AIDS in America

AIDS was first identified as a disease in America in 1981, and since then the epidemic has been growing with alarming rapidity, and shows little sign of slowing. Today, in 2005, most Americans know how AIDS threatens millions of lives around the world, and that many people in developing countries are dying because they can't access the drugs they desperately need. American leaders talk about the desperate need to help other countries, which leads people to believe that HIV is something that happens in these other countries, and to other people. But while it saves lives in Africa, is the US government ignoring problems at home?

In the developed world, many people feel that they are aware of what is risky and what isn't. It's often a surprise when they learn that there were estimated (by UNAIDS) to be around 950,000 people in the USA who were living with HIV at the end of 2003, and that the CDC estimated that there were 405,926 people who were living with AIDS. It was also estimated that AIDS has already killed over half a million Americans - that's close to the number killed in ten Vietnam wars - and more Americans still continue to become infected every day.

America is the world's third largest country, and has a very large landmass divided into 50 states. It has a population of just under 300 million people, fairly evenly divided between males and females, with an average age of around 36 years.

The adult HIV prevalence rate is estimated to be around 0.6%, but this is only an average figure, and America has a very diverse population. The HIV epidemic is as varied as the USA's population structure is, and, although HIV has spread across every part of American society, certain social groups are markedly more affected by HIV than others. The number of HIV+ people living in America varies between 900,000 and 1 million according to different estimates - UNAIDS estimates it to be 950,000. Furthermore, around 30% of those infected with HIV do not know it - and may unknowingly infect even more people.

It is estimated that 40,000 new HIV infections occur in America each year, and, although this is reduced from a peak of about 150,000 new infections per year in the 80s, the figure hasn't declined over the past decade. Of these 40,000 annual infections, about 70% are amongst males and about 30% females. CDC data tells us that, in 2003, 32,842 HIV infections were reported (which doesn't mean that they occurred in 2003). The graph below shows the way in which annual AIDS cases, in spite of the availability of antiretroviral therapy, have remained fairly constant since 1999, even rising a little. At the same time, deaths of people with AIDS have also remained stable with 18,017 people with AIDS dying in 2003, the most recent year for which CDC data is available. There is no guarantee that someone with AIDS will be provided with medical treatment, even in the USA.

In many ways, it is difficult to be sure about the development of the epidemic in America because HIV data collection has, in the past, been patchy and incomplete - HIV infections were recorded only in a few states. Diagnoses of AIDS have been recorded, so when we look back at previous years of America's epidemic, it is usually AIDS cases which are discussed. The reporting of AIDS cases in most areas of the US is now more than 85% complete6. It is necessary to remember that AIDS cases are not the same as HIV infections - in fact, an AIDS diagnosis may occur many years after the initial HIV infection took place. Indeed, since about 1996, when antiretroviral drug treatment became more common in America, AIDS diagnoses have been even less reliable a way to judge HIV infections - the time between HIV infection and AIDS diagnosis might be even more variable. This could result in AIDS data giving a misleadingly optimistic impression of HIV infection trends in America. Today, most states have instigated HIV surveillance.

In spite of the large numbers of deaths which have already occurred in America, and in spite of the even larger numbers of Americans who are now living with HIV or AIDS, the media-led complacency continues. Many people in the USA continue to think that AIDS is something which could never happen to them, and many people in the USA continue to become infected. Debate continues about how best to deal with the American epidemic.