AIDS/HIV

161 Pages·2005·3.698 MB·English

by  Barbara Wexler

AIDS/HIV
1
ISSN1532-2718
AIDS/HIV
Barbara Wexler
INFORMATION PLUS(cid:2) REFERENCE SERIES
Formerly Published by Information Plus, Wylie, Texas
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AIDS/HIV ª2008Gale,CengageLearning
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TABLE OF CONTENTS
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii CHAPTER 6
HIV/AIDS Costs and Treatment . . . . . . . . . . . . . . 73
CHAPTER 1
Thecostsoftreatmentandresearchareinvestigatedinthischap-
The Nature of HIV/AIDS. . . . . . . . . . . . . . . . . . . .1
ter.SpecialemphasisisgiventoFoodandDrugAdministration–
This chapter investigates the natureof HIV/AIDS, including an
approved drugs, an HIV-resistant gene, new research, and the
in-depthlookattheHIVvirus,itsorigins,andhowitattacksthe
searchfora vaccine.ThischaptertracksHIV/AIDS health-care
immunesystem.DiseasesassociatedwithHIVinfection,suchas
financing, covering issues such as state programs to provide
tuberculosisandcancer,arealsocovered.
drugs; costs to the insurance industry; and challenges to the
delivery systems of hospitals, physicians’ offices, and direct-care
CHAPTER 2 staff. It also discusses issues pertaining to health-care workers
Definition, Symptoms, and Transmittal . . . . . . . . . . 15 andHIV/AIDS.
The first section of this chapter defines AIDS and examines the
Centers for Disease Control and Prevention’s classification and
CHAPTER 7
expandedcasesurveillance.Asecondsectiondetailsthediagnosis
People with HIV/AIDS. . . . . . . . . . . . . . . . . . . . . 91
and symptoms of AIDS, transmission, and the safety of blood
transfusions and transplant procedures. Information about test- Now more thanever, Americans are likely toknow ofsomeone
ingforHIVandtrackingtheprogressofHIVtofull-blownAIDS with HIV/AIDS. This chapter focuses on celebrities and older
isalsoincluded. peoplewithAIDS.Problemsandissuessuchashousing,depres-
sion,andsuicidearealsoconsidered.
CHAPTER 3
Patterns and Trends in HIV/AIDS Surveillance. . . . . 27 CHAPTER 8
AIDS is infecting an increasingly diverse population. Once Testing, Prevention, and Education. . . . . . . . . . . . . 99
thought to affect only homosexual males and intravenous drug FewthingsaboutHIV/AIDSinspireasmuchcontroversyasHIV
users,theincidenceofAIDSisincreasinginheterosexualgroups. testing. This chapter discusses such issues as mandatory versus
This chapter explores AIDS case numbers, including regional voluntary testing and partner notification. Other areas covered
differencesandthecontinuingincreaseinthenumberofwomen includeeducatingyouth,condomuse,andimprovingprevention
withAIDS.ThischapteralsodiscussesHIVtransmissionandlife programs. Intravenous drug users and syringe exchange pro-
expectancyofpeopleinfectedwithHIV/AIDS. gramsaregivenspecialattention.
CHAPTER 4
CHAPTER 9
Populations at Risk . . . . . . . . . . . . . . . . . . . . . . . 47
HIV and AIDS Worldwide . . . . . . . . . . . . . . . . . 115
This chapter focuses on the rates of HIV/AIDS in various pop-
HIV/AIDS is a global problem. This chapter investigates the
ulations, including heterosexuals, intravenous drug users, and
scopeoftheHIV/AIDSpandemic,coveringareassuchasglobal
women.Specialcoverageisgiventohemophiliacsandprisoners.
trends and projections, the effect of AIDS on birth and death
rates, and patterns of infection. The status of HIV/AIDS in
CHAPTER 5 Africa, Europe, Asia, Latin America, the Caribbean, and the
Children, Adolescents, and HIV/AIDS. . . . . . . . . . . 63 MiddleEastisalsodiscussed.
HIV/AIDS in children is different from HIV/AIDS in adults.
This chapter explains how by presenting a case definition, dis-
CHAPTER 10
cussing the number of children infected, and describing the
Knowledge, Awareness, Behavior, and Opinion. . . . 129
routes by which children acquire HIV/AIDS. The balance of
thechapterexploresadolescentsandAIDS,detailingsuchissues Surveys and polls discussed in this chapter display how Ameri-
as transmission by sexually active teens and young people as cans feel about HIV/AIDS. Topics covered include concerns
AIDSactivists. about HIV/AIDS, knowledge and tolerance, teen attitudes, and
AIDS/HIV v
persistence of misinformation about HIV/AIDS. Efforts to IMPORTANT NAMES AND ADDRESSES. . . . . . 137
heighten public awareness such as the AIDS Memorial Quilt,
RESOURCES. . . . . . . . . . . . . . . . . . . . . . . . . . 139
AIDS activist organizations, and celebrity activists also are
described. INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
vi TableofContents AIDS/HIV
PREFACE
AIDS/HIV is part of the Information Plus Reference tions and important ideas that shape how the book’s
Series. The purpose of each volume of the series is to subject is discussed in the United States. These positions
present the latest facts on a topic of pressing concern in are explained in detail and, where possible, in the words
modernAmericanlife.These topicsincludetoday’smost of their proponents. Some of the other material to be
controversial and most studied social issues: abortion, found in these books includes: historical background;
capital punishment, care for the elderly, crime, the envi- descriptions of major events related to the subject; rele-
ronment, health care, immigration, minorities, national vant laws and court cases; and examples of how these
security, social welfare, women, youth, and many more. issuesplayoutinAmericanlife.Somebooksalsofeature
Althoughwrittenespeciallyforthehighschoolandunder- primary documents or have pro and con debate sections
graduate student, this series is an excellent resource for giving the words and opinions of prominent Americans
anyonein needoffactual informationon currentaffairs. on both sides of a controversial topic. All material is
presented in an even-handed and unbiased manner; the
By presenting the facts, it is the intention of Gale, a
readerwillnever beencouragedtoacceptoneviewofan
part of Cengage Learning, to provide its readers with
issue over another.
everything they need to reach an informed opinion on
current issues. To that end, there is a particular emphasis
in this series on the presentation of scientific studies, HOW TO USE THIS BOOK
surveys,andstatistics.Thesedataaregenerallypresented ThespreadofAIDShasbecomeaglobalepidemic.As
in the form of tables, charts, and other graphics placed of2007,anestimated33.2millionpeopleworldwidewere
within the text of each book. Every graphic is directly living with HIV, according to the Joint United Nations
referredtoandcarefullyexplainedinthetext.Thesource ProgramonAIDS/HIV(UNAIDS).Approximately2.1mil-
ofeachgraphicispresentedwithinthegraphicitself.The lion people died of AIDS that year. This book provides
data used in these graphics are drawn from the most a snapshot of AIDS/HIV. Included is information on the
reputable and reliable sources, in particular from the natureofAIDS/HIVandtheAIDSepidemic;symptomsand
various branches of the U.S. government and from major transmittal; patterns and trends in AIDS/HIV surveillance;
independent polling organizations. Every effort has been populations at risk; children, adolescents, and AIDS/HIV;
made to secure the most recent information available. AIDS/HIV cost and treatment; people living with AIDS/
The reader should bear in mind that many major studies HIV; testing, prevention, and education; HIV and AIDS
takeyearstoconduct,andthatadditionalyearsoftenpass worldwide;andknowledge,awareness,behavior,andopin-
before the data from these studies are made available to ionofthoseaffectedbyAIDS/HIV.
the public. Therefore, in many cases the most recent
AIDS/HIV consists of ten chapters and three appen-
information available in 2008 dated from 2005 or 2006.
dixes. Each of the chapters is devoted to a particular
Older statistics are sometimes presented as well if they
aspect of AIDS/HIV. For a summary of the information
are of particular interest and no more-recent information
coveredineachchapter,pleaseseethesynopsesprovided
exists.
intheTableofContentsatthefrontofthebook.Chapters
Although statistics are a major focus of the Informa- generally begin with an overview of the basic facts and
tion Plus Reference Series, they are by no means its only background information on the chapter’s topic, then pro-
content. Each book also presents the widely held posi- ceed to examine subtopics of particular interest. For
AIDS/HIV vii
example, Chapter 2: Definition, Symptoms, and Transmit- NamesandAddressesdirectory.Herethereaderwillfind
talbeginswithdefinitionsofAIDSandHIV,andanexplan- contact information for a number of government and
ation of the 1993 classification revision and expanded privateorganizationsthatcanprovidefurtherinformation
surveillance case definition. The chapter then goes on to on AIDS/HIV. The second appendix is the Resources
provide information about the diagnosis and symptoms of section, which can also assist the reader in conducting
thedisease,itstransmission,safetyofbloodandtransplant his or her own research. In this section, the author and
procedures, and testing for HIV (including diagnostic, editors of AIDS/HIV describe some of the sources that
urine,andhometests).Readerscanfindtheirwaythrough were most useful during the compilation of this book.
a chapter by looking for the section and subsection head- ThefinalappendixisthedetailedIndex,whichfacilitates
ings,whichareclearlysetofffromthetext.Theycanalso reader access to specific topics in this book.
refer to the book’s extensive Index if they already know
whattheyarelookingfor. ADVISORY BOARD CONTRIBUTIONS
The staff of Information Plus would like to extend
Statistical Information
their heartfelt appreciation to the Information Plus Advi-
The tables and figures featured throughout AIDS/HIV
sory Board. This dedicated group of media professionals
willbeofparticularusetothereaderinlearningaboutthis
provides feedback on the series on an ongoing basis.
issue. These tables and figures represent an extensive col-
Their comments allow the editorial staff who work on
lectionofthemostrecentandimportantstatisticsonAIDS/
the project to make the series better and more user-
HIV,andrelatedissues—forexample,graphicsinthebook
friendly.Ourtoppriorityistoproducethehighest-quality
coverclinicalcategoriesofAIDSinfection;adultandado-
and most useful books possible, and the Advisory
lescent HIV infection and AIDS cases; pediatric AIDS
Board’s contributions to this process are invaluable.
cases; office visits, by diagnostic and screening services
orderedorprovided;syringeexchangestatistics;stateswith ThemembersoftheInformationPlusAdvisoryBoard
confidential HIV reporting; and teens’ concerns about are:
becoming infected with AIDS/HIV. Gale believes that
(cid:129) Kathleen R. Bonn, Librarian, Newbury Park High
making this information available to the reader is the
School, Newbury Park, California
most important way in which we fulfill the goal of this
book: to help readers to understand the issues and con- (cid:129) Madelyn Garner, Librarian, San Jacinto College–
troversies surrounding AIDS/HIV in the United States North Campus, Houston, Texas
and to reach their own conclusions. (cid:129) Anne Oxenrider, Media Specialist, Dundee High
Eachtableorfigurehasauniqueidentifierappearing School, Dundee, Michigan
above it, for ease of identification and reference. Titles
(cid:129) Charles R. Rodgers, Director of Libraries, Pasco-
for the tables and figures explain their purpose. At the
Hernando Community College, Dade City, Florida
endofeachtableorfigure,theoriginalsourceofthedata
(cid:129) James N. Zitzelsberger, Library Media Department
is provided.
Chairman, Oshkosh West High School, Oshkosh,
In order to help readers understand these often com-
Wisconsin
plicated statistics, all tables and figures are explained in
the text. References in the text direct the reader to the
COMMENTS AND SUGGESTIONS
relevant statistics. Furthermore, the contents of all tables
The editors of the Information Plus Reference Series
and figures are fully indexed. Please see the opening
welcome your feedback on AIDS/HIV. Please direct all
section of the Index at the back of this volume for a
correspondence to:
description of how to find tables and figures within it.
Editors
Appendixes Information Plus Reference Series
In addition to the main body text and images, AIDS/ 27500 Drake Rd.
HIV has three appendixes. The first is the Important Farmington Hills, MI 48331-3535
viii Preface AIDS/HIV
CHAPTER 1
THE NATURE OF HIV/AIDS
The acquired immunodeficiency syndrome (AIDS) is effective drug treatments such as protease inhibitors. In
the late stage of an infection that is caused by the human 1997 HIV infection was the fourteenth-leading cause of
immunodeficiency virus (HIV). HIV is a retrovirus that deathoverallintheUnitedStates.By1999HIVinfection
attacksanddestroyscertainwhitebloodcells.Thetargeted no longer ranked among the fifteen leading causes of
destructionweakensthebody’simmunesystemandmakes death in the United States. Figure 1.1 shows the sharp
the infected person susceptible to infections and diseases decline in deaths from HIV disease since the mid-1990s
thatordinarilywouldnotbelifethreatening.AIDSiscon- and the subsequent stabilization in the number of deaths
sideredabloodborne,sexuallytransmitteddiseasebecause attributable to HIV/AIDS from 1999–2000 to 2004.
HIV is spread through contact with blood, semen, or vag-
Whenexaminedatagenerallevel,theoveralldecline
inalfluidsfromaninfectedperson.
in HIV/AIDS deaths between 1995 and 2000 was a
Before 1981 AIDS was virtually unknown in the positive trend for people infected with HIV and those
United States. In that year, testing of blood and other suffering from AIDS. Nonetheless, the reality was that
samples for HIV began, and reporting of the disease the actual number of people living with HIV/AIDS
becamemandatory.Awarenessgrewastheannualnumber increased during this time span. In other words, even
ofdiagnosedcasesanddeathssteadilyincreased.In‘‘First though not as many people were dying from HIV/AIDS,
500,000 AIDS Cases—United States, 1995’’ (Morbidity more people were living with the disease due to the
and Mortality Weekly Report, vol. 44, no. 46, November success of new therapies. These people require ongoing
24, 1995), the Centers for Disease Control and Prevention treatment and care.
(CDC)statedthatthenumberofU.S.AIDScasesreported
The observed decline in HIV/AIDS deaths is no
since 1981 reachedthe half-millionmarkin 1995. Indeed,
reassurance to the estimated forty thousand people who
in 1995 HIV infection was the leading cause of death
acquire an HIV infection each year in the United States.
amongAmericansagedtwenty-fivetoforty-four.
Furthermore, Michael Glynn and Philippa Rhodes indi-
cate in ‘‘Estimated HIV Prevalence in the United States
By1998,however,HIV/AIDSdeathsamongthisage
at the End of 2003’’ (National HIV Prevention Confer-
group hadfallen dramatically, andHIV infectionwas the
ence, June 2005) that about one-quarter of the 1,039,000
fifth most common cause of death among people in the
to 1,185,000 people living with HIV in the United States
United States between twenty-five and forty-four years
are unaware of their infection.
old. HIV/AIDS deaths fell to sixth place in the 2001
summary. This rank was the same in 2004, the most Despite the overall decline in the death rate, in 1997
recent year for which data were available, with the dis- HIV remained a leading cause of death for African-
ease claiming a reported 6,312 lives. (See Table 1.1.) Americans aged twenty-five to forty-four. By 1999 this
death rate was nearly eleven times higher than for white
Bycontrast,HIVasacauseofdeathincreasedinthose
Americans, according to the CDC. African-Americans
agedfifteentotwenty-fourbetween2000(178deaths)and
accounted for 9,085 (or 54%) of AIDS deaths in 2001
2004 (191 deaths).(See Table 1.1.) HIV infectionwasthe
and 8,562 (or 53%) in 2005; these deaths are dispropor-
ninth-leadingcauseofdeathinthisagegroupin2004.
tionately high because African-Americans accounted for
Overall, HIVmortality(death) ratesbegan todecline about 13% of the U.S. population in both years. (See
in 1996, even before the widespread use of new and Table 1.2.)
AIDS/HIV 1
TABLE1.1
Deaths and death rates for the 10 leading causes of death in specified age groups, preliminary 2004
[Data are based on a continuous file of records received from the states. Rates are per 100,000 population in specified group. Figures are based on weighted data rounded to the nearest
individual, so categories may not add to totals or subtotals.]
Ranka Cause of death and age Number Rate
All agesb
— All causes 2,398,365 816.7
1 Diseases of heart 654,092 222.7
2 Malignant neoplasms 550,270 187.4
3 Cerebrovascular diseases 150,147 51.1
4 Chronic lower respiratory diseases 123,884 42.2
5 Accidents (unintentional injuries) 108,694 37.0
— Motor vehicle accidents 43,947 15.0
— All other accidents 64,747 22.0
6 Diabetes mellitus 72,815 24.8
7 Alzheimer’s disease 65,829 22.4
8 Influenza and pneumonia 61,472 20.9
9 Nephritis, nephrotic syndrome and nephrosis 42,762 14.6
10 Septicemia 33,464 11.4
— All other causes 534,936 182.2
1–4 years
— All causes 4,775 29.9
1 Accidents (unintentional injuries) 1,606 10.0
— Motor vehicle accidents 630 3.9
— All other accidents 976 6.1
2 Congenital malformations deformations and chromosomal abnormalities 580 3.6
3 Malignant neoplasms 388 2.4
4 Assault (homicide) 354 2.2
5 Diseases of heart 191 1.2
6 Influenza and pneumonia 132 0.8
7 Septicemia 76 0.5
8 Certain conditions originating in the perinatal period 58 0.4
9 In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior 53 0.3
10 Chronic lower respiratory diseases 43 0.3
— All other causes 1,294 8.1
5–14 years
— All causes 6,755 16.6
1 Accidents (unintentional injuries) 2,578 6.3
— Motor vehicle accidents 1,592 3.9
— All other accidents 986 2.4
2 Malignant neoplasms 1,028 2.5
3 Congenital malformation deformations and chromosomal abnormalities 385 0.9
4 Assault (homicide) 318 0.8
5 Intentional self-harm (suicide) 292 0.7
6 Diseases of heart 233 0.6
7 Chronic lower respiratory diseases 113 0.3
8 In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior 91 0.2
9 Influenza and pneumonia 84 0.2
10 Cerebrovascular diseases 77 0.2
— All other causes 1,556 3.8
15–24 years
— All causes 32,904 78.9
1 Accidents (unintentional injuries) 15,163 36.4
— Motor vehicle accidents 10,874 26.1
— All other accidents 4,289 10.3
2 Assault (homicide) 4,877 11.7
3 Intentional self-harm (suicide) 4,214 10.1
4 Malignant neoplasms 1,680 4.0
5 Diseases of heart 978 2.3
6 Congenital malformations, deformations and chromosomal abnormalities 482 1.2
7 Cerebrovascular diseases 207 0.5
8 Influenza and pneumonia 193 0.5
9 Human immunodeficiency virus (HIV) disease 191 0.5
10 Chronic lower respiratory diseases 168 0.4
— All other causes 4,751 11.4
The dramatic 42% decline in AIDS deaths between 1999.Thismaybeduetoacombinationofseveralfactors:
1996 and 1997 was the result of the introduction and use resistance to the drug treatments developed in some
ofeffectiveantiretroviraldrugsthatslowtheprogressionof patients, the complicated drug treatment regimens that are
HIV infection. This decline continued but slowed to 20% difficult for patients to maintain, and a possible lack of
between 1997 and 1998, and to 8% between 1998 and accessto prompt testing or treatment.The CDCreports in
2 TheNatureofHIV/AIDS AIDS/HIV