“[The drop in AIDS-related deaths is] great news for all Americans living with AIDS and those who love them.”
—Donna E. Shalala, February 27, 1997
“The AIDS epidemic is not over.”
—Bill Clinton, February 27, 1997
In 1980 and 1981, doctors in Los Angeles and New York became alarmed about the possibility of a new disease when they noticed that some of their homosexual patients had contracted rare forms of cancer and pneumonia.The Centers for Disease Control and Prevention (CDC) identified the new disease—now known as acquired immunodeficiency syndrome (AIDS)—in June 1981. AIDS is believed to be caused by HIV, the human immunodeficiency virus, which is mainly transmitted in one of three ways: in semen during sexual intercourse, from mother to fetus during pregnancy or delivery, and by the use of a syringe infected with the virus. HIV invades a person’s white blood cells and disables the body’s immune system. The weakened immune system is unable to fight off diseases, including those that are otherwise not serious or deadly. These various illnesses, which are collectively labeled “AIDS,” eventually result in death. However, recent advances in treatment have raised hopes that AIDS may no longer be fatal in every case.
The strain of HIV that is prevalent in North America is most easily transmitted during anal sex. For this reason, AIDS has disproportionately affected gay men. HIV has also spread rapidly among intravenous drug users, many of whom share needles. Furthermore, the virus can be readily transmitted from an HIV-positive woman to her child during pregnancy, during delivery when the baby may swallow fluid in the birth canal, or from breast milk.
From 1981 to 1996, between 750,000 and one million Americans have been diagnosed with HIV or AIDS. Of those, 362,000 have died. The number of AIDS-related deaths rose steadily each year until 1995. That year, an all-time high of 49,500 deaths was recorded by the CDC. However, the CDC is cautiously optimistic that U.S. deaths from the AIDS epidemic may have reached a plateau. In July 1997, the public health organization reported that the number of deaths nationwide for the first nine months of 1996 had dropped 19 percent from the same period in 1995—from 37,900 to 30,700. The decline in AIDS Frontmatter 2/26/04 3:48 PM Page 12 AIDS deaths was seen in all racial and ethnic groups, according to the CDC. Whites experienced the greatest drop in deaths (28 percent) compared to blacks (10 percent) and Hispanics (16 percent).
The CDC’s figures were consistent with the January 1997 announcement by New York City health officials that AIDS deaths had dropped by 30 percent for 1996. Canada reported a similar decline. According to the Laboratory Centre for Disease Control in Ottawa, the number of AIDS deaths in 1996 fell 20 to 30 percent from the average number of deaths during the previous three years.
The CDC also noted that while the incidence of AIDS (the rate of newly diagnosed AIDS cases) is still rising, it is increasing at a slower rate. In 1995, 62,200 people were diagnosed with AIDS, a 2 percent increase over new cases in 1994. In comparison, the growth rate of new cases was 5 percent from 1993 to 1994 and was in the double digits in the late 1980s and early 1990s.
Officials at the CDC attribute the decline in AIDS deaths to several factors: the growing use of drug combinations, or “cocktails,” to fight the disease; the increased availability of AIDS health care; and effective AIDS prevention programs. AIDS experts are quick to note that the number of AIDS deaths had started dropping before the 1996 introduction of protease inhibitors, a new class of drugs that has been effective in fighting AIDS. Some believe that protease inhibitors will have a dramatic effect on lowering the AIDS death rate even further. “If protease inhibitors had been available for a full year, I think the reduction in deaths [in 1996] could have been 25 percent to 30 percent,” asserts Jerome Groopman, the director of the Mapplethorpe Laboratory for AIDS Research at Beth-Israel Deaconess Hospital in Boston.
The CDC’s report was encouraging for gay men—even though this group continues to make up the majority of AIDS cases. However, the news was not as good for women and blacks. Although the number of AIDS deaths declined 19 percent for all racial and ethnic categories, and 22 percent for men, it fell only 7 percent among women.Women now constitute 20 percent of all new AIDS cases, up from 7 percent in 1985. AIDS has become the third-leading cause of death among American women between the ages of twenty-five and forty-four; it is the leading cause of death among black women in that age group. Moreover, while the number of AIDS deaths fell 10 percent for blacks, the number of new AIDS cases among blacks rose at a higher rate than it did among whites. For the first time, blacks—who represent 12 percent of the U.S. popula- tion—made up a larger proportion of AIDS cases than whites: 41 percent versus 38 percent, compared to 24 percent black and 60 percent white in 1986. This disparity exists among children as well as adults. Of the 7,500 children below the age of thirteen who had AIDS in 1996, 58 percent were black.The CDC estimates that by the year 2000, blacks will make up more than half of all AIDS cases in the United States.
Although the incidence of new AIDS cases has dropped dramatically, health officials continue to express concern about society’s ability to care for the increasing number of people who are living with AIDS. As people live longer with the deadly disease, they will create a larger demand for affordable health care. “The decline in deaths doesn’t mean that the epidemic is going away,” asserts Patricia Fleming, an epidemiologist with the CDC. “We will have a growing population of HIV-infected people [who] will need resources. . . . And to prevent that population from growing any further, we have got to prevent new infections.” How to prevent the spread of AIDS is one of the issues examined in AIDS: Opposing Viewpoints, which contains the following chapters: How Serious Is the AIDS Epidemic? What Policies Should Be Adopted for HIV Testing? How Can the Spread of AIDS Be Prevented? How Can AIDS Be Treated? The authors in the following anthology present a wide range of opinions on the many controversies surrounding the prevention and treatment of this disease.