20 Years of AIDS: 450,000 Americans dead, over 1 million have been infected

AIDS has had a tremendous toll in the United States. Since the first case was identified in 1981, 774,467 AIDS cases have been reported*, and approximately 450,000 Americans have died.

"AIDS continues to have a tragic impact, not only on those who have died or are living with HIV infection, but also on the many friends, families, and entire communities that have been forever changed by the epidemic," said CDC Director Jeffrey P. Koplan, M.D., M.P.H.

Today an estimated 500,000 to 600,000 people in the United States are living with HIV infection, and another 320,000 people are living with AIDS. New infections, which peaked at over 150,000 in the mid-1980s, were reduced to an estimated 40,000 a year in the early 1990s. Since the beginning of the epidemic, well over one million Americans have been infected.

"At this solemn milestone, the best way to honor those lost to AIDS is to stop the spread of the disease," added Koplan. "As we remember those who have died, we must recommit ourselves to prevention on a national, community, and personal level, or we greatly risk seeing infections rise again. As a nation, we must also express our gratitude to the many who have dedicated their lives to the fight against HIV and AIDS. Many lives have been protected through public health interventions that have reduced sexual and drug-related infections, ensured the safety of the blood supply, reduced mother-to-child infections and protected healthcare workers. But, even more can and must be done."

New CDC study finds high rates of infection among young gay and bisexual men

As the agency recounted the tremendous toll AIDS has had, CDC released new data showing that 4.4 percent of young men who have sex with men (MSM), 23-29 years of age--and 14.7 percent of African-American MSM in this age group--were infected annually in a six-city study conducted between 1998 and 2000. This high rate of new infections, combined with recent increases in STDs and risk behavior among MSM, suggests that HIV incidence may be increasing in this population, adding to what has become a major crisis 20 years into the AIDS epidemic.

HIV incidence was 3.5 percent among Latino MSM, and 2.5 percent among white MSM in the study.

HIV incidence indicates the number of people newly infected with HIV each year — as opposed to prevalence — the total number of people with HIV, regardless of when they became infected. These preliminary incidence data are from the ongoing CDC Young Men's Survey and come on the heels of data released earlier this year indicating that HIV prevalence among African-American MSM in the study was 30 percent.

The results were released in a special June 1 issue of CDC's Morbidity and Mortality Weekly Report entirely dedicated to AIDS. The MMWR commemorates 20 years since a 1981 MMWR carried the first reports of the then-unknown disease. In addition to the study on MSM, the June 1 MMWR includes articles on domestic and international trends in the epidemic over 20 years and a commentary on HIV/AIDS by Helene Gayle, M.D., M.P.H., director of CDC's National Center for HIV, STD, and TB Prevention. CDC released the special issue at a press conference at the National Press Club in Washington, D.C., where it also outlined the agency' s new prevention strategy to cut HIV infections in the United States in half within five years.

Commenting on the new study results, Dr. Gayle said, "This study has documented the dramatic impact HIV is having among gay and bisexual men of all races and the urgent need to expand our prevention efforts for these men, particularly in these African-American communities." Dr. Gayle cautioned that the sample size was small and the findings may not be representative of all gay men. However, with the extremely high incidence, CDC believed the release of these data were of critical public health importance. Even the lower bound of the 95% confidence interval, 7.9%, indicates an extraordinarily high level of infection among African-American MSM in this study.

The study was conducted by CDC epidemiologist Linda Valleroy, Ph.D., and colleagues, and sampled 2,942 MSM, age 23 to 29 years, at public venues in Baltimore, Dallas, Los Angeles, Miami, New York City and Seattle. Of the 2,942 MSM, 373 were HIV-positive, of which 290 could be tested for recent infection. The study builds on an earlier CDC study on HIV prevalence and incidence among 3,492, 15- to 22-year-old MSM in seven cities, also detailed in the June 1 MMWR article. Together, the studies indicate that the rate of new infections increased substantially between adolescence and the early twenties, underscoring the need to reach each generation of at-risk MSM early.

CDC's new HIV prevention strategic plan — announced in January — is highly targeted to both HIV-positive individuals and populations at high risk for infection, including MSM of color. Responding to evidence of a possible resurgence in HIV among MSM, the agency has convened two meetings with researchers and community representatives from across the country, which resulted in a recent public health bulletin to state and local health departments and community based organizations outlining prevention priorities for MSM. Today's data follow multiple reports over the past year of increasing rates of STDs and risk behavior. CDC will convene additional meetings in the future, plans to issue detailed technical guidance to the AIDS community this summer, and will provide specific training on this issue in the fall. "We must address the urgent prevention needs of African-American and Latino gay and bisexual men, especially young men, " Dr. Gayle said. "Efforts must continue to be tailored to the specific needs of these men, expanded where needed, and embraced by the affected communities in order to be effective." Gayle added that programs for MSM of color must address the stigma of homosexuality which prevents many of these men from identifying themselves as gay and bisexual and may keep them from accessing needed prevention and treatment services.

CDC currently provides almost $400 million to state and local prevention programs targeting high-risk individuals, including MSM. To expand HIV prevention efforts for MSM of color, this year CDC is providing $12 million in direct funding to community-based organizations to develop and implement programs tailored to the needs of this population, and $3 million to national and regional organizations to provide training and technical assistance to groups serving MSM of color.

The third decade of AIDS — CDC's new HIV Prevention Strategic Plan

CDC outlined the agency's new HIV prevention strategic plan at the press conference, describing the three-part plan to cut annual HIV infections in the United States in half within five years. The strategy includes: mobilization to increase the proportion of infected individuals who know their status; new prevention programs for individuals living with HIV, combined with improved linkages to treatment and care; and highly targeted prevention programs for HIV-negative individuals at greatest risk. The plan expands CDC's existing approach to prevention by reaching the nearly 300,000 Americans who are HIV-positive but do not know it, and linking all of the 800,000 to 900,000 HIV-positive Americans to prevention and care services.

CDC's new HIV prevention strategy builds on the central role the agency has played in the nation's response to AIDS. CDC's surveillance programs have tracked the course of the AIDS epidemic since the first case reports in 1981. The agency, through public health field and laboratory research, the promotion of proven behavioral interventions, and the implementation of targeted prevention programs nationwide, has contributed to significant reductions in sexual and drug-related infections. CDC also led efforts to ensure the safety of the national blood supply, to reduce mother-to-child infections from an estimated 1,000 to 2,000 per year to 300-400 today, and to protect healthcare professionals from infection through universal precautions and post-exposure therapy. All of CDC's accomplishments have been achieved in partnership with state and local organizations.

In a special commentary, Dr. Gayle reviews CDC's contributions throughout 20 years of AIDS and provides perspective on both the U.S. and global epidemics. She offers encouragement that progress against AIDS can be made, while emphasizing the major commitment that is required.

"When AIDS was first identified in 1981, the nation could not have foreseen the enormous toll the disease would have in the coming 20 years," she said at the press conference. "With the subsequent benefit of research, knowledge and experience, we as a nation are now obligated to confront this epidemic more boldly. We owe it to the people reflecting on the epidemic 20 years from now — whose lives will be greatly affected by decisions made today —to invest ourselves in the one known cure for AIDS: not becoming infected in the first place."