Factual News you want to know

Since the beginning of the HIV and AIDS epidemic well over half a million people have died of AIDS in America1 - the equivalent of the entire population of Las Vegas.

Since the beginning of the HIV and AIDS epidemic well over half a million people have died of AIDS in America¹  - the equivalent of the entire population of Las Vegas. There are currently more than one million people living with HIV and AIDS in America and around a fifth of these are unaware of their infection,² posing a high risk of onward transmission.

America's response to the AIDS epidemic has produced mixed results. HIV prevention efforts have not always been successful and every year approximately 56,000 Americans are infected with HIV.³ Stigma and discrimination towards HIV positive people still persist and thousands of uninsured Americans struggle to access good HIV care and antiretroviral therapy. The world's biggest donor of AIDS-related funding is itself facing a major, ongoing AIDS epidemic, which shows little sign of abating.

Who Is affected by AIDS in America?

Although HIV and AIDS can and do affect all sectors of American society, the impact has been more serious among some groups than others. In the early years of the epidemic, the most commonly identified 'vulnerable groups' in America were men who have sex with men, injecting drug users, haemophiliacs and Haitians. Today, AIDS continues to directly affect thousands of gay and bisexual men and injecting drug users every year, but it has also become a serious problem among heterosexual African Americans and, more recently, among the Hispanic/Latino population.

The table below shows how the burden of AIDS among various ethnic groups compares to the percentage of the population that each ethnic group represents.

The table below shows how the burden of AIDS among various ethnic groups compares to the percentage of the population that each ethnic group represents.

African Americans: An increasing number of new infections occur within the black community and, as the table above shows, African Americans are now very much disproportionately affected by the epidemic. The AIDS-related deaths of well-known African Americans - such as anchorman Max Robinson, tennis player Arthur Ashe, and rapper Eazy-E - during the 1980s and 90s, increased awareness of the threat of the epidemic among the black community. However, denial about HIV among African Americans still exists and talking openly about sensitive subjects such as drug use, sex outside marriage and sexuality, is often seen as taboo.⁶ Although the government has been criticised for not doing enough to protect African Americans from AIDS, the CDC devotes almost half of its $652 million prevention budget to programmes designed for this group.⁷

Hispanics/Latinos: Hispanics/Latinos are also disproportionately affected by the AIDS epidemic in America. The number of deaths from AIDS among Hispanic/Latinos has remained relatively stable since the beginning of the new millennium, even though there has been a decline in overall AIDS mortality in America.⁸ Language barriers, social structures, migration patterns and lack of regular health care have been identified as barriers to HIV treatment and prevention among the Hispanic/Latino community.⁹

Men who have sex with men: At the beginning of America's epidemic, AIDS primarily affected men who have sex with men (MSM). Today, although there are more high-risk groups, MSM still account for around two-thirds of HIV diagnoses among male adults and adolescents.¹⁰ There have been concerns that an increasing number of MSM are having unprotected sex, leading to a rise in the number of new HIV infections among this group.¹¹ The CDC has reported that between 2001 and 2006, HIV/AIDS diagnoses among MSM increased by 8.6 percent.¹² It is thought that the availability of antiretroviral treatment may have lessened the fear surrounding AIDS, leading to complacency about condom use.¹³

Injecting drug users: Injecting drug users (IDUs) have accounted for around a quarter of all AIDS diagnoses in America.¹⁴ Throughout the epidemic, prevention efforts amongst IDUs have been controversial. Needle exchange services - where users exchange their used needles for clean ones - are not allowed any federal funding, even though in some areas of America these programmes have proved to be successful in reducing the rate of HIV transmission.^{15 16} The CDC reported a 9.5 percent decline in HIV transmission among this group between 2001 and 2006.¹⁷

HIV and AIDS prevention in America
During the early years of the epidemic, America's prevention efforts primarily targeted people most at risk of acquiring HIV. In the new millennium more focus has been placed upon people living with HIV. One particular programme, Advancing HIV Prevention (AHP), established by the CDC in 2003, has the aim of identifying undiagnosed HIV infections in order to prevent onward transmission.¹⁹ Although AHP is rarely referred to by name today, its principles persist in America's prevention strategy.

The success of prevention efforts in America has been variable. One area where efforts have been particularly successful is the prevention of mother-to-child transmission.²⁰ Routine HIV testing for pregnant women in many states, and good preventive interventions, mean that diagnoses of HIV in babies have dropped dramatically.

In other areas, prevention efforts have had less of an effect and while combination antiretroviral treatment has helped to dramatically reduce the number of people developing and dying of AIDS in America, there are still around 56,000 new HIV infections every year.²¹

AIDS and sex education in America
Education is an important part of HIV prevention. It is vital not only for teaching people affected by HIV/AIDS about treatment and care, but also for educating people about the ways in which HIV is transmitted and how to minimise the risk of infection. This can help to reduce the number of new infections and can assist in combating stigma.

The level and type of HIV/AIDS education received by school children and students in America tend to vary depending on state regulations and the type of school or college. In some areas, sex education that incorporates information about HIV is comprehensive and compulsory. In others, it is not, and children may leave school knowing virtually nothing about HIV and AIDS.

Since the Welfare Reform Law earmarked $100 million for abstinence only education in 1996, increasing amounts of federal funding have become available for this type of education. Abstinence only education encourages people to abstain from sex until after they are married, and unlike comprehensive sex education, it does not teach people how to protect themselves during sex from disease and unwanted pregnancy. A number of studies have shown that abstinence only education is largely ineffective,²⁶ and as a result, this form of sex education has proved controversial. Many AIDS and sexual health organisations advocate a more comprehensive approach that includes information about condoms and general discussion of teenage sexual relationships.

AIDS education amongst adults is used as a prevention tool in America, particularly in communities where HIV levels are high. Discussion of AIDS in the workplace, or at community meetings and religious gatherings, can provide essential information to adults who might otherwise be unaware that they are at risk. Due to the increasing number of new HIV infections among people over 50 years old, some communities have started to provide AIDS education for the older generation.²⁷

HIV and AIDS treatment and care in America
Antiretroviral treatment is available to anyone with good medical insurance in America. For those who are without insurance, or are underinsured for their condition, there are a number of options available to help fund treatment, including Medicaid, Medicare, and funding provided by the Ryan White Comprehensive AIDS Resource Emergency (CARE) Act.²⁸

Unfortunately for those underinsured, levels of funding have not always been sufficient to provide adequate treatment and care services for an ever-growing HIV positive population. The US AIDS Drug Assistance Program (ADAP), which aims to provide treatment for the very poorest through Ryan White CARE Act funding, was critically underfunded for many years. By June 2004 there were 1,629 people waiting for AIDS drugs in 11 states.²⁹ These waiting lists were not fully cleared until September 2007.

Those with advanced HIV infection who need newer, more expensive AIDS drugs to keep their condition under control may also face problems with obtaining funding from their insurance company. This said, 'expanded access' trials of new antiretroviral drugs for people who have exhausted their treatment options are regularly conducted across America, extending the lives of many who might otherwise die of AIDS.³⁰ This is a legacy of strong activism in the early days of the epidemic that encouraged better and more rapid access to new drugs.

Stigma and discrimination
While HIV and AIDS today affect more people than ever before, the general attitude towards AIDS has relaxed somewhat. Once a subject that caused considerable panic and hysteria in the media, AIDS in America is now comparatively overlooked by the press. This is in part due to the fact that AIDS never became the generalised epidemic once feared, and also because the introduction of antiretroviral therapy in the mid-1990s signalled the end of AIDS as a condition always considered fatal. Better knowledge of transmission routes and risk factors has also helped to calm fears.

Legislation has contributed to the improvement of the lives of those living with HIV and AIDS in America. In 1986, the government made clear to employers that they would be prosecuted if they discriminated against HIV positive people. The 'Americans with Disabilities Act' now makes it illegal to discriminate against someone on the basis of their HIV status.³¹

However, stigma and discrimination in America do persist and many HIV positive people find that they are discriminated against on a day-to-day basis. In 2007, a woman from New York State filed a lawsuit against a summer holiday camp after her 10-year-old son was turned away for having HIV.³²

Surprisingly, America also still has a restriction on HIV positive people entering the country, whether they are on holiday or visiting on a longer-term basis. Those who do not hold an approved medical waiver form (which can be difficult to acquire) risk being barred entry or deported if they test HIV positive or are found to be carrying antiretroviral medication.

Spending on AIDS in America
The 2009 budget request for HIV/AIDS domestic spending is estimated at just over $18 billion. Of this, roughly 68 percent is for care, 15 percent for research, 10 percent for cash and housing assistance, and 4 percent for prevention.³³

Although spending on the domestic HIV epidemic has risen in recent years, many AIDS organisations say it remains inadequate. Cash shortages are particularly severe in Southern states, where the epidemic is newer, and funding has not yet been allocated to reflect the increase in cases. Recent changes to the Ryan White CARE Act were designed to address this problem, but have met with strong opposition from those in higher prevalence areas, who have suffered cuts in federal funding to pay for improved services in the South.³⁴

At the end of 2007, an estimated 33 million people were living with HIV, the virus that causes AIDS. This number includes men, women and children of all ethnic and social backgrounds. Virtually every country in the world has been affected.

In 2007 an estimated 370,000 children became infected with HIV, most of whom acquired the virus from their mothers. HIV can have a powerful impact on children even if they are not themselves infected. When a family member falls ill, children often fill the role of carer or wage-earner, and so are robbed of their childhoods and education.

An estimated 15 million children have lost at least one parent to AIDS. Around 80% of these orphans live in sub-Saharan Africa, the world's worst affected region. Traditionally these children would have been supported by their extended families. However, the epidemic is now so severe in some countries that family structures cannot cope, and many orphans are forced to live in child-headed households.

Conclusion
Of all the industrialised countries in the world, America is home to the largest number of people living with HIV. Tens of thousands of people are newly infected with HIV in America every year and although infection rates have declined among injecting drug users, there has been an alarming increase among men who have sex with men.³⁵

Over 14,500 people died of AIDS in 2007 alone, yet increasingly AIDS is seen as an 'overseas' or an 'African' problem, rather than something that directly affects American citizens. The President's Emergency Plan for AIDS Relief (PEPFAR) tends to receive greater attention and attract considerably more comment in the press than the work taking place within America.

When AIDS is mentioned on a national level, it is often in relation to the chronic funding shortages for AIDS services; the epidemic among African Americans; or the ban on HIV positive people entering the country. With the exception of the reduction in mother-to-child transmission in recent years, the news is rarely good. AIDS continues to affect marginalised groups, and continues to receive nowhere near the attention or funding that is required to effectively tackle the problem.

* Source, Avert. Avert is an international AIDS charity.