HIV/AIDS in the United States
The United States was the epicenter of the AIDS epidemic of the 1980s, first noticed by doctors in young gay men in Los Angeles, New York City, and San Francisco in 1981. Since then, 1.1 million people live with HIV, more than half of which are unaware of their infection.
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.
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.
- Criminal transmission of HIV in the United States
- HIV/AIDS in American prisons
- Adult Industry Medical Health Care Foundation
- AIDS Education and Training Centers (AETCs)
- AIDS pandemic
- People With AIDS Self-Empowerment Movement
- HIV/AIDS in North America
- 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.
- 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.
- Highleyman L (1999). "First AIDS case in 1969". BETA 12 (4): 5. PMID 11367253.
- "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.
- Wilson, Phill; Wright, Kai; Isbell, Michael T. (August 2008). "Left Behind: Black America: a Neglected Priority in the Global AIDS Epidemic" (PDF). Black AIDS Institute. Retrieved March 20, 2010.[dead link]
- "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.
- Russell, Sabin (December 2, 2006). "Bush to ease rule limiting HIV-positive foreign visitors". San Francisco Chronicle (Hearst Communications). Retrieved March 21, 2010.
- | 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
- 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.
- "HIV Final Rule". United States Department of State. 2010-01-04. Retrieved 2010-04-30.
- Smith, Michael (October 27, 2008). "ICAAC-IDSA: HIV Treatment Started Sooner than Later Lessens Early Death Risk". MedPage Today, LLC. Retrieved March 21, 2010.
- "Epidemiology Research, HIV/AIDS". National Institute of Allergy and Infectious Diseases. November 12, 2009. Retrieved March 20, 2010.
- "2008 HIV/AIDS Epidemiology Annual Report" (PDF). San Francisco Department of Public Health. July 9, 2009. Retrieved March 21, 2010.
- "HIV/AIDS Basic Statistics". US Centers for Disease Control. February 26, 2009. Retrieved March 21, 2010.
- "The HIV/AIDS Epidemic in the United States". Kaiser Family Foundation. March 22, 2013. Retrieved June 2, 2012.
- "United States". HIV/AIDS Knowledge Base. University of California, San Francisco. Retrieved November 25, 2011.
- "December 2008 Monthly HIV/AIDS Statistics" (PDF). California Department of Public Health Office of AIDS. July 9, 2009. Retrieved March 21, 2010.
- "New York State HIV/AIDS Surveillance Annual Report For Cases Diagnosed Through December 2007" (PDF). New York State Department of Public Health. May 2009. Retrieved March 21, 2010.
- UNAIDS Report on the Global AIDS Epidemic 2010 (p 50)
- "Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review". AIDS Behav 12 (1): 1–17. Jan 2008. doi:10.1007/s10461-007-9299-3. PMID 17694429.
- CDC Fact Sheet - HIV and AIDS among Gay and Bisexual Men - Sept 2010
- CDC: One In Five Gay Men HIV-Positive
- Block, Melissa; Adams, Jerome (24 April 2015). "HIV Outbreak In Indiana Grows With Nearly 140 Confirmed Cases". NPR. Retrieved 4 May 2015.
- Cante, Richard C. (March 2008). Gay Men and the Forms of Contemporary US Culture. London: Ashgate Publishing. ISBN 0-7546-7230-1.
- Bogart, Laura; Thorburn, Sheryl (February 2005). "Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?". J. Acquir. Immune Defic. Syndr. 38 (2): 213–8. doi:10.1097/00126334-200502010-00014. PMID 15671808.
- 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 0-391-03859-1. OCLC 30399464.
- Siplon, Patricia (2002). AIDS and the policy struggle in the United States. Washington D.C.: Georgetown University Press. ISBN 978-0-87840-378-3. OCLC 48964730.
- AIDS.gov – The U.S. Federal Domestic HIV/AIDS Resource
- AIDSVu.org - Interactive Map Illustrating HIV Prevalence in the United States