The 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 family members, loved ones, and health care professionals who witnessed, died, or survived the early years of the AIDS epidemic in the United States experienced an unimaginable holocaust. Hundreds of young people died each week. We lived through a time and in a system that lacked the medical, ethical, technical, and spiritual resources to soften the blow of so many young people dying of so mysterious an illness.
In the United States, there have been more than 600,000 cases of AIDS reported since 1981, and it's estimated that there may currently be as many as 900,000 Americans infected with HIV.
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.
Though the rate of HIV infections 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 much less common and much easier to treat with the 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 outside the United States.
AIDS is the fourth leading cause of death worldwide, the #1 cause of death due to infectious disease, and has surpassed malaria as the #1 killer in Africa. There are more than 2.2 million AIDS cases reported worldwide, and 33.6 million people are living with HIV/AIDS. More than 16 million people have died from AIDS. According to the NIH, AIDS caused 2.6 million deaths in 1999 and more than 3 million deaths in 2000.
Because of its incredible toll on human life, the United States formally identified AIDS as a threat to world security, expecting it to have catastrophic long-term consequences in sub-Saharan Africa, South Asia, and the former Soviet Union.
HIV/AIDS & 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 world's HIV-positive population and more than 80% of all AIDS deaths occur there. In 1999, nearly 70% of the 5.6 million new HIV infections occurred in sub-Saharan Africa.
Uganda has reportedly taken the lead in AIDS prevention efforts in Africa, by establishing a National AIDS Control Program in 1987 and hosting the first Phase I HIV vaccine trial in 1999. Through extensive education efforts, approximately 90% of the population has awareness about HIV and AIDS, and many people have adopted safe sex practices. Unfortunately, other African countries are not following Uganda's lead.
The epidemic is made grimmer by the fact that most Africans cannot afford the antiretroviral drugs that are the cornerstone of AIDS care in the United States and other Western nations. The drugs can cost up to $20,000 per year. Although efforts are being made in the United States and elsewhere to lower the cost, some African leaders say that even an 80% cut in price would not be enough to make the drugs affordable.
Further, the strict regimen that the drugs demand requires a drastic change in lifestyle that may be difficult for many people. Perhaps even more basic than medicine, many HIV-infected Africans are undernourished and hungry. Getting food to the people may be even more important than providing drugs.
Various factors have contributed to the current AIDS crisis in Africa, including the following:
- The likelihood that the HIV virus originated in Africa and spread and evolved before preventative actions could be taken
- A fierce denial on the part of many Africans, including presidents of nations, that HIV causes AIDS, that sex education is necessary to stop its spread, and that Western medicine or science can be trusted
- The inability to pay for the expensive antiretroviral drugs
- The malnourishment and poor health of many Africans
Because education, prevention, and AIDS therapy present insurmountable challenges, some people think that Africa's best hope for stopping the epidemic is a vaccine. Though more than two dozen experimental vaccines have been tested worldwide, only oneAIDSVAXhas reached a Phase III clinical trial.
HIV/AIDS & Asia and the Pacific
In 1999, 20% of the 5.6 million new HIV infections worldwide were in southern Asia. HIV began its spread in Asia in the early to mid-1980s. With a population of nearly 3.5 billion60% of the world's populationthis region has the potential to greatly affect the course of the AIDS epidemic.
Nearly one-half million of China's more than 1 billion inhabitants are infected with HIV; most new cases are among 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 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.