AIDS in the USA

Today, HIV/AIDS is an accepted part of American public health concerns. However, HIV/AIDS has only become an issue in the United States in the last half century.

History of AIDS in the USA

The earliest cases of the disease in the US date to 1969. It is believed that the virus arrived in the country from an single individual infected by the virus. Following this first exposure, early evidence of the infection popped up in major cities by the late years of 1970s and early years of 1980s. In San Francisco, Los Angeles, and New York, doctors began diagnosing men with Kaposi’s Sarcoma. This raised a red flag because Kaposi’s Sarcoma is a rare type of cancer. It had previously affected mostly elderly Mediterranean men.

Evolution of beliefs about possible causes of AIDS

Many of the patients diagnosed with and dying from this rare cancer were young homosexual men. This fact led to the sarcoma being labeled  ”gay cancer.” However, an increase in Kaposi’s Sarcoma was only the beginning of the symptoms. Medical scientists soon discovered these same patients were being afflicted by a number of other  previously uncommon disorders. This included pneumocystis pneumonia, also known as PCP, a form of pneumonia caused by a fungal infection. At this point the disease believed to cause all the unusual illnesses was renamed as Gay Related Immune Deficiency or “GRID”. This name and the obvious implication that the disease was caused by being gay led to an increase in homophobia in the United States. People believed that having anal sex without protection was the only way to get GRID.

Despite these public prejudices, doctors and researchers soon determined that not only gay men contracted the disease.  The list of infected patients grew to include people who had received a blood transfusion, intravenous drug users who shared needles, women who had sex with men, and newborn babies. In light of this, in 1982 the CDC (Centers for Disease Control and Prevention) changed the name of the syndrome to AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. It was also determined that the syndrome was caused by a virus, Human immunodeficiency virus (HIV). One of the ways this virus is spread is through contaminated blood, and in the late seventies and early eighties evidence piled up to support this conclusion. At this time, people suffering from hemophilia, a disease that often requires injections as part of its treatment, tested positive for HIV in huge number all over the world. Today, an estimated 1 million people in the United States suffer from HIV infection. Sadly, every year this number is increasing.

HIV/AIDS statistics

According to the CDC, around half of all new cases of HIV/AIDS are gay and bisexual men. Around 20% of new infection cases are people who use needles to inject drugs. Some nonprofit and government funded programs offer needle exchange to drug users. The belief is that by supplying drug users with clean needles and disposing of the possibly infected ones, it will help curb new infections of HIV. However, many drug users don’t use these programs and still reuse and share needles.

New cases of HIV/AIDS are not occurring evenly across the US. Studies show more new cases in the Southern and Eastern states. As of 2009, the states that have the largest numbers of new diagnoses were New York, Florida, Maryland, and Louisiana. For the most part, there are a larger number of new diagnoses in states found along the coasts. However, in states with large cities, like Nevada and Illinois, the numbers are also higher than surrounding states. The conclusion can be drawn that it is the most densely populated states where the virus spreads faster. States without large cities and states that are less densely populated show fewer new instances of infection. Another reason HIV/AIDS infections might be more common along coasts is because these are places where people from other countries are likely to arrive. The spread of HIV/AIDS or really any disease is greater and faster the more people move around and interact with other countries.

AIDS and the American Public

The AIDS epidemic has had interesting social effects in the United States. Public perception of both the disease and sexuality has shifted. A number of books were written during 1980s discussing both the disease and how the public, medical community, and government reacted to it. Randy Shilts 1987 book And the Band Played On is one of the most well known histories of HIV in America. Shilts book partially blames the Ronald Reagan presidency for allowing AIDS to spread. Shilts believes that Reagan did not do enough to get the word out to the gay community because of homophobia. The gay community was then distrustful of government efforts and messages. The result was an epidemic that caused the outbreak of the disease among hundreds and thousands of men. There was clearly a need for more information on the disease and public advocacy for those affected. To fill this need, in 1987 activist Larry Kramer founded the group ACT-UP, also known as the AIDS Coalition to Unleash Power.

Another result of Shilts’s book is that introduced the idea of “Patient Zero.” The CDC believed that the arrival of the disease might be caused by a single carrier. In his book, Shilts gave this original patient a name and a face. Shilts believed that “Patient Zero” was a man named GaÎtan Dugas. Dugas was a gay, French Canadian flight attendant.  Despite Shilts’s claims, later research showed that HIV infections might have existed earlier than originally predicted. Blood samples infected with the virus were found in Africa as far back as 1959. There was a male sex worker in St Louis who died from AIDS in 1969. It was believed that this young man was sexually abused. He may have contracted the disease when he was as young as 7. This occurrence opened up the theory that, instead of coming from abroad, HIV/AIDS might have randomly generated itself in the United States.

In his book, Shilts also condemns blood banks, the nonprofits in charge of running them, and the CDC for not taking action. He believed they should have banned men who had sexual contact with other men from donating blood as soon as it was discovered that the virus could be transferred through blood. This was not done, largely because the blood banks didn’t want to risk having blood shortages. Because of this, in some cities where AIDS  was common, people who received blood transfusions became infected. Thousands of people suffering from hemophilia died as a consequence.

Blood transfusions are only one way people might have contracted HIV through medical treatment. In San Francisco some have theorized that vaccinations against hepatitis given to the gay community might have accidentally led to the spread of AIDS. However, this has need been proven. All those who received the vaccination were also at high risk for contracting HIV, so it is impossible to know the cause of transmission.  HIV and hepatitis are spread in similar ways. People with high chance of contracting HIV also have high probability for getting hepatitis and vice versa.

Another difficultly in medical research and progress in the fight against HIV/AIDS were the researchers themselves. In the medical research community, there is a lot of pressure to be the first to make a new discovery. Two famous scientists were at work on the AIDS problem: Robert Gallo and Luc Montagnier, American and French scientists respectively. The two men ended up in a legal battle over who had discovered HIV. AIDS activists were upset and believed that scientists and researchers were too concerned with the fame and fortune, and less concerned with all the people who were dying of the disease. After a long drawn out battle, both scientists finally decided to share credit for the discovery.

Throughout it’s history, public perception in the United States has maintained that HIV/AIDS is only a problem for gay men. In the hopes of ending this misconception, a number of publicity campaigns were started to spread information about the disease. Ryan White, a  young hemophiliac AIDS sufferer, became a poster child for one of these campaigns. Additionally celebrities who had the disease joined the cause. These included Los Angeles Lakers superstar Magic Johnson, tennis great Arthur Ashe, and the lead singer of the band Queen, Freddy Mercury. Many people wore red ribbons to show solidarity to people with HIV/AIDS. In 1993, a film version of And the Band Played On came out and also helped raise awareness.  There was also an increase in programs teaching about sex education in schools. These methods helped to make people realize the dangers of AIDS for people of all walks of life, not just gay men.

Containing the Virus

While awareness is a big step, it can only help those who haven’t yet contracted HIV. For those who had the disease, there was no cure. However, medical research has made great strides in containing it. HIV treatments with protease inhibitors help slow the spread of the virus in the body. This means it can take longer for a person who contracts HIV to have it turn into full blown AIDS. The creator of these anti-viral drug cocktails, David Ho, was honored in 1996 by Time Magazine for his contributions. Thanks to these new treatments, deaths from AIDS reduced by half. There was also a drop in the rate of new HIV infections. From that point forward, the number of deaths due to AIDS has gone down each year. This decline has been slower in African Americans than in other infected populations.

Tightening Borders

In addition to containing the virus within the infected person, the United States government has also attempted to contain it beyond American borders. In 1993, the United States Congress put of strict border controls for people with HIV/AIDS. Anyone found bringing anti-HIV medications in the United States was sent back to his or her home country.

To combat these laws, HIV-positive travelers began mailing their medicine to friends before traveling. This worked for a while. However, following the terrorist attacks on September 11, 2001, higher airport and mail security put a stop to this method.

It was still possible for HIV-positive travelers to visit the United States. However, not without a great deal of trouble. One had to apply for a visa just for HIV-positive people.  Then there was an interview with the American Embassy. The applicant’s passport was held throughout the application process. If the application was granted, the visa was permanently attached to the applicant’s passport. HIV/AIDS advocacy groups spoke out against this process. They believed it was too great a hardship for HIV-positive individuals. They also disagreed with permanently attaching a visa that displays the passport carrier’s HIV status. This meant that any country the passport carrier went to, their status would be known.

These protests were finally answered in the 2000s. President George W. Bush stated he intended to allow HIV-positive travelers to enter the country without a special visa in late 2006. Despite this stated intention, the ban held throughout his presidency. Then in 2007, Congress introduced a new bill called the HIV Nondiscrimination in Travel and Immigration Act. This bill would have allowed HIV-positive travelers to come to the US without revealing their HIV status at all. The bill failed to pass in Congress. George W. Bush removed the ban in official written law in July 2008. Meanwhile, the Department of Health still included the ban in their regulations. For all intents and purposes, the ban was still in affect. In 2009, Paul Thorn, an HIV-positive tuberculosis expert from the UK, was supposed to deliver a speech at a conference in Seattle. His visa was denied. Thorn wrote a letter that was read at the conference instead of his speech. The letter and Thorn’s cause was taken up by Congressman Jim McDermott. The congressman encouraged President Barack Obama’s Health Secretary to revisit the issue.

On October 30, 2009, Obama authorized the Ryan White HIV/AIDS Bill. This bill increased federal funding for treatment and care of people suffering from HIV/AIDS. The expanded funding could help treat nearly half a million people. Obama also pushed the Department of Health to create new regulations. On January 4, 2010, the ban was finally lifted. HIV status is no longer considered in the criteria for getting a visa to visit the US.

Distributing Medications

Not everyone who is HIV-positive is considered to have AIDS. A person is considered to have AIDS when their T-cell count falls below 200. T-cells are a very important part of the body’s immune system. Without T-cells, the body is unable to fight off infections. In the United States, anti-HIV medicines are given to those most in need. Originally, medications were only allocated to people who had a T-cell count under 200. This changed in the mid-2000s when the Journal of the American Medical Association began recommending anti-viral medications for patients with a T-cell count of 350. Those without health insurance can get federally funded medications provided by the Ryan White Care Act. They are received through either Medicaid or AIDS Drug Assistance Programs (ADAP).

Recent studies show the anti-HIV medications can cause big improvements. One study was on HIV positive patients without symptoms who began treatment with about 350- 500 T-cells. It showed they were 70 percent more likely to survive than the patients who started treatment with a lower T-cell count. These studies show that the earlier treatment is begun the better. Unfortunately, many people wait until the Journal of the American Medical Association recommended 300 T-cell count. HIV-positive people without health insurance have to wait even longer. A T-cell count of 200 is required to receive Medicaid. Since many patients can’t afford these expensive life-saving medications without federally funded help, the number of AIDS-related deaths hasn’t declined much since 2002. There is still good news though. Due to greater research and screening, the population of children born with HIV has greatly decreased. Unfortunately, this is only true in the US. In many developing countries around the world, the population of children born HIV-positive continues to rise.

Death Rate

Many people don’t realize they have HIV when they are first infected. The virus can be latent for a long time before any symptoms appear. Today, with anti-HIV medications, time it takes from HIV infection to AIDS can range from 5 to 12 years. Historically, this progression could occur in as little as 1 or 2 years. Unfortunately, when AIDS does occur, it is very deadly disease. Currently, nearly half a million patients have died of AIDS in the US. The numbers of AIDS-related deaths have declined over the years due to awareness and retro-viral drugs.

AIDS Today

The number of deaths has dropped substantially since the original epidemic. That said, AIDS still cuts short far too many lives.  The CDC estimates the number of AIDS related deaths through the year 2007 to be 583,298. Of these deaths, 4,891 are children young than 13. By the end of 2009, an estimated 1,148,200 Americans aged 13 and older were living with the HIV infection. Around 310 thousand of these cases were women at least 15 years old

As of December 2008, just in California, a total 184,429 people, including women and children have contracted HIV. Of these cases, 85,958 passed away, with the largest numbers of deaths occurring in large cities. Of these deaths, Los Angeles had 31,076, San Francisco had 18,838, and San Diego had 7,135. On the east coast, the largest city has even more cases. As of 2007, New York City reported 92,669 cases of people living with HIV.

High risk groups

AIDS continues to be a problem for illegal sex workers and drug users. Today, women with HIV are most likely to get it through heterosexual sex. Both men and women are at greater risk when not using protection, such as condoms, during sex. Experts worry that young people don’t use protection. Those who were not around or sexually active in the 1980s during the AIDS epidemic are less scared of the disease. For this reason, some are less likely to use protection and more likely to practice high-risk sexual behaviors. This trend, known as “AIDS fatigue,” is a major source of worry to public health workers.

African Americans are disproportionately affected by AIDS

In the US, 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. Today, African Americans account for 47 percent of the HIV-positive population. African Americans make up only 12% of the entire United States population, and yet they make up over half of all new cases of HIV infection. Additionally, African American women’s chance to contract HIV is 19 times more than that of white women,

Sexual orientation affects risk of HIV transmission

In a study in 2008 on gay and bisexual men, the CDC discovered that almost 1 in 5 were HIV positive. 44% of these men didn’t know they had the virus. The CDC study went on to track the demographics of those most affected. White gay and bisexual men showed the greatest number of cases of new HIV infections. Within this group, the majority of new infections occurred in men age 30-39. After white gay and bisexual men, the greatest number of new infections are seen in African American gay and bisexual men.  In this group, plurality of new infections occurred in black men from 13 to 29 years old.