HIV & AIDS in the United States of America

Since the beginning of the HIV and AIDS epidemic well over half a million people have died of AIDS in the United States of America – the equivalent of the entire population of Las Vegas. There are currently around 1.2 million people living with HIV in the United States of America and around a fifth of these are unaware of their infection, posing a high risk of onward transmission.
The USA’s response to the AIDS epidemic has produced mixed results. HIV prevention efforts have not always been successful and in 2009 approximately 54,000 Americans were infected with HIV, that is about one every nine-and-a-half minutes. Washington DC has an HIV prevalence of 3.2 percent among people over 12 years - similar to rates in some parts of sub-Saharan Africa.
Despite the seriousness of the epidemic, particularly in certain geographic areas and among certain demographic groups, the USA lacked a comprehensive plan on AIDS until 2010. President Obama had promised to rectify this during his election campaign by committing to the creation of a National HIV/AIDS Strategy. The Strategy, which was launched in July 2010, is structured around three core aims: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related disparities and health inequities.
Stigma and discrimination towards HIV positive people still persist and thousands of uninsured Americans struggle to access good HIV care and antiretroviral therapy. The world’s biggest donor of AIDS-related funding is itself facing a major, ongoing AIDS epidemic.

Who is affected by AIDS in the United States of America? 

Although HIV and AIDS can and do affect all sectors of American society, the impact has been more serious among some groups than others. In the early years of the epidemic, the most commonly identified ‘vulnerable groups’ in the USA were men who have sex with men, injecting drug users, haemophiliacs and Haitians. However, the inclusion of Haitians in this group caused a lot of controversy. To find out more visit our History of AIDS in the United States of America page.
Today, AIDS continues to directly affect thousands of gay and bisexual men and injecting drug users every year, but it has also become a serious problem among Black Americans and, more recently, among the Hispanic/Latino population. However, it is not necessarily individual behaviour, but rather a person's sexual network which determines an individual's HIV risk in the USA. Therefore, black males are much more likely to be infected because of the high prevalence in this community and a tendency to choose racially similar partners as opposed to simply high-risk behaviour.
Wealth status also determines the likelihood of HIV infection in the USA. A study by the Centers for Disease Control and Prevention (CDC) in 2010 showed that in America's poorest urban neighbourhoods HIV prevalence was 2.1 percent among heterosexuals, or more than 4 times the national average. Race or ethnicity did not account for any significant differences within the high-poverty groups studied. Rather, higher HIV risk within poor urban areas was attributed to, among other factors, high HIV prevalence, limited access to health care and other basic services, and high rates of substance abuse and incarceration. Socioeconomic status and HIV prevalence are also linked among men who have sex with men.
Younger people are also a more at-risk group. Although overall, the rate of new infections remained stable between 2006 and 2009, among adolescents and young adults HIV incidence increased by 21 percent. For young people who belong to key populations at higher risk, the increase was especially high; for example there was a 34 percent increase among young men who have sex with men during the same period.
The table below shows how the burden of AIDS among various ethnic groups compares to the percentage of the population that each ethnic group represents.

Race	Estimated % of new AIDS diagnoses in 2009	% of population in 2008
White	27%	65%
Black/African American	47.9%	12%
Hispanic/Latino	21.2%	15%
Asian	1.2%	4%
American Indian/Alaska Native	<1%	<1%
Native Hawaiian/Other Pacific Islander	<1%	<1%
Multiple races	2%	2%

African Americans: As the table above shows, African Americans are disproportionately affected by the AIDS epidemic. To date, black Americans account for 40 percent of all recorded AIDS related deaths.¹³ The AIDS related deaths of well-known African Americans - such as anchorman Max Robinson, tennis player Arthur Ashe, and rapper Eazy-E - during the 1980s and 90s, increased awareness of the AIDS epidemic among the black community, though there are signs that this level is decreasing. Both African American men and women are most likely to have become infected through sex with a man, with injecting drug use being the second most likely infection route. Factors such as heightened levels of poverty, lack of access to adequate healthcare, and stigma surrounding men who have sex with men shape the epidemic among African Americans.
Visit our HIV & AIDS among African Americans page for more information.
Hispanics/Latinos: Hispanics/Latinos are also disproportionately affected by the AIDS epidemic in the USA. It is estimated that 1 in every 52 Hispanics/Latinos will be diagnosed with HIV in their lifetime.¹⁴ The risk for men and women differs widely though; 1 in 36 Hispanic/Latino men will be diagnosed with HIV in their lifetime compared to 1 in 106 Hispanic/Latino women. Three quarters of new HIV infections among Hispanic/Latino men occur among men who have sex with men (MSM), and Hispanic/Latino MSM are thought to have the highest rates of unprotected sex among MSM in the US. Additionally, the Hispanic/Latino community has a disproportionately low access to healthcare. This is reflected in the number of deaths from AIDS among Hispanics/Latinos which has remained relatively stable since the beginning of the new millennium despite an overall decline in AIDS mortality in the USA. Language barriers, cultural factors, and migration patterns have also been identified as barriers to HIV treatment and prevention within the Hispanic/Latino community. In New York City, where 40 percent of all households are made up of Latinos born outside the US, the majority of health and civil society organisations cite a lack of bilingual and culturally sensitive HIV and AIDS services as a key obstacle to dealing with the city's epidemic. HIV was the fifth leading cause of death for Hispanics/Latinos aged 35–44 and the sixth leading cause of death for Hispanics/Latinos aged 25–34 in the US in 2007.

Pedro Zamora, who died of AIDS in 1994

Men who have sex with men: At the beginning of the USA’s epidemic, AIDS primarily affected men who have sex with men (MSM). Today, MSM still account for around three-quarters of HIV diagnoses among male adults and adolescents and the rate of HIV diagnoses among MSM is more than 44 times that of other men. According to one study published by the CDC in 2010, one in five MSM in the 21 cities surveyed has HIV and almost half are unaware of their status. Gay and bisexual men of all races are the only group where new infections are rising every year and it is thought this rising number of new infections is due to an increasing number of MSM having unprotected sex. The availability of antiretroviral treatment may also have lessened the fear surrounding AIDS, leading to complacency about using condoms. This complacency is evident in Washington D.C, where a study by the city's HIV/AIDS Administration revealed 40 percent of gay men had not used a condom with their last sexual partner. The study also found that, contrary to popular belief, men older than 30 had more sexual partners and were less likely to use condoms or get tested than their younger counterparts. Low testing rates among young MSM mean that the majority of HIV infected men under 30 are unaware of their HIV status. Due to their high HIV transmission risk MSM in the USA are recommended to go for HIV testing at least once a year.
Injecting drug users: Among those living with an AIDS diagnosis in the US in 2008, around 20 percent were infected with HIV through injecting drug use (IDU). Throughout the epidemic, prevention efforts among IDUs have been controversial. For 21 years, needle exchange services – where users exchange their used needles for clean ones – were not permitted any federal funding, even though in some areas of the USA these programmes have proved to be successful in reducing the rate of HIV transmission. The ban on federal funding for needle exchanges was lifted in 2009, however, in a controversial move Congress failed to allocate funding for needle exchanges for fiscal year (FY) 2012.