Since the first reported case of AIDS in 1981, 1.5 million people in the United States have become infected with HIV, including more than 500,000 who have died (UNAIDS, 2005b). Worldwide, there are between 36.7 million and 45.3 million people living with HIV (see Table 15.2). One-third of these HIV-infected people throughout the world are under the age of 25 (S. Sternberg, 2002). Since it was first recognized in 1981, over 25 million people have died from HIV/AIDS complications worldwide (UNAIDS, 2005c).
As mentioned earlier in this chapter, all 50 U. S. states require that HIV and AIDS cases be reported to local or state health departments. These statistics help to track the spread of the illness. Some were fearful that mandatory HIV reporting would deter men and women from being tested. Yet, with more HIV-infected people living longer without progressing to AIDS, it may be important to begin documenting these cases. Some states have begun using codes to keep HIV-positive people anonymous and confidential; but doing this does not ensure that every person is counted only once.
The transmission of HIV has also shifted over time. The proportion of newly diagnosed heterosexual AIDS cases rose from 3% in 1985 to 31% in 2003 (Kaiser Family Foundation, 2005b). Individuals don’t always know whether their partner is putting them at risk for HIV, and this is especially the case for women (Hader et al., 2001). Women are the fastest-growing group with AIDS in the United States (UNAIDS, 2005c). It is estimated that half of the people now infected with HIV worldwide are women (UNAIDS, 2005c). As we have discussed, the vaginal tissue is thinner than penile tissue and easily traumatized during sexual intercourse, making infection more likely if the penetrative partner has the infection.
The increase in infections in women is also due to the continued spread of AIDS in women in sub-Saharan Africa. Overall, women have been found to be 17 times more likely to be infected by their partners than they are to give the infection (Padian et al., 1991); yet, it is men who drive the spread of the virus (Schoofs & Zimmerman, 2002). Generally this is due to the fact that men have more sexual partners than women, and they also have more control over whether or not a condom is used (see Figure 15.11 for more information about the percentage of women living with HIV/AIDS globally).
An infected mother can also transmit HIV to her fetus. It is estimated that approximately 750,000 children have become infected with HIV worldwide, and most of these are through mother-to-child transmission (Newell, 2005). Although infection may be possible through breast-feeding, it is more likely that transmission takes place during pregnancy
through the placenta or through the birth canal during delivery (Newell, 2005). Fortunately, due to improvements in obstetric care, rates of maternal — infant transmission have decreased. Today HIV tests are routinely offered to pregnant women; and if a test is positive, medications can be used to reduce viral load, and a planned cesarean section can be done to reduce the risk of transmission to the infant during delivery.
Teens are also affected by HIV and AIDS. At least half of all new HIV infections are among those under the age of 25 (Centers for Disease Control and Prevention, 2004b; Kaiser Family Foundation, 2005b). An HIV diagnosis in children is not always a death sentence, however;
Global
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Sub-Saharan Africa Caribbean North Africa/Middle East Latin America Eastern Europe/Central Asia South/Southeast Asia North America Western Europe East Asia Oceania
there are children who were born with HIV who have survived and are living through adulthood.
AIDS is most dramatically affecting African Americans and continues to disproportionately affect minority communities. In the United States, 71% of the new AIDS cases are diagnosed among racial and ethnic minorities (Kaiser Family Foundation, 2005a). African Americans have the highest rates of AIDS, followed by Latinos, American Indian/Alaskan Natives, Caucasians, and Asian/Pacific Islanders (UNAIDS, 2005b). There are a variety of reasons for these racial differences, including late identification of HIV infection in African Americans, less access to healthcare and HIV therapy, and a lack of health insurance (Maldonado, 1999).
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