HIV/AIDS in the United States

The history of HIV/AIDS in the United States began in the early 1980s when 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. Eventually these men died. These men were gay, or at least had sex with other men.

As the realization 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, heroin 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 1980s also contracted HIV in large numbers worldwide through the spread of contaminated blood products.

Public perception
Regarding the social effects of the HIV/AIDS pandemic, there has been since the 1980s a "profound re-medicalization of sexuality".

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 St. Louis boy in 1969.

Shilts also details the fact that despite recommendations from the Centers for Disease Control, the Red Cross and other non-profit 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. 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, and tennis player Arthur Ashe) were significant in making the general public aware of the dangers of the disease to people of all sexual orientations.

Containment
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 situation remains fragile - for example, Britain recently suffered a resurgence in HIV infections despite similar measures.

The second prong of the American approach to containment has been to maintain strict entry controls to the county 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 adovacy groups in advance. This meant that the traveller would not be discovered with any medication. However, the security clampdown following 9/11 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. 



Current status
The CDC estimates the cumulative number of deaths of persons with AIDS in the U.S. through 2005 to be 525,442, including 4,865 children under the age of 13. For the U.S. and its dependencies (including Puerto Rico), it is 550,394. Persons living with AIDS is 437,982. Persons living with HIV in reporting cities with confidential name based reporting (a fraction of the USA only) is 38,133

In California alone, 143,946 cumulative people have contracted AIDS by year end 2006. Of those, 82,989 have died, with 30,268 in Los Angeles County and 18,139 in San Francisco County. . In the same period, 169,556 AIDS cases have been diagnosed in New York State, with 136,412 of those in New York City alone. New York City is the HIV/AIDS epicenter of the U.S., with almost 100,000 people known to be living with the virus. New York City has the highest AIDS case rate in the country, with more AIDS cases than Los Angeles, San Francisco, Miami and Washington DC combined. People with HIV are now living longer, healthier lives, and as a result the HIV-positive population is aging. Today in New York City, more than 30 percent of people with the virus are over the age of 50, and 70 percent are over the age of 40.

Of all AIDS cases in 2003 in the United States:
 * 48% were tracked back to male-to-male contact
 * 27% were tracked back to male-to-female contact and intravenous drug use,
 * 7% were tracked back to male-to-male contact and intravenous drug use,
 * 16% tracked back to male-to-female contact, and
 * 2% were tracked back to other causes, including hemophilia and other blood recipients, perinatal, and risk not reported or not identified.

AIDS continues to be a problem with illegal sex workers and injecting drug users. 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 behaviour 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. This trend is of major concern to public health workers.

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. 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. AIDS continues to be a problem with illegal sex workers and injecting drug users. African American women are 19 times more likely to contract HIV than white women.