HIV/AIDS in the United States
The first appearance of HIV/AIDS in the United States was in about 1969, when HIV likely entered the U.S. through a single infected immigrant. In the late 1970s (i.e., 1978) and early 1980s, doctors in Los Angeles, New York City, and San Francisco began seeing young men with Kaposi's Sarcoma, a cancer.
As the knowledge that men who had sex with men were dying of an otherwise rare cancer began to spread throughout the medical communities, the syndrome began to be called by the colloquialism "gay cancer." As medical scientists discovered that the syndrome included other manifestations, such as pneumocystis pneumonia, (PCP), a rare form of fungal pneumonia, its name was changed to "GRID," or Gay Related Immune Deficiency. This had an effect of boosting homophobia and adding stigma to homosexuality in the general public, particularly since it seemed that unprotected anal sex was the prevalent way of spreading the disease.
Within the medical community, it quickly became apparent that the disease was not specific to men who have sex with men (as blood transfusion patients, intravenous drug users, heterosexual and bisexual women, and newborn babies became added to the list of afflicted), and the Centers for Disease Control and Prevention (CDC) renamed the syndrome AIDS (Acquired Immune Deficiency Syndrome) in 1982. Hemophiliacs, who require injections of blood clotting factor as a course of treatment, during the late 1970s and 1980s also contracted HIV in large numbers worldwide through the spread of contaminated blood products. It is estimated that nearly 1 million individuals are currently infected with HIV in the country, and the number appears to be increasing each year. From the mid-1980s on, AIDS had a pivotal role in the rollback of Sexual Revolution habits in the big cities of the United States.
Male to male sexual contact accounted for about half of new cases, and intravenous drug use contributed about a fifth of cases. Despite the availability of syringe access programs, many individuals continue to share and use dirty or infected needles in most American cities.
One of the best-known works on the history of HIV is 1987's book And the Band Played On, by Randy Shilts. Shilts contends that Ronald Reagan's administration dragged its feet in dealing with the crisis due to homophobia, while the gay community viewed early reports and public health measures with corresponding distrust, thus allowing the disease to spread and hundreds of thousands of people to needlessly die. This resulted in the formation of ACT-UP, the AIDS Coalition to Unleash Power by Larry Kramer.
This work popularized the misconception that the disease was introduced by a gay flight attendant named Gaëtan Dugas, referred to as "Patient Zero." However, subsequent research has revealed that there were cases of AIDS much earlier than initially known. HIV-infected blood samples have been found from as early as 1959 in Africa (see HIV main entry), and HIV has been shown to have caused the death of Robert Rayford, a 16 year old St. Louis male, in 1969, who could have contracted it as early as 7 years old due to sexual abuse, raising the question of spontaneous random genesis.
Shilts also details the fact that despite recommendations from the Centers for Disease Control, the Red Cross and other non-profits, blood banking organizations refused to ban bisexual and gay men from donating blood in an effort to keep the blood bank industry from suffering shortages, particularly in cities having large homosexual communities; many of the same cities where AIDS was first discovered in. As a result, tens of thousands of hemophiliacs and transfusion recipients were infected and died.
It has been theorized that a series of inoculations against hepatitis that were performed in the gay community of San Francisco were tainted with HIV. Although there was a high correlation between recipients of that vaccination and initial cases of AIDS, this theory has never been proven. HIV, hepatitis B, and hepatitis C are bloodborne diseases with very similar modes of transmission, and those at risk for one are at risk for the others.
Activists and critics of current AIDS policies allege that another preventable impediment to the attack on the disease was the academic elitism of "celebrity" scientists. Robert Gallo, an American scientist who was one of many to attempt to figure out if there was some kind of new virus in the people who were affected by the disease, became embroiled in a legal battle with French scientist Luc Montagnier. Gallo, too, appeared hung up on the possible connection between the virus causing AIDS and HTLV, a retrovirus that he had worked with previously. Critics claim that because some scientists (and biological research companies) wanted glory and fame (and lucrative patent rights), research progress was delayed and more people needlessly died. Eventually, after meeting, the French scientists and Gallo agreed to "share" the discovery of HIV.
Publicity campaigns were started in attempts to counter the often vitriolic and homophobic perception of AIDS as a "gay plague." In particular this included the Ryan White case, red ribbon campaigns, celebrity dinners, the 1993 film version of And the Band Played On, sex education programs in schools, and television advertisements. Announcements by various celebrities that they had contracted HIV (including actor Rock Hudson, basketball star Magic Johnson, tennis player Arthur Ashe and singer Freddie Mercury) were significant in making the general public aware of the dangers of the disease to people of all sexual orientations.
Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included protease inhibitors. David Ho, a pioneer of this approach, was honored as Time Magazine Man of the Year for 1996. Deaths were rapidly reduced by more than half, with a small but welcome reduction in the yearly rate of new HIV infections. Since this time, AIDS deaths have continued to decline, but much more slowly, and not as completely in black Americans as in other population segments.
The second prong of the American approach to containment has been to maintain strict entry controls to the country for people with HIV or AIDS. Under legislation enacted by the United States Congress in 1993, patients found importing anti-HIV medication into the country were arrested and placed on flights back to their country of origin.
Some HIV-positive travellers took to sending anti-HIV medication through the post to friends or contacts in advocacy groups in advance. This meant that the traveller would not be discovered with any medication. However, the security clampdown following the September 11 attacks in 2001 meant this was no longer an option.
The only legal alternative to this was to apply for a special visa beforehand, which entailed interview at an American Embassy, confiscation of the passport during the lengthy application process, and then, if permission were granted, a permanent attachment being made to the applicant's passport.
This process was condemned as intrusive and invasive by a number of advocacy groups, on the grounds that any time the passport was later used for travel elsewhere or for identification purposes, the holder's HIV status would become known. It was also felt that this rule was unfair because it applied even if the traveller was covered for HIV-related conditions under their own travel insurance.
In early December 2006, President George W. Bush indicated that he would issue an executive order allowing HIV-positive people to enter the United States on standard visas. It is unclear whether applicants will still have to declare their HIV status. However, the ban remained in effect throughout Bush's Presidency. In August 2007, Congressperson Barbara Lee of California introduced H.R. 3337, the HIV Nondiscrimination in Travel and Immigration Act of 2007. This bill would allow travelers and immigrants entry to the United States without having to disclose their HIV status. The bill died at the end of the 110th Congress. In July 2008, then President George W. Bush signed H.R. 5501 that lifted the ban in statutory law. However, the United States Department of Health and Human Services still held the ban in administrative (written regulation) law. New impetus was added to repeal efforts when Paul Thorn, a UK tuberculosis expert who was invited to speak at the 2009 Pacific Health Summit in Seattle, was denied a visa due to his HIV positive status. A letter written by Mr. Thorn, and read in his place at the Summit, was attained by Congressman Jim McDermott, who advocated the issue to the Obama administration's Health Secretary.
On October 30, 2009 President Barack Obama reauthorized the Ryan White HIV/AIDS Bill which expanded care and treatment through federal funding to nearly half a million. He also announced that the Department of Health and Human Services crafted regulation that would end the HIV Travel and Immigration Ban effective in January 2010; on January 4, 2010, the United States Department of Health and Human Services, Centers for Disease Control and Prevention removed HIV status as a factor to be considered in the granting of travel visas.
Previously in the U.S., HIV drugs were only given to those who had T-cell counts of under 200, but that had been boosted in the mid 2000s to 350 on advice from the Journal of the American Medical Association (JAMA) guidelines which recommend therapy for all patients at 350 or certain patients higher. For the uninsured, there are generally two funding sources, Medicaid and AIDS Drug Assistance Programs (ADAP), both administered differently in each state but still consistent with federal requirements established by the Ryan White Care Act.
According to a recent large scale study, asymptomatic HIV positive patients who started on medication with T-cell counts 350 to 500 had a 70 percent higher survival rate than those who waited. The results from this shows that waiting even until the cell count reaches 350 (current JAMA recommendation) increases the risk of death, let alone the Medicaid eligible 200. As many patients can't afford medicines without Medicaid help, HIV annual death counts have failed to decline significantly since 2002 despite great advances made before that date. The number of new cases in children has dropped significantly as a result of better screening of infected mothers as well as having established uniform testing and screening of blood products. This is not the same for places outside the United States, especially developing countries where the number of children affected by HIV continue to rise exponentially each year.
Mortality and morbidity
Invariably, HIV is a silent disease when first acquired, and this period of latency varies. The progression from HIV infection to AIDS varies from 5–12 years. In the past, most individuals succumbed to the disease in 1–2 years after being diagnosed with AIDS. However, since the introduction of potent anti retroviral drug therapy and better prophylaxis against opportunistic infections, death rates have significantly declined.
The cumulative number of deaths in the U.S. due to causes related to AIDS is estimated to be more than 650,000. The cumulative number of estimated AIDS cases in the U.S. is estimated to be 1.8 million. Over 1.1 million people are estimated to be currently living with HIV in the U.S. About 50,000 people are infected with HIV in the U.S. each year, a number which has remained fairly steady over the last decade.
In California alone, 184,429 cumulative people (including children) have reported to have contracted HIV by December 2008. Of those, 85,958 have died, with 31,076 in Los Angeles County, 18,838 in San Francisco, and 7,135 in San Diego County.
Washington DC has a particularly high incidence of HIV/AIDS, about 2.7% overall but much higher in the Black male population.
In the United States, homosexuals, Hispanics, African Americans and White Males make up about 78% of the total HIV-positive population and 75% the amount of new HIV cases. A review of four studies in which trans women in the United States were tested for HIV found that 27.7% tested positive.
In a 2008 study, the Center for Disease Control found that, of the study participants who were men who had sex with men ("MSM"), almost one in five (19%) had HIV and "among those who were infected, nearly half (44 percent) were unaware of their HIV status." The research found that those who are white MSM "represent a greater number of new HIV infections than any other population, followed closely by black MSM — who are one of the most disproportionately affected subgroups in the U.S." and that most new infections among white MSM occurred among those aged 30–39 followed closely by those aged 40–49, while most new infections among black MSM have occurred among young black MSM (aged 13–29).
In 2015, a major HIV outbreak, Indiana's largest-ever, occurred in two largely rural, economically depressed and poor counties in the southern portion of the state, due to the injection of a relatively new opioid-type drug called Opana (oxymorphone), which should be taken in pill form but is ground up and injected intravenously using needles. Because of the lack of HIV cases in that area beforehand and the youth of many but not all of those affected, the relative unavailability in the local area of safe needle exchange programs and of treatment centers capable of dealing with long-term health needs, HIV care, and drug addiction during the initial phases of the outbreak, it was not initially adequately contained and dealt with until those were set up by the government and the public and private sector, and acute awareness of the issue spread. Such centers have now been opened, and short-term care is beginning to be provided; despite some initial reservations, the Governor, once the scope of the outbreak became clear, approved a legislative measure to allow safe, clean needle exchange programs and treatment for those affected, which could end up being instituted statewide.
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