title: UEFA European Championship

text: The competition was expanded to eight teams in the 1980 tournament, again hosted by Italy. It involved a group stage, with the winners of the groups going on to contest the final, and the runners-up playing in the third place play-off. West Germany won their second European title by beating Belgium 2–1, with two goals scored by Horst Hrubesch at the Stadio Olimpico in Rome. Horst Hrubesch scored early in the first half before René Vandereycken equalised for Belgium with a penalty in the second half. With two minutes remaining, Hrubesch headed the winner for West Germany from a Karl-Heinz Rummenigge corner.


title: UEFA European Championship

text: France won their first major title at home in the 1984 tournament, with their captain Michel Platini scoring 9 goals in just 5 games, including the opening goal in the final, in which they beat Spain 2–0. The format also changed, with the top two teams in each group going through to a semi-final stage, instead of the winners of each group going straight into the final. The third place play-off was also abolished.


title: UEFA European Championship

text: West Germany hosted UEFA Euro 1988, but lost 2–1 to the Netherlands, their traditional rivals, in the semi-finals, which sparked vigorous celebrations in the Netherlands. The Netherlands went on to win the tournament in a rematch of their first game of the group stage, beating the Soviet Union 2–0 at the Olympia Stadion in Munich. Marco van Basten scored the second goal, a volley over the keeper from the right wing which is often considered one of the best goals ever scored.


title: UEFA European Championship

text: UEFA Euro 1992 was held in Sweden, and was won by Denmark, who were only in the finals because UEFA did not allow Yugoslavia to participate as some of the states constituting the Socialist Federal Republic of Yugoslavia were at war with each other. The Danes beat holders the Netherlands on penalties in the semi-finals, then defeated world champion Germany 2–0. This was the first tournament in which a unified Germany took part and also the first major tournament to have the players' names printed on their backs.


title: UEFA European Championship

text: England hosted UEFA Euro 1996, the first tournament to use the nomenclature "Euro [year]" and would see the number of teams taking part double to 16. The hosts, in a replay of the 1990 FIFA World Cup semi-final, were knocked out on penalties by Germany. The surprise team of the tournament was the newly formed Czech Republic, participating on its first international competition following the dissolution of Czechoslovakia, which reached the final after beating Portugal and France in the knockout stage. Germany would go on to win the Final 2–1 thanks to the first golden goal ever in a major tournament, scored by Oliver Bierhoff five minutes into extra time. This was Germany's first title as a unified nation.


title: UEFA European Championship

text: UEFA Euro 2000 was the first tournament to be held by two countries, in the Netherlands and Belgium. France, the reigning World Cup champions, were favoured to win, and they lived up to expectations when they beat Italy 2–1 after extra time, having come from being 1–0 down: Sylvain Wiltord equalised in the last minute of regular time and David Trezeguet scored the winning golden goal in extra time.


title: UEFA European Championship

text: UEFA Euro 2004, like 1992, produced an upset: Greece, who had only qualified for one World Cup (1994) and one European Championship (1980) before, beat hosts Portugal 1–0 in the final (after having also beaten them in the opening game) with a goal scored by Angelos Charisteas in the 57th minute to win a tournament that they had been given odds of 150–1 to win before it began (being the second least likely team to have any success after Latvia). On their way to the Final, they also beat holders France as well as the Czech Republic with a silver goal, a rule which replaced the previous golden goal in 2003, before being abolished itself shortly after this tournament.


title: UEFA European Championship

text: The 2008 tournament, hosted by Austria and Switzerland, marked the second time that two nations co-hosted and the first edition where the new trophy was awarded. It commenced on 7 June and finished on 29 June. The Final between Germany and Spain was held at the Ernst Happel Stadion in Vienna. Spain defeated Germany 1–0, with a goal scored by Fernando Torres in the 33rd minute, sparking much celebration across the country. This was their first title since the 1964 tournament. Spain were the highest scoring team with 12 goals scored and David Villa finished as the top scorer with four goals. Xavi was awarded the player of the tournament, and nine Spanish players were picked for the team of the tournament.


title: UEFA European Championship

text: The UEFA Euro 2012 tournament was co-hosted by Poland and Ukraine. Spain defeated Italy 4–0 in the Final, thus becoming the first nation to defend a European Championship title, as well as the first European team to win three consecutive major tournaments. In scoring the third goal of the final, Torres became the first player to score in two European Championship finals. He was equal top scorer for the tournament with three goals in total, along with Mario Balotelli, Alan Dzagoev, Mario Gómez, Mario Mandžukić, and Cristiano Ronaldo, despite only being used as a substitute player. The tournament was otherwise notable for having the most headed goals in a Euro tournament (26 out of 76 goals in total); a disallowed goal in the England versus Ukraine group game which replays showed had crossed the goal line, and which prompted President of FIFA Sepp Blatter to tweet, "GLT (Goal-line technology) is no longer an alternative but a necessity", thus reversing his long-held reluctance to embrace such technology; and some crowd violence in group games.


title: UEFA European Championship

text: In 2007, the Football Association of Ireland and Scottish Football Association proposed the expansion of the tournament, which was later confirmed by the UEFA Executive Committee in September 2008. Out of the 54 member associations of UEFA, only three, including England and Germany, opposed the expansion. On 28 May 2010, UEFA announced that UEFA Euro 2016 would be hosted by France. France beat bids of Turkey (7–6 in voting in the second voting round) and Italy, which had the fewest votes in the first voting round. Euro 2016 was the first to have 24 teams in the finals. This was the third time France have hosted the competition. Portugal, which qualified for the knock-out phase despite finishing third in its group, went on to win the championship by defeating heavily favoured host team France 1–0 in the Final, thanks to a goal from Eder in the 109th minute. Cristiano Ronaldo, Portugal's world-renowned striker, came out of the game due to injury in the 25th minute. This was the first time Portugal won a major tournament.


title: UEFA European Championship

text: For the 2020 tournament, three bids were proposed, including a bid from Turkey, a joint bid from the Republic of Ireland, Scotland and Wales, and a joint bid from Georgia and Azerbaijan. In December 2012, however, UEFA announced that the 2020 tournament would be hosted in several cities in various countries across Europe, with the semi-finals and Final being played in London. The venues were selected and announced by UEFA on 19 September 2014. However, Brussels was removed as a host city on 7 December 2017 due to delays with the building of the Eurostadium. On 17 March 2020, UEFA announced that Euro 2020 would be delayed by a year due to the COVID-19 pandemic in Europe, and proposed it take place from 11 June to 11 July 2021. The competition was postponed in order to reduce pressure on the public services in affected countries and to provide space in the calendar for the completion of domestic leagues that had been suspended. Before the Euro 2020, Dublin was also removed as one of the host cities due to its inability to guarantee spectators to the stadium, while Bilbao was replaced by Seville for the same reason. In the Final, Italy defeated maiden finalists England 3–2 on penalties, after the game was tied 1–1 after extra time, to win their second European Championship.


title: UEFA European Championship

text: The Henri Delaunay Trophy, which is awarded to the winner of the European Championship, is named in honour of Henri Delaunay, the first General Secretary of UEFA, who came up with the idea of a European championship but died five years before the first tournament in 1960. His son Pierre was in charge of creating the trophy. Since the first tournament it has been awarded to the winning team for them to keep for four years, until the next tournament. This trophy bore the words "Coupe d'Europe" ("European Cup"), "Coupe Henri Delaunay" ("Henri Delaunay Cup"), and "Championnat d'Europe" ("European Championship") on the front and a juggling boy on the back.


title: UEFA European Championship

text: For the 2008 tournament, the Henri Delaunay Trophy was remodelled to make it larger, as the old trophy was overshadowed by UEFA's other trophies such as the new European Champion Clubs' Cup. The new trophy, which is made of sterling silver, now weighs and is tall, being heavier and longer than the old one. The marble plinth that was serving as base was removed. The new silver base of the trophy had to be enlarged to make it stable. The names of the winning countries that had appeared on the plaques glued to the plinth are now engraved on the back of the trophy, under the word "Coupe Henri Delaunay" and are written in English rather than French its predecessor had. The 1972 and 1980 winning country, West Germany, is written as just "Germany". Since 2016, the juggling boy was returned on the trophy's back.


title: UEFA European Championship

text: The players and coaches of the winning team and the runner-up team are awarded gold and silver medals, respectively. Each association that competes in the final tournament receives a commemorative plaque. Each time the team losing semi-finalist, as well as each finalist, receive a dedicated plaque. Though there is no longer a third place play-off, UEFA decided in the 2008 edition to award the semi-final losers (Turkey and Russia) bronze medals for the first time, and did the same in the 2012 edition when Germany and Portugal received bronze medals. However, UEFA decided that losing semi-finalists would no longer receive medals from the 2016 edition onwards. Bronze medals were previously awarded for winners of the third place play-off, the last of which was held in 1980.


title: UEFA European Championship

text: Before 1980, only four teams qualified for the final tournament. From 1980, eight teams competed. In 1996 the tournament expanded to 16 teams, since it was easier for European nations to qualify for the World Cup than their own continental championship; 14 of the 24 teams at the 1982, 1986 and 1990 World Cups had been European, whereas the European Championship finals still involved only eight teams.


title: UEFA European Championship

text: In 2007, there was much discussion about an expansion of the tournament to 24 teams, started by Scotland and the Republic of Ireland, due to the increased number of football associations in Europe after the break-ups of Czechoslovakia, Yugoslavia and the Soviet Union, and the inclusion of Israel and Kazakhstan. The new president of UEFA, Michel Platini, was reported to be in favour of expansion which proved an accurate assumption. Whilst on 17 April 2007, UEFA's executive committee formally decided against expansion in 2012, Platini indicated in June 2008 that UEFA will increase participation from 16 to 24 teams in future tournaments, starting from 2016. On 25 September, it was announced by Franz Beckenbauer that an agreement had been reached, and the expansion to 24 teams would be officially announced the next day.


title: UEFA European Championship

text: The competing teams are chosen by a series of qualifying games: in 1960 and 1964 through home and away play-offs; from 1968 through a combination of both qualifying groups and play-off games. The host country was selected from the four finalists after they were determined through qualifying.


title: UEFA European Championship

text: Since the expansion of the final tournament starting from 1980, the host country, or countries, have been chosen beforehand and qualify automatically.


title: UEFA European Championship

text: In most tournaments, the tournament consists of a round-robin group stage followed by a single-elimination knockout stage.


title: UEFA European Championship

text: Up to 1968 draws were to be broken via a coin toss in all matches but the final, draw in final match was resolved via a replay.


title: UEFA European Championship

text: To qualify, a team must finish in one of the qualifying spots or win a play-off. After this, a team proceeds to the finals round in the host country, although hosts qualify for the tournament automatically. The qualifying phase begins in the autumn after the preceding FIFA World Cup, almost two years before the finals.


title: UEFA European Championship

text: The groups for qualification are drawn by a UEFA committee using seeding. Seeded teams include reigning champions and other teams based on their performance in the preceding FIFA World Cup qualifying and the last European Championship qualifying. To obtain an accurate view of the teams' abilities, a ranking is produced. This is calculated by taking the total number of points won by a particular team and dividing it by the number of games played, i.e. points per game. In the case of a team having hosted one of the two previous competitions and therefore having qualified automatically, only the results from the single most recent qualifying competition are used. If two teams have equal points per game, the committee then bases their positions in the rankings on:


title: UEFA European Championship

text: The qualifying phase is played in a group format, the composition of the groups is determined through means of a draw of teams from pre-defined seeded bowls. The draw takes place after the preceding World Cup's qualifying competition. For UEFA Euro 2020, the group qualifying phase consisted of ten groups; five of six teams and the remainder of five teams each.


title: UEFA European Championship

text: Each group is played in a league format with teams playing each other home and away. The top two teams then qualified for the final tournament, with remaining places decided by playoffs depending on their ranking in the UEFA Nations League. As with most leagues, the points are awarded as three for a win, one for a draw, and none for a loss. In the eventuality of one or more teams having equal points after all matches have been played, the following criteria are used to distinguish the sides:


title: UEFA European Championship

text: Sixteen teams progressed to the final tournament for the 2012 tournament. They were joint hosts Poland and Ukraine, the winners and the highest ranked second-placed team from the nine qualifying groups as well as the winners of four play-off matches between the runners-up of the other groups. These sixteen teams were divided equally into four groups, A, B, C and D, each consisting of four teams. The groups were drawn up by the UEFA administration, again using seeding. The seeded teams being the host nations, the reigning champions, should they qualify, and those with the best points per game coefficients over the qualifying phase of the tournament and the previous World Cup qualifying. Other finalists were assigned to by means of a draw, using coefficients as a basis.


title: UEFA European Championship

text: For the 2016 tournament, the expansion to 24 teams means that the teams will be drawn into six groups of four, with the six group winners, six group runners-up and the four best third-placed teams advancing to the round of 16 when it becomes a knockout competition.


title: UEFA European Championship

text: The groups are again played in a league format, where a team plays its opponents once each. The same points system is used (three points for a win, one point for a draw, no points for a defeat). A schedule for the group matches will be drawn up, but the last two matches in a group must kick off simultaneously. The winner and runner-up of each group progress to the next round, where a knockout system is used (the two teams play each other once, the winner progresses), this is used in all subsequent rounds as well. The winners of the quarter-finals matches progress to the semi-finals, where the winners play in the final. If in any of the knockout rounds, the scores are still equal after normal playing time, extra time and penalties are employed to separate the two teams. Unlike the FIFA World Cup, this tournament no longer has a third place playoff.


title: Black Swan (film)

text: Black Swan is a 2010 American psychological horror film directed by Darren Aronofsky from a screenplay by Mark Heyman, John McLaughlin, and Andres Heinz, based on a story by Heinz. The film stars Natalie Portman, Vincent Cassel, Mila Kunis, Barbara Hershey, and Winona Ryder, and revolves around a production of Tchaikovsky's "Swan Lake" by the New York City Ballet company. The production requires a ballerina to play the innocent and fragile White Swan, for which the committed dancer Nina Sayers (Portman) is a perfect fit, as well as the dark and sensual Black Swan, which are qualities better embodied by the new rival Lily (Kunis). Nina is overwhelmed by a feeling of immense pressure when she finds herself competing for the role, causing her to lose her tenuous grip on reality and descend into madness.


title: Black Swan (film)

text: Aronofsky conceived the premise by connecting his viewings of a production of "Swan Lake" with an unrealized screenplay about understudies and the notion of being haunted by a double, similar to the folklore surrounding doppelgängers. Aronofsky cites Fyodor Dostoevsky's "The Double" as another inspiration for the film. The director also considered "Black Swan" a companion piece to his 2008 film "The Wrestler", with both films involving demanding performances for different kinds of art. He and Portman first discussed the project in 2000, and after a brief attachment to Universal Pictures, "Black Swan" was produced in New York City in 2009 by Fox Searchlight Pictures. Portman and Kunis trained in ballet for several months before filming began.


title: Black Swan (film)

text: "Black Swan" premiered at the 67th Venice International Film Festival on September 1, 2010, and had a limited release in the United States starting on December 3, before opening in wide release on December 17. Upon its release, the film received critical acclaim, with particular praise toward Aronofsky's direction and the performances of Portman and Kunis. It was also a commercial success, grossing $329 million worldwide against a $13 million budget. The film received five nominations at the 83rd Academy Awards, including Best Picture, with Portman winning Best Actress; it also received four nominations at the 68th Golden Globe Awards, including Best Motion Picture – Drama, with Portman winning Best Actress. In 2021, Portman's performance was included in "The New Yorker"s list of the best film performances of the 21st century.


title: Black Swan (film)

text: Nina Sayers, a young ballerina with the New York City Ballet company, lives with her overprotective mother, Erica, herself a former dancer. The company is opening the season with Tchaikovsky's "Swan Lake". After forcing prima ballerina Elizabeth "Beth" MacIntyre into retirement, artistic director Thomas Leroy announces he is looking for a new dancer for the dual roles of the innocent and fragile White Swan Odette and the sensual and dark Black Swan Odile. Nina auditions for the roles and gives a flawless rehearsal as Odette, but fails to embody Odile.


title: Black Swan (film)

text: The next day, Nina asks Thomas to reconsider her role. When he forcibly kisses her, she bites him and runs out of his office. Later that day, Nina sees the cast list and discovers to her surprise she has received the lead roles. At a gala celebrating the new season, an intoxicated Beth accuses Nina of providing sexual favors to Thomas in return for a promotion. The next day, Nina hears Beth was hit by a car, but Thomas believes she was attempting suicide. Nina visits an unconscious Beth in the hospital and sees to her horror that her legs have been severely injured, meaning she will be unable to perform as a ballet dancer again.


title: Black Swan (film)

text: During rehearsals, Thomas tells Nina to observe a newcomer, Lily, who has a physical resemblance to Nina but also an uninhibited quality Nina lacks. Nina has hallucinations and finds scratch marks on her back.


title: Black Swan (film)

text: One night, despite Erica's objection, Nina accepts Lily's invitation to go out for drinks. Lily offers Nina an ecstasy capsule, saying it would help her relax. Nina turns it down at first, but then accepts. She repeats Lily's assurance that the effects will only last for a few hours, and quickly begins to act under the ecstasy's influence. Nina flirts with men at the bar and Lily as well. The two dance at a nightclub and return to Nina's apartment late that night. After arguing with her mother, Nina barricades herself in her room and Lily performs oral sex on her. The next morning, she wakes up alone and realizes that she is late for the dress rehearsal.


title: Black Swan (film)

text: Upon arriving at Lincoln Center, Nina sees Lily dancing as Odile and confronts her about their night together. She seems confused by Nina's insinuation that they had sex and denies going home with Nina, saying she went home with one of the men from the bar. Nina becomes convinced Lily intends to take her place, especially after learning that Thomas has made Lily her alternate. Nina's hallucinations grow stronger and her injuries increase, going as far as hallucinating herself transforming into Odile. On opening night, she shouts to her mother, "I'm the swan queen, you're the one who never left the corps!", after her mother tells her she called the theater and told them Nina was not well enough to perform and tries to convince Nina that the role has been too much for her. As Nina is late, Lily is prepared to replace her. Nina confronts Thomas, who is impressed by her newfound confidence and allows her to take back her roles.


title: Black Swan (film)

text: Towards the end of the ballet's second act, Nina is distracted by another hallucination and loses her stability as Odette. This causes the male dancer playing the prince to drop her on stage, which infuriates Thomas. She returns to her dressing room and finds Lily preparing as Odile. During a confrontation, Lily transforms into Nina. The two fight, breaking a mirror. Nina stabs her doppelgänger with a large shard of glass from the mirror, killing her. The body reverts to Lily. Nina hides the corpse in the bathroom, and takes the stage, dancing flawlessly as Odile and seemingly turns into a black swan, her arms covered in feathers. Amidst a standing ovation from the audience, Nina surprises Thomas with a passionate kiss and returns to her dressing room.


title: Black Swan (film)

text: As Nina resumes the Odette tutu and white swan makeup, she hears a knock at her door. She opens it to find Lily alive. Lily apologizes for the misunderstanding and congratulates her before taking her to leave. Confused, Nina sees the mirror is still broken; but the towel she used to mop up the blood is cleanthere is no corpse. She looks down and pulls a piece of glass from her abdomen, realizing she stabbed herselfnot Lily.


title: Black Swan (film)

text: Nina dances the final act of the ballet, which ends with Odette throwing herself off a cliff and Nina landing on a mattress. The theater erupts in thunderous applause while Thomas, Lily, and the others gather to congratulate Nina, who remains lying on the mattress. Thomas sees the blood spreading at her waist and shouts for help. He frantically asks Nina what happened to her. Nina calmly replies that she was perfect as the screen fades to white.


title: Black Swan (film)

text: During the closing credits, the major cast members are credited both as their film characters as well as their corresponding characters from "Swan Lake".


title: Black Swan (film)

text: Darren Aronofsky first became interested in ballet when his sister studied dance at the High School of Performing Arts in New York City. The basic idea for the film started when he hired screenwriters to rework a screenplay called "The Understudy", which portrayed off-Broadway actors and explored the notion of being haunted by a double. Aronofsky said the screenplay had elements of "All About Eve", Roman Polanski's "The Tenant", and Fyodor Dostoyevsky's novella "The Double". The director had also seen numerous productions of "Swan Lake", and he connected the duality of the White Swan and the Black Swan to the script. When researching for the production of "Black Swan", Aronofsky found ballet to be "a very insular world" whose dancers were "not impressed by movies". Regardless, the director found active and inactive dancers to share their experiences with him. He also stood backstage to see the Bolshoi Ballet perform at the Lincoln Center for the Performing Arts.


title: Black Swan (film)

text: Aronofsky called "Black Swan" a companion piece to his previous film "The Wrestler", recalling one of his early projects about a love affair between a wrestler and a ballerina. He eventually separated the wrestling and the ballet worlds as "too much for one movie". He compared the two films: "Wrestling some consider the lowest art—if they would even call it art—and ballet some people consider the highest art. But what was amazing to me was how similar the performers in both of these worlds are. They both make incredible use of their bodies to express themselves." About the psychological thriller nature of "Black Swan", actress Natalie Portman compared the film's tone to Polanski's 1968 film "Rosemary's Baby", while Aronofsky said Polanski's "Repulsion" (1965) and "The Tenant" (1976) were "big influences" on the final film. Actor Vincent Cassel also compared "Black Swan" to Polanski's early works and additionally compared it to David Cronenberg's early works.


title: Black Swan (film)

text: Aronofsky first discussed with Portman the possibility of a ballet film in 2000, and he found she was interested in playing a ballet dancer. Portman explained being part of "Black Swan", "I'm trying to find roles that demand more adulthood from me because you can get stuck in a very awful cute cycle as a woman in film, especially being such a small person." Portman suggested to Aronofsky that her good friend Mila Kunis would be perfect for the role. Kunis contrasted Lily with Nina, "My character is very loose ... She's not as technically good as Natalie's character, but she has more passion, naturally. That's what [Nina] lacks." The female characters are directed in the "Swan Lake" production by Thomas Leroy, played by Cassel. He compared his character to George Balanchine, who co-founded New York City Ballet and was "a control freak, a true artist using sexuality to direct his dancers".


title: Black Swan (film)

text: Portman and Kunis started training six months before the start of filming in order to attain a body type and muscle tone more similar to those of professional dancers. Portman worked out for five hours a day, doing ballet, cross-training, and swimming. A few months closer to filming, she began choreography training. Kunis engaged in cardio and Pilates, "train[ing] seven days a week, five hours, for five, six months total, and ... was put on a very strict diet of 1,200 calories a day." She lost 20 pounds from her normal weight of about 117 pounds, and reported that Portman "became smaller than I did." Kunis said, "I did ballet as a kid like every other kid does ballet. You wear a tutu and you stand on stage and you look cute and twirl. But this is very different because you can't fake it. You can't just stay in there and like pretend you know what you're doing. Your whole body has to be structured differently." Georgina Parkinson, a ballet mistress from the American Ballet Theatre (ABT), coached the actors in ballet. ABT soloists Sarah Lane and Maria Riccetto served as "dance doubles" for Portman and Kunis respectively. Dancer Kimberly Prosa also served as a double for Portman. She stated: "Natalie took class, she studied for several months, from the waist up is her. Sarah Lane, a soloist at ABT, did the heavy tricks, she did the fouettés, but they only had her for a limited time, a couple of weeks, so I did the rest of whatever dance shots they needed."


title: Black Swan (film)

text: In addition to the soloist performances, members of the Pennsylvania Ballet were cast as the corps de ballet, backdrop for the main actors' performances. Also appearing in the film are Kristina Anapau, Toby Hemingway, Sebastian Stan, and Janet Montgomery.


title: Black Swan (film)

text: Aronofsky and Portman first discussed a ballet film in 2000, after the release of "Requiem for a Dream", though the script had not yet been written. He told her about a love scene between competing ballet dancers, and Portman recalled, "I thought that was very interesting because this movie is in so many ways an exploration of an artist's ego and that narcissistic sort of attraction to yourself and also repulsion with yourself." On the decade's wait before production, she said, "The fact that I had spent so much time with the idea ... allowed it to marinate a little before we shot."


title: Black Swan (film)

text: The screenplay "The Understudy" was written by Andres Heinz; Aronofsky first heard about it while editing his second film "Requiem for a Dream" (2000) and described it as ""All About Eve" with a double, set in the off-Broadway world." After making "The Fountain" (2006), Aronofsky and producer Mike Medavoy had screenwriter John McLaughlin rewrite "The Understudy"; Aronofsky said McLaughlin "took my idea of "Swan Lake" and the ballet and put [the story] into the ballet world and changed the title to "Black Swan"." When Aronofsky proposed a detailed outline of "Black Swan" to Universal Pictures, the studio decided to fast-track development of the project in January 2007. The project "sort of died, again" according to Aronofsky, until after the making of "The Wrestler" (2008), when he had Mark Heyman, director of development of Aronofsky's production company Protozoa Pictures, write for "Black Swan" "and made it something that was workable." By June 2009, Universal had placed the project in turnaround, generating attention from other studios and specialty divisions, particularly with actress Portman attached to star. "Black Swan" began development under Protozoa Pictures and Overnight Productions, the latter financing the film. In July 2009, Kunis was cast.


title: Black Swan (film)

text: Fox Searchlight Pictures distributed "Black Swan" and gave the film a production budget of $10–12 million. Principal photography was achieved using Super 16 mm cameras and began in New York City toward the end of 2009. Part of filming took place at the Performing Arts Center at State University of New York at Purchase. Aronofsky filmed "Black Swan" with a muted palette and a grainy style, which he intended to be similar to "The Wrestler". Aronofsky said:


title: Black Swan (film)

text: The non-original music featured in "Black Swan" consists of music by Tchaikovsky featuring performances on-screen and in the soundtrack by violinist Tim Fain and a track of electronica dance music by English production duo The Chemical Brothers. It marks the fifth consecutive collaboration between Aronofsky and English composer Clint Mansell, who composed the original score for the film. Mansell attempted to score the film based on Tchaikovsky's ballet but with radical changes to the music. Because of the use of Tchaikovsky's music, the score was deemed ineligible to be entered into the 2010 Academy Awards for Best Original Score.


title: Black Swan (film)

text: The Chemical Brothers' music, which is featured prominently during the club scene in "Black Swan", is omitted from the soundtrack album.


title: Black Swan (film)

text: "Black Swan" had its world premiere as the opening film at the 67th Venice Film Festival on September 1, 2010. It received a standing ovation whose length "Variety" said made it "one of the strongest Venice openers in recent memory". The festival's artistic director Marco Mueller had chosen "Black Swan" over "The American" (starring George Clooney) for opening film, saying, "[It] was just a better fit ... Clooney is a wonderful actor, and he will always be welcome in Venice. But it was as simple as that." "Black Swan" screened in competition and is the third consecutive film directed by Aronofsky to premiere at the festival, following "The Fountain" and "The Wrestler". "Black Swan" was presented in a sneak screening at the Telluride Film Festival on September 5, 2010. It also had a Gala screening at the 35th Toronto International Film Festival later in the month. In October 2010, "Black Swan" was screened at the New Orleans Film Festival, the Austin Film Festival, and the BFI London Film Festival. In November 2010, the film was screened at American Film Institute's AFI Fest in Los Angeles, the Denver Film Festival and Camerimage Festival in Bydgoszcz, Poland.


title: Black Swan (film)

text: The release of "Black Swan" in the United Kingdom was brought forward from February 11 to January 21, 2011. According to "The Independent", the film was considered one of "the most highly anticipated" films of late 2010. The newspaper then compared it to the 1948 ballet film "The Red Shoes" in having "a nightmarish quality ... of a dancer consumed by her desire to dance".


title: Black Swan (film)

text: "Black Swan" had a limited release in select cities in North America on December 3, 2010, in 18 theaters and was a surprise box office success. The film took in a total of $415,822 on its opening day, averaging $23,101 per theater. By the end of its opening weekend it grossed $1,443,809—$80,212 per theater. The per location average was the second highest for the opening weekend of 2010 behind "The King's Speech". The film is Fox Searchlight Pictures' highest per-theater average gross ever, and it ranks 21st on the all-time list. On its second weekend the film expanded to 90 theaters, and grossed $3.3 million, ranking it as the sixth film at the box-office. In its third weekend, it expanded again to 959 theaters and grossed $8,383,479. The film went on to gross over $106 million in the United States and over $329 million worldwide.


title: Black Swan (film)

text: The film was released on DVD and Blu-ray Disc in Region 1/Region A on March 29, 2011. The Region 2/Region B version was released on May 16, 2011.


title: Black Swan (film)

text: Review aggregator Rotten Tomatoes gives the film an approval rating of 85% based on 318 reviews, and an average rating of 8.20/10. The website's critical consensus reads, "Bracingly intense, passionate, and wildly melodramatic, "Black Swan" glides on Darren Aronofsky's bold direction—and a bravura performance from Natalie Portman." At Metacritic, which assigns a weighted average score out to reviews, the film received an average score of 79 out of 100, based on 42 critics, indicating "generally favorable reviews".


title: Black Swan (film)

text: In September 2010, "Entertainment Weekly" reported that based on reviews from the film's screening at the Venice Film Festival, "["Black Swan"] is already set to be one of the year's most love-it-or-hate-it movies." Leonard Maltin, on his blog "Movie Crazy", admitted that he "couldn't stand" the film, despite praising Natalie Portman's performance. Reuters described the early response to the film as "largely positive" with Portman's performance being highly praised. "The Sydney Morning Herald" reported that "the film divided critics. Some found its theatricality maddening, but most declared themselves 'swept away'."


title: Black Swan (film)

text: Kurt Loder of "Reason" magazine called the film "wonderfully creepy", and wrote that "it's not entirely satisfying; but it's infused with the director's usual creative brio, and it has a great dark gleaming look." Mike Goodridge from "Screen Daily" called "Black Swan" "alternately disturbing and exhilarating" and described the film as a hybrid of "The Turning Point" and Polanski's films "Repulsion" and "Rosemary's Baby". Goodridge described Portman's performance, "[She] is captivating as Nina ... she captures the confusion of a repressed young woman thrown into a world of danger and temptation with frightening veracity." The critic also commended Cassel, Kunis, and Hershey in their supporting roles, particularly comparing Hershey to Ruth Gordon in the role of "the desperate, jealous mother". Goodridge praised Libatique's cinematography with the dance scenes and the psychologically "unnerving" scenes: "It's a mesmerising psychological ride that builds to a gloriously theatrical tragic finale as Nina attempts to deliver the perfect performance."


title: Black Swan (film)

text: Kirk Honeycutt of "The Hollywood Reporter" gave the film a mixed review. He wrote, "["Black Swan"] is an instant guilty pleasure, a gorgeously shot, visually complex film whose badness is what's so good about it. You might howl at the sheer audacity of mixing mental illness with the body-fatiguing, mind-numbing rigors of ballet, but its lurid imagery and a hellcat competition between two rival dancers is pretty irresistible." Honeycutt commended Millepied's "sumptuous" choreography and Libatique's "darting, weaving" camera work. The critic said of the thematic mashup, "Aronofsky ... never succeeds in wedding genre elements to the world of ballet ... White Swan/Black Swan dynamics almost work, but the horror-movie nonsense drags everything down the rabbit hole of preposterousness." Similarly, in a piece for "The Huffington Post", Rob Kirkpatrick praised Portman's performance but compared the film's story to that of "Showgirls" (1995) and "Burlesque" (2010) while concluding "Black Swan" is "simply higher-priced cheese, Aronofsky's camembert to ["Burlesque" director Steve] Antin's cheddar. "Vulture" Kyle Buchanan also noted the similarities of the film's plot to the widely derided "Showgirls", and said that the director Darren Aronofsky "owes a feather-tip to Paul Verhoeven's exploitation classic more than [he] might be willing to admit".


title: Black Swan (film)

text: The film has been criticized for its portrayal of ballet and ballet dancers. Upon the film's release in the United Kingdom, "The Guardian" interviewed four professional ballet dancers in the UK: Tamara Rojo, Lauren Cuthbertson, Edward Watson, and Elena Glurjidze. Rojo called the film "lazy ... featuring every ballet cliche going." Watson felt that the film "makes [ballet] look so naff and laughable. It doesn't show why ballet is so important to us – why we would want to try so hard." The Canadian Press also reported that many Canadian ballet dancers felt that the film depicted dancers negatively and exaggerated elements of their lives but gave Portman high marks for her dance technique. In an interview with the "Los Angeles Times", Gillian Murphy, a principal dancer with American Ballet Theatre praised the visual elements of the film but noted that the film presentation of the ballet world was "extreme."


title: Black Swan (film)

text: Several critics noted striking similarities between Satoshi Kon's 1997 anime film "Perfect Blue" and Aronofsky's "Black Swan". In response to comparisons between "Perfect Blue" and "Black Swan", Aronofsky acknowledged the similarities in 2010, but denied that "Black Swan" was inspired by "Perfect Blue". Kon noted in his blog that he had met with Aronofsky in 2001.


title: Black Swan (film)

text: Amy Westcott is credited as the costume designer and received several award nominations. A publicized controversy arose regarding the question of who had designed 40 ballet costumes for Portman and the dancers. An article in the British newspaper "The Independent" suggested those costumes had actually been created by Rodarte's Kate and Laura Mulleavy. Westcott challenged that view and stated that in all only seven costumes, among them the Black and White Swan, had been created in a collaboration between Rodarte, Westcott, and Aronofsky. Furthermore, the corps ballet's costumes were designed by Zack Brown (for the American Ballet Theatre), and slightly adapted by Westcott and her costume design department. Westcott said: "Controversy is too complimentary a word for two people using their considerable self-publicising resources to loudly complain about their credit once they realized how good the film is."


title: Black Swan (film)

text: ABT dancer Sarah Lane served as a "dance double" for Portman in the film. In a March 3 blog entry for "Dance Magazine", editor-in-chief Wendy Perron asked: "Do people really believe that it takes only one year to make a ballerina? We know that Natalie Portman studied ballet as a kid and had a year of intensive training for the film, but that doesn't add up to being a ballerina. However, it seems that many people believe that Portman did her own dancing in "Black Swan"." This led to responses from Benjamin Millepied and Aronofsky, who both defended Portman, as well as a response from Lane claiming that she has not been given due credit.


title: Black Swan (film)

text: "Black Swan" appeared on many critics' top ten lists of 2010 and is frequently considered to be one of the best films of the year. It was featured on the American Film Institute's 10 Movies of the Year. On January 25, 2011, the film was nominated for five Academy Awards (Best Picture, Best Director, Best Actress, Best Cinematography and Best Film Editing) and won one for Portman's performance.


title: HIV/AIDS

text: Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual may not notice any symptoms, or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged incubation period with no symptoms. If the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors which are rare in people who have normal immune function. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.


title: HIV/AIDS

text: HIV is spread primarily by unprotected sex (including anal and vaginal sex), contaminated blood transfusions, hypodermic needles, and from mother to child during pregnancy, delivery, or breastfeeding. Some bodily fluids, such as saliva, sweat and tears, do not transmit the virus. Oral sex has little to no risk of transmitting the virus. Methods of prevention include safe sex, needle exchange programs, treating those who are infected, as well as both pre- and post-exposure prophylaxis. Disease in a baby can often be prevented by giving both the mother and child antiretroviral medication.


title: HIV/AIDS

text: HIV/AIDS has had a large impact on society, both as an illness and as a source of discrimination. The disease also has large economic impacts. There are many misconceptions about HIV/AIDS, such as the belief that it can be transmitted by casual non-sexual contact. The disease has become subject to many controversies involving religion, including the Catholic Church's position not to support condom use as prevention. It has attracted international medical and political attention as well as large-scale funding since it was identified in the 1980s.


title: HIV/AIDS

text: HIV made the jump from other primates to humans in west-central Africa in the early-to-mid 20th century. AIDS was first recognized by the U.S. Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade. Since when AIDS was identified and as of 2021, the disease has caused an estimated 40 million deaths worldwide. In 2021, there were 650,000 deaths and about 38 million people worldwide living with HIV. An estimated 20.6 million of these people live in eastern and southern Africa. HIV/AIDS is considered a pandemic—a disease outbreak which is present over a large area and is actively spreading.


title: HIV/AIDS

text: The United States' National Institutes of Health (NIH) and the Gates Foundation have pledged $200 million focused on developing a global cure for AIDS. While there is no broadly available cure or vaccine, antiretroviral treatment can slow the course of the disease and may lead to a near-normal life expectancy. Treatment is recommended as soon as the diagnosis is made. Without treatment, the average survival time after infection is 11 years. Two individuals have been reported cured of AIDS, known as the Berlin Patient and the London Patient.


title: HIV/AIDS

text: The initial period following the contraction of HIV is called acute HIV, primary HIV or acute retroviral syndrome. Many individuals develop an influenza-like illness or a mononucleosis-like illness 2–4 weeks after exposure while others have no significant symptoms. Symptoms occur in 40–90% of cases and most commonly include fever, large tender lymph nodes, throat inflammation, a rash, headache, tiredness, and/or sores of the mouth and genitals. The rash, which occurs in 20–50% of cases, presents itself on the trunk and is maculopapular, classically. Some people also develop opportunistic infections at this stage. Gastrointestinal symptoms, such as vomiting or diarrhea may occur. Neurological symptoms of peripheral neuropathy or Guillain–Barré syndrome also occur. The duration of the symptoms varies, but is usually one or two weeks.


title: HIV/AIDS

text: Owing to their nonspecific character, these symptoms are not often recognized as signs of HIV infection. Even cases that do get seen by a family doctor or a hospital are often misdiagnosed as one of the many common infectious diseases with overlapping symptoms. Thus, it is recommended that HIV be considered in people presenting with an unexplained fever who may have risk factors for the infection.


title: HIV/AIDS

text: The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. Without treatment, this second stage of the natural history of HIV infection can last from about three years to over 20 years (on average, about eight years). While typically there are few or no symptoms at first, near the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. Between 50% and 70% of people also develop persistent generalized lymphadenopathy, characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months.


title: HIV/AIDS

text: Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high levels of CD4 T cells (T helper cells) without antiretroviral therapy for more than five years. These individuals are classified as "HIV controllers" or long-term nonprogressors (LTNP). Another group consists of those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 infected persons.


title: HIV/AIDS

text: Acquired immunodeficiency syndrome (AIDS) is defined as an HIV infection with either a CD4 T cell count below 200 cells per µL or the occurrence of specific diseases associated with HIV infection. In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%), and esophageal candidiasis. Other common signs include recurrent respiratory tract infections.


title: HIV/AIDS

text: Opportunistic infections may be caused by bacteria, viruses, fungi, and parasites that are normally controlled by the immune system. Which infections occur depends partly on what organisms are common in the person's environment. These infections may affect nearly every organ system.


title: HIV/AIDS

text: People with AIDS have an increased risk of developing various viral-induced cancers, including Kaposi's sarcoma, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer. Kaposi's sarcoma is the most common cancer, occurring in 10% to 20% of people with HIV. The second-most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3% to 4%. Both these cancers are associated with human herpesvirus 8 (HHV-8). Cervical cancer occurs more frequently in those with AIDS because of its association with human papillomavirus (HPV). Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more common in those with HIV.


title: HIV/AIDS

text: Additionally, people with AIDS frequently have systemic symptoms such as prolonged fevers, sweats (particularly at night), swollen lymph nodes, chills, weakness, and unintended weight loss. Diarrhea is another common symptom, present in about 90% of people with AIDS. They can also be affected by diverse psychiatric and neurological symptoms independent of opportunistic infections and cancers.


title: HIV/AIDS

text: HIV is spread by three main routes: sexual contact, significant exposure to infected body fluids or tissues, and from mother to child during pregnancy, delivery, or breastfeeding (known as vertical transmission). There is no risk of acquiring HIV if exposed to feces, nasal secretions, saliva, sputum, sweat, tears, urine, or vomit unless these are contaminated with blood. It is also possible to be co-infected by more than one strain of HIV—a condition known as HIV superinfection.


title: HIV/AIDS

text: The most frequent mode of transmission of HIV is through sexual contact with an infected person. However, an HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually. The existence of functionally noncontagious HIV-positive people on antiretroviral therapy was controversially publicized in the 2008 Swiss Statement, and has since become accepted as medically sound.


title: HIV/AIDS

text: Globally, the most common mode of HIV transmission is via sexual contacts between people of the opposite sex; however, the pattern of transmission varies among countries. , most HIV transmission in the United States occurred among men who had sex with men (82% of new HIV diagnoses among males aged 13 and older and 70% of total new diagnoses). In the US, gay and bisexual men aged 13 to 24 accounted for an estimated 92% of new HIV diagnoses among all men in their age group and 27% of new diagnoses among all gay and bisexual men.


title: HIV/AIDS

text: With regard to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear to be four to ten times higher in low-income countries than in high-income countries. In low-income countries, the risk of female-to-male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per act for male-to-female transmission. The risk of transmission from anal intercourse is especially high, estimated as 1.4–1.7% per act in both heterosexual and homosexual contacts. While the risk of transmission from oral sex is relatively low, it is still present. The risk from receiving oral sex has been described as "nearly nil"; however, a few cases have been reported. The per-act risk is estimated at 0–0.04% for receptive oral intercourse. In settings involving prostitution in low-income countries, risk of female-to-male transmission has been estimated as 2.4% per act, and of male-to-female transmission as 0.05% per act.


title: HIV/AIDS

text: Risk of transmission increases in the presence of many sexually transmitted infections and genital ulcers. Genital ulcers appear to increase the risk approximately fivefold. Other sexually transmitted infections, such as gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis, are associated with somewhat smaller increases in risk of transmission.


title: HIV/AIDS

text: The viral load of an infected person is an important risk factor in both sexual and mother-to-child transmission. During the first 2.5 months of an HIV infection a person's infectiousness is twelve times higher due to the high viral load associated with acute HIV. If the person is in the late stages of infection, rates of transmission are approximately eightfold greater.


title: HIV/AIDS

text: Commercial sex workers (including those in pornography) have an increased likelihood of contracting HIV. Rough sex can be a factor associated with an increased risk of transmission. Sexual assault is also believed to carry an increased risk of HIV transmission as condoms are rarely worn, physical trauma to the vagina or rectum is likely, and there may be a greater risk of concurrent sexually transmitted infections.


title: HIV/AIDS

text: The second-most frequent mode of HIV transmission is via blood and blood products. Blood-borne transmission can be through needle-sharing during intravenous drug use, needle-stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63% and 2.4% per act, with an average of 0.8%. The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the risk following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. This risk may, however, be up to 5% if the introduced blood was from a person with a high viral load and the cut was deep. In the United States, intravenous drug users made up 12% of all new cases of HIV in 2009, and in some areas more than 80% of people who inject drugs are HIV-positive.


title: HIV/AIDS

text: HIV is transmitted in about 90% of blood transfusions using infected blood. In developed countries the risk of acquiring HIV from a blood transfusion is extremely low (less than one in half a million) where improved donor selection and HIV screening is performed; for example, in the UK the risk is reported at one in five million and in the United States it was one in 1.5 million in 2008. In low-income countries, only half of transfusions may be appropriately screened (as of 2008), and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. It is possible to acquire HIV from organ and tissue transplantation, although this is rare because of screening.


title: HIV/AIDS

text: Unsafe medical injections play a role in HIV spread in sub-Saharan Africa. In 2007, between 12% and 17% of infections in this region were attributed to medical syringe use. The World Health Organization estimates the risk of transmission as a result of a medical injection in Africa at 1.2%. Risks are also associated with invasive procedures, assisted delivery, and dental care in this area of the world.


title: HIV/AIDS

text: People giving or receiving tattoos, piercings, and scarification are theoretically at risk of infection but no confirmed cases have been documented. It is not possible for mosquitoes or other insects to transmit HIV.


title: HIV/AIDS

text: HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk, resulting in the baby also contracting HIV. As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. In the absence of treatment, the risk of transmission before or during birth is around 20%, and in those who also breastfeed 35%. Treatment decreases this risk to less than 5%.


title: HIV/AIDS

text: Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed. If blood contaminates food during pre-chewing it may pose a risk of transmission. If a woman is untreated, two years of breastfeeding results in an HIV/AIDS risk in her baby of about 17%. Due to the increased risk of death without breastfeeding in many areas in the developing world, the World Health Organization recommends either exclusive breastfeeding or the provision of safe formula. All women known to be HIV-positive should be taking lifelong antiretroviral therapy.


title: HIV/AIDS

text: HIV is the cause of the spectrum of disease known as HIV/AIDS. HIV is a retrovirus that primarily infects components of the human immune system such as CD4 T cells, macrophages and dendritic cells. It directly and indirectly destroys CD4 T cells.


title: HIV/AIDS

text: HIV is a member of the genus "Lentivirus", part of the family "Retroviridae". Lentiviruses share many morphological and biological characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period. Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses. Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors. Once integrated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system. Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew.


title: HIV/AIDS

text: HIV is now known to spread between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it employs hybrid spreading mechanisms. In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. HIV can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. The hybrid spreading mechanisms of HIV contribute to the virus's ongoing replication against antiretroviral therapies.


title: HIV/AIDS

text: Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was originally discovered (and initially referred to also as LAV or HTLV-III). It is more virulent, more infective, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 as compared with HIV-1 implies that fewer people exposed to HIV-2 will be infected per exposure. Because of its relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.


title: HIV/AIDS

text: After the virus enters the body, there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. This response is accompanied by a marked drop in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells, which kill HIV-infected cells, and subsequently with antibody production, or seroconversion. The CD8 T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.


title: HIV/AIDS

text: Ultimately, HIV causes AIDS by depleting CD4 T cells. This weakens the immune system and allows opportunistic infections. T cells are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic phases. During the acute phase, HIV-induced cell lysis and killing of infected cells by CD8 T cells accounts for CD4 T cell depletion, although apoptosis may also be a factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4 T cell numbers.


title: HIV/AIDS

text: Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4 T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. The reason for the preferential loss of mucosal CD4 T cells is that the majority of mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to gain access to the cells, whereas only a small fraction of CD4 T cells in the bloodstream do so. A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV-1 infection.


title: HIV/AIDS

text: HIV seeks out and destroys CCR5 expressing CD4 T cells during acute infection. A vigorous immune response eventually controls the infection and initiates the clinically latent phase. CD4 T cells in mucosal tissues remain particularly affected. Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic phase. Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. It is also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4 T cells during the acute phase of disease.


title: HIV/AIDS

text: HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms. HIV screening is recommended by the United States Preventive Services Task Force for all people 15 years to 65 years of age, including all pregnant women. Additionally, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. In many areas of the world, a third of HIV carriers only discover they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency has become apparent.


title: HIV/AIDS

text: Most people infected with HIV develop specific antibodies (i.e. seroconvert) within three to twelve weeks after the initial infection. Diagnosis of primary HIV before seroconversion is done by measuring HIV-RNA or p24 antigen. Positive results obtained by antibody or PCR testing are confirmed either by a different antibody or by PCR.


title: HIV/AIDS

text: Antibody tests in children younger than 18 months are typically inaccurate, due to the continued presence of maternal antibodies. Thus HIV infection can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen. Much of the world lacks access to reliable PCR testing, and people in many places simply wait until either symptoms develop or the child is old enough for accurate antibody testing. In sub-Saharan Africa between 2007 and 2009, between 30% and 70% of the population were aware of their HIV status. In 2009, between 3.6% and 42% of men and women in sub-Saharan countries were tested; this represented a significant increase compared to previous years.


title: HIV/AIDS

text: Two main clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease, and the CDC classification system for HIV infection. The CDC's classification system is more frequently adopted in developed countries. Since the WHO's staging system does not require laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow a comparison for statistical purposes.


title: HIV/AIDS

text: The World Health Organization first proposed a definition for AIDS in 1986. Since then, the WHO classification has been updated and expanded several times, with the most recent version being published in 2007. The WHO system uses the following categories:


title: HIV/AIDS

text: The U.S. Centers for Disease Control and Prevention also created a classification system for HIV, and updated it in 2008 and 2014. This system classifies HIV infections based on CD4 count and clinical symptoms, and describes the infection in five groups. In those greater than six years of age it is:


title: HIV/AIDS

text: For surveillance purposes, the AIDS diagnosis still stands even if, after treatment, the CD4 T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.


title: HIV/AIDS

text: Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term. When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. There is some evidence to suggest that female condoms may provide an equivalent level of protection. Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor) immediately before sex seems to reduce infection rates by approximately 40% among African women. By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency to cause vaginal and rectal irritation.


title: HIV/AIDS

text: Circumcision in sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". Owing to these studies, both the World Health Organization and UNAIDS recommended male circumcision in 2007 as a method of preventing female-to-male HIV transmission in areas with high rates of HIV. However, whether it protects against male-to-female transmission is disputed, and whether it is of benefit in developed countries and among men who have sex with men is undetermined.


title: HIV/AIDS

text: Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk. Evidence of any benefit from peer education is equally poor. Comprehensive sexual education provided at school may decrease high-risk behavior. A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Voluntary counseling and testing people for HIV does not affect risky behavior in those who test negative but does increase condom use in those who test positive. Enhanced family planning services appear to increase the likelihood of women with HIV using contraception, compared to basic services. It is not known whether treating other sexually transmitted infections is effective in preventing HIV.


title: HIV/AIDS

text: Antiretroviral treatment among people with HIV whose CD4 count ≤ 550 cells/µL is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). TASP is associated with a 10- to 20-fold reduction in transmission risk. Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir, with or without emtricitabine, is effective in people at high risk including men who have sex with men, couples where one is HIV-positive, and young heterosexuals in Africa. It may also be effective in intravenous drug users, with a study finding a decrease in risk of 0.7 to 0.4 per 100 person years. The USPSTF, in 2019, recommended PrEP in those who are at high risk.


title: HIV/AIDS

text: Universal precautions within the health care environment are believed to be effective in decreasing the risk of HIV. Intravenous drug use is an important risk factor, and harm reduction strategies such as needle-exchange programs and opioid substitution therapy appear effective in decreasing this risk.


title: HIV/AIDS

text: A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV-positive blood or genital secretions is referred to as post-exposure prophylaxis (PEP). The use of the single agent zidovudine reduces the risk of a HIV infection five-fold following a needle-stick injury. , the prevention regimen recommended in the United States consists of three medications—tenofovir, emtricitabine and raltegravir—as this may reduce the risk further.


title: HIV/AIDS

text: PEP treatment is recommended after a sexual assault when the perpetrator is known to be HIV-positive, but is controversial when their HIV status is unknown. The duration of treatment is usually four weeks and is frequently associated with adverse effects—where zidovudine is used, about 70% of cases result in adverse effects such as nausea (24%), fatigue (22%), emotional distress (13%) and headaches (9%).


title: HIV/AIDS

text: Programs to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of transmission by 92–99%. This primarily involves the use of a combination of antiviral medications during pregnancy and after birth in the infant, and potentially includes bottle feeding rather than breastfeeding. If replacement feeding is acceptable, feasible, affordable, sustainable and safe, mothers should avoid breastfeeding their infants; however, exclusive breastfeeding is recommended during the first months of life if this is not the case. If exclusive breastfeeding is carried out, the provision of extended antiretroviral prophylaxis to the infant decreases the risk of transmission. In 2015, Cuba became the first country in the world to eradicate mother-to-child transmission of HIV.


title: HIV/AIDS

text: Currently there is no licensed vaccine for HIV or AIDS. The most effective vaccine trial to date, RV 144, was published in 2009; it found a partial reduction in the risk of transmission of roughly 30%, stimulating some hope in the research community of developing a truly effective vaccine. Further trials of the RV 144 vaccine are ongoing.


title: HIV/AIDS

text: There is currently no cure, nor an effective HIV vaccine. Treatment consists of highly active antiretroviral therapy (HAART), which slows progression of the disease. , more than 6.6 million people were receiving HAART in low- and middle-income countries. Treatment also includes preventive and active treatment of opportunistic infections. , four people have been successfully cleared of HIV. Rapid initiation of antiretroviral therapy within one week of diagnosis appear to improve treatment outcomes in low and medium-income settings.


title: HIV/AIDS

text: Current HAART options are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes", of antiretroviral agents. Initially, treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). , dolutegravir/lamivudine/tenofovir is listed by the World Health Organization as the first-line treatment for adults, with tenofovir/lamivudine/efavirenz as an alternative. Combinations of agents that include protease inhibitors (PI) are used if the above regimen loses effectiveness.


title: HIV/AIDS

text: The World Health Organization and the United States recommend antiretrovirals in people of all ages (including pregnant women) as soon as the diagnosis is made, regardless of CD4 count. Once treatment is begun, it is recommended that it is continued without breaks or "holidays". Many people are diagnosed only after treatment ideally should have begun. The desired outcome of treatment is a long-term plasma HIV-RNA count below 50 copies/mL. Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50 copies/mL checks every three to six months are typically adequate. Inadequate control is deemed to be greater than 400 copies/mL. Based on these criteria treatment is effective in more than 95% of people during the first year.


title: HIV/AIDS

text: Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death. In the developing world, treatment also improves physical and mental health. With treatment, there is a 70% reduced risk of acquiring tuberculosis. Additional benefits include a decreased risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission. The effectiveness of treatment depends to a large part on compliance. Reasons for non-adherence to treatment include poor access to medical care, inadequate social supports, mental illness and drug abuse. The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. Even though cost is an important issue with some medications, 47% of those who needed them were taking them in low- and middle-income countries , and the rate of adherence is similar in low-income and high-income countries.


title: HIV/AIDS

text: Specific adverse events are related to the antiretroviral agent taken. Some relatively common adverse events include: lipodystrophy syndrome, dyslipidemia, and diabetes mellitus, especially with protease inhibitors. Other common symptoms include diarrhea, and an increased risk of cardiovascular disease. Newer recommended treatments are associated with fewer adverse effects. Certain medications may be associated with birth defects and therefore may be unsuitable for women hoping to have children.


title: HIV/AIDS

text: Treatment recommendations for children are somewhat different from those for adults. The World Health Organization recommends treating all children less than five years of age; children above five are treated like adults. The United States guidelines recommend treating all children less than 12 months of age and all those with HIV RNA counts greater than 100,000 copies/mL between one year and five years of age.


title: HIV/AIDS

text: The European Medicines Agency (EMA) has recommended the granting of marketing authorizations for two new antiretroviral (ARV) medicines, rilpivirine (Rekambys) and cabotegravir (Vocabria), to be used together for the treatment of people with human immunodeficiency virus type 1 (HIV-1) infection. The two medicines are the first ARVs that come in a long-acting injectable formulation. This means that instead of daily pills, people receive intramuscular injections monthly or every two months.


title: HIV/AIDS

text: The combination of Rekambys and Vocabria injection is intended for maintenance treatment of adults who have undetectable HIV levels in the blood (viral load less than 50 copies/ml) with their current ARV treatment, and when the virus has not developed resistance to a certain class of anti-HIV medicines called non-nucleoside reverse transcriptase inhibitors (NNRTIs) and integrase strand transfer inhibitors (INIs).


title: HIV/AIDS

text: Cabotegravir combined with rilpivirine (Cabenuva) is a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults to replace a current antiretroviral regimen in those who are virologically suppressed on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.


title: HIV/AIDS

text: Measures to prevent opportunistic infections are effective in many people with HIV/AIDS. In addition to improving current disease, treatment with antiretrovirals reduces the risk of developing additional opportunistic infections.


title: HIV/AIDS

text: Adults and adolescents who are living with HIV (even on anti-retroviral therapy) with no evidence of active tuberculosis in settings with high tuberculosis burden should receive isoniazid preventive therapy (IPT); the tuberculin skin test can be used to help decide if IPT is needed. Children with HIV may benefit from screening for tuberculosis. Vaccination against hepatitis A and B is advised for all people at risk of HIV before they become infected; however, it may also be given after infection.


title: HIV/AIDS

text: Trimethoprim/sulfamethoxazole prophylaxis between four and six weeks of age, and ceasing breastfeeding of infants born to HIV-positive mothers, is recommended in resource-limited settings. It is also recommended to prevent PCP when a person's CD4 count is below 200 cells/uL and in those who have or have previously had PCP. People with substantial immunosuppression are also advised to receive prophylactic therapy for toxoplasmosis and MAC. Appropriate preventive measures reduced the rate of these infections by 50% between 1992 and 1997. Influenza vaccination and pneumococcal polysaccharide vaccine are often recommended in people with HIV/AIDS with some evidence of benefit.


title: HIV/AIDS

text: The World Health Organization (WHO) has issued recommendations regarding nutrient requirements in HIV/AIDS. A generally healthy diet is promoted. Dietary intake of micronutrients at RDA levels by HIV-infected adults is recommended by the WHO; higher intake of vitamin A, zinc, and iron can produce adverse effects in HIV-positive adults, and is not recommended unless there is documented deficiency. Dietary supplementation for people who are infected with HIV and who have inadequate nutrition or dietary deficiencies may strengthen their immune systems or help them recover from infections; however, evidence indicating an overall benefit in morbidity or reduction in mortality is not consistent.


title: HIV/AIDS

text: Evidence for supplementation with selenium is mixed with some tentative evidence of benefit. For pregnant and lactating women with HIV, multivitamin supplement improves outcomes for both mothers and children. If the pregnant or lactating mother has been advised to take anti-retroviral medication to prevent mother-to-child HIV transmission, multivitamin supplements should not replace these treatments. There is some evidence that vitamin A supplementation in children with an HIV infection reduces mortality and improves growth.


title: HIV/AIDS

text: In the US, approximately 60% of people with HIV use various forms of complementary or alternative medicine, whose effectiveness has not been established. There is not enough evidence to support the use of herbal medicines. There is insufficient evidence to recommend or support the use of medical cannabis to try to increase appetite or weight gain.


title: HIV/AIDS

text: HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world. Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months. HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years. This is between two thirds and nearly that of the general population. If treatment is started late in the infection, prognosis is not as good: for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years. Half of infants born with HIV die before two years of age without treatment.


title: HIV/AIDS

text: The primary causes of death from HIV/AIDS are opportunistic infections and cancer, both of which are frequently the result of the progressive failure of the immune system. Risk of cancer appears to increase once the CD4 count is below 500/μL. The rate of clinical disease progression varies widely between individuals and has been shown to be affected by a number of factors such as a person's susceptibility and immune function; their access to health care, the presence of co-infections; and the particular strain (or strains) of the virus involved.


title: HIV/AIDS

text: Tuberculosis co-infection is one of the leading causes of sickness and death in those with HIV/AIDS being present in a third of all HIV-infected people and causing 25% of HIV-related deaths. HIV is also one of the most important risk factors for tuberculosis. Hepatitis C is another very common co-infection where each disease increases the progression of the other. The two most common cancers associated with HIV/AIDS are Kaposi's sarcoma and AIDS-related non-Hodgkin's lymphoma. Other cancers that are more frequent include anal cancer, Burkitt's lymphoma, primary central nervous system lymphoma, and cervical cancer.


title: HIV/AIDS

text: Even with anti-retroviral treatment, over the long term HIV-infected people may experience neurocognitive disorders, osteoporosis, neuropathy, cancers, nephropathy, and cardiovascular disease. Some conditions, such as lipodystrophy, may be caused both by HIV and its treatment.


title: HIV/AIDS

text: Some authors consider HIV/AIDS a global pandemic. approximately 36.7 million people worldwide have HIV, the number of new infections that year being about 1.8 million. This is down from 3.1 million new infections in 2001. Slightly over half the infected population are women and 2.1 million are children. It resulted in about 1 million deaths in 2016, down from a peak of 1.9 million in 2005.


title: HIV/AIDS

text: Sub-Saharan Africa is the region most affected. In 2010, an estimated 68% (22.9 million) of all HIV cases and 66% of all deaths (1.2 million) occurred in this region. This means that about 5% of the adult population is infected and it is believed to be the cause of 10% of all deaths in children. Here, in contrast to other regions, women comprise nearly 60% of cases. South Africa has the largest population of people with HIV of any country in the world at 5.9 million. Life expectancy has fallen in the worst-affected countries due to HIV/AIDS; for example, in 2006 it was estimated that it had dropped from 65 to 35 years in Botswana. Mother-to-child transmission in Botswana and South Africa, , has decreased to less than 5%, with improvement in many other African nations due to improved access to antiretroviral therapy.


title: HIV/AIDS

text: South & South East Asia is the second most affected; in 2010 this region contained an estimated 4 million cases or 12% of all people living with HIV resulting in approximately 250,000 deaths. Approximately 2.4 million of these cases are in India.


title: HIV/AIDS

text: During 2008 in the United States approximately 1.2 million people were living with HIV, resulting in about 17,500 deaths. The US Centers for Disease Control and Prevention estimated that in that year, 20% of infected Americans were unaware of their infection. about 675,000 people have died of HIV/AIDS in the US since the beginning of the HIV epidemic. In the United Kingdom , there were approximately 101,200 cases which resulted in 594 deaths. In Canada as of 2008, there were about 65,000 cases causing 53 deaths. Between the first recognition of AIDS (in 1981) and 2009, it has led to nearly 30 million deaths. Rates of HIV are lowest in North Africa and the Middle East (0.1% or less), East Asia (0.1%), and Western and Central Europe (0.2%). The worst-affected European countries, in 2009 and 2012 estimates, are Russia, Ukraine, Latvia, Moldova, Portugal and Belarus, in decreasing order of prevalence.


title: HIV/AIDS

text: The first news story on the disease appeared on May 18, 1981, in the gay newspaper "New York Native". AIDS was first clinically reported on June 5, 1981, with five cases in the United States. The initial cases were a cluster of injecting drug users and gay men with no known cause of impaired immunity who showed symptoms of "Pneumocystis carinii" pneumonia (PCP), a rare opportunistic infection that was known to occur in people with very compromised immune systems. Soon thereafter, a large number of homosexual men developed a generally rare skin cancer called Kaposi's sarcoma (KS). Many more cases of PCP and KS emerged, alerting U.S. Centers for Disease Control and Prevention (CDC) and a CDC task force was formed to monitor the outbreak.


title: HIV/AIDS

text: In the early days, the CDC did not have an official name for the disease, often referring to it by way of diseases associated with it, such as lymphadenopathy, the disease after which the discoverers of HIV originally named the virus. They also used "Kaposi's sarcoma and opportunistic infections", the name by which a task force had been set up in 1981. At one point the CDC referred to it as the "4H disease", as the syndrome seemed to affect heroin users, homosexuals, hemophiliacs, and Haitians. The term "GRID", which stood for gay-related immune deficiency, had also been coined. However, after determining that AIDS was not isolated to the gay community, it was realized that the term "GRID" was misleading, and the term "AIDS" was introduced at a meeting in July 1982. By September 1982 the CDC started referring to the disease as AIDS.


title: HIV/AIDS

text: In 1983, two separate research groups led by Robert Gallo and Luc Montagnier declared that a novel retrovirus may have been infecting people with AIDS, and published their findings in the same issue of the journal "Science". Gallo claimed a virus which his group had isolated from a person with AIDS was strikingly similar in shape to other human T-lymphotropic viruses (HTLVs) that his group had been the first to isolate. Gallo's group called their newly isolated virus HTLV-III. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness, two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV). As these two viruses turned out to be the same, in 1986, LAV and HTLV-III were renamed HIV.


title: HIV/AIDS

text: Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century. HIV-1 appears to have originated in southern Cameroon through the evolution of SIV(cpz), a simian immunodeficiency virus (SIV) that infects wild chimpanzees (HIV-1 descends from the SIVcpz endemic in the chimpanzee subspecies "Pan troglodytes troglodytes"). The closest relative of HIV-2 is SIV (smm), a virus of the sooty mangabey ("Cercocebus atys atys"), an Old World monkey living in coastal West Africa (from southern Senegal to western Ivory Coast). New World monkeys such as the owl monkey are resistant to HIV-1 infection, possibly because of a genomic fusion of two viral resistance genes. HIV-1 is thought to have jumped the species barrier on at least three separate occasions, giving rise to the three groups of the virus, M, N, and O.


title: HIV/AIDS

text: There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, SIV is a weak virus which is typically suppressed by the human immune system within weeks of infection. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Furthermore, due to its relatively low person-to-person transmission rate, SIV can only spread throughout the population in the presence of one or more high-risk transmission channels, which are thought to have been absent in Africa before the 20th century.


title: HIV/AIDS

text: Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout society, depend on the proposed timing of the animal-to-human crossing. Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to 1910. Proponents of this dating link the HIV epidemic with the emergence of colonialism and growth of large colonial African cities, leading to social changes, including a higher degree of sexual promiscuity, the spread of prostitution, and the accompanying high frequency of genital ulcer diseases (such as syphilis) in nascent colonial cities. While transmission rates of HIV during vaginal intercourse are low under regular circumstances, they are increased manyfold if one of the partners has a sexually transmitted infection causing genital ulcers. Early 1900s colonial cities were notable for their high prevalence of prostitution and genital ulcers, to the degree that, as of 1928, as many as 45% of female residents of eastern Kinshasa were thought to have been prostitutes, and, as of 1933, around 15% of all residents of the same city had syphilis.


title: HIV/AIDS

text: An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single-use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread.


title: HIV/AIDS

text: The earliest well-documented case of HIV in a human dates back to 1959 in the Congo. The virus may have been present in the U.S. as early as the mid-to-late 1950s, as a sixteen-year-old male named Robert Rayford presented with symptoms in 1966 and died in 1969. In the 1970s, there were cases of getting parasites and becoming sick with what was called “gay bowel disease,” but what is now suspected to have been AIDS.


title: HIV/AIDS

text: The earliest retrospectively described case of AIDS is believed to have been in Norway beginning in 1966. In July 1960, in the wake of Congo's independence, the United Nations recruited Francophone experts and technicians from all over the world to assist in filling administrative gaps left by Belgium, who did not leave behind an African elite to run the country. By 1962, Haitians made up the second-largest group of well-educated experts (out of the 48 national groups recruited), that totaled around 4500 in the country. Dr. Jacques Pépin, a Canadian author of "The Origins of AIDS", stipulates that Haiti was one of HIV's entry points to the U.S. and that a Haitian may have carried HIV back across the Atlantic in the 1960s. Although there was known to have been at least one case of AIDS in the U.S. from 1966, the vast majority of infections occurring outside sub-Saharan Africa (including the U.S.) can be traced back to a single unknown individual who became infected with HIV in Haiti and then brought the infection to the U.S. at some time around 1969. The epidemic then rapidly spread among high-risk groups (initially, sexually promiscuous men who have sex with men). By 1978, the prevalence of HIV-1 among gay male residents of New York City and San Francisco was estimated at 5%, suggesting that several thousand individuals in the country had been infected.


title: HIV/AIDS

text: AIDS stigma exists around the world in a variety of ways, including ostracism, rejection, discrimination and avoidance of HIV-infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV-infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV-infected individuals. Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.


title: HIV/AIDS

text: Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, prostitution, and intravenous drug use.


title: HIV/AIDS

text: In many developed countries, there is an association between AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice, such as anti-homosexual or anti-bisexual attitudes. There is also a perceived association between AIDS and all male-male sexual behavior, including sex between uninfected men. However, the dominant mode of spread worldwide for HIV remains heterosexual transmission. To get a better understanding of the anti-homosexual attitudes around AIDs the musical "Rent" explores this.


title: HIV/AIDS

text: In 2003, as part of an overall reform of marriage and population legislation, it became legal for those diagnosed with AIDS to marry in China.


title: HIV/AIDS

text: In 2013, the U.S. National Library of Medicine developed a traveling exhibition titled "Surviving and Thriving: AIDS, Politics, and Culture"; this covered medical research, the U.S. government's response, and personal stories from people with AIDS, caregivers, and activists.


title: HIV/AIDS

text: HIV/AIDS affects the economics of both individuals and countries. The gross domestic product of the most affected countries has decreased due to the lack of human capital. Without proper nutrition, health care and medicine, large numbers of people die from AIDS-related complications. Before death they will not only be unable to work, but will also require significant medical care. It is estimated that as of 2007 there were 12 million AIDS orphans. Many are cared for by elderly grandparents.


title: HIV/AIDS

text: Returning to work after beginning treatment for HIV/AIDS is difficult, and affected people often work less than the average worker. Unemployment in people with HIV/AIDS also is associated with suicidal ideation, memory problems, and social isolation. Employment increases self-esteem, sense of dignity, confidence, and quality of life for people with HIV/AIDS. Anti-retroviral treatment may help people with HIV/AIDS work more, and may increase the chance that a person with HIV/AIDS will be employed (low-quality evidence).


title: HIV/AIDS

text: By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS, resulting in increasing pressure on the state's finances and slower growth of the economy. This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay, and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility from the family to the government in caring for these orphans.


title: HIV/AIDS

text: At the household level, AIDS causes both loss of income and increased spending on healthcare. A study in Côte d'Ivoire showed that households having a person with HIV/AIDS spent twice as much on medical expenses as other households. This additional expenditure also leaves less income to spend on education and other personal or family investment.


title: HIV/AIDS

text: The topic of religion and AIDS has become highly controversial, primarily because some religious authorities have publicly declared their opposition to the use of condoms. The religious approach to prevent the spread of AIDS, according to a report by American health expert Matthew Hanley titled "The Catholic Church and the Global AIDS Crisis", argues that cultural changes are needed, including a re-emphasis on fidelity within marriage and sexual abstinence outside of it.


title: HIV/AIDS

text: Some religious organizations have claimed that prayer can cure HIV/AIDS. In 2011, the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney-based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to many deaths. The Synagogue Church Of All Nations advertised an "anointing water" to promote God's healing, although the group denies advising people to stop taking medication.


title: HIV/AIDS

text: One of the first high-profile cases of AIDS was the American gay actor Rock Hudson. He had been diagnosed during 1984, announced that he had had the virus on July 25, 1985, and died a few months later on October 2, 1985. Another notable British casualty of AIDS that year was Nicholas Eden, a gay politician and son of the late prime minister Anthony Eden. On November 24, 1991, the virus claimed the life of British rock star Freddie Mercury, lead singer of the band Queen, who died from an AIDS-related illness having only revealed the diagnosis on the previous day.


title: HIV/AIDS

text: One of the first high-profile heterosexual cases of the virus was American tennis player Arthur Ashe. He was diagnosed as HIV-positive on August 31, 1988, having contracted the virus from blood transfusions during heart surgery earlier in the 1980s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April 1992. He died as a result on February 6, 1993, aged 49.


title: HIV/AIDS

text: Therese Frare's photograph of gay activist David Kirby, as he lay dying from AIDS while surrounded by family, was taken in April 1990. "Life" magazine said the photo became the one image "most powerfully identified with the HIV/AIDS epidemic." The photo was displayed in "Life", was the winner of the World Press Photo, and acquired worldwide notoriety after being used in a United Colors of Benetton advertising campaign in 1992.


title: HIV/AIDS

text: Many famous artists and AIDS activists such as Larry Kramer, Diamanda Galás and Rosa von Praunheim campaign for AIDS education and the rights of those affected. These artists worked with various media formats.