7.5.1: HIV/AIDS
In chapter 3 we covered a brief history of HIV/AIDS, which was first discovered in the U.S. the early 1980’s, but had likely been a zoonotic disease transmitted to humans at least a century prior. Human immunodeficiency virus (HIV) attacks the body’s immune system, particularly white blood cells that typically fight off infectious diseases: helper T cells (CD4+T), macrophages, and dendritic cells. This can lead to dangerously low levels of these cells, which disarms the cell-mediated immune response. If the disease progresses to the advanced stage, it can cause acquired immunodeficiency syndrome (AIDS), in which so-called opportunistic infections and cancers take hold. HIV is a uniquely devastating infection in this way: it attacks the body’s defenses themselves, allowing other infections or cancers to easily overwhelm the person’s weakened immune system. HIV is transmitted via direct contact with bodily fluids, whether from sex, sharing needles, infected blood transfusion, or perinatally and via breastmilk (Contributors to Wikimedia projects, 2024). Although some people get flu-like symptoms 2-4 weeks after infection with HIV, it may take between 9-11 years for HIV to progress to AIDS (untreated). Within that time frame, a person who does not know their HIV status may transmit it to many more people.(CDC, 2022).
The most current estimated rates in the U.S. from 2021 are below.
- Incidence: 32,100 new cases.
- Prevalence: 1.2 million people currently living with HIV. The CDC estimates that 13% of HIV positive people are unaware of their status.
- Mortality: 19,986 deaths in people who were HIV positive, from any cause including COVID-19 (HIV.gov, 2023).
Significant medical advancements in testing, prevention and treatment have been made, including: antiretroviral therapy (ART) for those HIV positive, prophylactic medicines for pre-exposure (PrEP) and post-exposure (PEP) treatment. These medicines can decrease viral load to the point that not only is the virus undetectable, it is also not transmissible to a partner (HIV.gov, 2024). There is still a significant negative stigma associated with an HIV positive status, which deters many at-risk individuals from getting tested (CDC, 2022b). Self-tests that can be taken at home may help to reduce testing avoidance.
In 2021, President Joseph Biden’s administration began the National HIV/AIDS Strategy (NHAS) 2022-2025 which set goals for reducing the number of new infections by 75% by 2025, and 90% by 2030. This plan coordinates national and local efforts, increases public health messaging on HIV, releases funding for testing and PrEP and PEP medications, and focuses on reducing disparities in HIV and addressing the associated social determinants of health (SDOH) (The White House, 2021). According to the 2023 Interim Report, estimated new infections had dropped by 12% between 2017-2023, and the number of people receiving PrEP treatment had increased significantly. Still, the report recognizes that racial, ethnic, and gender disparities still need to be addressed. Also of note in the report is that over half of those living with diagnosed HIV in the U.S. are over the age of 50 (The White House, 2023).