HIV/AIDS History & Early HIV Crisis in the United States

The AIDS epidemic was first recognized in the United States in the spring of 1981. HIV, the virus that causes AIDS, was not isolated until 1983. From 1981 through 1987, the average life expectancy for people diagnosed with AIDS was 18 months.

The early years of the U.S. AIDS epidemic caused an unimaginable holocaust for the family members and loved ones of patients, and for health care professionals. Hundreds of young people died each week and the health care system lacked the medical, ethical, technical, and spiritual resources to soften the blow of so many young people dying of so mysterious an illness.

According to the Centers for Disease Control and Prevention (CDC), more than 940,000 cases of AIDS were reported in the United States from 1981 through 2004. In 2004, about 39,000 new cases of HIV infection were reported. Currently, there are approximately 1.1 million people in the United States who are infected with the human immunodeficiency virus.

According to the National Institutes of Health (NIH), HIV infections are increasing more rapidly among women, who contract the virus primarily through unprotected sex with an infected male partner. In the United States, AIDS is the fourth leading cause of death for women between 25 and 44 years old. AIDS cases among women increased threefold from 1985 to 1996.

Although the rate of HIV infection continues to increase in the United States, the number of AIDS cases has fallen dramatically since 1996, when antiretroviral drugs came onto the market. HIV-related infections and cancers are less common and easier to treat with potent combination antiretroviral therapy. The U.S. mortality rate due to AIDS has plummeted.

Current Worldwide HIV Crisis

Unfortunately, the AIDS epidemic continues today in Africa and much of Asia, where antiretroviral therapy is not available and health care is seriously inadequate. Over 95% of AIDS cases and deaths occur in parts of the world other than the United States.

AIDS is the fourth leading cause of death worldwide, the leading cause of death due to infectious disease, and has surpassed malaria as the number one killer in Africa. There are more than 2.2 million AIDS cases reported worldwide, and 33 million people are living with HIV/AIDS. More than 16 million people have died from AIDS, including more than 3 million in 2000.

Because of its incredible toll on human life, AIDS has been identified as a threat to world security. It is expected to cause catastrophic long-term consequences in sub-Saharan Africa, South Asia, and the former Soviet Union.

HIV in Sub-Saharan Africa

AIDS is the leading cause of death in southern Africa. Sub-Saharan Africa makes up one-tenth of the world's population, but two-thirds of the HIV-positive population and more than 80% of all AIDS deaths occur in this region. In 1999, nearly 70% of the 5.6 million new cases of HIV infection occurred in sub-Saharan Africa.

Uganda established a National AIDS Control Program in 1987 and hosted the first Phase I HIV vaccine trial in 1999, taking the lead in AIDS prevention efforts in Africa. Through extensive education efforts, approximately 90% of the population in Uganda has awareness about HIV and AIDS, and many people have adopted safe sex practices. Unfortunately, many other African countries have not following Uganda's lead.

Even grimmer, is the fact that most people in Africa cannot afford the antiretroviral drugs that are the cornerstone of AIDS care in the United States and other Western nations, which can cost more than $20,000 per year. Although efforts are being made to lower the cost, even an 80% cut in price may not be enough to make the drugs affordable.

Further, the strict regimen that the drugs require often demands a drastic change in lifestyle that is difficult for many people. Even more basic than medicine, many HIV-infected Africans are undernourished and hungry. Getting food to these people may be even more important than providing medications.

Various factors have contributed to the current AIDS crisis in Africa, including the following:

  • Likelihood that the HIV virus originated in Africa and spread and evolved before preventative actions could be taken
  • Fierce denial on the part of many people, including presidents of African nations, that HIV causes AIDS, that sex education is necessary to stop its spread, and that Western medicine or science can be trusted
  • Inability to pay for the expensive antiretroviral drugs
  • Malnourishment and poor health of many people in Africa

Because education, prevention, and AIDS therapy present insurmountable challenges, the best hope for stopping the epidemic in Africa may be development of a vaccine. Although more than two dozen experimental vaccines have been tested worldwide, only one—AIDSVAX—reached Phase III clinical trials. In 2003, studies determined this vaccine is ineffective in preventing HIV infection.

HIV in Asia and the Pacific

In 1999, 20% of the 5.6 million new HIV infections worldwide occurred in southern Asia. HIV began to spread in Asia in the early to mid-1980s. With a population of nearly 3.5 billion—60% of the world's population—this region can have a substantial impact on the course of the AIDS epidemic:

  • Nearly one-half million of the more than 1 billion people in China are infected with HIV; most new cases occur in injectable drug users who share needles.
  • India has more people infected with HIV than any other country in the world; 3.7 million Indians have HIV or AIDS.
  • HIV was first reported in Thailand in the mid-1980s and cases have increased dramatically to 800,000 in 1999; prevention programs have stabilized its prevalence.
  • In Malaysia, HIV transmission appears to have stabilized since it reached its peak in the 1990s; 15% to 20% of all injectable drug users are infected with HIV.
  • In Vietnam, transmission is increasing, especially among injectable drug users and sex workers; the prevalence of HIV among injectable drug users has risen from less than 1% in 1995 to nearly 70% in 1998.
  • In Bangladesh, transmission is increasing among injectable drug users and sex workers.
  • The highest rate of HIV infection in Asia is in Cambodia, where the primary mode of transmission is heterosexual contact.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Dec 2000

Last Modified: 01 Dec 2011