How Has the HIV/AIDS Epidemic Changed Over the Past 30 Years?

CDC data reveal notable shifts in the HIV epidemic in the United States, with a higher proportion of new infections today occurring among young men who have sex with men (MSM), racial/ethnic minorities, and women. Early in the HIV/AIDS epidemic, infections emerged mainly among White, urban MSM, or male injection drug users (IDUs). However, over the past 30 years, the boundaries between groups at greater and lesser risk for contracting the virus have been dissolving. From 2005 to 2008, estimated HIV diagnoses increased approximately 17 percent among MSM, particularly minority MSM. Risky sexual behavior linked to substance abuse exacerbates this trend, a specific example being the link between risky sexual behavior and methamphetamine abuse.⁹

Although HAART has transformed the face of HIV/AIDS in this country and around the world, it has also altered the consequences of HIV infection. While new diagnoses of HIV-associated infections and some neurological complications, such as HIV dementia, have decreased since the treatment’s introduction,¹ other medical complications have increased. For example, individuals receiving HAART therapy are more vulnerable to developing diabetes, hypertension, and chronic kidney disease.¹⁰ HIV+ patients also have lower bone mineral density,¹¹ which HAART can amplify by contributing to bone loss, resulting in fractures. Some individual medications that are included in HAART can be toxic to the liver, especially in older individuals, for whom liver function may already be declining due to the natural aging process; this can lead to liver disease.¹²

Another unintended consequence of effective HAART therapy is the development of complacency. Because HAART reduces viral load, some patients mistakenly believe that they do not need to adhere strictly to the treatment regimen or that reduced viral load means elimination of transmission risk.^13-15 This belief can, in turn, lead to a resumption of unsafe sex and drug abuse practices.¹⁶ These and other unhealthy behaviors, such as smoking cigarettes, diminish the benefit achieved with HAART therapy. For example, cigarette smoking among HIV+ individuals is 2–3 times higher than in the general population. HIV-infected smokers are unusually susceptible to respiratory complications, chronic obstructive pulmonary disease, lung cancer, cardiovascular disease, and suppressed immune function.¹⁷