HIV/AIDS in the United States
The
Initially, infected foreign nationals were turned back at the United States border to help prevent additional infections.[5][6] The number of United States deaths from AIDS has declined sharply since the early years of the disease's presentation domestically.[1] In the United States in 2016, 1.1 million people aged over 13 lived with an HIV infection, of whom 14% were unaware of their infection.[1] African Americans, Hispanic/Latino Americans, homosexual and bisexual men, and intravenous drug users remain disproportionately affected.[1][4]
Mortality and morbidity
As of 2018[update], about 700,000 people have died of HIV/AIDS in the United States since the beginning of the HIV/AIDS epidemic, and nearly 13,000 people with AIDS in the United States die each year.[7]
With improved treatments and better prophylaxis against opportunistic infections, death rates have significantly declined.[8]
The overall death rate among persons diagnosed with HIV/AIDS in New York City decreased by sixty-two percent from 2001 to 2012.[9]
Containment
After the HIV/AIDS outbreak in the 1980s, various responses emerged in an effort to alleviate the issue.[10] These included new medical treatments,[11] travel restrictions,[12] and new public health policies[13] in the United States.
Medical treatment
Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included
Travel restrictions
In 1987, the
During the turn of the 21st century, people who were HIV positive and seeking temporary visas or vacationing to the US had to avoid revealing their status on application forms, and either plan for their medication to be sent to the US or stop taking their medication.[19] Eventually the US began offering temporary admission waivers for people who were HIV positive. As stated in an interoffice memorandum in 2004, foreign nationals who were HIV positive could qualify for the waiver for either humanitarian/public interest reasons, or being "attendees of certain designated international events held in the United States".[20]
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 was unclear whether applicants would still have to declare their HIV status.[21]
In August 2007, Congresswoman Barbara Lee of California introduced H.R. 3337, the HIV Nondiscrimination in Travel and Immigration Act of 2007. This bill allowed 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.[22]
In July 2008, 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 obtained by Congressman Jim McDermott, who advocated the issue to the Obama administration's Health Secretary.[22]
On October 30, 2009, President
Public health policies
Since the beginning of the HIV/AIDS epidemic, several U.S. presidents have attempted to implement a national plan to control the issue. In 1987, Ronald Reagan created a Presidential Commission on the HIV Epidemic. This commission was recruited to investigate what steps are necessary for responding to the HIV/AIDS outbreak in the country, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the United States.[25] However, these changes were not implemented during this time, and the commission recommendations were largely ignored.
Another attempt to respond to the HIV/AIDS outbreak took place in 1996, when Bill Clinton established the National AIDS Strategy, which aimed to reduce number of infections, enhance research on HIV treatment, increase access to resources for people affected by AIDS, and also alleviate the racial disparities in HIV treatment and care.[26] Similarly to Reagan's plan, the National AIDS Strategy was not successfully enforced, providing only objectives without a specific action plan for implementation.
In 2010, Barack Obama created the National HIV/AIDS Strategy for the United States (NHAS), with its three main objectives being to reduce the annual number of HIV infections, reduce health disparities, and increase access to resources and HIV care.[25] However, this new strategy differs in that it includes an Implementation Plan, with a timeline for achieving each of the three goals, as well as a document outlining the specific action plan that will be used.[27]
In 2019,
In February 2019, U.S. District Court Judge Leonie Brinkema issued an temporary order barring the U.S. military for discharging or denying officer commissions to personnel based on HIV status.[30] Judge Brinkema's order became permanent in April 2022.[31]
Localized efforts
Local health educators found it upon themselves to promote modes of
Pappas saw opening the eyes of the
Public perception
During the HIV/AIDS epidemic of the 1980s,
An early theory asserted that a series of inoculations against hepatitis B 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 long been discredited. However, the theory has never been officially proven or disproven. 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.[38]
Publicity campaigns were started in attempts to counter the incorrect and often vitriolic perception of AIDS as a
Perspective of doctors
The global spread of HIV/AIDS was met with great fear and concern by the American population in the 1980s, much like any other epidemic, and those who were primarily affected were African Americans, Hispanic/Latino Americans, homosexual and bisexual men, and intravenous drug users.[1][4] During the early years of the epidemic, doctors began to not treat patients affected with HIV/AIDS, not only to create distance from these groups of people, but also because they were afraid to contract the disease themselves. At the time, a surgeon in Milwaukee stated: "I've got to be selfish. It's an incurable disease that's uniformly fatal, and I'm constantly at risk for getting it. I've got to think about myself. I've got to think about my family. That responsibility is greater than to the patient."[41]
Some doctors thought it was their duty to stay away from the risk of contracting the
By race and ethnicity
While there is no cure for HIV/AIDS as of yet, prevention methods and access to medical care are major ways to know one's
Healthcare access varies greatly by race and ethnicity in the United States.[44][49][58][59] Out of those living with HIV/AIDS who received medical care only 63% of Native Americans, 61% of African Americans, 65% of Hispanic and Latino Americans, and 85% of Native Hawaiians and other Pacific Islander Americans were virally suppressed in 2019.[48] This is in comparison to 71% of White Americans who were virally suppressed in 2019 according to the CDC.[57] African–American, Hispanic/Latino, and multiracial populations were significantly more likely to miss at least one medical appointment in the past year compared with White American populations.[48] African–American, Hispanic/Latino, and multiracial populations that were diagnosed with HIV/AIDS in the United States in 2019 all experienced higher need of dental care, SNAP or WIC benefits, shelter or housing services, and/or mental health services than White American populations according to the CDC.[48]
National HIV/AIDS strategy
The 2022–2025 National HIV/AIDS strategy "recognizes racism as a serious public health threat that drives and affects both HIV outcomes and disparities", and while every part of the U.S. is threatened with the HIV/AIDS epidemic, "certain populations bear most of the burden signaling where our HIV prevention, care, and treatment efforts must be focused."[60] The 2022–2025 National HIV/AIDS strategy focuses on five priority populations including: gay men, bisexual men, and other men who have sex with men (MSM), in particular African–American, Hispanic/Latino, and Native American men; African–American women; transgender women; youth aged 13–24 years; and people who inject drugs.[60]
"Down-low" subculture among Black MSM
In medical research, the term down-low is used to identify sexual identity-behaviour discordance among men who have sex with men (MSM).[68] According to a study published in the Journal of Bisexuality, "[t]he Down Low is a lifestyle predominately practiced by young, urban Black men who have sex with other men and women, yet do not identify as gay or bisexual".[69]
In this context, "being on the down-low" is more than just men having sex with men in secret, or a variant of closeted homosexuality or bisexuality—it is a sexual identity that is, at least partly, defined by its "cult of masculinity" and its rejection of what is perceived as White American culture (including what is perceived as White American LGBT culture) and terms.[65][70][71][72] A 2003 cover story in The New York Times Magazine on the down-low phenomenon explains that the American Black community sees "homosexuality as a white man's perversion."[70] It then goes on to describe the down-low subculture as follows:
Rejecting a
gay culture they perceive as white and effeminate, many black men have settled on a new identity, with its own vocabulary and customs and its own name: Down Low. There have always been men – black and white – who have had secret sexual lives with men. But the creation of an organized, underground subculture largely made up of black men who otherwise live straight lives is a phenomenon of the last decade. ... Most date or marry women and engage sexually with men they meet only in anonymous settings like bathhouses and parks or through the Internet. Many of these men are young and from the inner city, where they live in a hypermasculine thug culture. Other DL men form romantic relationships with men and may even be peripheral participants in mainstream gay culture, all unknown to their colleagues and families. Most DL men identify themselves not as gay or bisexual but first and foremost as black. To them, as to many blacks, that equates to being inherently masculine.[70]
The CDC cited three findings that relate to African-American men who operate on the down-low (engage in MSM activity but don't disclose to others):
- African American men who have sex with men (MSM), but who do not disclose their sexual orientation (nondisclosers), have a high prevalence of HIV infection (14%); nearly three times higher than nondisclosing MSMs of other races/ethnicities (5%).
- Confirming previous research, the study of 5,589 MSM, aged 15–29 years, in six U.S. cities found that African American MSM were more likely not to disclose their sexual orientation compared with white MSM (18% vs. 8%).
- HIV-infected nondisclosers were less likely to know their HIV status (98% were unaware of their infection compared with 75% of HIV-positive disclosers), and more likely to have had recent female sex partners.[73]
Risk factors contributing to the Black HIV/AIDS rate
The United States have a mixed private/public health system, with more privatization than most other developed countries.[74] Access to healthcare services is very important in preventing and treating HIV/AIDS among the U.S. population.[44][49] It can be affected by health insurance which is available to people through private insurers, Medicare and Medicaid, which leaves many U.S. citizens still vulnerable and untreated.[74] Historically, African Americans have faced discrimination when it comes to receiving healthcare.[59]
Homosexuality is viewed negatively within the African-American community:[75] "In a qualitative study of 745 racially and ethnic diverse undergraduates attending a large Midwestern university, Calzo and Ward (2009) determined that parents of African-American participants discussed homosexuality more frequently than the parents of other respondents. In analyses of the values communicated, Calzo and Ward (2009) reported that Black parents offered greater indication that homosexuality is perverse and unnatural".[75]
A
Activism and response
Starting in the early 1980s, HIV/AIDS activist groups and organizations began to emerge and advocate for people infected with HIV in the United States. Though it was an important aspect of the movement, activism went beyond the pursuit of funding for HIV/AIDS research. These groups acted to educate and raise awareness of the disease and its effects on different populations, even those thought to be at low-risk of contracting HIV/AIDS. This was done through publications and "alternative media" created by those living with or close to the disease.[78]
In contrast to this "alternative media" created by activist groups, mass media reports on HIV/AIDS were not as prevalent, most likely due to the stigma surrounding the topic. The general public was therefore not exposed to information regarding the disease. In addition, the federal government and laws in place essentially prevented individuals affected by HIV/AIDS from getting sufficient information about the disease. Risk reduction education was not easily accessible, so activist groups took action in releasing information to the public through these publications.[79]
AIDS activist groups worked to prevent spread of HIV by distributing information about
Both men and women, heterosexual and LGBTQ+ populations were active in establishing and maintaining these parts of the movement. Because HIV/AIDS was initially thought only to impact
During the HIV/AIDS epidemic of the 1980s, LGBTQ+ communities were further
Among the landmark legal cases in the history of LGBT rights in the United States on the topic of HIV/AIDS is Braschi vs. Stahl. Litigant Miguel Braschi sued his landlord for the right to continue living in their rent controlled apartment after his gay partner Leslie Blanchard died of AIDS.[83] The NY Court of Appeals became the first American appellate court to conclude that same-sex relationships are entitled to legal recognition.[84] The case was litigated at the height of the AIDS crisis and the plaintiff himself died only a year after his groundbreaking court victory. The case focused on emotional and economic interdependency rather than on the existence of legal formalities; the verdict made it more difficult for government officials to reject the notion that same-sex couples could constitute families and that they were entitled to at least some of the protections afforded by law.[85]
Response from the Catholic Church
The United States Conference of Catholic Bishops was the first church body to address the HIV/AIDS pandemic in 1987 with a document entitled "The Many Faces of AIDS: A Gospel Response."[86][87] In the document they stated that the Catholic Church must provide pastoral care to those infected with HIV/AIDS as well as medical care.[88] It called discrimination against people with AIDS "unjust and immoral",[88] but rejected extra-marital sex and the use of condoms.[88] They reiterated the Church's teaching that human sexuality was a gift and was to be used in monogamous marriages.[88]
The Catholic Church, with over 117,000 health centers, is the largest private provider of HIV/AIDS care.
The bishops of the United States issued a pastoral letter in the 1980s titled, "A Call to Compassion," saying those with AIDS "deserve to remain within our communal consciousness and to be embraced with unconditional love."
In 1987, the bishops of
Present-day activism
An effective response to HIV/AIDS requires that groups of vulnerable populations have access to HIV prevention programs with information and services that are specific to them.[98] In the present day, some AIDS activist groups and organizations that were established during the height of the epidemic are still present and working to assist people living with HIV/AIDS.[80] They may offer any combination of the following: health education, counseling and support, or advocacy for law and policy. AIDS activist groups and organizations also continue to call for public awareness and support through participation in events like LGBT pride parades, World AIDS Day, or AIDS Walks.
Current Status
The CDC estimates at the end of 2019, there were 1,189,700 people aged 13 or older with diagnosed HIV in the US and dependent areas.[1] Since 2010, the number of people living with HIV has increased, while the annual number of new HIV infections has declined over the past few years. In 2021, 36,136 people have been newly diagnosed with HIV, compared to 37,832 diagnosed in 2018.[1] Within the overall estimates, however, there are some groups that have higher rates of infection than others. For instance, 67% of 2021 diagnoses were among men who have sex with men, 7% were among injection drug users, 40% were from Black/African American people, and 56% were among adolescents and young adults between the ages of 13 and 34 .[1]
The most recent CDC HIV Surveillance Report estimates that 36,136 new cases of HIV were diagnosed in the United States in 2021, a rate of 11.3 per 100,000 population.[99] This rate is an increase from the previous year's estimates, which indicated 30,585 new infections and a rate of 9.5 per 100,000 population.[99]This increase has been peculiar among epidemiologists, since over the past few years before 2021, rates of HIV were decreasing overtime. Because the pandemic occurred in 2020, many barriers have made getting tested for HIV/AIDS more difficult, with many who are racially and economically disadvantaged to have reduced resources in terms of testing.[100]
Individuals in the age range 25–29 years-old had the highest rates of new infection, with a rate of 32.9 per 100,000.[99] With regard to race and ethnicity, the highest rates of new infections in 2017 occurred in the Black/African-American population, with a new infection rate of 4.5 per 100,000. This more than doubled the next highest rate for a racial or ethnic group, which was Hispanic/Latino with a rate of 3.2 per 100,000.[99] The lowest rates of new infection in 2021 occurred in the Asian population, with a new infection rate of 2.3 per 100,000.[99]
According to CDC estimates, the most common transmission category of new infections remained male-to-male sexual contact, which accounted for roughly 79. of all new infections in the United States in 2021.[99] Among the proportion of new HIV positive gay and bisexual men in 2021, 40% are African American, 25% are white, and 29% are Hispanic/Latino.[101] With regard to region of residence, the highest rates of new infections in 2021 occurred in the United States South, with about 52% of new total cases being from the South.[99] The region identified as 'South' includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.[99]
In the United States, men who have sex with men (MSM), described as gay and bisexual,[101] make up about 55% of the total HIV-positive population, and 83% of the estimated new HIV diagnoses among all males aged 13 and older, and approximately 92% of new HIV diagnoses among all men in their age group. 1 in 6 gay and bisexual men are therefore expected to be diagnosed with HIV in their lifetime if current rates continue. The CDC estimates that more than 600,000 gay and bisexual men are currently living with HIV in the United States.[101] A review of four studies in which trans women in the United States were tested for HIV found that 27.7% tested positive.[102]
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 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).[103][104]
In 2015, a major HIV outbreak,
See also
- Adult Industry Medical Health Care Foundation
- AIDS Education and Training Centers
- Bugchasing
- Criminal transmission of HIV in the United States
- Hank M. Tavera
- HIV/AIDS in New York City
- People With AIDS
- President's Emergency Plan for AIDS Relief
- HIV/AIDS in Atlanta
- African-American LGBT community#HIV/AIDS
- HIV/AIDS and African Americans
International:
- AIDS education and training centers
- HIV/AIDS activism
- HIV/AIDS activists
- HIV/AIDS global epidemic
- HIV/AIDS in North America
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Further reading
- Buso, Michael Alan (2017). "Here There Is No Plague": The Ideology and Phenomenology of AIDS in Gay Literature AIDS in Gay Literature. University of West Virginia. Archived from the original on March 18, 2020. Retrieved June 18, 2020. - Document ID 5291