History of HIV in the U.S.
In the United States, the AIDS epidemic began in 1981, when it was first noticed in men who had sex with men. On June 5 of that year the U.S. Centers for Disease Control (CDC) published an article in its Morbidity and Mortality Weekly Report. The article described cases of a rare lung infection, Pneumocystis pneumonia (PCP), diagnosed in five young, previously healthy gay men in Los Angeles. Doctors reported that all the men had other rare infections as well, suggesting that their immune systems were compromised. Two of the men had died when the report was published and the other three died shortly thereafter. This was the first government report of the AIDS epidemic. By the end of 1981, 270 cases of severe immune deficiency were reported among gay men, and 121 of them had already died.
In 1982 the CDC coined the term “AIDS” for Acquired Immunodeficiency Syndrome. The next year, scientists had identified and named the virus Human Immunodeficiency Virus (HIV). There was no effective treatment, and thousands of people were dying. Activists demonstrated in the streets to urge the government to fund research and treatment of HIV, and in March of 1987, six years after the first cases were identified in the U.S., the Food and Drug Administration approved the first drug to treat HIV infection, AZT.
World AIDS Day
The next year, 1988, was the first year that the World Health Organization and partners around the globe declared December 1 as World AIDS Day. Each year the theme has focused on a different aspect of working to end the pandemic. This year’s theme is “Putting Ourselves to the Test: Achieving Equity to End HIV.” It urges people to unite worldwide to eliminate the disparities and inequities that create barriers to HIV testing, prevention, and access to HIV care. World AIDS Day is a day to come together to end HIV and to remember those lost to AIDS-related illnesses.
Today, it is estimated that in the U.S., 1.2 million people are living with HIV. Approximately 13 percent of them do not know they are infected. That’s why it’s critically important for sexually active people to be tested. Sexually active young people between the ages of 15 and 24 have a 50% chance of getting a sexually transmitted infection every year (not necessarily HIV). As a group that is at risk, men who have sex with men are most affected, representing an estimated 69 percent of new HIV infections.
In 2019, 36,801 people received an HIV diagnosis in the U.S. and 15,815 people with HIV died in the U.S. that year. It is estimated that there are between 40,000 and 60,000 new HIV infections in the U.S. every year, and the number of current deaths is 17,000 cases per year.
There are also racial disparities in the rate of infection among African American and Hispanic people. They have rates of HIV infection that are three to six times higher than the rest of the population. The social determinants of health often result in stigmatized people having poorer health outcomes than those in more privileged places in society. This is one of the reasons the theme for World AIDS Day is to achieve equity in ending HIV. Numerous organizations throughout society can work to reduce disparities that limit access to testing, quality health care, and social supports for those living with HIV. Earnshaw, et al. (2015) reports that “Through its structural and individual-level manifestations, societal stigma contributes to racial and ethnic disparities in who acquires HIV, is aware of their sero-status, receives treatment, and dies early.”
Racism is one of the expressions of social stigma. Blacks/African Americans make up just 12 percent of the population, but account for 42 percent of people living with HIV in the U.S. This is approximately 2.5 times more than in the Hispanic/Latinx population, and 7.3 times higher than in whites/Europeans. Public health and policy efforts are needed to work toward social reforms to reduce stigma and racism, which will have an impact on the prevention, diagnosis, and treatment of HIV. Public health professionals have a responsibility to advocate clearly and compellingly about the structural inequities that impact the health of marginalized people and offer concrete recommendations for remedying them.
HIV Globally
Around the world, HIV infection is a pandemic. AIDS is currently the fourth leading cause of death. It comes after heart disease, stroke, and acute lower respiratory infections. There are high rates of AIDS in Africa and Asia, and it is spreading rapidly in some countries in Eastern Europe. In 2019, 38 million people around the world were living with HIV. Of these, 1.8 million were children under 15. About 67 percent of those infected (21 million people) live in Eastern and Southern Africa. In Eastern Europe and Central Asia, the number of people infected with HIV rose quickly between 2010 and 2019 (970,000 to 1.7 million). This was caused by a surge of injection drug use. But since 2015, the prevalence of HIV has slightly declined to 1.4 million in 2017. In the region of Asia and the Pacific, the HIV prevalence increased from 4.7 to 5.8 million from 2010 to 2019.
At the height of the AIDS pandemic in 2004 there were 1.7 million deaths, and this number has fallen by about 60 percent. Around the world, the most common cause of death for HIV infected people is tuberculosis. These account for about one-third of all AIDS-related deaths. The worldwide decline in AIDS-related deaths is due to the increased access to, and use of antiretroviral medication in many parts of the world.
Effective Treatments and Prevention
Today, people in treatment for HIV are able to live long and healthy lives. The FDA has approved over 45 drugs to treat HIV infection. People living with HIV who take their medication as directed are able to reduce their viral load to the point that the virus is undetectable in their blood. It is important to know that undetectable equals untransmissable. That is, someone whose viral load is undetectable cannot transmit the virus to another person sexually.
Pre-Exposure Prophylaxis (PrEP) is a daily pill that is highly effective at preventing infection among those at risk. And for people who may have been exposed to HIV because the condom broke, they shared injection drug needles with someone who might be living with HIV, or another reason, can take Post Exposure Prophylaxis (PEP). It should be taken as soon as possible after the possible exposure (and not later than 72 hours). It is available in emergency departments in hospitals, urgent care centers, and other health care providers, and should be taken for 28 days. It is highly effective at preventing HIV when the full four weeks of medication are taken.
And as we learn in high school health classes, condoms are always a good method to reduce the likelihood of infection. Nowadays there are both the internal (female) condom and the external (male) condom, and both offer protection from HIV and other sexually transmitted infections (STI). When used consistently and correctly, the external (male) condom is 90% effective at reducing the risk of HIV infection, and the internal (female) condom is 94% effective. Condoms made of latex are highly effective, as are plastic (polyurethane), or synthetic rubber condoms (Polyisoprene) for people with latex allergies. People should be aware that plastic condoms may break more frequently than latex condoms.
Natural membrane (such as lambskin) condoms have small pores (holes) in them and don’t block HIV and other STIs. These should not be used for HIV or STI prevention.
Moving Forward
While tremendous progress has been made toward ending the pandemic of HIV, the World Health Association says, “The global HIV response is in danger, even as HIV remains a major public health issue that affects millions of people worldwide. Over the last few years progress towards HIV goals has stalled, resources have shrunk, and millions of lives are at risk as a result.”
They argue that division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis. We can join them in calling on global leaders to recognize and attend to the inequities that hold back progress in ending AIDS; and provide access to essential HIV services – particularly for key populations and their partners – men who have sex with men, transgender people, people who use drugs, sex workers, and people in prisons.
