HIV/AIDS

In 1981, medical literature first described an unusual constellation of symptoms in five young homosexual men in Los Angeles. Subsequent reports described similar symptoms in residents of other cities, such as San Francisco and New York, not only among men who were having sex with men (MSM) but also among individuals who injected drugs and in people with hemophilia. These cases suggested that the cause was in the blood and was transmitted by sexual contact, sharing infected drugs, or receiving blood donations. In September of 1982, the Centers for Disease Control and Prevention (CDC) published a case definition using the current name acquired immune deficiency syndrome (AIDS).

It is now known that AIDS is caused by the human immunodeficiency virus (HIV). The virus can be transmitted when infected blood or bodily fluids (including semen and vaginal secretions) gain access to the bloodstream of an uninfected person. HIV can also be transmitted to babies during pregnancy or delivery and through breast-feeding.

Being HIV-positive is not the same as having AIDS. A person with HIV can look and feel healthy for many years. Over time, HIV weakens the immune system, and the ability of a person to fight ailments diminishes. Consequently, persons living with HIV/AIDS are susceptible to “opportunistic” infections such as bacteria, protozoa, fungi, and viruses. HIV becomes AIDS when the CD4+ cell count drops below 200. The progression of HIV to AIDS is different in every person. New medications have revolutionized treatment for HIV/AIDS and have extended the life of people with HIV/AIDS. These medications do not cure HIV or AIDS; rather, they delay the progression of the disease and treat opportunistic infections. AIDS became the leading cause of death for people between the ages of 25 to 44 years old, although new medications have cut the AIDS death rate dramatically.

In the United States, the CDC estimates there are 1 to 1.2 million people living with HIV/AIDS; about one quarter of these people do not know that they [Page 477]have the virus. Men represent 75% of HIV infections. In the past, transmission was mainly via MSM and injection drug use, but in recent years heterosexual intercourse has become the predominant mode of transmission. Biologically, women are more susceptible than men to heterosexual infection, and HIV is increasing more rapidly among women than men. Another change is the racial and ethnic distribution of HIV. Initially HIV/AIDS disease affected mainly White Anglos; now the vast majority of new cases in the United States occur among Blacks, Hispanics, and, more recently, Asians. Few new cases are attributed to blood transfusions because of safety measures that have been implemented. A few studies show that there are different strains of HIV. Right now, there is much evidence of HIV1, and cases of HIV2 are rare. With no cure for HIV/AIDS in sight, scientists are working to develop a vaccine.

In the absence of a cure or vaccine, the best hope for combating the HIV/AIDS epidemic is prevention. It is recommended that people who are sexually active use protection for every sexual act, and get tested periodically. In totally monogamous couples who have both tested negative after an extended period of 100% precaution, it is recommended to use protection for every sexual act outside the couple. The use of clean needles is recommended for people using intravenous drugs. A variety of behavioral interventions have been developed for specific risk groups. Definitions of “risk” extend beyond the spheres of the individual and the couple and include contextual factors such as community and societal factors. Poverty, discrimination, substance use or abuse, and violence have been recognized as risk factors, particularly in communities of color.

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