s no easy task, but Switzerland overcame it with courage and tenacity.

On 2 June 1985, the Swiss AIDS Federation was founded by gay organisations with the backing of the Federal Office of Public Health. Famous TV journalist, André Ratti, was appointed as its first President.

The day after the Federation’s foundation, André Ratti appeared on Swiss television, where he announced publicly: “I am homosexual and I have AIDS.” As President of the Swiss AIDS Federation, his announcement was intended to raise public awareness of the disease and boost prevention efforts. Ratti died in October 1986. With this courageous double coming-out, Ratti – along with many others – paved the way for the creation of the Swiss AIDS Federation.

Information without judgement

When the Swiss AIDS Federation launched its first prevention campaign following its foundation in 1985, the focus was on the major risk of an HIV infection and the mortal danger presented by AIDS. And rightly so, as over 3,000 new infections and hundreds of deaths were recorded in 1987 alone. This was the peak of the HIV pandemic in Switzerland.

Demonstrating how to use a condom on prime time TV? Charles Clerc, the presenter of SRF’s Tagesschau, was brave enough to do this in 1987, in a moment that would change Switzerland forever. All of a sudden, sexuality and protection methods – topics which tended to be elegantly swept under the rug – were hot topics in homes throughout the country. Switzerland still benefits from that watershed moment to this day.

“This little thing is the difference between life and death.”

During a 1987 episode of Tagesschau, Charles Clerc sat in front of the camera and pulled a condom over his middle finger, attracting international attention. This became a historic moment in Swiss HIV/AIDS prevention.

AIDS becomes a pandemic

HIV tests became available in the mid-1980s, and it quickly became clear that condoms reduce the risk of transmission. Despite this, the virus continued to spread at a growing rate, and to further and further corners of the globe. Common modes of transmission were anal and vaginal sex, as well as the sharing of needles for drug consumption. Early on, some people were even infected through blood transfusions, before the policy of consistently testing blood samples for HIV was introduced.

Many famous people died of AIDS, including musicians, photographers and actors. In 1985, Hollywood star Rock Hudson became the first celebrity to contract AIDS. This changed the way many people perceived the disease. In 1988, 1 December was designated as World AIDS Day to remember the dead and promote solidarity and rights for people living with HIV.

The 1990s were largely marked by despair and loss, but with just enough moments of hope scattered in between. In 1991, the red ribbon became the international symbol of solidarity with the victims.

Switzerland took on a pioneering role in the efforts to mitigate the spread of HIV through drug use. Swiss drug policy and the dispensing of clean needles quickly reduced the number of new HIV infections.

All around the world, AIDS becomes the bogeyman of the late 20th century, dictating people’s behaviour not only in their sex lives, but also in ordinary everyday activities. The United Nations established UNAIDS. The Swiss AIDS Federation became the main point of contact and information with regional help centres all over Switzerland. Through a combination of creative campaigns, the provision of pragmatic, realistic information, and countless projects, measures and ideas, the federation has since sought to create a society in which sexual health is increased – with and despite HIV – and people’s sex lives are not defined by the disease.

Finally an effective treatment – and a brave Switzerland

The long-awaited treatment was revealed at the 11th International AIDS Conference in Vancouver in 1996. It relied on “protease inhibitors”, which offered effective treatment when combined with pre-existing substances. These drugs may not have been able to remove HIV from the body, but they did block viral replication and thus prevent the development of AIDS.

HIV is still treated in this way today, but now there are numerous agents which can be combined in different ways. For people in Western countries with adequate financial means at their disposal, antiretroviral therapy (ART) provides a stark improvement in quality of life and life expectancy. However, for people living in poorer regions of the world, access to treatment remains a pipe dream.

As ART became more widely distributed over the years, evidence of its decisive effect mounted: the viral load is so heavily reduced that HIV becomes virtually undetectable in the blood, and thus no longer transmissible. In 2008, the Swiss Federal Commission for AIDS/HIV (EKAF) became the first public authority in the world to recognise this finding and thus free people with HIV from their constant fear that they could pass the virus on to others. The Swiss Statement, as it became known, was highly controversial and it look a long time before it was accepted around the world, all too often for ethical reasons. 

Today, though, this scientific finding is a guiding principle of the WHO: people with HIV who are undergoing successful treatment cannot pass the virus on to others, even through unprotected sex. This is also vital for prevention. The sooner treatment is begun after a positive diagnosis, the sooner transmission of HIV is ruled out. And so, the TasP principle was born: therapy as prevention.

New tasks for the Swiss AIDS Federation

Since the introduction of live-saving treatment and the Swiss Statement, the situation for people with HIV – medically speaking – has greatly improved, even though there is still no cure.

HIV has become a less dramatic issue in Switzerland, as fewer and fewer people are dying of AIDS. Nowadays, many people with HIV are free from symptoms. Nonetheless, living with the virus continues to be a challenge. Many HIV-positive people are scared to talk about their infection, experience exclusion in their daily lives, and feel isolated and alone. As a patients’ organisation, the Swiss AIDS Federation continues to offer support to people living with HIV. This also includes legal assistance in the event of discrimination.

In the early 2010s, the Swiss AIDS Federation recalibrated its focus, but kept people with HIV front and centre, as its contribution to HIV prevention through treatment remains decisive in preventing new infections. This continued focus on those affected led to a massive victory in 2012: thanks to the Swiss AIDS Federation, the total revision of the Epidemics Act (EpidA) meant that Art. 231 of the Swiss Criminal Code (“Transmission of human diseases”) no longer automatically applied to everyone living with HIV.

However, new HIV infections have been on the rise among gay men and other men who have sex with men since 2000. Old preventive formulae stopped working. The Swiss AIDS Federation underwent a change: the focus was shifted to those affected, the participation of experts and activists was increased, and preventive outreach work was intensified. In addition to the “STOP AIDS LOVE LIFE” campaign, the Swiss AIDS Federation began conducting its own targeted campaigns within key groups, such as the 2008 “Mission Impossible” campaign on primary infections and “Break the Chains” in 2012. Services such as Dr. Gay, the information and advice platform established in 1999, were expanded.

This period also saw the introduction of the checkpoints (2005 in Geneva and 2008 in Zurich). All this was done with the perspective that characterised the Swiss AIDS Federation upon its foundation twenty years prior: those who are personally affected will always be best positioned to devise and implement the most effective prevention. To this day, the checkpoints serve as a model across Europe – a true Swiss success story! They also led to the first wave of medicalisation of prevention, with all the positives and negatives that entailed. This trend has intensified with additional protective measures such as PrEP. And this doesn’t just benefit those affected.

With its 2008 Strategy, the Swiss AIDS Federation expanded its remit to include other common sexually transmitted infections. The rate of syphilis and gonorrhoea infections increased dramatically in the 2010s, particularly among men who have sex with men.

Our work with and in key groups made clear the Swiss AIDS Federation’s dedication to the sexual health of at-risk and vulnerable groups, including sex workers, as well as people with experience of migration and, since 2023, trans people. These groups all face specific health-related challenges, and equal access to prevention and treatment is still a key objective of the Swiss AIDS Federation.

Switzerland is different now – so is the Swiss AIDS Federation

People have sex. And sex is often beautiful and exciting. It’s not unusual for people to feel nervous, and sometimes they’re worried that they’ll do something wrong or fail to properly protect themselves from sexually transmitted infections. We are confronted with the risks that sex can pose. We hear about HIV and AIDS, and the risk of being infected.

Several decades of HIV prevention have shown that fear and moralising achieve nothing. What really makes a difference is communicating openly with the affected groups and treating them as equals.

It is important to know the risks, but this shouldn’t take the joy out of sex. Since its foundation, the Swiss AIDS Federation has carried out preventive work with the goal of giving people the knowledge they need to make informed, autonomous decisions, while also breaking taboos. As such, one of our declared goals is to ensure that everyone has a satisfying sex life.

The work of the Swiss AIDS Federation has become more complicated. The famous slogan “at least put a rubber on it” may still be valid, but it’s not a cure-all. Those at high risk of exposure can turn to PrEP, for example, as preventive medication.

In prevention, there is still a need for innovative, creative and courageous ideas which incorporate the latest scientific and societal developments and bring them to the masses in a comprehensible way so that they can be implemented in everyday life.

Prevention work is still a challenge, as the fear of HIV and other sexually transmitted infections is deep-seated in people’s minds, regardless of all the medical advances we have made.

A lot has changed, but one thing remains true: condoms still offer the best and most affordable protection against transmission of HIV. And people with HIV are still to this day dependent on the solidarity of their fellow humans. Solidarity with victims and equal opportunities for vulnerable people remain the core driving forces of the Swiss AIDS Federation.