Epidemiology of Acquired Immunodeficiency Syndrome in the United States - Essay Example

Running Head: EPIDIEMOLOGY OF HIV/AIDS IN THE UNITED S Epidiemology of HIV/AIDS in the United s with an Emphasis on Demographic Analysis [Name of Writer] [Name of Institution] Introduction The first case in the United States of obtained immunodeficiency syndrome (AIDS) was reported in 1981. After two decades there were well over half a million cumulative reported AIDS cases nationwide, with 40,000 additional people likely to contract HIV or AIDS in 1996 alone. Researchers and policy-makers have illustrated the overwhelming potential of this epidemic across multiple magnitudes. AIDS has potentially far-reaching influences on the productivity of American nation. According to one analysis, HIV has become the leading cause of death for young adults in many cities across the United States. Public spending on AIDS had reached tens of billions of dollars by early 1990s, with these costs including medical care, research, education, and blood screening. Now there had been approximately 150,000 reported cases of AIDS, and estimates of between 800,000 and 1.2 million individuals diagnosed with HIV. Spatial-analytic analyses of the diffusion and distribution of AIDS in the United States have indicated that AIDS during the early 1980s was concentrated in major metropolitan areas in California, New York/ New Jersey/ Connecticut/ Rhode Island, and Florida, and has since spread outward from these core areas. Large cities in the United States have become central in the developing characterization of AIDS. Reported AIDS cases in the metropolitan areas of New York City, Los Angeles, San Francisco, Miami, and Washington, DC, account for nearly one-third of all cases nationally (Appendix A). Defining AIDS and its Transmission From tracking and analyzing epidemiological information over time, researchers and policy-makers have concluded that AIDS can only be transmitted through sexual contact, exposure to infected blood or infected tissue such as through needle sharing, infected blood products, or transplantation, or parentally. Following these conclusions, policy-makers and service providers have attempted to dispel widely held myths concerning the potential for AIDS transmission via casual and non-sexual contact and insect bites. Epidemiological data have continued largely to characterize AIDS as critical for men who have sex with men and injecting drug users; over eight in ten of the cumulative reported AIDS cases nationwide have occurred between these two groups (Appendix A). With the rise in the numbers of individuals diagnosed HIV positive or living with AIDS, the nation has also witnessed an increasing diversity in the epidemiology of AIDS. The Centers for Disease Control and Prevention's (CDC) tracking of reported AIDS cases has indicated that, while the epidemiology of AIDS remains largely defined through the two behavioral categories of male homosexual/bisexual contact and intravenous/injecting substance use, there has also been an increasing incidence of AIDS among newly emerging at risk groups, particularly women and individuals of color. For women, intravenous/injecting drug use and heterosexual transmission have constituted the primary modes of transmission, while children have contracted AIDS primarily through prenatal exposure. Studies of reported cases to the CDC have also indicated that African Americans and Hispanics are disproportionately at risk of contracting AIDS, considering their representation in the United States population and compared to the White non-Hispanic population. Race in particular has become a potent factor in the contemporary and changing portrait of AIDS. The emphasis on race as a significant indicator of AIDS transmission and as a descriptor of AIDS epidemiology reflects the ongoing radicalization of the condition. But while there has been a growing emphasis on the connections between race and AIDS incidence, the risk of AIDS has not remained confined to any particular group. Populations, for example, once thought to be at little risk of contracting AIDS are now showing increasing risk of HIV infection. The definition of AIDS has been managed primarily through the Centers for Disease Control and Prevention (CDC). This has meant that government funding and programmes for AIDS treatment and prevention have been available only to those fitting the definitions constructed by the Centers for Disease Control and Prevention. This has had particular manifestations in the epidemiological portrait of AIDS, particularly as it relates to women. (National Center for HIV, STD, and TB Prevention, 2005) Since the early data on AIDS in the 1980s indicated that AIDS affected men almost exclusively, there was limited acknowledgement of the gynecological conditions associated with AIDS in women, and hence women living with AIDS were likely not to be recognized as such. Homelessness and AIDS Although researchers, policy-makers, human service providers, and the public continue to view and respond to homelessness and AIDS as distinct issues, there is growing evidence that the two crises have become increasingly interconnected. Homelessness often has associated with it highly risky behaviors when considering the transmission of AIDS. Research has indicated for example that between 13 per cent and 52 per cent of homeless individuals is users of street drugs, and sexual assault and sexually transmitted diseases are widespread. (HIV Insite, 2005) Homeless individuals living with HIWAIDS also tend to be at greater risk of tuberculosis and other diseases than domiciled individuals living with HIV/ AIDS. There are also interactions among race, homelessness, and AIDS. It is found that homeless individuals living with AIDS are more likely to be African American or Latino than homed individuals living with AIDS. In addition to the marginalization associated with homelessness, diagnosis as 'HIV positive' and its consequent stigmatization further complicates access to the housing and labour markets. As such, HIV diagnosis is a contributing factor to incipient homelessness. The individuals living with AIDS have in the past been evicted, family members have at times been unwilling or unable to care for a person living with AIDS and income earning has been made problematic because of unemployment. Even with such increasing evidence of the links between homelessness and AIDS the public, service providers, researchers, and policy-makers continue to address them as relatively distinct. Dealing with AIDS In response to the drastic rise in the number of people living with HIV/ AIDS, the United States Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1990, providing funding for outpatient and ambulatory medical and support services for individuals living with AIDS. This Act, whose funds are administered by the Health Resources and Services Administration (HRSA), was divided into four titles to reflect the diffusion and distribution of individuals living with HIV/ AIDS and to provide assistance for development and provision of health and support services. Title I of the CARE Act (commonly referred to as Ryan White Title I funds) bases funding for eligible metropolitan areas (EMAs) on reported AIDS cases. Title II supports state-level efforts at improving quality and access of health care and support services. Title III funds early intervention services provided by community health centers and non-profit organizations. Title IV provides funding support for comprehensive service programmes for children, adolescents, and families. (AIDS in America, 2005) Funds were first allocated in fiscal year 1991, when $86 million was allocated to EMAs reporting more than 2500 cumulative cases to the CDC. Funding through Ryan White CARE allocations is tied to local level planning processes, requiring that voting members of local planning councils include individuals living with AIDS, health care providers, community-based organizations, public health agencies, non-elected community leaders, and state government officials. (AIDS in America, 2005) But federal legislation has also had to deal with the complexities inherent in the political and medical nature of AIDS. Federal level policy-makers, for example, have not generally supported needle-exchange programmes as a method of controlling the spread of HIV among intravenous drug users even though case studies have indicated that such programmes lead to both a reduction in HIV transmission risks and the participation of drug users in treatment programmes. Policy-makers perceive such programmes as coming into direct conflict with the 'war on drugs'. The changing epidemiology of AIDS in the United States indicates that HIV/ AIDS has become critical for greater numbers and differing groups across the nation. Appendices Appendix A United States Cumulative Reported Aids Cases By Geographic Concentration Cumulative Cases 513,486 Total deaths 319,849 Characteristics (Adult Cases Only) Number Of Cases % of Cases Five highest geographic concentrations by state New York 94,751 18 California 88,933 17 Florida 51,838 10 Texas 35,144 7 New Jersey 29,327 6 Five highest geographic concentrations by metropolitan area New York City 81,604 16 Los Angeles 31,085 6 San Francisco 22,835 4 Miami 16,372 3 Washington, DC 14,640 2 Cumulative Cases 513,486 Total Deaths 319,849 Characteristics (Adult Cases Only) Number Of Cases % of Cases Gender Male 434,719 86 Female 71,818 14 Race/Ethnicity White 243,107 47 African American 174,715 34 Hispanic 90,031 18 Asian/Pacific Islander 3,555 1 Native American/Alaskan 1,333 0 Unknown or none reported 745 0 Exposure Male homosexual/bisexual contact 259,672 51 Injection drug use (IDU) 128,696 25 Male homosexual/bisexual contact and IDU 33,195 6 High risk heterosexual contact 40,037 8 Receipt of blood transfusion 7,433 2 Haemophilia/coagulation disorder 4,107 1 Unknown or none reported 33,397 7 (National Center for HIV, STD, and TB Prevention, 2005 and HIV Insite, 2005) Bibliography AIDS in America, (Updated 1 November, 2005), retrieved on 20 November 2005 from http://www.avert.org/aids-america.htm Avert.Org, (Last updated November 21, 2005), United States HIV and AIDS Statistics by state retrieved on 21 November 2005 from http://www.avert.org/usastats.htm HIV Insite, (Updated November 2005), United States, retrieved on 20 November 2005 from http://hivinsite.ucsf.edu/globalpage=cr07-us-00 National Center for HIV, STD, and TB Prevention, (Last Revised: June 20, 2005), Divisions of AIDS Prevention, http://www.cdc.gov/hiv/stats.htm#aidscases Read More