AIDS around world - High-income Countries

In high-income nations, HIV infections have historically been concentrated principally among injecting drug users and gay men, and this is largely still where the main thrust of the epidemic lies. However, in several Western European countries a significant proportion of new HIV diagnosis (59% more, overall, between 1997 and 2001) is occurring through heterosexual intercourse. Very early in the epidemic, once information and services for prevention had been made available to most of the population, the level of unprotected sex fell in many countries and the demand rose for reproductive health services, HIV counselling and testing and other preventive services.

Among gay men, the virus had spread widely before it was even identified and had established a firm grip on the population by the early 1980's. With massive early prevention campaigns targeted at gay communities, risk behaviour was substantially reduced and the rate of new infections dropped significantly during the mid-and late 1980's. Recent information suggests, however, that risky behaviour may be increasing again in some communities. People think that the danger is over because of lack of media coverage of the issues around HIV and AIDS – and new infections continue to occur

While the infection rates have been low in high-income countries, some countries have been reporting increases in their HIV rates. For example, Sweden currently has one of the lowest rates of HIV infection in the world. According to the Swedish Institute for Infectious Disease Control the rate of new HIV cases in Sweden rose by 48% during the first half of 2001.

Prevention work in high-income countries has declined, and sexual-health education in schools is still commonly not by any means guaranteed, in spite of the fact that the risks of HIV are well-known to governments. Political factors have been allowed to control the HIV prevention work that is done, and politicians are commonly keen to avoid talking about any sexual issues. Furthermore, it's very hard to show that a number of people are not HIV+ who otherwise would be – and politicians like the electorate to see results.

Some communities and countries, however, have initiated aggressive HIV prevention efforts, particularly among high-risk groups such as injecting drug users, containing the HIV prevalence rate at below 5%. In many places, however, the political cost of implementing needle-exchange and other prevention programmes has been considered too high for such programmes to be started or maintained. As a result, there are continuing high prevalence rates among injecting drug-users in many high-income countries. For example, in Spain, a recent study in Barcelona found a prevalence rate of 51% among injecting drug users.

Many high-income countries suffer from the belief that HIV is something that effects other people, not their own populations. On a national level, this belief prevents policy-makers and budget-setters from seeing the epidemic on their own door-steps, looking instead to the situation in areas such as Africa . Many high-income countries fund medication provision for low-income countries whilst failing to provide medicines for their own citizens who have AIDS. Even in the US, there are people who are unable to afford to buy the drugs they need.