America Living With AIDS

CHAPTER ONE
INTRODUCTION
ince scientists first began to understand the dynamics that govern transmission of the human immunodeficiency virus
(HIV), it has been possible to predict with chilling accuracy the toll the epidemic
would exact in sickness and in lives lost. As the nation enters the second decade of
the HIV epidemic, the accuracy of predictions made in the mid-1980s stand as a
silent rebuke. One need take only a brief look at these statistics to understand the
impact that AIDS has had in the United States.
By the end of 1990, more than 100,000 people in the United States had died of
AIDS, and nearly a third of those deaths occurred that year. Now more than a hundred people die in the United States every day of AIDS-one every 15 minutes-and
the pace is accelerating. As of June 1991, 182,834 cases of AIDS in the United States
and its commonwealths and territories had been reported to the federal Centers for
Disease Control (CDC). Between March 1990 and March 1991, the reported number
of new cases in the United States rose by more than one third. These numbers are a
telling indication that our efforts at prevention must be redoubled.
During the earliest years of the epidemic, from 1981 to 1982, nearly 80 percent of
all reported AIDS cases were from six large metropolitan areas in five states-New
York City, San Francisco, Los Angeles, Miami, Newark, and Houston. So far in 1991,
31 metropolitan areas and 25 states and the Commonwealth of Puerto Rico have
reported one thousand or more cumulative AIDS cases-and the number of communities, counties, and states affected by HIV disease continues to expand.
While the majority of new AIDS cases have been from metropolitan areas, there
has been a significant increase in new cases in municipalities with populations less
than 500,000. Lack of access to adequate health care has denied the benefits of
advances in treatment to many in these smaller cities and rural communities, despite
the dedication of stalwart health care providers and volunteers. More ominous still,
failure to acknowledge the dimensions of the crisis has resulted in insufficient attention to AIDS education and prevention programs.
HIV disease has had a disproportionate impact on some communities. The HIV
epidemic continues to affect gay and bisexual men more than any other single group

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