HIV/AIDS in the United States
Background
- The HIV epidemic is increasingly affecting younger people. It is estimated that at least one American teenager is infected with HIV every hour of every day.
- The Centers for Disease Control and Prevention (CDC) estimates that 850,000 to 950,000 people were living with HIV or AIDS in the U.S. in 2000. That number has likely risen.
- Almost 930,000 cases fo AIDS were diagnosed in the U.S. through 2003, including 43, 171 cases diagnosed in 2003 alone. This represents a 4.6% increase over AIDS cases diagnosed in 2002.
- Annual HIV incidence is down from its peak of more than 150,000 in the 1980s to approximately 40,000 new infections per year today. However, it has remained at this level for over a decade and recent analyses suggest a potential rise among some populations.
- Women account for a growing share of new AIDS diagnoses in the United States, particularly women of color.
- 25% of those infected with HIV in the U.S. do not know it
HIV/AIDS is one of the fastest growing diseases worldwide. As attention has shifted in recent years from HIV/AIDS in the United States to the Global AIDS Pandemic, the rate of infection of HIV in the United States has remained constant, and risen among minority populations, specifically women and the African-American community.
Though the number of new cases reported each year is drastically lower than it was in the 1980s, it has largely leveled off in the past decade. Yet studies show an slow, but steady increase recently due to the rise of HIV/AIDS in minority populations.
The decreasing death rate for those living with AIDS is credited to funding increases for care and a new powerful triple-drug therapy which helps extend the lives of AIDS sufferers. While this news does not mean that the AIDS epidemic is over, it does reaffirm that our medical and research efforts are paying off. Yet still, 42% to 59% of those infected in the United States are not in regular HIV care. If anything, the statistics further demonstrate the urgency to improve access to health care for all people living with AIDS, and the continued need to increase investments for research efforts to find a cure and effective treatments.
There still remains a great deal of misunderstanding and ignorance around the issue of HIV/AIDS. HIV is a virus which can be transmitted only through blood, intravenous drug use though shared needles, sexual intercourse and through a mother to her unborn child. The virus cannot be transmitted, as some people believe, through casual contact, such as kissing, using water fountains or public bathrooms. A person develops AIDS only when the HIV virus weakens the immune system to a severe degree, leaving it vulnerable to a host of other illnesses, such as pneumonia. The period it takes for HIV to develop into AIDS varies from six months to ten years. However, the new combination of drugs being developed has considerably extended the period in which a person can live with HIV before it develops into AIDS.
While the number of new AIDS cases is declining, the number of people living with the HIV infection is increasing. This increased prevalence means that even more prevention efforts are needed. Individuals may be less concerned about becoming infected with HIV due to treatment advances such as protease inhibitors. However, the drugs do not work for everyone, and their long-term effectiveness is still undetermined. In addition, many cannot tolerate the side effects of the drugs or do not have access to the medications. From 1996 to 1997, the number of children (under age 13) who were diagnosed with AIDS decreased by 40%. This is thought to reflect successful efforts to reduce prenatal transmission through voluntary testing and zidovudine therapy (AZT) for pregnant HIV-infected women.
People living with the disease are still subject to discrimination and humiliation, and those who advocate for them still fight against decreasing budgets. Misinformation about how HIV is transmitted and who acquires it has contributed to a heightened sense of fear and has caused many extremists to believe that the government must take drastic steps to protect the uninfected. Unfortunately, these steps have been translated into a barrage of legislation which discriminates against people with HIV/AIDS and violates many of their civil liberties, including their rights to privacy, a healthy life, and full employment.
Impact on Racial and Ethnic Minorities
Racial and ethnic minorities are disproportionately affected by HIV/AIDS. Minority Americans represent 71% of new AIDS cases and 64% of those living with AIDS in the United States. Among their relative population sizes, African-Americans are infected with HIV/AIDS at a rate almost 10 times that of white Americans. Furthermore, survival after an AIDS diagnosis is lower among African-Americans than among any other racial/ethnic group.
Impact on Women
African-American women make up 67% of female AIDS cases, though they account for just 13% of the U.S. female population. Though, as noted above, that HIV/AIDS is 10 times more prevalent in the African-American population than among whites, African-American women suffer a case rate 25 times that of white women. AIDS is the leading cause of death for African-American women between the ages of 25 to 34 in the U.S.
Women infected with HIV are primarily low-income. Almost two-thirds (64%) of women with HIV have annual incomes below $10,000 compared to 41% of infected men. Most women (71%) become infected through heterosexual intercourse.
The virus is transmitted more efficient from men to women during sexual intercourse. Women with HIV are at high risk for developing a wide range of reproductive diseases including cervical dysplasia and human papilomavirus (HPV), precursors to cervical cancer. 76% of women infected with HIV have children under the age of 18.
Impact on Youth
At least half of all new HIV infections are among those under the age of 25. Teen girls and young women are over-represented among AIDS cases in their age groups.
HIV/AIDS: A GLOBAL PANDEMIC
Please click here to read more on this topic on RAC's Global AIDS issue page.
Legislative Summary
FY 2005 Budget
President Bush’s fiscal year (FY) 2005, budget, he included modest increases for two HIV/AIDS programs: $35 million for the AIDS Drug Assistance Program (ADAP) and $3 million for the HIV/AIDS in Minority Communities Fund; however, all other HIV/AIDS programs received decreased or level funding. AIDS Action expressed that the President is “all but forgetting HIV positive Americans.” AIDS Action is concerned that “at a time of rising rates of HIV infection and AIDS, flat funding will not keep the U.S. response apace of the epidemic’s spread; instead, it will pitch the response backwards. Furthermore, inflation and higher drug prices have weakened the dollar’s power, placing more strain on HIV/AIDS funding.”
Congress incorporated funding for HIV/AIDS into its FY 2005 Omnibus spending bill, cutting funding for HIV and STD prevention programs, while increasing funding for abstinence only education. The Reform Jewish Movement believes appropriations for abstinence-only sexuality education programs fall short of real STD prevention and advocates for comprehensive sexuality education programs in public schools.
Ryan White CARE Act
In August 1990, the Ryan White Comprehensive AIDS Relief Emergency (CARE) Act was enacted to provide care and treatment for the thousands of Americans living with HIV/AIDS. The rate at which the AIDS epidemic was growing threatened to implode existing health care and service infrastructures. The CARE Act was reauthorized in 1996 due to the continued growth of the AIDS epidemic.
In the FY 2001 budget proposal, an additional $125 million should be invested in the Ryan White CARE Act program, an increase of almost 8 percent over last year's funding level. The Ryan White CARE Act, without question, plays a critical role in ensuring access to appropriate care and services for Americans living with HIV/AIDS. CARE Act funds are used to provide primary medical care, AIDS drugs, viral load testing, treatment information, adherence support, case management, and other essential support services for tens of thousands of individuals living with HIV/AIDS. While each of the CARE Act's components addresses a specific need, they complement each other and play an important role in making Ryan White the health care and social service safety net of last resort. The Ryan White CARE Act is needed to ensure that our nation can continue to meet service needs and successfully support access to life saving therapies. The structure of the CARE Act has worked effectively to: dramatically improve the quality of life for people living with HIV disease and their families; reduce use of costly inpatient care; and increase access to care for underserved populations, including people of color.
The legislation must be reauthorized every five years, and its next reauthorization is set for September 2005.
For more information please visit AIDS Action or the Office of National AIDS Policy.
Early Treatment for HIV Act (S.902/H.R. 1591)
Medicaid coverage for people with HIV/AIDS inched closer to reality when Representatives Nancy Pelosi (D-CA) and Richard Gephardt (D-MO) and Senator Torricelli (D-NJ) introduced the "Early Treatment for HIV Act" (S.902, H.R. 1591) This bill would give states the option to expand Medicaid coverage for low-income individuals living with asymptomatic HIV disease, making it possible for these individuals to receive primary health care and effective drug therapies before they progress to full-blown AIDS.
Senator Robert Torricelli said that the measure could prevent thousands of AIDS deaths and diagnoses by allowing more HIV positive patients to receive the drugs through Medicaid. Currently, most low-income, HIV-positive individuals cannot receive AIDS-prevention drugs under Medicaid until they have full-blown AIDS. Bill supporters argue that by this time, many of the AIDS drugs that have been proven effective at fighting the disease in its early stages no longer work.
"The Early Treatment for HIV Act" would allow these patients to be covered by Medicaid immediately upon being diagnosed with HIV. Medicaid would cover the cost of the drug treatment known as the protease cocktail, which supporters claim will allow those infected with HIV to live longer and better manage their illness.
As of June, there are seventy co-sponsors of the legislation in the House and five in the Senate. The bill was referred to the House Subcommittee on Health and the Environment.
Civil Rights
Bragdon v. Abbott
On June 25, 1998, a major development occurred in the Supreme Court ruling in the Bragdon v. Abbott case. The case revolved around Sidney Abbott, a woman living with HIV, who sued her dentist because he refused to treat her because of her HIV status. Abbott's argument rested on the premise that she should be protected from discrimination by health care workers under the Americans with Disabilities Act (ADA) because HIV disease is a disability.
The Supreme Court ruled in favor of Sidney Abbott in her contention that asymptomatic HIV disease is a disability covered under the Americans with Disabilities Act (ADA). The Supreme Court ruled that reproduction is a major life activity that is limited when a person is infected with HIV. The court also emphasized that "given the pervasive....course of the disease," its effects on many other major life activities would also be relevant.
This ruling is particularly important to the HIV/AIDS community, as well as the disability community, yet it remains to be seen what the extended implications might be. For more information on this case, please visit the Supreme Court web page.
Position of the Reform Jewish Movement
In 1985, the Union for Reform Judaism (URJ) issued a summons to action on AIDS. This landmark resolution calls for increased financial and human resources to be used for prevention, treatment, public education, and for an end to discrimination against those with HIV/AIDS or related illnesses. TheURJ, in its 1985 resolution, also calls upon every congregation to "form and join area coalitions to develop action programs for the prevention of AIDS and assistance to those with the disease." In 1986, the Union adopted the AIDS Committee and Research Resolution.
The Central Conference of American Rabbis (CCAR) passed two resolutions AIDS (1987) and AIDS (1990) in support of increased HIV/AIDS funding, increased accessibility and distribution of any and all drugs which have proven to be effective in treating HIV/AIDS, and the development and facilitation of AIDS education programs.
In December, 1998, the Religious Action Center issued a press statement in support of President Clinton's initiative to curb the spread of AIDS in the U.S. and abroad.
Jewish Values
The challenge of our Jewish tradition in responding to this epidemic is clear. Where pain and suffering exist, we must bring comfort and solace. Where prejudice and ignorance prevail, we must provide acceptance and knowledge. Bikur cholim, pikuach nefesh, gemulit chasidim , caring for the sick, saving lives, deeds of loving kindness; these have been our values and our commitments since Sinai. They remain our guiding principles in dealing with this harrowing epidemic.
We are committed to reaching out to individuals infected with HIV/AIDS, their families, their partners, and their friends by providing food, clothing, legal assistance, transportation, and empathetic listening.
