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2003 Face of HIV and AIDS |
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Global Perspective |
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In the two decades since the first
reports of the disease, AIDS has become a global epidemic. Worldwide,
at the
end of 2002, an estimated 42 million people — 38.6 million
adults and 3.2 million children younger than 15 years — were
living with HIV/AIDS. According to the United Nations Program
on HIV/AIDS (UNAIDS), in 2002, about 14,000 new infections occurred
each day. Of those 14,000, approximately 2,000 children under
the age of 15 years, and 6,000 young people aged 15 to 24 years
became infected with HIV. In 2002 alone, HIV/AIDS-related associated
illnesses caused the deaths of approximately 3.1 million people
worldwide. Of those who died, 610,000 were children younger than
15 years.
What's more, the face of AIDS has changed — for the
first time, as many women as men are now living with the disease
worldwide. In Africa, 58 percent of those infected are women,
raising concerns that more babies may contract the virus from
their mothers.
This is just one of the many devastating problems for sub-Saharan
Africa, where the impact of the AIDS epidemic is greatest
and where AIDS has become a crisis with enormous social and
economic consequences. In the hardest-hit regions, nearly
20 million children are expected to lose one or both parents
to AIDS within the next 8 years, and some countries could
lose up to a quarter of their workforce by the year 2020.
But Africa is not the only region devastated by AIDS. The
largest increase in HIV/AIDS has been in the Russian Federation,
where 1 million people are now living with the virus. China,
India and Eastern Europe face growing epidemics.
Learn more about the global AIDS epidemic by visiting the International AIDS Ministries Web site. |
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United States |
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Currently, an estimated
800,000 to 900,000 Americans are living with HIV/AIDS. This
is partly the result of improved treatments. Since 1995 the
number of medications available to treat AIDS has more than
tripled, and powerful combinations of newer antiretroviral
drugs have helped reduce serious complications of the disease
and prolong life. But the emergence of drug-resistant forms
of HIV threatens the positive news about treatment.
Of equal concern is a growing public complacency
about AIDS. Nearly a third of the people living with HIV don't
know they're infected and so are more likely to spread the
disease. And reports from several cities in both the United
States and Europe show increased high-risk behavior among young
gay men. Drug use is also fueling the spread of HIV here and
abroad. These facts have led experts to warn that the 20-year-old
epidemic is still in its early stages.
Populations at Risk
In the early 1980s, HIV/AIDS was considered
primarily a gay white male disease in the United States.
Today, however, the epidemic has expanded and the disease
is also a major health problem for African-Americans, women
of all ages, Latinos and older adults.
African-Americans |
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The HIV/AIDS epidemic continues
to be a major health crisis facing the African-American community.
Although
African-Americans make up only about 12 percent of the United
States population, they accounted for about 21,000, or 50 percent,
of the more than 41,000 estimated new AIDS cases diagnosed
among adults in the United States. AIDS (HIV disease) is the
leading cause of death among African-American women ages 25
to 34 and African-American men ages 35 to 44. AIDS (HIV disease)
is among the top three causes of death for African-American
men ages 25 to 54 and African-American women ages 35 to 44.
African-American women accounted for nearly 64 percent of HIV
cases reported among women in 2001.
African-Americans Contend with Multiple HIV Risk Factors
Race and ethnicity are not, themselves, risk factors for
HIV infection. However, African Americans are more likely
to face challenges associated with risk for
HIV infection, including:
- Poverty
Nearly one in four African Americans lives in poverty. Although poverty
itself is not a risk factor, studies have found a direct relationship
between higher
AIDS incidence and lower income. A variety of socioeconomic problems
associated with poverty directly or indirectly increase HIV risks, including
limited
access to quality health care and higher levels of unemployment.
- Denial
and Discrimination
Although a growing number of African Americans are responding to the
HIV/AIDS crisis in their community, others have been slow to join the
effort. One
reason is that some African-Americans are reluctant to acknowledge sensitive
issues, such as homosexuality and drug use that are associated with HIV
infection. The cost of denial can be great. For example, studies show
that a significant
number of African-American men who have sex with men identify themselves
as heterosexual. As a result, they may not relate to prevention messages
crafted for gay men. Without frank and open discussion of HIV risks, many
African Americans will not get the information and support they need to
protect themselves and their partners from HIV.
- Partners at Risk
African-American women are most likely to be infected with
HIV as a result of sex with men. They may not be aware
of their male partners' possible risks
for HIV infection (such as unprotected sex with multiple partners, bisexuality
or injection drug use). Women who suspect that their partners are at risk
for HIV infection may be reluctant to try to negotiate condom use for various
and complex reasons. For example, some women may not insist on condom use
out of fear that the man will physically abuse them or withdraw financial
support.
- Substance Abuse
Injection drug use is the second leading cause of HIV infection
for both African-American men and women. But sharing
needles is not the only HIV risk related to substance
abuse. Both casual and chronic substance abusers are more likely to engage
in high-risk behaviors, such as unprotected sex, when they are under the
influence of drugs or alcohol. Sharing needles associated with therapeutic
drugs does not seem dangerous as sharing needles in the use of illegal
or
recreational drugs, however, the risk is the same. It is the needle, not
the serum that transmits HIV/AIDS.
- Sexually Transmitted Disease (STD) Connection
For many of the reasons noted above, African Americans
also have the highest STD rates in the nation. Compared
to whites, African Americans are 27 times
more likely to have gonorrhea and 16 times more likely to have syphilis.
In part because of physical changes caused by STD infection, including
genital lesions that can serve as a portal of entry for
HIV, the presence of certain
STDs can increase by three- to five-fold the chances of contracting HIV.
Similarly, since co-infection with HIV and another STD can cause increased
HIV shedding, a person who is co-infected has a greater chance of spreading
HIV to others.
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Women
The HIV/AIDS epidemic has often been
perceived as primarily affecting men. Today, however, women
represent an estimated 30 percent of new HIV infections
in the United States and comprise an increasing share of new AIDS cases.
Women of color, particularly African-Americans, have been hardest hit among
women by this epidemic. Over the past decade, researchers and clinicians
have increasingly begun to focus on the impact of the epidemic among women;
but gender disparities continue to persist in access to care and treatment.
Since 1985, the proportion of all AIDS cases
reported among adult and adolescent women has more than tripled,
from 7percent in
1985 to 25 percent in 1999. The epidemic has increased most
dramatically among women of color. African American and Hispanic
women together
represent one-fourth of all U.S. women, yet they account for
more than three-fourths (78 percent) of AIDS cases reported
to date among women in our country. In 2000 alone, African
American
and Hispanic women represented an even greater proportion (80
percent) of cases reported in women.
Older women are also increasingly being diagnosed
with HIV infection. As of December 2001, women aged 45 and
older accounted
for 18 percent of the female AIDS cases reported to the Centers
for Disease Control and Prevention (CDC).
In 2000, 38 percent of women reported with
AIDS were infected through heterosexual exposure to HIV; injection
drug
use accounted
for 25 percent of cases. In addition to the direct risks associated
with drug injection (sharing needles), drug use also is fueling
the heterosexual spread of the epidemic. A significant proportion
of women infected heterosexually were infected through sex
with an injection drug user. Reducing the toll of the epidemic
among women will require efforts to combat substance abuse,
in addition to reducing HIV risk behaviors.
Studies in both the United States and abroad
have demonstrated that sexually transmitted diseases (STDs),
particularly infections that cause ulcerations of
the vagina (for example, genital herpes, syphilis, and chancroid),
greatly increase a woman's risk of becoming infected with HIV.
Studies in the United States have also found a number of other
factors to be associated with an increased risk of heterosexual
HIV transmission, including alcohol use, history of childhood
sexual abuse, current domestic abuse, and use of crack/cocaine.
Women suffer from the same complications of AIDS that afflict
men but also suffer gender-specific manifestations of HIV disease,
such as recurrent vaginal yeast infections and severe pelvic
inflammatory disease, which increase their risk of cervical
cancer. Women also exhibit different characteristics from men
for many of the same complications of antiretroviral therapy,
such as metabolic abnormalities.
The AIDS epidemic is far from over. Scientists
believe that cases of HIV infection reported among 13- to 24-year-olds
are
indicative of overall trends in HIV incidence (the number of
new infections in a given time period, usually a year) because
this age group has more recently initiated high-risk behaviors—and
females made up nearly half (47percent) of HIV cases in this
age group reported from the 34 areas with confidential HIV
reporting for adults and adolescents in 2000. Further, for
all years combined, young African American and Hispanic women
account for three-fourths of HIV infections reported among
females between the ages of 13 and 24 in these areas. |
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Hispanics
The United States has a large and growing
Hispanic population that is heavily affected by the HIV/AIDS
epidemic. In 2000,
Hispanics represented 13 percent of the United States population
(including residents of Puerto Rico), but accounted for 19
percent of the total
number of new United States AIDS cases reported that year (8,173
of 42,156 cases). The AIDS incidence rate per 100,000 population
(the number of new cases of a disease that occur during a specific
time period) among Hispanics in 2000 was 22.5, more than 3
times the rate for whites (6.6), but lower than the rate for
African Americans (58.1).
Males account for the largest proportion
(81percent) of AIDS cases reported among Hispanics in the United
States, although the
proportion of cases among females is rising. Females represent
19 percent of cumulative AIDS cases among Hispanics, but account
for 23 percent of cases reported in 2000 alone. Sixty percent
of Hispanics reported with AIDS in 2000 were born in the United
States;
of those, 42 percent were born in Puerto Rico.
From the beginning of the epidemic through
December 2000, 114,019 Hispanic men have been reported with
AIDS in the United States. Of these cases, men
who have sex with men (MSM) represent 42 percent, injection drug users (IDUs)
account for 35 percent, and 6 percent of cases were due to
heterosexual contact. About 7percent of cases
were among Hispanic men who both had sex with men and injected drugs. Among
men born in Puerto Rico, however, injection drug use accounts for a significantly
higher proportion of cases than male-male sex. For adult and adolescent Hispanic women,
heterosexual contact accounts for the largest proportion (47percent)
of cumulative AIDS cases, most of which are
linked to sex with an injection drug user. Injection drug use accounts for
an additional 40 percent of AIDS cases among U.S. Hispanic women.
Young People
It has been estimated that at least
half of all new HIV infections in the United States are among
people under 25, and the majority of young people are infected
sexually. However, only a fraction of these young people are actually aware
of their HIV serostatus, and an even smaller number have been successfully
linked to vital medical care and social services.
In 2000, 1,688 young people
(ages 13 to 24) were reported with AIDS, bringing the cumulative
total to 31,293 cases of AIDS in this age group. The majority of adolescent HIV infections
result from sexual transmission of the virus. Most young women
are infected through
heterosexual sex (75 percent), whereas many young men between
the ages of 13 and 24 are infected through same-sex encounters.
Additionally, with effective treatment strategies, there is
a growing number of perinatally infected youth who are living
to see teenage and young adult years.
Scientists believe that cases of HIV
infection diagnosed among 13- to 24-year-olds are indicative
of overall trends in HIV
incidence (the number of new infections in a given time period,
usually a year) because this age group has more recently initiated
high-risk behaviors. Females made up nearly half (47 percent)
of HIV cases in this age group reported from the 34 areas with
confidential
HIV reporting for adults and adolescents in 2000—and
in young people between the ages of 13 and 19, a much greater
proportion of HIV infections was reported among females (61percent)
than among males (39 percent). Cumulatively, young African
Americans are most heavily affected, accounting for 56 percent
of all HIV cases
ever reported among 13- to 24-year-olds in these 34 areas.
Overall, there is a decline in the number
of newly diagnosed HIV cases. But
among youth, there has not been a comparable decline. Now, more than ever,
there is a great need to identify at-risk adolescents, to introduce them
to counseling and testing as a component of HIV prevention,
and to bring HIV-infected
young people into care. |
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Older Adults |
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The aging process may mean facing a number of
health issues—we rarely consider HIV/AIDS to be among
them. The common stereotypes associated with those who contact
the disease—gay men, people with multiple partners, prostitutes,
drug addicts, young men and women—have provided a false
sense of insulation and security for those who see themselves
as different than the population at risk. Unfortunately, these
stereotypes do not provide protection from a growing threat
to older adults. The face of HIV/AIDS is changing. The newest
population to be substantially affected by HIV/AIDS is people
over 50.
According to the latest data released by the United States
Department of Health and Human Services, in June 2001, 45,903
cases of AIDS were confirmed among people 55 and older. Numerically,
that indicates 1 in every 7 new AIDS cases is an individual
over age 55, and, each year the number of cases doubles. The
primary mode of transmission is heterosexual sex.
There are many reasons why this is a growing issue:
- Ageism
Health professionals often do not consider older patients/clients
to be sexually active or having multiple or sequential
partners. Thus they do not view them at
risk for HIV and are less likely to ask these patients/clients about risk
factors or to suggest tests. Because of the stereotype
that older adults are not sexually
active and do not use drugs, many health professionals fail to ask older
patients/clients about their sex lives, sexual history
or drug usage—let alone educate
about how to reduce their risk. And, older patients/clients are often embarrassed
to talk about sex.
- Missed or Misdiagnoses
As HIV symptoms often are similar to some factors attributed
to the aging process (fatigue, dementia, hair loss, nausea,
night sweats, depression, pneumonia,
weight loss, diarrhea, skin rashes, swollen lymph nods), missed or misdiagnosis
is frequent in older people who are infected. As a result, many older adults
are diagnosed with HIV at a latter stage of infection and often become
ill with AIDS-related complications and die sooner than
their younger counterparts.
- Women No Longer At Risk For Becoming Pregnant
When women leave their child-bearing years and do not worry
about becoming pregnant, condom use for birth control
becomes unimportant. Also, they grew
up in an era where one did not have to negotiate for safer sex. Women are
at a disproportionate risk because normal aging causes the female reproductive
organs to be more vulnerable making it easier for the virus to enter into
the
bloodstream.
- Lack of Prevention Efforts
Few HIV prevention efforts that target adults over 50 exist.
Mainstream ad campaigns have yet to incorporate images
and issues concerning persons
over
50 and encourage at-risk older adults to be routinely tested for HIV.
- Sharing
Needles
Sharing needles associated with therapeutic drugs does
not seem dangerous as sharing needles in the use of illegal
or recreational drugs might.
It is the
needle, not the serum that transmits HIV/AIDS.
- Lack of Research
The general lack of awareness of HIV/AIDS in older adults
has resulted in this segment of the population, for the
most part, being omitted
from research,
clinical drug trials, educational prevention programs and intervention
efforts. Little research is available about the tolerability and
efficacy of HIV drugs
in older individuals. This can make treatment methods (dosage and
frequency) difficult. More research on sexual and drug
using behavior of older
adults is needed, as well as research on disease progression and
treatments. HIV-positive older persons will also need
to be recruited for clinical
trials.
What makes HIV/AIDS different for Older Adults?
Older people diagnosed with HIV/AIDS do not live as long
as younger people who have the virus. It is important
to get tested early. The
earlier
you begin medical treatment, the better your chances for living
longer. Many
older people
who have HIV/AIDS live in isolation because they are afraid to
tell family and friends about their illness. They may
have more severe
depression than younger people. Older people are less likely to
join support groups.
Older
people with HIV/AIDS need help coping both emotionally and physically
with the disease. As the infection progresses, they will need help
getting
around
and caring for themselves. Older people with AIDS need support
and understanding from their doctors, family, friends,
and community.
Learn more about HIV/AIDS and older
adults. |
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Gay Community
In the United States, HIV-related
illness and death historically have had a tremendous impact
on men who have sex with men (MSM).
Even though the toll of the epidemic among injection drug users
(IDUs) and heterosexuals has increased during the last decade,
MSM continue to account for the largest number of people reported
with AIDS each year. In 2000 alone, 13,562 AIDS cases were
reported among MSM, compared with 8,531 among IDUs and 6,530
among men and women who acquired HIV heterosexually.
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Continuing Risk Among Young MSM
Abundant evidence
shows a need to sustain prevention efforts for each generation
of young gay and bisexual men. We cannot
assume that the positive attitudinal and behavioral change
seen among older men also applies to younger men. Recent data
on HIV prevalence and risk behaviors suggest that young gay
and bisexual men continue to place themselves at considerable
risk for HIV infection and other sexually transmitted diseases
(STDs).
Research among gay and bisexual men suggests that some individuals
are now less concerned about becoming infected than in the
past and may be inclined to take more risks. This is backed
up by reported increases in gonorrhea among gay men in several
large U.S. cities between 1993 and 1996. Despite medical advances,
HIV infection remains a serious usually fatal disease that
requires complex, costly, and difficult treatment regimens
that do not work for everyone. As better treatment options
are developed, we must not lose sight of the fact that preventing
HIV infection in the first place precludes the need for people
to undergo these difficult and expensive therapies. |
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Need to Combat other STDs
Studies among MSM who
are treated in STD clinics have shown consistently high percentages
of HIV infection, ranging from
nearly 4 percent in Seattle to a high of almost 36 percent
in Atlanta. Some studies have shown that the likelihood of
both
acquiring
and
spreading HIV is 2-5 times greater in people with STDs, and
that aggressively treating STDs in a community may help reduce
the rate of new HIV infections. Along with prompt attention
to and treatment of STDs, efforts to reduce the behaviors that
spread STDs are critical.
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