Chapter 28 AIDS epidemiology in the United States

AIDS is an infectious disease with an unusually long and variable latency period between infection with HIV-1 and the development of an AIDS-defining condition. Most AIDS diagnoses represent the end stage of protracted infection with HIV-1. If one pictures the total number of people with HIV-1 infection as an iceberg, then the number of reported AIDS cases represents only the tip of the iceberg. Currently, in the United States, an estimated 1 in 100 men and 1 in 800 women are HIV-1 infected. Overall, 1 in 250 persons is estimated to be HIV-1 infected. In total, there are approximately 1 million persons with HIV-1 infection in the United States; of those, an estimated 110,000 are women. It is also estimated that approximately 40,000 new infections and a similar number of deaths from HIV-1 infection and AIDS occur annually in the United States (CDC, 1990). Thus, we can expect that AIDS will continue to be a major health problem well into the 21st century. The challenge that faces us today is twofold. First, we must further the progress made in helping HIV-infected persons to live longer with an improved quality of life. This will come through increasing our understanding of the pathogenesis of HIV-1 disease, developing new effective approaches to delay or halt disease progression, and ensuring access to quality health care and social services for all HIV-infected persons. Second, we must develop effective strategies to prevent new HIV-1 infections. This will require a multidisciplinary effort to develop and implement programs including behavioral interventions, female-controlled barrier methods, needle exchange programs and new microbicides and vaccines.