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[[File:U S Aids Map 2009 Estimated.svg|thumb|300px|Estimated rate of diagnosed HIV cases in U.S. 2009 (per 100,000)]]
[[File:U S Aids Map 2009 Estimated.svg|thumb|300px|Estimated rate of diagnosed HIV cases in U.S. 2009 (per 100,000)]]


The history of '''HIV/AIDS in the United States''' began in about 1969, when HIV likely entered the [[United States]] through a single infected immigrant from [[Haiti]].<ref name="pmid17978186">{{cite journal
The history of '''HIV/AIDS in the United States''' began in about 1969, when HIV likely entered the [[United States]] through an unknown source. In the late 1970s (i.e. 1978) and early 1980s, doctors in [[Los Angeles, California|Los Angeles]], [[New York City]], and [[San Francisco]] began seeing young men with [[Kaposis Sarcoma|Kaposi's Sarcoma]], a [[cancer]] usually associated with elderly men of Mediterranean ethnicity.
|author=Gilbert MT, Rambaut A, Wlasiuk G, Spira TJ, Pitchenik AE, Worobey M
|title=The emergence of HIV/AIDS in the Americas and beyond
|journal=Proc. Natl. Acad. Sci. U.S.A.
|volume=104 |issue=47 |pages=18566–70
|year=2007 |month=November
|pmid=17978186 |pmc=2141817 |doi=10.1073/pnas.0705329104
|url=http://www.pnas.org/cgi/pmidlookup?view=long&pmid=17978186
|accessdate=March 20, 2010
}}</ref> In the late 1970s (i.e. 1978) and early 1980s, doctors in [[Los Angeles, California|Los Angeles]], [[New York City]], and [[San Francisco]] began seeing young men with [[Kaposis Sarcoma|Kaposi's Sarcoma]], a [[cancer]] usually associated with elderly men of Mediterranean ethnicity.


As the knowledge that [[men who have sex with men|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 carinii pneumonia|pneumocystis pneumonia]], (PCP), a rare form of [[fungal pneumonia]], its name was changed to "GRID," or ''[[Gay related immune deficiency|Gay Related Immune Deficiency]]''.<ref name="Altman 1982">{{Cite news
As the knowledge that [[men who have sex with men|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 carinii pneumonia|pneumocystis pneumonia]], (PCP), a rare form of [[fungal pneumonia]], its name was changed to "GRID," or ''[[Gay related immune deficiency|Gay Related Immune Deficiency]]''.<ref name="Altman 1982">{{Cite news

Revision as of 15:23, 16 April 2012

Estimated rate of diagnosed HIV cases in U.S. 2009 (per 100,000)

The history of HIV/AIDS in the United States began in about 1969, when HIV likely entered the United States through an unknown source. 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 usually associated with elderly men of Mediterranean ethnicity.

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.[1] 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.

Male to male sexual contact accounted for about half of new cases, and intravenous drug use contributed about a fifth of cases.[2] Despite the availability of syringe access programs, many individuals continue to share and use dirty or infected needles in most American cities.[3]

In addition, the percentage of AIDS diagnoses in the United States in 2007 can be spatially analyzed. There is a higher percentage of AIDS diagnoses in the Eastern and in the Southern most states. The states with similar data figures tend to be clustered together with a few exceptions such as Illinois and Nevada. With the provided data, it can be concluded that the majority of the AIDS diagnoses can be found near coastal areas. It is a fair to state that these coastal areas have a higher population density, which could result in a higher distribution rate of the disease. In other words, areas with the greatest population density tend to transmit the disease more rapidly. In contrast, in less populated areas, the disease is more likely to be localized in a contained area and is not widespread. Also, these areas are harbor areas where various people and cultures make their way into the United States and vice versa. The risk of the high interaction between the U.S. and other countries is that people become more susceptible to disease contraction and transmissions.[4]

Public perception

Regarding the social effects of the HIV/AIDS pandemic, there has been since the 1980s a "profound re-medicalization of sexuality".[5][6][verification needed]

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 a sexually active 16 year old St. Louis male prostitute in 1969, who could have contracted it as early as 7 years old due to sexual abuse, raising the question of spontaneous random genesis.[7]

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.[8]

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.

Containment

Chart of AIDS deaths in the United States from 1987 to 1997.
Chart of AIDS deaths in the United States from 1998 to 2002.

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.[9][10]

Travel restrictions

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.[11] However, as of February 2008, the ban was still in effect.[needs update] In August 2007, Congressperson Barbara Lee of California introduced House Resolution 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. As of February 2008 it is still pending.[12][dead link]

In July 2008, then President George W. Bush signed the bill that would effectively lift the ban in statutory law. However, the Department of Health and Human Safety 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.[13]

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.[14] 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;[14] 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.[15]

Medicine disbursement

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 2000's 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.[16] 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.[17]

Mortality and morbidity

Invariably, HIV is a silent disease when first acquired, and this period of latency varies. Current estimates indicate that close to half a million individuals have died of AIDS in the USA. 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.[18]

Current status

Estimated number of US HIV/AIDS Cases, in 2007 by transmission category[19]

The CDC estimates the cumulative number of deaths of persons with AIDS in the U.S. through 2007 to be 583,298, including 4,891 children under the age of 13. Cumulative estimated AIDS cases are 1,051,875.[20] Persons living with HIV in reporting cities with confidential name based reporting (a fraction of the USA only) was 1,106,400 in 2006.[21] UNAIDS estimates that there are a total of about 1,200,000 people in the U.S. living with HIV as of 2009, and that 310,000 of these are women (female 15+ years of age).[22]

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.[23]

In 2007, 119,929 People were living with HIV in New York State, with 92,669 in New York City alone.[24][needs update]

From its male, same-sex beginnings, AIDS continues to be a problem with illegal sex workers and intravenous drug users. Today, the main route of transmission for women is through heterosexual sex, and the main risk factor for them is non-protection and the undisclosed risky behavior of their sexual partners. Experts attribute this to "AIDS fatigue" among younger people who have no memory of the worst phase of the epidemic in the 1980s and early 1990s, as well as "condom fatigue" among those who have grown tired of and disillusioned with the unrelenting safer sex message.[citation needed] This trend is of major concern to public health workers.[citation needed]

AIDS is one of the top three causes of death for African American men aged 25–54 and for African American women aged 35–44 years in the United States of America.[citation needed] In the United States, African Americans make up about 47% of the total HIV-positive population and more than half of new HIV cases, despite making up only 12% of the population.[25] African American women are 19 times more likely to have HIV than white women.[26]

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).[27][28]

See also

References

  1. ^ Altman, Charles (June 18, 1982). "Clue Found on Homosexuals' Precancer Syndrome". New York Times. New York Times Company. Retrieved March 20, 2010.
  2. ^ http://www.cdc.gov/hiv/resources/factsheets/us.htm
  3. ^ Davis CS, Beletsky L (2009). "Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities". Harm Reduct J. 6: 16. doi:10.1186/1477-7517-6-16. PMC 2716314. PMID 19602236. Retrieved March 20, 2010.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  4. ^ http://www.avert.org/his81_86.htm
  5. ^ Aggleton, Peter; Parker, Richard Bordeaux; Barbosa, Regina Maria (2000). Framing the sexual subject: the politics of gender, sexuality, and power. Berkeley: University of California Press. p. 3. ISBN 0-520-21838-8.{{cite book}}: CS1 maint: multiple names: authors list (link)
  6. ^ Vance, Carole S. (1991). "Anthropology rediscovers sexuality: a theoretical comment". Soc Sci Med. 33 (8): 875–84. doi:10.1016/0277-9536(91)90259-F. PMID 1745914. {{cite journal}}: |access-date= requires |url= (help)
  7. ^ Highleyman L (1999). "First AIDS case in 1969". BETA. 12 (4): 5. PMID 11367253. {{cite journal}}: |access-date= requires |url= (help)
  8. ^ "Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus". US National Institute for Occupational Safety and Health. March 10, 2010. Retrieved March 21, 2010.
  9. ^ Wilson, Phill; Wright, Kai; Isbell, Michael T. (2008). "Left Behind: Black America: a Neglected Priority in the Global AIDS Epidemic" (PDF). Black AIDS Institute. Retrieved March 20, 2010. {{cite web}}: Unknown parameter |month= ignored (help) [dead link]
  10. ^ "Deaths in New York City Reached Historic Low in 2002" (Press release). New York City Department of Health and Mental Hygiene. January 30, 2004. Retrieved March 20, 2010.
  11. ^ Russell, Sabin (December 2, 2006). "Bush to ease rule limiting HIV-positive foreign visitors". San Francisco Chronicle. Hearst Communications. Retrieved March 21, 2010.
  12. ^ "House Resolution 3337". GovTrack.us. Civic Impulse LLC. Retrieved February 3, 2008. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  13. ^ | url =http://news.bbc.co.uk/2/hi/uk_news/8136456.stm | title = Activist helps US HIV law change | publisher = BBC News | accessdate = January 9, 2012
  14. ^ a b Crowley, Jeffrey (October 30, 2009). "Honoring the Legacy of Ryan White". WhiteHouse.gov. Office of the President of the United States. Retrieved March 21, 2010.
  15. ^ "HIV Final Rule". United States Department of State. 2010-01-04. Retrieved 2010-04-30.
  16. ^ Smith, Michael (October 27, 2008). "ICAAC-IDSA: HIV Treatment Started Sooner than Later Lessens Early Death Risk". MedPage Today, LLC. Retrieved March 21, 2010.
  17. ^ "Epidemiology Research, HIV/AIDS". National Institute of Allergy and Infectious Diseases. November 12, 2009. Retrieved March 20, 2010.
  18. ^ "2008 HIV/AIDS Epidemiology Annual Report" (PDF). San Francisco Department of Public Health. July 9, 2009. Retrieved March 21, 2010.
  19. ^ "HIV/AIDS Basic Statistics". US Centers for Disease Control. February 26, 2009. Retrieved March 21, 2010.
  20. ^ "Basic Statistics HIV/AIDS". US Centers for Disease Control. February 26, 2009. Retrieved March 21, 2010.
  21. ^ "HIV Prevalence Estimates – United States, 2006". Morbidity and Mortality Weekly Report. Vol. 57, no. 39. US Centers for Disease Control. October 3, 2008. pp. 1073–1076.
  22. ^ "United States". HIV/AIDS Knowledge Base. University of California, San Francisco. Retrieved November 25, 2011.
  23. ^ "December 2008 Monthly HIV/AIDS Statistics" (PDF). California Department of Public Health Office of AIDS. July 9, 2009. Retrieved March 21, 2010.
  24. ^ "New York State HIV/AIDS Surveillance Annual Report For Cases Diagnosed Through December 2007" (PDF). New York State Department of Public Health. 2009. Retrieved March 21, 2010. {{cite web}}: Unknown parameter |month= ignored (help)
  25. ^ http://www.nccu.edu/research/osrp/documents/ResearchBrochure.pdf
  26. ^ UNAIDS Report on the Global AIDS Epidemic 2010 (p 50)
  27. ^ CDC Fact Sheet - HIV and AIDS among Gay and Bisexual Men - Sept 2010
  28. ^ CDC: One In Five Gay Men HIV-Positive

Bibliography

  1. Cante, Richard C. (2008). Gay Men and the Forms of Contemporary US Culture. London: Ashgate Publishing. ISBN 0 7546 7230 1. {{cite book}}: Unknown parameter |month= ignored (help)
  2. Bogart, Laura; Thorburn, Sheryl (2005). "Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?". J. Acquir. Immune Defic. Syndr. 38 (2): 213–8. PMID 15671808. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. Walker, Robert Searles (1994). AIDS: Today, Tomorrow : an Introduction to the HIV Epidemic in America (2nd ed.). Atlantic Highlands, New Jersey: Humanities Press Intl. ISBN 0391038591. OCLC 30399464.
  4. Siplon, Patricia (2002). AIDS and the policy struggle in the United States. Washington D.C.: Georgetown University Press. ISBN 978-0878403783. OCLC 48964730.

External links

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