The
AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
epidemic, caused by
HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
(Human Immunodeficiency Virus), found its way to the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
between the 1970s and 1980s,
but was first noticed after doctors discovered clusters of
Kaposi's sarcoma
Kaposi's sarcoma (KS) is a type of cancer that can form masses in the skin, in lymph nodes, in the mouth, or in other organs. The skin lesions are usually painless, purple and may be flat or raised. Lesions can occur singly, multiply in a limite ...
and
pneumocystis pneumonia in homosexual men in
Los Angeles
Los Angeles ( ; es, Los Ángeles, link=no , ), often referred to by its initials L.A., is the largest city in the state of California and the second most populous city in the United States after New York City, as well as one of the world' ...
,
New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
, and
San Francisco
San Francisco (; Spanish language, Spanish for "Francis of Assisi, Saint Francis"), officially the City and County of San Francisco, is the commercial, financial, and cultural center of Northern California. The city proper is the List of Ca ...
in 1981.
Treatment of HIV/AIDS is primarily via the use of multiple
antiretroviral drugs
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multipl ...
, and education programs to help people avoid infection.
Initially, infected foreign nationals were turned back at the United States border to help prevent additional infections.
The number of United States deaths from AIDS has declined sharply since the early years of the disease's presentation domestically. 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.
Gay
''Gay'' is a term that primarily refers to a homosexual person or the trait of being homosexual. The term originally meant 'carefree', 'cheerful', or 'bright and showy'.
While scant usage referring to male homosexuality dates to the late 1 ...
and
bisexual
Bisexuality is a romantic or sexual attraction or behavior toward both males and females, or to more than one gender. It may also be defined to include romantic or sexual attraction to people regardless of their sex or gender identity, whi ...
men,
African Americans
African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
, and
Hispanic/Latino Americans remain disproportionately affected by HIV/AIDS in the United States.
Mortality and morbidity
, 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.
With improved treatments and better
prophylaxis
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
against opportunistic infections,
death rates
Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of de ...
have significantly declined.
The overall death rate among persons diagnosed with HIV/AIDS in New York City decreased by sixty-two percent from 2001 to 2012.
Containment
After the HIV/AIDS outbreak in the 1980s, various responses emerged in an effort to alleviate the issue. These included new medical treatments, travel restrictions, and new public health policies in the United States.
Medical treatment
![AIDS Deaths-US 1998-2002](https://upload.wikimedia.org/wikipedia/commons/0/03/AIDS_Deaths-US_1998-2002.png)
Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included
antiretroviral drugs
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multipl ...
.
David Ho, a pioneer of this approach, was honored as ''
Time Magazine
''Time'' (stylized in all caps) is an American news magazine based in New York City. For nearly a century, it was published weekly, but starting in March 2020 it transitioned to every other week. It was first published in New York City on Mar ...
'' 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.
Travel restrictions
In 1987, the
Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...
(HHS) included HIV in its list of “communicable diseases of public health significance,” denying immigrants and short term foreign visits from anyone who tested positive for the virus.
In 1993, the US Congress passed the National Institutes of Health Revitalization Act of 1993, removing the HHS’ authority to dictate HIV as a “public health significance,” and explicitly including HIV as a cause for denying immigrants and foreign visitors entry into the US.
Anyone seeking US citizenship during the HIV ban was required to undergo a medical exam during the legalization process - testing positive would permanently deny the applicant entry into the country.
The law extended to include medication, where foreign travelers could be arrested for having antiretroviral drugs in their carry-on luggage. A famous example was in 1989, when a Dutch traveler to Minnesota was arrested for “several days” because he was carrying
AZT
Zidovudine (ZDV), also known as azidothymidine (AZT), is an antiretroviral medication used to prevent and treat HIV/AIDS. It is generally recommended for use in combination with other antiretrovirals. It may be used to prevent mother-to-child ...
in his luggage.
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.
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”.
In early December 2006, President
George W. Bush
George Walker Bush (born July 6, 1946) is an American politician who served as the 43rd president of the United States from 2001 to 2009. A member of the Republican Party, Bush family, and son of the 41st president George H. W. Bush, he ...
indicated that he would issue an executive order allowing HIV positive people to enter the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
on standard visas. It was unclear whether applicants would still have to declare their HIV status.
However, the ban remained in effect throughout Bush's presidency.
In August 2007, Congresswoman
Barbara Lee
Barbara Jean Lee (née Tutt; born July 16, 1946) is an American politician serving as the U.S. representative for . Now in her 12th term, Lee has served since 1998, and is a member of the Democratic Party. The district, numbered as the 9th di ...
of California introduced , 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.
In July 2008, President George W. Bush signed that lifted the ban in statutory law. However, the
United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
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
The goal of the Pacific Health Summit is to connect science, industry, and policy for a healthier world. Traditionally, the main work of the Summit has been an annual meeting, where top decision makers convene to discuss how to realize the dream of ...
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
James Adelbert McDermott (born December 28, 1936) is an American politician and psychiatrist who was the U.S. representative for from 1989 to 2017. He is a member of the Democratic Party. The 7th District includes most of Seattle, Vashon Isla ...
, who advocated the issue to the Obama administration's Health Secretary.
On October 30, 2009, President
Barack Obama
Barack Hussein Obama II ( ; born August 4, 1961) is an American politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, Obama was the first African-American president of the U ...
reauthorized the
Ryan White
Ryan Wayne White (December 6, 1971 – April 8, 1990) was an American teenager from Kokomo, Indiana, who became a national poster child for HIV/AIDS in the United States after his school barred him from attending classes following a diagn ...
HIV/AIDS Bill which expanded care and treatment through federal funding to nearly half a million.
The Department of Health and Human Services also crafted regulation that would end the HIV Travel and Immigration Ban, effective in January 2010.
On January 4, 2010, the
United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
and
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
removed HIV infection from the list of "
communicable diseases
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
of public health significance," due to its not being spread by casual contact, air, food or water, and removed HIV status as a factor to be considered in the granting of
travel visas, disallowing HIV status from among the diseases that could prevent people who were not U.S. citizens from entering the country.
Public health policies
![A woman with her hand in her hair and the other pulling up Wellcome L0052386](https://upload.wikimedia.org/wikipedia/commons/2/2b/A_woman_with_her_hand_in_her_hair_and_the_other_pulling_up_Wellcome_L0052386.jpg)
Since the beginning of the HIV/AIDS epidemic, several
U.S. presidents
The president of the United States is the head of state and head of government of the United States, indirectly elected to a four-year term
Term may refer to:
* Terminology, or term, a noun or compound word used in a specific context, in pa ...
have attempted to implement a national plan to control the issue. In 1987,
Ronald Reagan
Ronald Wilson Reagan ( ; February 6, 1911June 5, 2004) was an American politician, actor, and union leader who served as the 40th president of the United States from 1981 to 1989. He also served as the 33rd governor of California from 1967 ...
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.
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
William Jefferson Clinton ( né Blythe III; born August 19, 1946) is an American politician who served as the 42nd president of the United States from 1993 to 2001. He previously served as governor of Arkansas from 1979 to 1981 and agai ...
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. 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
Barack Hussein Obama II ( ; born August 4, 1961) is an American politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, Obama was the first African-American president of the U ...
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.
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.
In 2019,
Donald Trump
Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who served as the 45th president of the United States from 2017 to 2021.
Trump graduated from the Wharton School of the University of Pe ...
announced a plan in his
State of the Union Address
The State of the Union Address (sometimes abbreviated to SOTU) is an annual message delivered by the president of the United States to a joint session of the United States Congress near the beginning of each calendar year on the current conditio ...
to stop new HIV infections in the United States by 2030, though critics pointed to the President's policies reducing access to health insurance, anti-immigrant and anti-transgender policies as undermining this goal. The
Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...
issued grants to 32 HIV "hotspots" in 2019, and Congress earmarked over $291 million for the president's plan in FY2020.
In 2022, a federal judge ruled that the
U.S. military
The United States Armed Forces are the military forces of the United States. The armed forces consists of six service branches: the Army, Marine Corps, Navy, Air Force, Space Force, and Coast Guard. The president of the United States is the ...
could not discharge personnel nor bar them from becoming officers on the basis of HIV status.
Public perception
![AidsstatUSA](https://upload.wikimedia.org/wikipedia/commons/0/09/AidsstatUSA.svg)
During the HIV/AIDS epidemic of the 1980s,
LGBTQ communities were further
stigmatized
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
as they became the focus of
mass hysteria
Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria, involves the spread of illness symptoms through a population where there is no infectious agent responsible for c ...
, suffered
isolation and
marginalization
Social exclusion or social marginalisation is the social disadvantage and relegation to the fringe of society. It is a term that has been used widely in Europe and was first used in France in the late 20th century. It is used across discipline ...
, and were targeted with
extreme acts of violence in the United States. One of the best known works on the history of HIV/AIDS is the 1987 book ''
And the Band Played On
''And the Band Played On: Politics, People, and the AIDS Epidemic'' is a 1987 book by ''San Francisco Chronicle'' journalist Randy Shilts. The book chronicles the discovery and spread of the human immunodeficiency virus (HIV) and acquired immun ...
'' by
Randy Shilts
Randy Shilts (August 8, 1951February 17, 1994) was an American journalist and author. After studying journalism at the University of Oregon, Shilts began working as a reporter for both '' The Advocate'' and the ''San Francisco Chronicle'', as wel ...
, which contends that
Ronald Reagan
Ronald Wilson Reagan ( ; February 6, 1911June 5, 2004) was an American politician, actor, and union leader who served as the 40th president of the United States from 1981 to 1989. He also served as the 33rd governor of California from 1967 ...
's administration dragged its feet in dealing with the crisis due to
homophobia
Homophobia encompasses a range of negative attitude (psychology), attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay or bisexual. It has been defined as contempt, prejudice, aversion, h ...
, while the
gay community
The LGBT community (also known as the LGBTQ+ community, GLBT community, gay community, or queer community) is a loosely defined grouping of lesbian, gay, bisexual, transgender, and other queer individuals united by a common culture and social ...
viewed early reports and public health measures with corresponding distrust, thus allowing the disease to spread further and infect hundreds of thousands more. This resulted in the formation of ACT-UP, the
AIDS Coalition to Unleash Power
AIDS Coalition to Unleash Power (ACT UP) is an international, grassroots political group working to end the AIDS pandemic. The group works to improve the lives of people with AIDS through direct action, medical research, treatment and advocacy, ...
by
Larry Kramer
Laurence David Kramer (June 25, 1935May 27, 2020) was an American playwright, author, film producer, public health advocate, and gay rights activist. He began his career rewriting scripts while working for Columbia Pictures, which led him to Lo ...
. Galvanized by the
U.S. federal government
The federal government of the United States (U.S. federal government or U.S. government) is the Federation#Federal governments, national government of the United States, a federal republic located primarily in North America, composed of 50 ...
's inactivity, the movement led by AIDS activists to gain funding for AIDS research, which on a per-patient basis out-paced funding for more prevalent diseases such as
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
and
heart disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
, was used as a model for future lobbying for health research funding.
The Shilts work popularized the
misconception that the disease was introduced by a gay
flight attendant
A flight attendant, also known as steward/stewardess or air host/air hostess, is a member of the aircrew aboard commercial flights, many business jets and some government aircraft. Collectively called cabin crew, flight attendants are prima ...
named
Gaëtan Dugas
Gaëtan Dugas (; February 19, 1952 – March 30, 1984) was a Québécois Canadian flight attendant and a relatively early HIV patient who once was widely regarded as " Patient Zero," or the primary case for AIDS in the United States. This ...
, referred to as "
Patient Zero," although the author did not actually make this claim in the book. 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
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
main entry)'', and HIV has been shown to have caused the 1969 death of
Robert Rayford
Robert Lee Rayford (February 3, 1953 – May 15 1969), sometimes identified as Robert R. due to his age, was an American teenager from Missouri who has been suggested to represent the earliest confirmed case of HIV/AIDS in North America based ...
, a 16-year-old St. Louis male, who could have contracted it as early as 7 years old due to sexual abuse, suggesting that HIV had been present, at very low prevalence, in the U.S. since before the 1970s.
An early theory asserted that a series of
inoculation
Inoculation is the act of implanting a pathogen or other microorganism. It may refer to methods of artificially inducing immunity against various infectious diseases, or it may be used to describe the spreading of disease, as in "self-inoculati ...
s against
hepatitis B
Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. Fo ...
that were performed in the gay community of
San Francisco
San Francisco (; Spanish language, Spanish for "Francis of Assisi, Saint Francis"), officially the City and County of San Francisco, is the commercial, financial, and cultural center of Northern California. The city proper is the List of Ca ...
were tainted with HIV. Although there was a high correlation between recipients of that
vaccination
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
and initial cases of AIDS, this theory has long been discredited. However, the theory has never been officially proven or disproven. HIV,
hepatitis B
Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. Fo ...
, and
hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...
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 stemming the spread of the disease and/or finding a treatment was the vanity of "celebrity" scientists.
Robert Gallo
Robert Charles Gallo (; born March 23, 1937) is an American biomedical researcher. He is best known for his role in establishing the human immunodeficiency virus (HIV) as the infectious agent responsible for acquired immune deficiency syndrome ...
, an American scientist involved in the search for a new
virus
A virus is a submicroscopic infectious agent that replicates only inside the living cells of an organism. Viruses infect all life forms, from animals and plants to microorganisms, including bacteria and archaea.
Since Dmitri Ivanovsky's 1 ...
in the people affected by the disease, became embroiled in a legal battle with French scientist
Luc Montagnier
Luc Montagnier (; , ; 18 August 1932 – 8 February 2022) was a French virologist and joint recipient, with and , of the 2008 Nobel Prize in Physiology or Medicine for his discovery of the human immunodeficiency virus (HIV). He worked as a res ...
, who had first discovered such a virus in tissue cultures derived from a patient suffering from enlargement of the lymphnodes (an early sign of AIDS). Montagnier had named the new virus LAV (Lymphoadenopathy-Associated Virus).
Gallo, who appeared to question the primacy of the French scientist's discovery, refused to recognize the "French virus" as the cause of AIDS, and tried instead to claim the disease was caused by a new member of a retrovirus family,
HTLV
The human T-lymphotropic virus, human T-cell lymphotropic virus, or human T-cell leukemia-lymphoma virus (HTLV) family of viruses are a group of human retroviruses that are known to cause a type of cancer called adult T-cell leukemia/lymphoma an ...
, which he had discovered. Critics claim that because some scientists were more interested in trying to win a Nobel prize than in helping patients, research progress was delayed and more people needlessly died. After a number of meetings and high-level political intervention, the French scientists and Gallo agreed to "share" the discovery of HIV, although eventually Montagnier and his group were recognized as the true discoverers, and won the 2008 Nobel Prize for it.
Publicity campaigns were started in attempts to counter the incorrect and often vitriolic perception of AIDS as a "gay plague". These included the
Ryan White
Ryan Wayne White (December 6, 1971 – April 8, 1990) was an American teenager from Kokomo, Indiana, who became a national poster child for HIV/AIDS in the United States after his school barred him from attending classes following a diagn ...
case, red ribbon campaigns, celebrity dinners, the
1993 film version of ''And the Band Played On'',
sex education programs in schools, and
television advertisements
A television advertisement (also called a television commercial, TV commercial, commercial, spot, television spot, TV spot, advert, television advert, TV advert, television ad, TV ad or simply an ad) is a span of television programming produce ...
. Announcements by various celebrities that they had contracted HIV (including actor
Rock Hudson
Rock Hudson (born Roy Harold Scherer Jr.; November 17, 1925 – October 2, 1985) was an American actor. One of the most popular movie stars of his time, he had a screen career spanning more than three decades. A prominent heartthrob in the Golde ...
, basketball star
Magic Johnson
Earvin "Magic" Johnson Jr. (born August 14, 1959) is an American former professional basketball player. He is often regarded as the greatest point guard of all-time and has been compared with Stephen Curry. Johnson played 13 seasons in the ...
, tennis player
Arthur Ashe
Arthur Robert Ashe Jr. (July 10, 1943 – February 6, 1993) was an American professional tennis player who won three Grand Slam singles titles. He started to play tennis at six years old. He was the first black player selected to the Unite ...
and singer
Freddie Mercury
Freddie Mercury (born Farrokh Bulsara; 5 September 1946 – 24 November 1991) was a British singer and songwriter, who achieved worldwide fame as the lead vocalist of the rock band Queen. Regarded as one of the greatest singers in the ...
) were significant in arousing media attention and making the general public aware of the dangers of the disease to people of all sexual orientations.
Perspective of doctors
AIDS was met with great fear and concern by the nation, much like any other epidemic, and those who were primarily affected were homosexuals, African-Americans, Latinos, and intravenous drug users. The general thought of the population was to create distance and establish boundaries from these people, and some doctors were not immune from such impulses. During the epidemic, doctors began to not treat AIDS patients, not only to create distance from these groups of people, but also because they were afraid to contract the disease themselves. 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."
Some doctors thought it was their duty to stay away from the virus because they had other patients to think of. In a survey of doctors in the mid to late 1980s, a substantial number of physicians indicated that they didn't have an ethical obligation to treat and care for those patients with HIV/AIDS. A study of primary care providers showed that half would not care for patients if they were given a choice. In 1990, a national survey of doctors showed that "only 24% believed that office-based practitioners should be legally required to provide care to individuals with HIV infection."
However, there were many doctors who chose to care for these patients with AIDS for different reasons: they shared the same sexual orientation as the infected, a commitment to providing care to the diseased, an interest in the mysteries of infectious disease, or a desire to tame the awful threat.
Treating patients infected with the AIDS virus changed some doctors' personal lives, as it caused them to have to deal with some of the same stigmas that their patients had. This disease also weighed on their minds, because they often had to deal with witnessing the death of patients and most often those patients were as young or even younger than they were.
By race and ethnicity
African Americans
African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
are the ethnic group most disproportionately affected by HIV/AIDS, compared with other races and ethnicities in the United States.
They represented approximately 12% of the U.S. population in 2018,
but accounted for an estimated 43% of new HIV infections in 2017. Furthermore, they make up nearly 52% of AIDS-related deaths in the United States. A 2006 report from the
Centres for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) estimated that about half of the 1 million U.S. citizens living with HIV/AIDS were African–American. A 2010 study published on the ''
American Journal of Public Health
The ''American Journal of Public Health'' is a monthly peer-reviewed public health journal published by the American Public Health Association that covers health policy and public health. The journal was established in 1911 and its stated missio ...
'' reported that 64% of women infected with HIV/AIDS in the United States were African–American. In 2019, African–American and
multiracial
Mixed race people are people of more than one race or ethnicity. A variety of terms have been used both historically and presently for mixed race people in a variety of contexts, including ''multiethnic'', ''polyethnic'', occasionally ''bi-ethn ...
populations experienced the highest reported
homelessness rates of any other ethnic or racial group diagnosed with HIV/AIDS in the United States.
Hispanic and Latino Americans
Hispanic and Latino Americans ( es, Estadounidenses hispanos y latinos; pt, Estadunidenses hispânicos e latinos) are Americans of Spanish and/or Latin American ancestry. More broadly, these demographics include all Americans who identify as ...
are the second ethnic group most disproportionately affected by HIV/AIDS. Hispanics/Latinos represented 16% of the U.S. population but accounted for 21% of new HIV infections in 2010. This disparity is even more apparent among Hispanic/Latina women, which represent 13% of the population but account for 20% of reported HIV/AIDS cases among women in the United States. Hispanic and Latino Americans accounted for 20% of people living with HIV infection in 2011. Disparities persist in the estimated rate of new HIV infections in Hispanic and Latino Americans In 2010, the rate of new HIV infections for Hispanic/Latino men was 2.9 times that for
White American
White Americans are Americans who identify as and are perceived to be white people. This group constitutes the majority of the people in the United States. As of the 2020 Census, 61.6%, or 204,277,273 people, were white alone. This represented ...
men, and the rate of new infections for Hispanic/Latina women was 4.2 times that for White American women. Since the epidemic began, more than 100,888 Hispanic and Latino Americans with an AIDS diagnosis have died, including 2,863 in 2016.
Native American communities in the United States see a higher rate of HIV/AIDS in comparison to
White Americans
White Americans are Americans who identify as and are perceived to be white people. This group constitutes the majority of the people in the United States. As of the 2020 Census, 61.6%, or 204,277,273 people, were white alone. This represented ...
,
Asian Americans
Asian Americans are Americans of Asian ancestry (including naturalized Americans who are immigrants from specific regions in Asia and descendants of such immigrants). Although this term had historically been used for all the indigenous people ...
,
Native Hawaiians
Native Hawaiians (also known as Indigenous Hawaiians, Kānaka Maoli, Aboriginal Hawaiians, First Hawaiians, or simply Hawaiians) ( haw, kānaka, , , and ), are the indigenous ethnic group of Polynesian people of the Hawaiian Islands.
Hawaii ...
and other
Pacific Islander Americans
Pacific Islander Americans (also known as Oceanian Americans) are Americans who are of Pacific Islander ancestry (or are descendants of the indigenous peoples of Oceania or of Austronesian descent). For its purposes, the United States census ...
. Although Native Americans with HIV/AIDS only represent roughly 1% of positive cases in the U.S. population,
the number of diagnoses among Native American gay and bisexual men rose by 54% between 2011 and 2015. Additionally, the survival rate of diagnosed Native Americans was the lowest of all races in the United States between 1998 and 2005. In recent years, the
Centres for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) have put in place a "high impact prevention approach" in partnership with the Indian Health Service and the CDC Tribal Advisory Committee to tackle the growing rates in a culturally appropriate way.
The higher rate of HIV/AIDS cases among Native Americans have been attributed to a number of factors, including socioeconomic disadvantages faced by Native American communities, which may result in difficulty accessing healthcare and high-quality housing. It may be more difficult for Native American gay and bisexual men to access healthcare due to living in rural communities, or due to stigma attached to their sexualities. Native Americans have been reported to have higher rates of
other STIs, including
chlamydia
Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several wee ...
and
gonorrhea
Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium '' Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with ...
, which also increases likeliness of contracting or transmitting HIV. Furthermore, as there are over 560 federally recognized Native American tribes, there is some difficulty in creating outreach programs which effectively appeal to all tribes whilst remaining culturally appropriate. As well as fear of
social stigma
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
from within Native American communities, there may also be a fear among LGBTQ+ Native Americans of a lack of understanding from health professionals in the United States, particularly among
Two-Spirit
Two-spirit (also two spirit, 2S or, occasionally, twospirited) is a modern, , umbrella term used by some Indigenous North Americans to describe Native people in their communities who fulfill a traditional third-gender (or other gender-variant) ...
Native Americans. A 2013 NASTAD report calls for the inclusion of LGBTQ+ and Two-Spirit Native American peoples in HIV/AIDS program planning and asserts that "health departments should utilize local experts to better understand regional definitions of "Two Spirit" and incorporate modules on Native gay men and Two Spirit people into cultural sensitivity courses for public health service providers".
Racial disparities related to HIV/AIDS treatment
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 HIV status, become virally undetectable, and prevent transmission of HIV/AIDS. There are prevention methods to help reduce HIV rates in the United States. but these methods are not equally available or accessed. One prevention method is
PrEP
PowerPC Reference Platform (PReP) was a standard system architecture for PowerPC-based computer systems (as well as a reference implementation) developed at the same time as the PowerPC processor architecture. Published by IBM in 1994, it allo ...
which is an intervention taken orally or an injection that prevents HIV. According to the CDC,
Pre-exposure prophlyaxis or PrEP usage rates varied significantly by reported race and ethnicity in 2019.
For example, out of all the total number of individuals on PrEP, 63% of them identified as
White Americans
White Americans are Americans who identify as and are perceived to be white people. This group constitutes the majority of the people in the United States. As of the 2020 Census, 61.6%, or 204,277,273 people, were white alone. This represented ...
, 8% identified as
African Americans
African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
, 14% identified as
Hispanic and Latino Americans
Hispanic and Latino Americans ( es, Estadounidenses hispanos y latinos; pt, Estadunidenses hispânicos e latinos) are Americans of Spanish and/or Latin American ancestry. More broadly, these demographics include all Americans who identify as ...
, and 9% identified as other.
Healthcare access varies greatly by race and ethnicity in the United States. Out of those living with HIV/AIDS who received medical care only 63% of
Native Americans, 61% of
African Americans
African Americans (also referred to as Black Americans and Afro-Americans) are an ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American" generally denotes descendants of ens ...
, 65% of
Hispanic and Latino Americans
Hispanic and Latino Americans ( es, Estadounidenses hispanos y latinos; pt, Estadunidenses hispânicos e latinos) are Americans of Spanish and/or Latin American ancestry. More broadly, these demographics include all Americans who identify as ...
, and 85% of
Native Hawaiians
Native Hawaiians (also known as Indigenous Hawaiians, Kānaka Maoli, Aboriginal Hawaiians, First Hawaiians, or simply Hawaiians) ( haw, kānaka, , , and ), are the indigenous ethnic group of Polynesian people of the Hawaiian Islands.
Hawaii ...
and other
Pacific Islander Americans
Pacific Islander Americans (also known as Oceanian Americans) are Americans who are of Pacific Islander ancestry (or are descendants of the indigenous peoples of Oceania or of Austronesian descent). For its purposes, the United States census ...
were virally suppressed in 2019.
This is in comparison to 71% of
White Americans
White Americans are Americans who identify as and are perceived to be white people. This group constitutes the majority of the people in the United States. As of the 2020 Census, 61.6%, or 204,277,273 people, were white alone. This represented ...
who were virally suppressed in 2019 according to the CDC.
African–American, Hispanic/Latino, and
multiracial
Mixed race people are people of more than one race or ethnicity. A variety of terms have been used both historically and presently for mixed race people in a variety of contexts, including ''multiethnic'', ''polyethnic'', occasionally ''bi-ethn ...
populations were significantly more likely to miss at least one medical appointment in the past year compared with White American populations.
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.
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."
The 2022–2025 National HIV/AIDS strategy focuses on five priority populations including:
gay
''Gay'' is a term that primarily refers to a homosexual person or the trait of being homosexual. The term originally meant 'carefree', 'cheerful', or 'bright and showy'.
While scant usage referring to male homosexuality dates to the late 1 ...
,
bisexual
Bisexuality is a romantic or sexual attraction or behavior toward both males and females, or to more than one gender. It may also be defined to include romantic or sexual attraction to people regardless of their sex or gender identity, whi ...
, and other
men who have sex with men
Men who have sex with men (MSM) are male persons who engage in sexual activity with members of the same sex. The term was created in the 1990s by epidemiology, epidemiologists to study the spread of disease among all men who have sex with men, r ...
(MSM), in particular African–American, Hispanic/Latino, and Native American men; African–American women;
transgender women
A trans woman or a transgender woman is a woman who was assigned male at birth. Trans women have a female gender identity, may experience gender dysphoria, and may transition; this process commonly includes hormone replacement therapy and som ...
; youth aged 13–24 years; and people who
inject drugs.
"Down-low" subculture among Black MSM
''
Down-low'' is an
African-American slang term specifically used within the
African-American community that typically refers to a
sexual subculture
Sexuality and gender identity-based cultures are subcultures and communities composed of people who have shared experiences, backgrounds, or interests due to common sexual or gender identities. Among the first to argue that members of sexual mi ...
of
Black men
Black is a color which results from the absence or complete absorption of visible light. It is an achromatic color, without hue, like white and grey. It is often used symbolically or figuratively to represent darkness. Black and white have o ...
who usually identify as
heterosexual
Heterosexuality is romantic attraction, sexual attraction or sexual behavior between people of the opposite sex or gender. As a sexual orientation, heterosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to ...
but actively seek
sexual encounters and relations with other men, practice
gay cruising, and frequently adopt a specific
hip-hop attire during these activities.
They generally avoid disclosing their
same-sex sexual activities, and often have female sexual partner(s), and may be married or single.
According to a study published in the ''
Journal of Bisexuality
The ''Journal of Bisexuality'' is a peer-reviewed academic journal published quarterly by the Taylor & Francis Group under the Routledge imprint. It is the official journal of the American Institute of Bisexuality. It covers a wide range of topics ...
'', "
e 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".
In this context, "being on the ''down-low''" is more than just men having sex with men in secret, or a variant of
closeted
''Closeted'' and ''in the closet'' are metaphors for lesbian, gay, bisexual and transgender and other (LGBTQ+) people who have not disclosed their sexual orientation or gender identity and aspects thereof, including sexual identity and human ...
homosexuality
Homosexuality is romantic attraction, sexual attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" to peop ...
or
bisexuality
Bisexuality is a romantic or sexual attraction or behavior toward both males and females, or to more than one gender. It may also be defined to include romantic or sexual attraction to people regardless of their sex or gender identity, whic ...
—it is a sexual identity that is, at least partly, defined by its "cult of
masculinity
Masculinity (also called manhood or manliness) is a set of attributes, behaviors, and roles associated with men and boys. Masculinity can be theoretically understood as socially constructed, and there is also evidence that some behaviors con ...
" and its rejection of what is perceived as
White American culture
White Americans are Americans who identify as and are perceived to be white people. This group constitutes the majority of the people in the United States. As of the 2020 Census, 61.6%, or 204,277,273 people, were white alone. This represented ...
(including what is perceived as White American
LGBT culture
LGBT culture is a culture shared by lesbian, gay, bisexual, transgender, and queer individuals. It is sometimes referred to as queer culture (indicating people who are queer), while the term gay culture may be used to mean "LGBT culture" o ...
) and terms.
A 2003 cover story in ''
The New York Times Magazine
''The New York Times Magazine'' is an American Sunday magazine Supplement (publishing), supplement included with the Sunday edition of ''The New York Times''. It features articles longer than those typically in the newspaper and has attracted man ...
'' on the ''down-low'' phenomenon explains that the American Black community sees "homosexuality as a white man's perversion."
It then goes on to describe the ''down-low'' subculture as follows:
The
CDC
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
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.
Risk factors contributing to the Black HIV rate
Access to healthcare is very important in preventing and treating HIV/AIDS. It can be affected by health insurance which is available to people through private insurers,
Medicare and
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
which leaves some people still vulnerable. Historically, African-Americans have faced discrimination when it comes to receiving healthcare.
Homosexuality is viewed negatively in the African-American Community. "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".
Homosexuality is seen as a threat to the African-American empowerment. Masculinity is seen as important for the African-American community because it shows that the community is in control of their own destiny. Since the stigma circling homosexuality is that it is "effeminate", then homosexuality is seen as a threat to masculinity. "Black manhood, then, depends on men's ability to be provider, progenitor, and protector. But, as the Black male performance of parts of this script is thwarted by economic and cultural factors, the performance of Black masculinity becomes predicated on a particular performance of Black sexuality and avoidance of weakness and femininity. If sexuality remains one of the few ways that Black men can recapture a masculinity withheld from them in the marketplace, endorsing Black homosexuality subverts the cultural project of reinscribing masculinity within the Black community." This critical view is influenced by Internalized homophobia. "Internalized homophobia is defined as the lesbian, gay, or bisexual individual's inward direction of society's homophobic attitudes (Meyer 1995)."
A homophobic culture is sustained in the African-American community through the church because religion is a vital part of the African-American community: "As reported by Peterson and Jones (2009), AA MSM tended to be more involved with religious communities than NHW MSM." Because the church reiterates this stigma of homosexuality, the African-American community has higher rates of internalized homophobia. This internalized homophobia causes a lower chance of HIV/AIDS education on prevention and care within the African-American community.
Sex education varies throughout the United States and in some areas could use more informative measures. African-Americans and Hispanic/Latinos experience higher rates of lower socioeconomic statuses and fewer opportunities than white people. This causes limited access to (higher) education in lower socioeconomic areas. Sex education on HIV prevention has decreased from 64% (2000) to 41% (2014). Out of the 50 states, 26 put a larger emphasis on abstinence sex education. Abstinence-only sex education is correlated to increasing rates of HIV especially in teenagers and young adults.
With mass incarceration of the African-American community, HIV has been
spreading rapidly throughout jails and prisons. "Among jail populations, African American men are 5 times as likely as white men, and twice as likely as Hispanic/Latino men, to be diagnosed with HIV." Since most people contract HIV before being incarcerated, it is hard to know who has the disease and to keep it from spreading. Typical prison culture often makes transmission of HIV nearly an endemic problem to deal with. Many prisoners will either force themselves upon or be forced into sexual encounters, which coupled with a lack of condoms, often results in many prisoners contracting and spreading the disease further. Many inmates do not disclose their high-risk behaviors, such as injection drug use, because they fear being stigmatized and ostracized by other inmates. There is also a lack of educational programs on disease prevention for inmates. Because "nine out of ten jail inmates are released in under 72 hours which makes it hard to test them for HIV and help them find treatment," the problem persists outside of prison.
Activism and response
Starting in the early 1980s,
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
HIV/AIDS research includes all medical research that attempts to prevent, treat, or cure HIV/AIDS, as well as fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.
Transmission
A body of sc ...
. 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.
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 afflicted with 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.
AIDS activist groups worked to prevent spread of HIV by distributing information about
safe sex
Safe sex is sexual activity using methods or contraceptive devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer se ...
. They also existed to support people living with HIV/AIDS, offering therapy, support groups, and hospice care.
Organizations like
Gay Men's Health Crisis
The GMHC (formerly Gay Men's Health Crisis) is a New York City–based non-profit, volunteer-supported and community-based AIDS service organization whose mission statement is to "end the AIDS epidemic and uplift the lives of all affected."
Hist ...
,
Proyecto ContraSIDA por Vida Proyecto ContraSIDA por Vida (also known as PCPV and Proyecto) was a non-profit HIV-prevention agency located in the Mission District of San Francisco that provided community-based healthcare for the Latino/a and LGBT communities. It was one of sev ...
, the Lesbian AIDS Project, and SisterLove were created to address the needs of certain populations living with HIV/AIDS. Other groups, like the
NAMES Project
The NAMES Project AIDS Memorial Quilt, often abbreviated to AIDS Memorial Quilt or AIDS Quilt, is an enormous memorial to celebrate the lives of people who have died of AIDS-related causes. Weighing an estimated 54 tons, it is the largest piece ...
, emerged as a way of memorializing those who had passed, refusing to let them be forgotten by the historical narrative. One group, the Association for Drug Abuse Prevention and Treatment (ADAPT), headed by
Yolanda Serrano
Yolanda Serrano (died 1993) was a Puerto Rican-American drug counselor and HIV/AIDS activist. She received the National Organization for Women's Woman of the Year Award and was featured in ''Ms.'' magazine as one of the 1988 Women of the Year in ...
, coordinated with their local prison,
Riker's Island Correctional Facility, to advocate for those imprisoned and AIDS positive to be released early, so that they could pass away in the comfort of their own homes.
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
gay men
Gay men are male homosexuals. Some bisexual and homoromantic men may also dually identify as gay, and a number of young gay men also identify as queer. Historically, gay men have been referred to by a number of different terms, including ' ...
, most narratives of activism focus on their contributions to the movement. However, women also played a significant role in raising awareness, rallying for change, and caring for those impacted by the disease.
Lesbian women
A lesbian is a Homosexuality, homosexual woman.Zimmerman, p. 453. The word is also used for women in relation to their sexual identity or sexual behavior, regardless of sexual orientation, or as an adjective to characterize or associate n ...
helped organize and spread information about transmission between women, as well as supporting gay men in their work. Narratives of activism also tend to focus on organizing done in coastal cities, but AIDS activism was present and widespread across both urban and more rural areas of the United States. Organizers sought to address needs specific to their communities, whether that was working to establish
needle exchange programs
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
, fighting against housing or employment discrimination, or issues faced primarily by people identified as members of specific groups (such as
sex worker
A sex worker is a person who provides sex work, either on a regular or occasional basis. The term is used in reference to those who work in all areas of the sex industry.Oxford English Dictionary, "sex worker"
According to one view, sex work is d ...
s, mothers and children, or
incarcerated people).
During the HIV/AIDS epidemic of the 1980s, LGBTQ+ communities were further
stigmatized
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
as they became the focus of
mass hysteria
Mass psychogenic illness (MPI), also called mass sociogenic illness, mass psychogenic disorder, epidemic hysteria, or mass hysteria, involves the spread of illness symptoms through a population where there is no infectious agent responsible for c ...
, suffered
isolation and
marginalization
Social exclusion or social marginalisation is the social disadvantage and relegation to the fringe of society. It is a term that has been used widely in Europe and was first used in France in the late 20th century. It is used across discipline ...
, and were targeted with
extreme acts of violence.
Initially when the HIV/AIDS epidemic surfaced in the United States, a large proportion of patients were members of the
LGBTQ+ community, leading to further stigmatization of the disease.
Because of this, the AIDS activist groups took initiative in testing and experimenting with new possible medications for treating HIV, after researchers outside of the community refused. This research originally done by early AIDS activist groups contributed to treatments still being used today.
Among the landmark legal cases in the history of
LGBT rights in the United States
Lesbian, gay, bisexual and transgender (LGBT) rights in the United States are among the most socially, culturally, and legally permissive and advanced in the world, with public opinion and jurisprudence on the issue changing significantly si ...
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. The NY Court of Appeals became the first American appellate court to conclude that same-sex relationships are entitled to legal recognition. 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 more difficult for government officials to reject the notion that
same-sex couples
A same-sex relationship is a romantic or sexual relationship between people of the same sex. ''Same-sex marriage'' refers to the institutionalized recognition of such relationships in the form of a marriage; civil unions may exist in countries ...
could constitute families and that they were entitled to at least some of the protections afforded by law.
Response from the Catholic Church
![StVincents](https://upload.wikimedia.org/wikipedia/commons/5/54/StVincents.jpg)
The
United States Conference of Catholic Bishops
The United States Conference of Catholic Bishops (USCCB) is the episcopal conference of the Catholic Church in the United States. Founded in 1966 as the joint National Conference of Catholic Bishops (NCCB) and United States Catholic Conference (US ...
was the first church body to address the HIV/AIDS pandemic in 1987 with a document entitled "
On "The Many Faces of AIDS: A Gospel Response." In the document they stated that the
Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
must provide
pastoral care
Pastoral care is an ancient model of emotional, social and spiritual support that can be found in all cultures and traditions.
The term is considered inclusive of distinctly non-religious forms of support, as well as support for people from rel ...
to those infected with HIV/AIDS as well as medical care.
It called discrimination against people with AIDS "unjust and immoral.",
[ but rejected extra-marital sex and the use of condoms to halt the spread of the disease.][ They reiterated the Church's teaching that human sexuality was a gift and was to be used in monogamous marriages.][
The Catholic Church, with over 117,000 health centers, is the largest private provider of HIV/AIDS care.] Individual dioceses around the United States began hiring staff in the 1980s to coordinate AIDS ministry. By 2008, Catholic Charities USA had 1,600 agencies providing services to AIDS sufferers, including housing and mental health services. The Archdiocese of New York
The Archdiocese of New York ( la, Archidiœcesis Neo-Eboracensis) is an ecclesiastical territory or archdiocese of the Catholic Church ( particularly the Roman Catholic or Latin Church) located in the State of New York. It encompasses the boroug ...
opened a shelter for AIDS patients in 1985. In the same year, they opened a hotline for people to call for resources and information. The Missionaries of Charity
The Missionaries of Charity ( la, Congregatio Missionariarum a Caritate) is a Catholic centralized religious institute of consecrated life of Pontifical Right for women
established in 1950 by Mother Teresa, now known in the Catholic Church as ...
, led by Mother Teresa
Mary Teresa Bojaxhiu, MC (; 26 August 1910 – 5 September 1997), better known as Mother Teresa ( sq, Nënë Tereza), was an Indian-Albanian Catholic nun who, in 1950, founded the Missionaries of Charity. Anjezë Gonxhe Bojaxhiu () was bo ...
, opened hospices in the Greenwich Village
Greenwich Village ( , , ) is a neighborhood on the west side of Lower Manhattan in New York City, bounded by 14th Street to the north, Broadway to the east, Houston Street to the south, and the Hudson River to the west. Greenwich Village ...
neighborhood of New York, Washington D.C., and San Francisco in the 1980s.[ Individual parishes began opening hospices for AIDS patients, with the first being in New Orleans in 1985.][
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 Always Our Children, their 1997 pastoral letter on homosexuality, the American bishops noted "an importance and urgency" to minister to those with AIDS, especially considering the impact it had on the gay community. They encouraged church ministers to include prayers at Mass for those with AIDS and those who care for them, those who have died from AIDS, and all of their friends, families, and companions. They recommended special masses be said for healing with anointing of the sick or other events to take place around the time of ]World AIDS Day
World AIDS Day, designated on 1 December every year since 1988, is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection and mourning those who have died of the disease. The acquired immun ...
. They asked every Catholic to stand in solidarity with those who were affected by the disease.
In 1987, the bishops of California
California is a U.S. state, state in the Western United States, located along the West Coast of the United States, Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the List of states and territori ...
issued a document saying that just as Jesus loved and healed lepers, the blind, the lame, and others, so too should Catholics care for those with AIDS. The year before, they publicly denounced Proposition 64, a measure pushed by Lyndon H. LaRouche to forcibly quarantine those with AIDS, and encouraged Catholics to vote against it.[ Joseph L. Bernardin, the Archbishop of Chicago, issued a 12-page policy paper in 1986 that outlined "sweeping pastoral initiatives" his archdiocese would be undertaking.][
]
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. 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. 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
World AIDS Day, designated on 1 December every year since 1988, is an international day dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection and mourning those who have died of the disease. The acquired immun ...
, or AIDS Walks.
Current status
The CDC estimates at the end of 2017, there were 1,018,346 adults and adolescents with diagnosed HIV in the US and dependent areas. Since 2010, the number of people living with HIV has increased, while the annual number of new HIV infections has declined to 37,832 diagnosed in 2018. Within the overall estimates, however, some groups are affected more than others. 70% of 2018 diagnoses were among men who have sex with men, 7% were among injection drug users, and new infections disproportionately occurred among heterosexual women and African Americans.
The most recent CDC HIV Surveillance Report estimates that 38,281 new cases of HIV were diagnosed in the United States in 2017, a rate of 11.8 per 100,000 population. This rate is a decrease from the previous year's estimates, which indicated 39,589 new infections and a rate of 12.2 per 100,000 population. 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. 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 41.1 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 16.6 per 100,000. The lowest rates of new infection in 2017 occurred in the white population and Asian population, which each had a new infection rate of 5.1 per 100,000.
According to CDC estimates, the most common transmission category of new infections remained male-to-male sexual contact, which accounted for roughly 66.6% of all new infections in the United States in 2017. With regard to region of residence, the highest rates of new infections in 2017 occurred in the United States South, with 19,968 total new infections and 16.1 infections per 100,000. 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.
In the United States, men who have sex with men (MSM), described as gay and bisexual, 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. Among the proportion of new HIV positive gay and bisexual men in 2017, 39% are African American, 32% are white, and 24% are Hispanic/Latino. The CDC estimates that more than 600,000 gay and bisexual men are currently living with HIV in the United States. A review of four studies in which trans women in the United States were tested for HIV found that 27.7% tested positive.
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).
In 2015, a major HIV outbreak, Indiana
Indiana () is a U.S. state in the Midwestern United States. It is the 38th-largest by area and the 17th-most populous of the 50 States. Its capital and largest city is Indianapolis. Indiana was admitted to the United States as the 19th s ...
's largest-ever, occurred in two largely rural, economically depressed and poor counties in the southern portion of the state, due to the injection of a relatively new opioid-type drug called Opana (oxymorphone
Oxymorphone (sold under the brand names Numorphan and Opana among others) is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it beg ...
), which is designed be taken in pill form but is ground up and injected intravenously using needles. Because of the lack of HIV cases in that area beforehand and the youth of many but not all of those affected, the relative unavailability in the local area of treatment centers capable of dealing with long-term health needs, HIV care, and drug addiction during the initial phases of the outbreak, and political opposition to needle exchange programs
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
, the outbreak expanded for months, resulting in up to 127 preventable cases. Under pressure, officials eventually declared a state of emergency, but much of the damage had already been done.
See also
* Adult Industry Medical Health Care Foundation
The Adult Industry Medical Associates P.C. (formerly Adult Industry Medical Healthcare Foundation), also known simply as AIM or AIM Medical, was a non-profit organization devoted to STD testing of pornographic actors for HIV and other STDs on a s ...
* AIDS Education and Training Centers
The AIDS Education and Training Centers (AETC) are a United States network of five national centers, 11 regional training centers, and over 130 associated local performance sites that provide education on HIV and related co-morbidities such as hep ...
* Bugchasing
Bugchasing (alternatively bug chasing) is the rare practice of intentionally seeking human immunodeficiency virus (HIV) infection through sexual activity.
Bugchasers—those who eroticize HIV—constitute a subculture of barebackers, men who ...
* Criminal transmission of HIV in the United States
The criminal transmission of HIV in the United States varies among jurisdictions. More than thirty of the fifty U.S. states have prosecuted HIV-positive individuals for exposing another person to HIV. State laws criminalize different behaviors and ...
* Hank M. Tavera
Henry M. Tavera (January 19, 1944, East Los Angeles, California – February 27, 2000)Ramirez, Horacio N. Roque. "Claiming Queer Cultural Citizenship: Gay Latino (Im)Migrant Acts in San Francisco." Queer Migrations: Sexuality, U.S. Citizenship, an ...
* HIV/AIDS in New York City
New York City was affected by the AIDS epidemic of the 1980s more than any other U.S. city. The AIDS epidemic has been and continues to be highly localized due to a number of complex socio-cultural factors that affect the interaction of the popu ...
* People With AIDS
People With AIDS (PWA) means " person with HIV/AIDS", also sometimes phrased as, Person Living with AIDS. It is a term of self-empowerment, adopted by those with the virus in the early years of the pandemic (the 1980s), as an alternative to the p ...
* President's Emergency Plan for AIDS Relief
The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President Geor ...
International:
* AIDS education and training centers
The AIDS Education and Training Centers (AETC) are a United States network of five national centers, 11 regional training centers, and over 130 associated local performance sites that provide education on HIV and related co-morbidities such as hep ...
* HIV/AIDS activism
Social activism, Social and Political protest, political activism to raise awareness about HIV/AIDS, as well as to raise funds for treatment of HIV/AIDS, effective treatment and care of people with AIDS (PWAs), has taken place in multiple nations ...
* HIV/AIDS activists
Social and political activism to raise awareness about HIV/AIDS, as well as to raise funds for effective treatment and care of people with AIDS (PWAs), has taken place in multiple nations across the world since the 1980s. As a disease that bega ...
* HIV/AIDS global epidemic
* HIV/AIDS in North America
References
Bibliography
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Further reading
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Document ID 5291
External links
AIDS.gov – The U.S. Federal Domestic HIV/AIDS Resource
AIDSVu.org – Interactive Map Illustrating HIV Prevalence in the United States
{{DEFAULTSORT:Hiv Aids In The United States
1960 establishments in the United States
LGBT history in the United States