View source for HIV/AIDS in the United States

{{Short description|HIV/AIDS epidemic in the United States}}
{{Use mdy dates|date=May 2022}}
{{Multiple image
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| title = [[Centers for Disease Control and Prevention|CDC]] Infographics
| image1 = Hiv-us-map-2017.png
| caption1 = Rates of HIV/AIDS diagnoses in the [[United States]], 2017
| image2 = New-HIV-Infections-by-Race-and-Transmission-Group.png
| caption2 = New HIV infections by [[Race and ethnicity in the United States|race]] and [[Pathogen transmission|transmission]] group in the U.S., 2010–2016
| image3 = Cdc-hiv-us-at-a-glance.png
| caption3 = HIV diagnosis trends in [[Territories of the United States|the U.S. and dependent areas]], 2012–2016
|image4 = HIV cases by transmission category CDC 2007.svg
| caption4 = Estimated number of HIV/AIDS cases in the U.S. in 2007, by [[Pathogen transmission|transmission]] category<ref name="CDCBasicStats">{{Cite web |date=December 18, 2017 |title=HIV/AIDS Basic Statistics |url=https://www.cdc.gov/hiv/basics/statistics.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Fstatistics%2Fbasics.html |access-date=April 26, 2018 |publisher=[[Centers for Disease Control and Prevention]] |location=[[Atlanta, Georgia]] |archive-date=March 16, 2020 |archive-url=https://web.archive.org/web/20200316075754/https://www.cdc.gov/hiv/basics/statistics.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Fstatistics%2Fbasics.html |url-status=live }}</ref>
}}

The [[AIDS]] [[AIDS epidemic|epidemic]], caused by the emergence and spread of the [[HIV|human immunodeficiency virus]] (HIV),<ref name="origins.osu.edu">{{Cite web |last=McDow |first=Thomas F. |date=October 2018 |title=A Century of HIV |url=https://origins.osu.edu/article/century-hiv-world-aids-day-africa-actup-unaids?language_content_entity=en |url-status=live |location=[[Columbus, Ohio]] |publisher=[[Ohio State University]] |archive-url=https://web.archive.org/web/20220121155732/https://origins.osu.edu/article/century-hiv-world-aids-day-africa-actup-unaids?language_content_entity=en |archive-date=21 January 2022 |access-date=28 June 2022}}</ref> found its way to the [[United States]] between the 1970s and 1980s,<ref name="origins.osu.edu" /> but was first noticed after doctors discovered clusters of [[Kaposi's sarcoma]] and [[pneumocystis pneumonia]] in [[Gay men|homosexual men]] in [[Los Angeles]], [[New York City]], and [[San Francisco]] in 1981.<ref name="origins.osu.edu" /><ref>{{Cite web |last=<!--Staff writer(s); no by-line.--> |date=11 May 2016 |title=Timeline of the HIV and AIDS Epidemic |url=https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline |url-status=live |archive-url=https://web.archive.org/web/20231009043410/https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline/ |archive-date=9 October 2023 |access-date=10 October 2023 |website=[[HIV.gov]] |publisher=[[United States Department of Health and Human Services|U.S. Department of Health and Human Services]]}}</ref><ref name="Wang-Maher 2019">{{Cite journal |last1=Wang |first1=S.-C. |last2=Maher |first2=B. |date=December 2019 |title=Substance Use Disorder, Intravenous Injection, and HIV Infection: A Review |journal=Cell Transplantation |publisher=[[SAGE Journals]] |volume=28 |issue=12 |pages=1465–1471 |doi=10.1177/0963689719878380 |issn=1555-3892 |pmc=6923556 |pmid=31547679 |s2cid=202746148 |doi-access=free}}</ref> [[Management of HIV/AIDS|Treatment of HIV/AIDS]] is primarily via the use of multiple [[antiretroviral drugs]], and education programs to help people avoid infection.<ref name="origins.osu.edu" /><ref name="Wang-Maher 2019" />

Initially, infected foreign nationals were turned back at the United States border to help prevent additional infections.<ref name="usc8" /><ref name="byndinad" /> The number of United States deaths from AIDS has declined sharply since the early years of the disease's presentation domestically.<ref name="CDCBasicStats" /> In the United States in 2016, 1.1 million people aged over 13 lived with an HIV infection, of whom 14% were unaware of their infection.<ref name="CDCBasicStats" /> [[African Americans]], [[Hispanic and Latino Americans|Hispanic/Latino Americans]], [[Gay men|homosexual]] and [[Bisexuality|bisexual]] men, and [[Drug injection|intravenous drug users]] remain the most disproportionately affected populations in the United States.<ref name="CDCBasicStats" /><ref name="Wang-Maher 2019" />

== Mortality and morbidity ==
{{As of|2018}}, about 700,000 people have died of HIV/AIDS in the United States since the beginning of the HIV/AIDS epidemic, and nearly 13,000 people with AIDS in the United States die each year.<ref>{{Cite web |title=The HIV/AIDS Epidemic in the United States: The Basics |url=https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/ |access-date=April 26, 2020 |website=KFF.org |publisher=Kaiser Family Foundation |archive-date=April 16, 2021 |archive-url=https://web.archive.org/web/20210416102908/https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/ |url-status=live }}</ref>

With improved treatments and better [[Post-exposure prophylaxis|prophylaxis]] against opportunistic infections, [[Mortality rate|death rates]] have significantly declined.<ref name="declineRate">{{Cite web |last=NCHHSTP |first=CDC |date=February 14, 2017 |title=New HIV Infections Drop 18 Percent in Six Years |url=https://www.hiv.gov/blog/new-hiv-infections-drop-18-percent-in-six-years |website=HIV.gov |access-date=April 26, 2020 |archive-date=March 21, 2021 |archive-url=https://web.archive.org/web/20210321053404/https://www.hiv.gov/blog/new-hiv-infections-drop-18-percent-in-six-years |url-status=live }}</ref>

The overall death rate among persons diagnosed with HIV/AIDS in [[New York City]] decreased by sixty-two percent from 2001 to 2012.<ref>{{Cite book |url=https://www1.nyc.gov/assets/doh/downloads/pdf/dires/2013-hiv-surveillance-annual-report.pdf |title=HIV Surveillance Annual Report, 2013 |publisher=New York City Department of Health and Mental Hygiene |year=2013 |archive-url=https://ghostarchive.org/archive/20221009/https://www1.nyc.gov/assets/doh/downloads/pdf/dires/2013-hiv-surveillance-annual-report.pdf |archive-date=2022-10-09 |url-status=live}}</ref>

== Containment ==
After the HIV/AIDS outbreak in the 1980s, various responses emerged in an effort to alleviate the issue.<ref>{{Cite journal |last=Padamsee |first=Tasleem J. |date=August 2020 |title=Fighting an Epidemic in Political Context: Thirty-Five Years of HIV/AIDS Policy Making in the United States |journal=Social History of Medicine |publisher=[[Oxford University Press]] |volume=33 |issue=3 |pages=1001–1028 |doi=10.1093/shm/hky108 |issn=0951-631X |pmc=7784248 |pmid=33424441 |s2cid=80787678}}</ref> These included new medical treatments,<ref>{{Cite book |last1=Gambardella |first1=Alfonso |url=https://books.google.com/books?id=HQhe83DlX8EC&q=history+of+US+HIV+medical+treatments+1980s&pg=PR10 |title=Science and Innovation: The US Pharmaceutical Industry During the 1980s |last2=Gambardella |first2=Professor of Economics and Management Laboratory of Economics and Management Alfonso |date=March 9, 1995 |publisher=Cambridge University Press |isbn=978-0-521-45118-5 |language=en |access-date=June 8, 2021 |archive-date=February 28, 2024 |archive-url=https://web.archive.org/web/20240228143429/https://books.google.com/books?id=HQhe83DlX8EC&q=history+of+US+HIV+medical+treatments+1980s&pg=PR10#v=onepage&q=history%20of%20US%20HIV%20medical%20treatments%201980s&f=false |url-status=live }}</ref> travel restrictions,<ref>{{Cite web |last=Henry |first=Martha |date=July 21, 2016 |title=Florence Revisited: America's History of HIV Travel Restrictions |url=https://aids.harvard.edu/florence-revisited-americas-history-of-hiv-travel-restrictions/ |access-date=June 7, 2021 |archive-date=March 15, 2023 |archive-url=https://web.archive.org/web/20230315152024/https://aids.harvard.edu/florence-revisited-americas-history-of-hiv-travel-restrictions/ |url-status=live }}</ref> and new public health policies<ref>{{Cite journal |last1=Lazzarini |first1=Zita |last2=Galletly |first2=Carol L. |last3=Mykhalovskiy |first3=Eric |last4=Harsono |first4=Dini |last5=O'Keefe |first5=Elaine |last6=Singer |first6=Merrill |last7=Levine |first7=Robert J. |date=June 13, 2013 |title=Criminalization of HIV Transmission and Exposure: Research and Policy Agenda |journal=American Journal of Public Health |volume=103 |issue=8 |pages=1350–1353 |doi=10.2105/AJPH.2013.301267 |issn=0090-0036 |pmc=3966663 |pmid=23763428}}</ref> in the United States.

=== Medical treatment ===
[[File:AIDS Deaths-US 1987-1997.png|thumb|300px|A chart of AIDS deaths in the United States from 1987 to 1997]]
[[File:AIDS Deaths-US 1998-2002.png|thumb|300px|A chart of AIDS deaths in the United States from 1998 to 2002]]

Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included [[Management of HIV/AIDS|antiretroviral drugs]]. [[David Ho (scientist)|David Ho]], a pioneer of this approach, was honored as ''[[Time (magazine)|Time]]'' magazine [[Time Person of the Year|Man of the Year]] for 1996. Deaths were rapidly reduced by more than half, with a small but welcome reduction in the yearly rate of new HIV infections. Since this time, AIDS deaths have continued to decline, but much more slowly, and not as completely in [[African Americans]] as in other population segments.<ref name="Left Behind Black America">{{Cite web |last1=Wilson |first1=Phill |last2=Wright |first2=Kai |last3=Isbell |first3=Michael T. |date=August 2008 |title=Left Behind: Black America: a Neglected Priority in the Global AIDS Epidemic |url=http://www.blackaids.org/image_uploads/article_575/08_left_behind.pdf |url-status=dead |archive-url=https://web.archive.org/web/20100821072159/http://www.blackaids.org/image_uploads/article_575/08_left_behind.pdf |archive-date=August 21, 2010 |access-date=March 20, 2010 |publisher=Black AIDS Institute}}</ref><ref name="NYC DPH AIDS Mortality Historic Low 2002">{{Cite press release |title=Deaths in New York City Reached Historic Low in 2002 |date=January 30, 2004 |publisher=New York City Department of Health and Mental Hygiene |url=http://www.nyc.gov/html/doh/html/press_archive04/pr005-0130.shtml |access-date=March 20, 2010 |url-status=dead |archive-url=https://web.archive.org/web/20100604072407/http://www.nyc.gov/html/doh/html/press_archive04/pr005-0130.shtml |archive-date=June 4, 2010}}</ref>

=== Travel restrictions ===
In 1987, the [[Department of Health and Human Services]] (HHS) included HIV in its list of "communicable diseases of public health significance," denying immigrants and short term foreign visits from anyone who tested positive for the virus.<ref name="hivexclusion">{{Cite web |title=Federal Register Volume 52, Issue 167 (August 28, 1987) |url=https://www.govinfo.gov/content/pkg/USCODE-2018-title8/html/USCODE-2018-title8-chap12-subchapII-partII-sec1182.htm |access-date=April 6, 2020 |website=govinfo.gov |publisher=Office of the Federal Register |pages=32540–32544 |archive-date=March 18, 2021 |archive-url=https://web.archive.org/web/20210318032701/https://www.govinfo.gov/content/pkg/USCODE-2018-title8/html/USCODE-2018-title8-chap12-subchapII-partII-sec1182.htm |url-status=live }}</ref><ref name="usc8">{{Cite web |date=1988 |title=United States Code: Immigration and Nationality |url=http://cdn.loc.gov/service/ll/uscode/uscode1988-00200/uscode1988-002008012/uscode1988-002008012.pdf |url-status=live |archive-url=https://ghostarchive.org/archive/20221009/http://cdn.loc.gov/service/ll/uscode/uscode1988-00200/uscode1988-002008012/uscode1988-002008012.pdf |archive-date=2022-10-09 |access-date=April 6, 2020 |website=Library of Congress |publisher=Office of the Law Revision Counsel |page=1246}}</ref> In 1993, the US Congress passed the National Institutes of Health Revitalization Act of 1993, removing the HHS' authority to dictate HIV as a "public health significance," and explicitly including HIV as a cause for denying immigrants and foreign visitors entry into the US.<ref name="byndinad">{{Cite report |url=https://csis-website-prod.s3.amazonaws.com/s3fs-public/legacy_files/files/media/csis/pubs/movingbeyondinadmissibility.pdf |title=Moving Beyond the U.S. Government Policy of Inadmissibility of HIV-Infected Noncitizens (PDF) |last1=Nieburg |first1=Phillip |last2=Morrison |first2=J. Stephen |date=March 1, 2007 |pages=7{{hyphen}}19 |access-date=February 2, 2025}}</ref><ref>{{cite act|type= National Institutes of Health Revitalization Act|index=Sec. 2007|date=1993|legislature=103rd Congress|url=https://www.congress.gov/bill/103rd-congress/senate-bill/1}}</ref> Anyone seeking US citizenship during the HIV ban was required to undergo a medical exam during the legalization process - testing positive would permanently deny the applicant entry into the country.<ref name="imm_mexcal">{{Cite journal |last1=Morin |first1=Stephen F |last2=Carrillo |first2=Héctor |last3=Steward |first3=Wayne T |last4=Maiorana |first4=Andre |last5=Trautwein |first5=Mark |last6=Gómez |first6=Cynthia A |date=November 2004 |title=Policy Perspectives on Public Health For Mexican Migrants in California |journal=Journal of Acquired Immune Deficiency Syndromes |volume=37 |issue=Supplement 4 |pages=S252–S259 |doi=10.1097/01.qai.0000141254.61840.05 |pmid=15722867 |s2cid=1962566 |doi-access=free}}</ref> The law extended to include medication, where foreign travelers could be arrested for having antiretroviral drugs in their carry-on luggage. A famous example was in 1989, when a Dutch traveler to Minnesota was arrested for "several days" because he was carrying [[AZT]] in his luggage.<ref name="byndinad" />

During the turn of the 21st century, people who were HIV positive and seeking temporary visas or vacationing to the US had to avoid revealing their status on application forms, and either plan for their medication to be sent to the US or stop taking their medication.<ref name="mahto2006">{{Cite journal |last1=Mahto |first1=M |last2=Ponnusamy |first2=K |last3=Schuhwerk |first3=M |last4=Richens |first4=J |last5=Lambert |first5=N |last6=Wilkins |first6=E |last7=Churchill |first7=DR |last8=Miller |first8=RF |last9=Behrens |first9=RH |date=May 2006 |title=Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA |url=https://kar.kent.ac.uk/103757/1/HIV%20Medicine%20-%202006%20-%20Mahto%20-%20Knowledge%20%20attitudes%20and%20health%20outcomes%20in%20HIV%E2%80%90infected%20travellers%20to%20the%20USA.pdf |journal=HIV Medicine |volume=7 |issue=4 |pages=201–204 |doi=10.1111/j.1468-1293.2006.00371.x |pmid=16630031 |s2cid=23404829 |access-date=May 7, 2024 |archive-date=September 17, 2024 |archive-url=https://web.archive.org/web/20240917140137/https://kar.kent.ac.uk/103757/1/HIV%20Medicine%20-%202006%20-%20Mahto%20-%20Knowledge%20%20attitudes%20and%20health%20outcomes%20in%20HIV%E2%80%90infected%20travellers%20to%20the%20USA.pdf |url-status=live }}</ref> Eventually the US began offering temporary admission waivers for people who were HIV positive. As stated in an interoffice memorandum in 2004, foreign nationals who were HIV positive could qualify for the waiver for either humanitarian/public interest reasons, or being "attendees of certain designated international events held in the United States".<ref name="waivers">{{Cite report |url=https://www.uscis.gov/sites/default/files/USCIS/Laws/Memoranda/Static_Files_Memoranda/Archives%201998-2008/2004/kandv_hiv110204.pdf |title=Exception to Nonimmigrant HIV Waiver Policy for K and V Nonimmigrants (PDF) |last=R. Yates |first=William |date=November 2, 2004 |publisher=U.S. Citizenship and Immigration Services (USCIS) |archive-url=https://ghostarchive.org/archive/20221009/https://www.uscis.gov/sites/default/files/USCIS/Laws/Memoranda/Static_Files_Memoranda/Archives%201998-2008/2004/kandv_hiv110204.pdf |archive-date=2022-10-09 |url-status=live}}</ref>

In early December 2006, President [[George W. Bush]] indicated that he would issue an executive order allowing HIV positive people to enter the [[United States]] on standard visas. It was unclear whether applicants would still have to declare their HIV status.<ref name="Russell2006">{{Cite news |last=Russell |first=Sabin |date=December 2, 2006 |title=Bush to ease rule limiting HIV-positive foreign visitors |url=https://www.sfgate.com/politics/article/Bush-to-ease-rule-limiting-HIV-positive-foreign-2544720.php |access-date=March 21, 2010 |work=San Francisco Chronicle |publisher=Hearst Communications |archive-date=February 2, 2013 |archive-url=https://archive.today/20130202100511/http://articles.sfgate.com/2006-12-02/news/17323943_1_hiv-positive-world-aids-day-international-aids-conferences |url-status=live }}</ref>

In August 2007, Congresswoman [[Barbara Lee]] of California introduced {{USBill|110|h|3337}}, the HIV Nondiscrimination in Travel and Immigration Act of 2007. This bill allowed travelers and immigrants entry to the United States without having to disclose their HIV status. The bill died at the end of the [[110th United States Congress|110th Congress]].<ref name="BBC2009">{{Cite web |date=July 6, 2009 |title=Activist helps US HIV law change |url=https://news.bbc.co.uk/2/hi/uk_news/8136456.stm |access-date=April 26, 2018 |website=BBC News |archive-date=February 25, 2021 |archive-url=https://web.archive.org/web/20210225045426/http://news.bbc.co.uk/2/hi/uk_news/8136456.stm |url-status=live }}</ref>

In July 2008, President George W. Bush signed {{USBill|110|h|5501}} that lifted the ban in statutory law. However, the [[United States Department of Health and Human Services]] still held the ban in administrative (written regulation) law. New impetus was added to repeal efforts when Paul Thorn, a UK tuberculosis expert who was invited to speak at the 2009 [[Pacific Health Summit]] in Seattle, was denied a visa due to his HIV positive status. A letter written by Mr. Thorn, and read in his place at the Summit, was obtained by Congressman [[Jim McDermott]], who advocated the issue to the Obama administration's Health Secretary.<ref name="BBC2009" />

On October 30, 2009, President [[Barack Obama]] reauthorized the [[Ryan White]] HIV/AIDS Bill which expanded care and treatment through federal funding to nearly half a million.<ref name="obamawh">{{Cite web |last=Crowley |first=Jeffrey |author-link=Jeffrey Crowley |date=October 30, 2009 |title=Honoring the Legacy of Ryan White |url=https://obamawhitehouse.archives.gov/blog/2009/10/30/honoring-legacy-ryan-white |access-date=March 21, 2010 |website=[[whitehouse.gov]] |via=[[NARA|National Archives]] |archive-date=April 12, 2021 |archive-url=https://web.archive.org/web/20210412133508/https://obamawhitehouse.archives.gov/blog/2009/10/30/honoring-legacy-ryan-white |url-status=live }}</ref> The Department of Health and Human Services also crafted regulation that would end the HIV Travel and Immigration Ban, effective in January 2010.<ref name="obamawh" /> On January 4, 2010, the [[United States Department of Health and Human Services]] and [[Centers for Disease Control and Prevention]] removed HIV infection from the list of "[[communicable diseases]] of public health significance," due to its not being spread by casual contact, air, food or water, and removed HIV status as a factor to be considered in the granting of [[Visa (document)|travel visas]], disallowing HIV status from among the diseases that could prevent people who were not U.S. citizens from entering the country.<ref>{{Cite web |date=January 19, 2010 |title=Final Rule Removing HIV Infection from U.S. Immigration Screening |url=https://www.cdc.gov/immigrantrefugeehealth/laws-regs/hiv-ban-removal/final-rule-technical-qa.html |access-date=January 2, 2017 |publisher=[[United States Department of State]] |archive-date=March 21, 2021 |archive-url=https://web.archive.org/web/20210321041134/https://www.cdc.gov/immigrantrefugeehealth/laws-regs/hiv-ban-removal/final-rule-technical-qa.html |url-status=live }}</ref>

=== Public health policies ===
{{see also|Ronald Reagan and AIDS}}
[[File:A woman with her hand in her hair and the other pulling up Wellcome L0052386.jpg|thumb|upright|1993 poster for "America responds to AIDS", a campaign by the [[United States Department of Health and Human Services|U.S. Department of Health and Human Services]]]]

Since the beginning of the HIV/AIDS epidemic, several [[President of the United States|U.S. presidents]] have attempted to implement a national plan to control the issue. In 1987, [[Ronald Reagan]] created a [[President's Commission on the HIV Epidemic|Presidential Commission on the HIV Epidemic]]. This commission was recruited to investigate what steps are necessary for responding to the HIV/AIDS outbreak in the country, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the United States.<ref name=":2">{{Cite journal |last1=Yehia |first1=Baligh |last2=Frank |first2=Ian |date=2011 |title=Battling AIDS in America: An Evaluation of the National HIV/AIDS Strategy |journal=American Journal of Public Health |volume=101 |issue=9 |pages=e4–e8 |doi=10.2105/ajph.2011.300259 |issn=0090-0036 |pmc=3154226 |pmid=21778507}}</ref> However, these changes were not implemented during this time, and the commission recommendations were largely ignored.

Another attempt to respond to the HIV/AIDS outbreak took place in 1996, when [[Bill Clinton]] established the National AIDS Strategy, which aimed to reduce the number of infections, enhance research on HIV treatment, increase access to resources for people affected by AIDS, and also alleviate the racial disparities in HIV treatment and care.<ref>{{Cite book |last=Collins, Chris. |title=Improving outcomes blueprint for a national AIDS plan for the United States. |date=2007 |publisher=Open Society Institute |oclc=1100047917}}</ref> In [[Vancouver]], the 11th International AIDS Conference highlighted the effectiveness [[highly active antiretroviral therapy]] (HAART), thus creating a new period of optimism.<ref name="responsetohivaids" /> 1996 would mark the first year since the beginning of the epidemic that the number of new HIV/AIDS cases would decline.<ref>{{Cite web |title=Update: Trends in AIDS Incidence -- United States, 1996 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00049322.htm |access-date=September 16, 2024 |publisher=Center for Disease Control |archive-date=June 6, 2024 |archive-url=https://web.archive.org/web/20240606100456/https://www.cdc.gov/mmwr/preview/mmwrhtml/00049322.htm |url-status=live }}</ref><ref name="responsetohivaids" /> AIDS was now no longer the leading cause of death in Americans aged 25-44, although it remained the leading cause of death for African Americans in this age group.<ref name="responsetohivaids" /> The [[AIDS Memorial Quilt]] would be displayed in its entirety for the last time on the [[National Mall]] in October 1996.<ref name="responsetohivaids" /> 1997 would mark the first time that the number of AIDS-related deaths would substantially decline, with the U.S. [[Centers for Disease Control and Prevention]] (CDC) reporting a 47% decline in AIDS-related deaths compared to the previous year.<ref name="drugtherapyeffectiveness">{{Cite news |last=Brown |first=David |date=October 7, 1998 |title=AIDS Death Rate In '97 Down 47% |url=https://www.washingtonpost.com/archive/politics/1998/10/08/aids-death-rate-in-97-down-47/6ca3a56d-2015-42fa-b4f4-0ffe2aa22d12/ |access-date=September 16, 2024 |newspaper=Washington Post}}</ref><ref name="responsetohivaids">{{Cite news |title=A Timeline of HIV and AIDS |url=https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline |access-date=September 16, 2024 |work=hiv.gov |archive-date=May 25, 2017 |archive-url=https://web.archive.org/web/20170525214323/https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ |url-status=live }}</ref> The effectiveness of drug therapy such as HAART would be credited for this significant decline in new cases and deaths.<ref name="responsetohivaids" /><ref name="drugtherapyeffectiveness" />

In 2010, [[Barack Obama]] created the National HIV/AIDS Strategy for the United States (NHAS), with its three main objectives being to reduce the annual number of HIV infections, reduce health disparities, and increase access to resources and HIV care.<ref name=":2" /> However, this new strategy differs in that it includes an Implementation Plan, with a timeline for achieving each of the three goals, as well as a document outlining the specific action plan that will be used.<ref>{{Cite book |title=National HIV/AIDS strategy : federal implementation plan |date=2010 |publisher=White House Office of National AIDS Policy |oclc=656320879}}</ref>

In 2019, [[Donald Trump]] announced a plan in his [[State of the Union Address]] to stop new HIV infections in the United States by 2030, though critics pointed to the President's policies reducing access to health insurance, anti-immigrant and anti-transgender policies as undermining this goal.<ref>{{Cite news |last1=Neel |first1=Joe |last2=Simmons-Duffin |first2=Selena |date=2019-02-06 |title=Halting U.S. HIV Epidemic By 2030: Difficult But Doable |url=https://www.npr.org/sections/health-shots/2019/02/06/691934890/halting-u-s-hiv-epidemic-by-2030-difficult-but-doable |work=NPR |access-date=January 10, 2020 |archive-date=October 6, 2023 |archive-url=https://web.archive.org/web/20231006180022/https://www.npr.org/sections/health-shots/2019/02/06/691934890/halting-u-s-hiv-epidemic-by-2030-difficult-but-doable |url-status=live }}</ref> The [[Department of Health and Human Services]] issued grants to 32 HIV "hotspots" in 2019, and Congress earmarked over $291 million for the president's plan in FY2020.<ref>{{Cite news |last=<!--staff byline; no author given--> |date=2019-12-18 |title=Some Big Health Care Policy Changes Are Hiding In The Federal Spending Package |url=https://www.npr.org/sections/health-shots/2019/12/18/789291340/some-big-health-care-policy-changes-are-hiding-in-the-federal-spending-package |work=NPR |access-date=January 10, 2020 |archive-date=October 2, 2023 |archive-url=https://web.archive.org/web/20231002182356/https://www.npr.org/sections/health-shots/2019/12/18/789291340/some-big-health-care-policy-changes-are-hiding-in-the-federal-spending-package |url-status=live }}</ref>

In February 2019, U.S. District Court Judge [[Leonie Brinkema]] issued an temporary order barring the [[United States Armed Forces|U.S. military]] for discharging or denying officer commissions to personnel based on HIV status.<ref>{{Cite news |last=Weiner |first=Rachel |date=February 15, 2019 |title=Federal judge temporarily blocks military from forcing out HIV-positive airmen |url=https://www.washingtonpost.com/local/public-safety/federal-judge-temporarily-blocks-military-from-forcing-out-hiv-positive-airmen/2019/02/15/5e40b1a2-313c-11e9-813a-0ab2f17e305b_story.html |access-date=May 18, 2023 |newspaper=Washington Post |language=en |archive-date=December 5, 2022 |archive-url=https://web.archive.org/web/20221205224303/https://www.washingtonpost.com/local/public-safety/federal-judge-temporarily-blocks-military-from-forcing-out-hiv-positive-airmen/2019/02/15/5e40b1a2-313c-11e9-813a-0ab2f17e305b_story.html |url-status=live }}</ref> Judge Brinkema's order became permanent in April 2022.<ref>{{Cite web |last=Lavoie |first=Denise |date=April 11, 2022 |title=Judge Rules U.S. Military Can't Discharge HIV-Positive Troops |url=https://www.huffpost.com/entry/bc-us-military-hiv-policy_n_62541243e4b0e97a35145a29 |access-date=April 11, 2022 |website=HuffPost |language=en |archive-date=April 11, 2022 |archive-url=https://web.archive.org/web/20220411115603/https://www.huffpost.com/entry/bc-us-military-hiv-policy_n_62541243e4b0e97a35145a29 |url-status=live }}</ref>

== Public Health Response in California ==
California has been one of the leading states when it comes to addressing the AIDS epidemic. Since the early 1980s, it has been one of the first to implement statewide policies to fund testing, education, and treatment. In 1985, the state established the Office of AIDS under the California Department of Health Services to coordinate prevention and care efforts statewide.<ref>{{Cite web |title=California Department of Public Health |url=https://www.cdph.ca.gov/Programs/CID/DOA |access-date=2025-07-31 |website=www.cdph.ca.gov |language=en}}</ref> By 1999, California had expanded the Medi-Cal coverage to include a broader range of HIV-related treatments, which also made it one of the first states to do this.<ref>{{Cite web |title=HIV/AIDS Archives |url=https://www.kff.org/state-category/hivaids/ |access-date=2025-07-31 |website=KFF |language=en-US}}</ref> California's investment in the syringe exchange programs and different harm reduction services also has contributed to the declines in HIV transmission among intravenous drug users.<ref>{{Cite journal |last=Kimbro |first=Rachel Tolbert |last2=Brooks-Gunn |first2=Jeanne |last3=McLanahan |first3=Sara |date=February 2007 |title=Racial and Ethnic Differentials in Overweight and Obesity Among 3-Year-Old Children |url=https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2005.080812 |journal=American Journal of Public Health |volume=97 |issue=2 |pages=298–305 |doi=10.2105/AJPH.2005.080812 |issn=0090-0036}}</ref>

== Demographics and Health Disparities ==
Despite there being major public health funding, disparities in HIV/AIDS rates continue to rise across racial and socioeconomic lines in California. According to the California Department of Public Health, only 6% of the state's population is made up of African American individuals, yet they accounted for 17% of new HIV diagnoses in 2022.<ref>{{Cite web |last=California Department of Public Health |date=July 2023 |title=California HIV Surveillance Report – 2022 |url=https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/California-HIV-Surveillance-Report-2022.pdf}}</ref> Similarly, Latino communities, mainly in Southern California, face very high infection rates. Many public health officials attribute this to the limited access to healthcare that is culturally appropriate, barriers in language, and low rates of viral suppression.<ref>{{Cite web |title=Armed With New Research, California Tries to Address HIV Disparities – California Health Report |url=https://www.calhealthreport.org/2018/09/18/armed-new-research-california-tries-address-hiv-disparities/ |access-date=2025-07-31 |language=en-US}}</ref> Rural areas in California, like the Central Valley, have persistent HIV disparities, including higher rates of new cases and lower viral suppression. This is due to barriers in access to care, limited provider access, and socioeconomic challenges.<ref>{{Cite web |last=California Department of Public Health |date=July 2022 |title=HIV/AIDS Epidemiology and Health Disparities Report: 2017–2021. |url=https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/CA-Epi-Profile-2017-2021.pdf}}</ref> Public health professionals and advocates are arguing that to close these gaps, especially in communities as described prior, it requires sustained investment in outreach that is culturally competent, expanded access to PrEP, and an increased use of telehealth services that can reach these populations who may have limited provider access, like the Central Valley.<ref>{{Cite web |last=California Department of Public Health |date=July 2023 |title=HIV/AIDS Epidemiology and Health Disparities Report – 2022. |url=https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/HIV-AIDS-Epi-Health-Disparities-Report-2022.pdf}}</ref>

=== Localized efforts ===
{{Main|National Task Force on AIDS Prevention|Transgender HIV/AIDS Prevention Program}}
{{Further|AIDS Project Los Angeles|Gay Men's Health Crisis|Prevention Point Philadelphia}}

Local health educators found it upon themselves to promote modes of [[safe sex]] amongst [[gay men]], [[Bisexuality|bisexual men]], and other [[men who have sex with men]] (MSM) to combat the HIV/AIDS epidemic. In 1987, Les Pappas, an educator from the [[San Francisco AIDS Foundation]] (SFAF), spoke at a conference encouraging gay and bisexual men to use [[condom]]s during sexual intercourse.<ref>{{Cite book |last=Brier |first=Jennifer |url=https://www.jstor.org/stable/10.5149/9780807895474_brier |title=Infectious Ideas: U.S. Political Responses to the AIDS Crisis |date=2009 |publisher=University of North Carolina Press |isbn=978-0-8078-7211-6 |jstor=10.5149/9780807895474_brier |access-date=November 29, 2023 |archive-date=May 21, 2019 |archive-url=https://web.archive.org/web/20190521223009/https://www.jstor.org/stable/10.5149/9780807895474_brier |url-status=live }}</ref> In Pappas' speech, he takes it as the community's responsibility to educate men on using condoms, alluding to the degree of educating gay men as if they had no idea how to use condoms or were even aware of the existence of condoms at all.

Pappas saw opening the eyes of the [[gay community]] to condoms would create a successful economic "[[LGBT marketing|gay market]]" that was unprecedented for the [[San Francisco Bay Area]]. Where he saw bringing attention to buying and using condoms, Pappas also believed that seeing condom paraphernalia would make gay men embrace their sexuality more, thus practicing safer sex.<ref>{{Cite book |last=Reis |first=Elizabeth |title=American Sexual Histories |publisher=Wiley-Blackwell |year=2012 |isbn=9781444339291 |edition=2nd |pages=364–367}}</ref>

== Public perception ==
{{main|Discrimination against people with HIV/AIDS}}
{{further|AIDS pandemic|History of HIV/AIDS}}
[[File:AidsstatUSA.svg|thumb|400px|The number of people living with HIV in the United States, and the number of deaths caused by AIDS by year (1980–2015)<ref>{{Cite magazine |date=December 2001 |title=U.S. HIV and AIDS cases reported through December 2001 |url=https://www.cdc.gov/hiv/pdf/statistics_2001_HIV_Surveillance_Report_vol_13_no2.pdf |url-status=live |archive-url=https://web.archive.org/web/20210831060400/https://www.cdc.gov/hiv/pdf/statistics_2001_HIV_Surveillance_Report_vol_13_no2.pdf |archive-date=August 31, 2021 |access-date=July 14, 2022 |magazine=HIV/AIDS Surveillance Report |publisher=[[Centers for Disease Control and Prevention]] |location=[[Atlanta, Georgia]] |volume=13 |issue=2}}</ref><ref>{{Cite magazine |date=November 2014 |title=Diagnoses of HIV Infection in the United States and Dependent Areas, 2012–2013 |url=https://www.cdc.gov/hiv/pdf/statistics_2012_HIV_Surveillance_Report_vol_24.pdf |url-status=live |archive-url=https://web.archive.org/web/20220123093141/http://www.cdc.gov/hiv/pdf/statistics_2012_hiv_surveillance_report_vol_24.pdf |archive-date=January 23, 2022 |access-date=July 14, 2022 |magazine=HIV/AIDS Surveillance Report |publisher=[[Centers for Disease Control and Prevention]] |location=[[Atlanta, Georgia]] |volume=24}}</ref>]]

During the HIV/AIDS epidemic of the 1980s, [[LGBT in the United States|LGBTQ+ communities]] were further [[Stigmatization|stigmatized]] as they became the focus of [[mass hysteria]], suffered [[Social isolation|isolation]] and [[Social exclusion|marginalization]], and were targeted with [[Violence against LGBT people|extreme acts of violence]] in the United States.<ref name="Westengard 2019" /> One of the best known works on the history of HIV/AIDS is the 1987 book ''[[And the Band Played On]]'' by [[Randy Shilts]], which contends that [[Ronald Reagan]]'s administration dragged its feet in dealing with the crisis due to [[homophobia]], while the [[gay community]] viewed early reports and public health measures with corresponding distrust, thus allowing the disease to spread further and infect hundreds of thousands more. This resulted in the formation of the [[AIDS Coalition to Unleash Power]] (ACT UP) by [[Larry Kramer]]. Galvanized by the [[Federal government of the United States|U.S. federal government]]'s inactivity, the movement led by AIDS activists to gain funding for [[HIV/AIDS research]], which on a per-patient basis out-paced funding for more prevalent diseases such as [[cancer]] and [[heart disease]], was used as a model for future lobbying for health research funding.<ref>{{Cite journal |last=Kahn Best |first=Rachel |year=2012 |title=Disease Politics and Medical Research Funding: Three Ways Advocacy Shapes Policy |journal=American Sociological Review |volume=77 |issue=5 |pages=780–803 |doi=10.1177/0003122412458509 |s2cid=145537490}}</ref>

An early theory asserted that a series of [[inoculation]]s against [[hepatitis B]] that were performed in the gay community of [[San Francisco]] were tainted with HIV. Although there was a high correlation between recipients of that [[vaccination]] and initial cases of AIDS, this theory has long been discredited. However, the theory has never been officially proven or disproven. HIV, [[hepatitis B]], and [[hepatitis C]] are [[Blood-borne disease|bloodborne diseases]] with very similar modes of transmission, and those at risk for one are at risk for the others.<ref name="NIOSH Bloodborne">{{Cite web |date=March 10, 2010 |title=Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus |url=https://www.cdc.gov/niosh/topics/bbp/ |access-date=March 21, 2010 |publisher=US National Institute for Occupational Safety and Health |archive-date=May 7, 2021 |archive-url=https://web.archive.org/web/20210507054253/https://www.cdc.gov/niosh/topics/bbp/ |url-status=live }}</ref>

Publicity campaigns were started in attempts to counter the incorrect and often vitriolic perception of AIDS as a [[Homophobic propaganda|"gay plague"]].<ref name="Westengard 2019" /><ref>{{Cite journal |last1=Ruel |first1=Erin |last2=Campbell |first2=Richard T. |date=June 2006 |title=Homophobia and HIV/AIDS: Attitude Change in the Face of an Epidemic |journal=[[Social Forces]] |location=[[Oxford]] and [[New York City|New York]] |publisher=[[Oxford University Press]] for the Department of Sociology at the [[University of North Carolina at Chapel Hill]] |volume=84 |issue=4 |pages=2167–2178 |doi=10.1353/sof.2006.0110 |issn=0037-7732 |jstor=3844494 |s2cid=145701441}}</ref> These included the [[Ryan White]] case, red ribbon campaigns, celebrity dinners, the [[And the Band Played On (film)|1993 film version]] of ''And the Band Played On'', [[AIDS education|sex education programs]] in schools, and [[Public service announcement|television advertisements]]. Announcements by various celebrities that they had contracted HIV (including actor [[Rock Hudson]], basketball star [[Magic Johnson]], tennis player [[Arthur Ashe]] and singer [[Freddie Mercury]]) were significant in arousing media attention and making the general public aware of the dangers of the disease to people of all sexual orientations.<ref>{{cite journal |last=Small |first=Neil |title=Dying in a Public Place: AIDS Deaths |journal=The Sociological Review |volume=40 |issue=S1 |date=May 1992 |pages=87–111|doi=10.1111/j.1467-954X.1992.tb03388.x }}</ref>

== Perspective of doctors ==
{{Main|Epidemiology of HIV/AIDS}}
{{Further|Management of HIV/AIDS|Prevention of HIV/AIDS}}

The [[History of HIV/AIDS|global spread of HIV/AIDS]] was met with great fear and concern by the American population in the 1980s, much like any other epidemic, and those who were primarily affected were [[African Americans]], [[Hispanic and Latino Americans|Hispanic/Latino Americans]], [[Gay men|homosexual]] and [[Bisexuality|bisexual]] men, and [[Drug injection|intravenous drug users]].<ref name="CDCBasicStats" /><ref name="Wang-Maher 2019" /> During the early years of the epidemic, doctors began to not treat patients affected with HIV/AIDS, not only to create distance from these groups of people, but also because they were afraid to contract the disease themselves. At the time, a surgeon in Milwaukee stated: "I've got to be selfish. It's an incurable disease that's uniformly fatal, and I'm constantly at risk for getting it. I've got to think about myself. I've got to think about my family. That responsibility is greater than to the patient."<ref name=":02">{{Cite book |last=Bayer |first=Ronald |url=https://archive.org/details/aidsdoctorsvoice00rona/page/4 |title=Aids Doctors Voices from the Epidemic |publisher=Oxford University |year=2000 |isbn=0-19-512681-5 |pages=[https://archive.org/details/aidsdoctorsvoice00rona/page/4 4–5]}}</ref>

Some doctors thought it was their duty to stay away from the risk of contracting HIV because they had other patients to think of. In a survey of doctors in the mid to late 1980s, a substantial number of physicians indicated that they did not have an [[Medical ethics|ethical obligation]] to treat and care for those patients affected with HIV/AIDS.<ref>{{Cite journal |last=Link |first=Nathan |date=April 1988 |title=Concerns of Medical and Pediatric House Officers about Acquiring AIDS from their Patients |journal=American Journal of Public Health |volume=78 |issue=4 |pages=445–459 |doi=10.2105/ajph.78.4.455 |pmc=1349375 |pmid=3348474}}</ref> A study of [[primary care]] providers showed that half would not care for patients if they were given a choice.<ref>{{Cite journal |last=Gerbert |first=Barbara |date=1991 |title=Primary Care Physicians and AIDS |journal=Journal of the American Medical Association |volume=266 |issue=20 |pages=2837–2842 |doi=10.1001/jama.1991.03470200049033}}</ref> In 1990, a national survey of doctors showed that "only 24% believed that office-based practitioners should be legally required to provide care to individuals with HIV infection."<ref name=":02" /> Nonetheless, there were many doctors who chose to care for patients affected with HIV/AIDS for different reasons: they shared the same sexual orientation as the infected; a commitment to providing care to the diseased; an interest in the mysteries of infectious disease; and/or a desire to tame the awful threat.<ref name=":02" />

== By race and ethnicity ==
{{Main|Race and ethnicity in the United States}}
===African Americans===
[[African Americans]] are the ethnic group most disproportionately affected by HIV/AIDS, compared with other races and ethnicities in the United States.<ref name="Black-HIV/AIDS">{{Cite journal |last1=Murdock |first1=Christopher J. |last2=Laurencin |first2=Lynne |last3=Christensen |first3=Donna M. |last4=Laurencin |first4=Cato T. |date=June 2018 |title=HIV/AIDS and the African-American Community 2018: A Decade Call To Action |journal=Journal of Racial and Ethnic Health Disparities |publisher=[[Springer Nature]] |volume=5 |issue=3 |pages=449–458 |doi=10.1007/s40615-018-0491-0 |issn=2196-8837 |pmc=8224540 |pmid=29869005}}</ref> They represented approximately 12% of the U.S. population in 2018,<ref name="Black-HIV/AIDS"/> but accounted for an estimated 43% of new HIV infections in 2017.<ref>{{Cite web |date=March 19, 2019 |title=HIV and African Americans {{!}} Race/Ethnicity {{!}} HIV by Group {{!}} HIV/AIDS {{!}} CDC |url=https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html |access-date=July 10, 2019 |website=www.cdc.gov |language=en-us |archive-date=August 8, 2019 |archive-url=https://web.archive.org/web/20190808195815/https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html |url-status=live }}</ref> Furthermore, they make up nearly 52% of AIDS-related deaths in the United States. A 2006 report from the [[Centers for Disease Control and Prevention]] (CDC) estimated that about half of the 1 million U.S. citizens living with HIV/AIDS were African–American.<ref>{{Cite web |date=July 29, 2008 |title=Report: Black U.S. AIDS rates rival some African nations - CNN.com |url=http://www.cnn.com/2008/HEALTH/conditions/07/29/black.aids.report/index.html |access-date=August 14, 2020 |website=www.cnn.com |archive-date=April 8, 2022 |archive-url=https://web.archive.org/web/20220408050648/https://www.cnn.com/2008/HEALTH/conditions/07/29/black.aids.report/index.html |url-status=live }}</ref> A 2010 study published on the ''[[American Journal of Public Health]]'' reported that 64% of women infected with HIV/AIDS in the United States were African–American.<ref>{{Cite journal |last1=Steiner |first1=Riley J. |last2=Finocchario-Kessler |first2=Sarah |last3=Dariotis |first3=Jacinda K. |date=August 2013 |title=Engaging HIV Care Providers in Conversations With Their Reproductive-Age Patients About Fertility Desires and Intentions: A Historical Review of the HIV Epidemic in the United States |journal=[[American Journal of Public Health]] |publisher=[[American Public Health Association]] |volume=103 |issue=8 |pages=1357–1366 |doi=10.2105/AJPH.2013.301265 |issn=0090-0036 |pmc=4007857 |pmid=23763424}}</ref> In 2019, African–American and [[Multiracial Americans|multiracial]] populations experienced the highest reported [[Homelessness in the United States|homelessness rates]] of any other ethnic or racial group diagnosed with HIV/AIDS in the United States.<ref name=":3">{{Cite web |last=CDC |date=2022-07-01 |title=HIV in the United States by Race/Ethnicity: Viral Suppression |url=https://www.cdc.gov/hiv/group/racialethnic/other-races/viral-suppression.html |access-date=2022-10-30 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=September 24, 2023 |archive-url=https://web.archive.org/web/20230924133153/https://www.cdc.gov/hiv/group/racialethnic/other-races/viral-suppression.html |url-status=live }}</ref> In the year 2021, approximately 60% of new HIV diagnoses among women in the United States were represented by [[Black women]].<ref>{{Cite web |url=https://oneill.law.georgetown.edu/the-forgotten-community-black-women-weathering-the-waves-of-hiv/#:~:text=In%202021%2C%20Black%20women%20represented,percentage%20of%20the%20new%20diagnoses. |title=The Forgotten Community: Black Women Weathering the Waves of HIV |date=February 15, 2024 |access-date=July 14, 2024 |archive-date=July 14, 2024 |archive-url=https://web.archive.org/web/20240714072023/https://oneill.law.georgetown.edu/the-forgotten-community-black-women-weathering-the-waves-of-hiv/#:~:text=In%202021%2C%20Black%20women%20represented,percentage%20of%20the%20new%20diagnoses. |url-status=live }}</ref>

==== Risk factors contributing to the Black HIV/AIDS rate ====
The United States has a [[Health insurance in the United States|mixed private/public health system]], with more privatization than most other developed countries.<ref name="USC Price">{{Cite web |last=<!--Staff writer(s); no by-line.--> |date=2023 |title=How to Improve Access to Health Care: Issues & Potential Solutions |url=https://healthadministrationdegree.usc.edu/blog/how-to-improve-access-to-health-care/ |url-status=live |archive-url=https://web.archive.org/web/20230421051321/https://healthadministrationdegree.usc.edu/blog/how-to-improve-access-to-health-care/ |archive-date=21 April 2023 |access-date=12 May 2023 |website=healthadministrationdegree.usc.edu |publisher=[[USC Price School of Public Policy]], [[University of Southern California]] |location=[[Los Angeles]] and [[Sacramento, California]]}}</ref> [[Healthcare in the United States|Access to healthcare services]] is very important in preventing and treating HIV/AIDS among the U.S. population.<ref name="Black-HIV/AIDS"/><ref name="Latino HIV Crisis" /> It can be affected by health insurance which is available to people through private insurers, [[Medicare (United States)|Medicare]] and [[Medicaid]], which leaves many U.S. citizens still vulnerable and untreated.<ref name="USC Price"/> Historically, [[African Americans]] have faced discrimination when it comes to receiving healthcare.<ref name="Med. Care">{{Cite journal |last1=Armstrong |first1=Katrina |last2=Putt |first2=Mary |last3=Halbert |first3=Chanita H. |last4=Grande |first4=David |last5=Schwartz |first5=Jerome Sanford |last6=Liao |first6=Kaijun |last7=Marcus |first7=Noora |last8=Demeter |first8=Mirar B. |last9=Shea |first9=Judy A. |date=February 2013 |title=Prior Experiences of Racial Discrimination and Racial Differences in Health Care System Distrust |journal=[[Medical Care (journal)|Medical Care]] |publisher=[[Lippincott Williams & Wilkins]] on behalf of the [[American Public Health Association]] |volume=51 |issue=2 |pages=144–150 |doi=10.1097/mlr.0b013e31827310a1 |issn=0025-7079 |pmc=3552105 |pmid=23222499 |s2cid=46125799}}</ref>

[[Societal attitudes toward homosexuality|Homosexuality is viewed negatively]] within the African-American community:<ref name="Hill 2013 475–487" /> "In a qualitative study of 745 racially and ethnic diverse undergraduates attending a large Midwestern university, Calzo and Ward (2009) determined that parents of African-American participants discussed homosexuality more frequently than the parents of other respondents. In analyses of the values communicated, Calzo and Ward (2009) reported that Black parents offered greater indication that homosexuality is perverse and unnatural".<ref name="Hill 2013 475–487">{{Cite journal |last1=Hill |first1=William Allen |last2=McNeely |first2=Clea |date=June 2013 |title=HIV/AIDS Disparity between African-American and Caucasian Men Who Have Sex with Men: Intervention Strategies for the Black Church |journal=[[Journal of Religion and Health]] |publisher=[[Springer Verlag]] |volume=52 |issue=2 |pages=475–487 |doi=10.1007/s10943-011-9496-2 |issn=1573-6571 |jstor=24484999 |pmid=21538178 |s2cid=9557761 |jstor-access=free}}</ref>

[[Homosexuality]] is also seen as a threat to the African-American empowerment.<ref>{{Cite book |last=Robertson |first=Gil |title=Not In My Family |publisher=Agate |year=2006 |isbn=978-1-932841-24-4 |location=Canada |pages=80–82}}</ref> [[Masculinity]] is seen as important for the African-American community because it shows that the community is in control of their own destiny.<ref name="Hill 2013 475–487" /> Since the [[social stigma]] circling homosexuality is that it is considered "[[Effeminacy|effeminate]]", then homosexuality is seen as a threat to [[masculinity]] in the African-American community:<ref name="Hill 2013 475–487" /> "Black manhood, then, depends on men's ability to be provider, progenitor, and protector. But, as the Black male performance of parts of this script is thwarted by economic and cultural factors, the performance of Black masculinity becomes predicated on a particular performance of Black sexuality and avoidance of weakness and femininity. If sexuality remains one of the few ways that Black men can recapture a masculinity withheld from them in the marketplace, endorsing Black homosexuality subverts the cultural project of reinscribing masculinity within the Black community."<ref name="Hill 2013 475–487" /> This critical view is influenced by [[internalized homophobia]]: "Internalized homophobia is defined as the lesbian, gay, or bisexual individual's inward direction of society's homophobic attitudes (Meyer 1995)."<ref name="Hill 2013 475–487" />

A [[Homophobia in ethnic minority communities#Black community|homophobic culture and discrimination towards LGBTQ+ people is sustained in the African-American community]] further through the involvement of [[Black church|Black churches and congregations]], because religion is a vital part of the African-American community:<ref name="Hill 2013 475–487" /> "As reported by Peterson and Jones (2009), AA MSM tended to be more involved with religious communities than NHW MSM."<ref name="Hill 2013 475–487" /> Because [[Christianity]] reiterates homosexuality as a [[Sin in Christianity|sin]] and [[social stigma]], the African-American community has higher rates of internalized homophobia.<ref name="Hill 2013 475–487" /> This internalized homophobia causes a lower chance of HIV/AIDS education on prevention and care within the African-American community.<ref name="Hill 2013 475–487" />

==== "Down-low" subculture among Black MSM ====
{{Main|Down-low (sexual slang)}}

''[[Down-low (sexual slang)|Down-low]]'' is an [[African-American English|African-American slang term]]<ref name="Cassell's Dic">{{Cite book |last=Green |first=Jonathon |url=https://books.google.com/books?id=5GpLcC4a5fAC&q=slang+down-low&pg=PA414 |title=Cassell's Dictionary of Slang |date=2006 |publisher=Sterling Publishing |isbn=978-0-304-36636-1 |page=893 |quote=down low n. [1990s+] (US Black) a state of secrecy. down low adj. [1990s+] () covert, secret (i.e. keeping a low profile) |access-date=2008-03-19 |archive-date=December 22, 2023 |archive-url=https://web.archive.org/web/20231222072025/https://books.google.com/books?id=5GpLcC4a5fAC&q=slang+down-low&pg=PA414#v=snippet&q=slang%20down-low&f=false |url-status=live }}</ref> specifically used within the [[African Americans|African-American community]] that typically refers to a [[Sexuality and gender identity-based cultures|sexual subculture]] of [[Black people|Black men]] who usually identify as [[Heterosexuality|heterosexual]] but actively seek [[Men who have sex with men|sexual encounters and relations with other men]], practice [[Cruising for sex|gay cruising]], and frequently adopt a specific [[Hip hop fashion|hip-hop attire]] during these activities.<ref name="Am. J. Public Health">{{Cite journal |last1=Bond |first1=Lisa |last2=Wheeler |first2=Darrell P. |last3=Millett |first3=Gregorio A. |last4=LaPollo |first4=Archana B. |last5=Carson |first5=Lee F. |last6=Liau |first6=Adrian |date=April 2009 |editor-last=Morabia |editor-first=Alfredo |editor-link=Alfredo Morabia |title=Black Men Who Have Sex With Men and the Association of Down-Low Identity With HIV Risk Behavior |journal=[[American Journal of Public Health]] |publisher=[[American Public Health Association]] |volume=99 |issue=Suppl 1 |pages=S92–S95 |doi=10.2105/AJPH.2007.127217 |issn=0090-0036 |eissn=1541-0048 |pmc=2724949 |pmid=19218177 |s2cid=40119540}}</ref><ref name="Hovey 2007">{{Cite book |last=Hovey |first=Jaime |title=Encyclopedia of Sex and Gender |publisher=[[Gale (publisher)|Macmillan Reference USA]] |year=2007 |isbn=9780028661155 |editor-last=Malti-Douglas |editor-first=Fedwa |series=Macmillan Social Science Library |volume=4 |location=[[Farmington Hills, Michigan]] |pages=1372–1374 |chapter=Sexual subcultures |oclc=922889305}}</ref> They generally avoid disclosing their [[same-sex sexual activities]], and often have female sexual partner(s), and may be married or single.<ref name="Coming Up from the Down Low">{{Cite web |last1=King |first1=J.L. |last2=Carreras |first2=Courtney |date=April 25, 2006 |title=Coming Up from the Down Low: The Journey to Acceptance, Healing and Honest Love |url=http://www.enotalone.com/article/4411.html |url-status=dead |archive-url=https://web.archive.org/web/20100818015102/http://www.enotalone.com/article/4411.html |archive-date=August 18, 2010 |access-date=December 18, 2009 |publisher=Three Rivers Press |page=36}}</ref><ref name="Secret Gay">{{Cite news |last=Johnson |first=Jason |date=May 1, 2005 |title=Secret gay encounters of black men could be raising women's infection rate |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/05/01/MNG4TCID0F1.DTL&type=health |access-date=December 18, 2009 |work=San Francisco Chronicle |archive-date=January 31, 2012 |archive-url=https://web.archive.org/web/20120131080800/http://www.sfgate.com/cgi-bin/article.cgi?file=%2Fc%2Fa%2F2005%2F05%2F01%2FMNG4TCID0F1.DTL&type=health |url-status=live }}</ref><ref name="Black masculinities">{{Cite book |last=Mutua |first=Athena |url=https://books.google.com/books?id=GAzEzR3dap4C&q=%22down%20low%22%2C%20adapted%20by%20a%20subculture%20of%20black%20men&pg=PT197 |title=Progressive Black Masculinities |date=September 28, 2006 |publisher=Routledge |isbn=978-0-415-97687-9 |page=169 |access-date=December 18, 2009 |archive-date=December 22, 2023 |archive-url=https://web.archive.org/web/20231222072025/https://books.google.com/books?id=GAzEzR3dap4C&q=%22down%20low%22%2C%20adapted%20by%20a%20subculture%20of%20black%20men&pg=PT197 |url-status=live }}</ref><ref name="Outing Hip-Hop">{{Cite magazine |last=Bennett |first=Jessica |date=May 19, 2008 |title=Outing Hip-Hop |url=http://www.newsweek.com/id/137380/page/1 |url-status=dead |archive-url=https://web.archive.org/web/20081006205253/http://www.newsweek.com/id/137380/page/1 |archive-date=October 6, 2008 |access-date=December 19, 2009 |magazine=[[Newsweek]]}}</ref>

In [[medical research]], the term ''down-low'' is used to identify sexual identity-behaviour discordance among [[men who have sex with men]] (MSM).<ref name="Syst.Rev. 2023">{{Cite journal |last1=Eaton |first1=A.D. |last2=Scheadler |first2=T.R. |last3=Bradley |first3=C. |last4=McInroy |first4=L.B. |date=September 2023 |title=Identity development, attraction, and behaviour of heterosexually identified men who have sex with men: scoping review protocol |journal=[[Systematic Reviews (journal)|Systematic Reviews]] |publisher=[[Springer Nature]] |volume=12 |issue=184 |page=184 |doi=10.1186/s13643-023-02355-6 |issn=2046-4053 |pmc=10542689 |pmid=37777815 |s2cid=263231942 |doi-access=free}}</ref> According to a study published in the ''[[Journal of Bisexuality]]'', "[t]he Down Low is a lifestyle predominately practiced by young, urban Black men who have sex with other men and women, yet do not identify as gay or bisexual".<ref name="Attitudes Towards">{{Cite journal |last1=Heath |first1=Jessie |last2=Goggin |first2=Kathy |date=January 2009 |title=Attitudes Towards Male Homosexuality, Bisexuality, and the Down Low Lifestyle: Demographic Differences and HIV Implications |journal=Journal of Bisexuality |volume=9 |issue=1 |pages=17–31 |doi=10.1080/15299710802659997 |s2cid=143995029}}</ref>

In this context, "being on the ''down-low''" is more than just men having sex with men in secret, or a variant of [[closeted]] [[homosexuality]] or [[bisexuality]]—it is a sexual identity that is, at least partly, defined by its "cult of [[masculinity]]" and its rejection of what is perceived as [[White Americans#Culture|White American culture]] (including what is perceived as White American [[LGBT culture]]) and terms.<ref name="Secret Gay" /><ref name="Double Lives">{{Cite news |last=Denizet-Lewis |first=Benoit |date=August 3, 2003 |title=Double Lives On The Down Low |url=https://www.nytimes.com/2003/08/03/magazine/double-lives-on-the-down-low.html |access-date=April 26, 2012 |work=[[The New York Times Magazine]] |archive-date=April 19, 2012 |archive-url=https://web.archive.org/web/20120419020003/http://www.nytimes.com/2003/08/03/magazine/double-lives-on-the-down-low.html |url-status=live }}</ref><ref name="Down-Low Debate">{{Cite news |last=Wright |first=Kaimeans |date=June 5, 2001 |title=The Great Down-Low Debate: A New Black Sexual Identity May Be an Incubator for AIDS |url=http://www.villagevoice.com/2001-06-05/news/the-great-down-low-debate/1 |url-status=dead |archive-url=https://web.archive.org/web/20121019134820/http://www.villagevoice.com/2001-06-05/news/the-great-down-low-debate/1/ |archive-date=October 19, 2012 |access-date=March 19, 2008 |work=The Village Voice}}</ref><ref name="Sex, lies">{{Cite news |date=August 16, 2004 |title=Sex, lies and the "down low" |url=http://www.salon.com/mwt/feature/2004/08/16/down_low/index.html |url-status=dead |archive-url=https://archive.today/20130201164625/http://www.salon.com/mwt/feature/2004/08/16/down_low/index.html |archive-date=February 1, 2013 |access-date=December 18, 2009 |work=Salon.com}}</ref> A 2003 cover story in ''[[The New York Times Magazine]]'' on the ''down-low'' phenomenon explains that the American Black community sees "homosexuality as a white man's perversion."<ref name="Double Lives" /> It then goes on to describe the ''down-low'' subculture as follows:

{{cquote|Rejecting a [[gay culture]] they perceive as white and effeminate, many black men have settled on a new identity, with its own vocabulary and customs and its own name: Down Low. There have always been men – black and white – who have had secret sexual lives with men. But the creation of an organized, underground subculture largely made up of black men who otherwise live straight lives is a phenomenon of the last decade. ... Most date or marry women and engage sexually with men they meet only in anonymous settings like bathhouses and parks or through the Internet. Many of these men are young and from the inner city, where they live in a hypermasculine thug culture. Other DL men form romantic relationships with men and may even be peripheral participants in mainstream gay culture, all unknown to their colleagues and families. Most DL men identify themselves not as gay or bisexual but first and foremost as black. To them, as to many blacks, that equates to being inherently masculine.<ref name="Double Lives" />}}

The [[Centers for Disease Control and Prevention|CDC]] cited three findings that relate to African-American men who operate on the ''down-low'' (engage in MSM activity but don't disclose to others):
* African American men who have sex with men (MSM), but who do not disclose their sexual orientation (nondisclosers), have a high prevalence of HIV infection (14%); nearly three times higher than nondisclosing MSMs of other races/ethnicities (5%).
* Confirming previous research, the study of 5,589 MSM, aged 15–29 years, in six U.S. cities found that African American MSM were more likely not to disclose their sexual orientation compared with white MSM (18% vs. 8%).
* HIV-infected nondisclosers were less likely to know their HIV status (98% were unaware of their infection compared with 75% of HIV-positive disclosers), and more likely to have had recent female sex partners.<ref name="MMWR">{{Cite web |date=February 7, 2003 |title=CDC: Morbidity and Mortality Weekly Report |url=https://www.cdc.gov/media/mmwrnews/n030207.htm#mmwr1 |url-status=dead |archive-url=https://web.archive.org/web/20091005104759/http://cdc.gov/media/mmwrnews/n030207.htm#mmwr1 |archive-date=October 5, 2009 |access-date=October 31, 2009 |publisher=CDC: US Center for Disease Control and Prevention}}</ref>

===Hispanic and Latino Americans===
[[Hispanic and Latino Americans]] are the second ethnic group most disproportionately affected by HIV/AIDS.<ref name="Latino HIV Crisis">{{Cite journal |last1=Guilamo-Ramos |first1=V |last2=Thimm-Kaiser |first2=M |last3=Benzekri |first3=A |last4=Chacón |first4=G |last5=Rios |first5=E |last6=Scaccabarrozzi |first6=L |date=January 2020 |title=The Invisible US Hispanic/Latino HIV Crisis: Addressing Gaps in the National Response |journal=[[American Journal of Public Health]] |publisher=[[American Public Health Association]] |volume=110 |issue=1 |pages=27–31 |doi=10.2105/AJPH.2019.305309 |issn=0090-0036 |pmc=6893335 |pmid=31725313}}</ref> The annual number of Hispanics/Latinos newly diagnosed with HIV infection has increased by 7% between 2012 and 2016.<ref name="Latino HIV Crisis" /> Specific Hispanic/Latino populations most heavily affected by HIV/AIDS are [[men who have sex with men]] (MSM), accounting for approximately 80% of estimated HIV incidence among Hispanics/Latinos, followed by [[Transgender women|transgender Hispanic/Latina women]] and [[Immigration to the United States|recent Hispanic/Latino immigrants]].<ref name="Latino HIV Crisis" /> Hispanics/Latinos represented 16% of the U.S. population but accounted for 21% of new HIV infections in 2010. This disparity is even more apparent among Hispanic/Latina women, which represent 13% of the population but account for 20% of reported HIV/AIDS cases among women in the United States.<ref>{{Cite journal |last=Peragallo |date=2005 |title=A Randomized Clinical Trial of an HIV-Risk-Reduction Intervention Among Low-Income Latino Women |journal=Nursing Research |volume=54 |issue=4 |pages=264 |doi=10.1097/00006199-200507000-00008 |issn=0029-6562 |doi-access=free}}</ref> Hispanic and Latino Americans accounted for 20% of people living with HIV infection in 2011. Disparities persist in the estimated rate of new HIV infections in Hispanic and Latino Americans In 2010, the rate of new HIV infections for Hispanic/Latino men was 2.9 times that for [[White Americans|White American]] men, and the rate of new infections for Hispanic/Latina women was 4.2 times that for White American women. Since the epidemic began, more than 100,888 Hispanic and Latino Americans with an AIDS diagnosis have died, including 2,863 in 2016.<ref name="cdchisplats">{{Cite web |date=August 21, 2018 |title=HIV and Hispanics/Latinos |url=https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html |access-date=April 6, 2020 |website=CDC.gov |publisher=Centre for Disease Control and Prevention |archive-date=April 4, 2020 |archive-url=https://web.archive.org/web/20200404164539/https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html |url-status=live }}</ref>

===Native Americans===
[[Native Americans in the United States|Native American communities in the United States]] see a higher rate of HIV/AIDS in comparison to [[White Americans]], [[Asian Americans]], [[Native Hawaiians]] and other [[Pacific Islander Americans]]. Although Native Americans with HIV/AIDS only represent roughly 1% of positive cases in the U.S. population,<ref name="CDCAIAN">{{Cite web |date=August 21, 2018 |title=HIV and American Indians and Alaska Natives |url=https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |access-date=December 4, 2018 |website=CDC.gov |publisher=Centre for Disease Control and Prevention |archive-date=December 4, 2018 |archive-url=https://web.archive.org/web/20181204102152/https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |url-status=live }}</ref> the number of diagnoses among Native American gay and bisexual men rose by 54% between 2011 and 2015. Additionally, the survival rate of diagnosed Native Americans was the lowest of all races in the United States between 1998 and 2005.<ref>{{Cite web |title=A Briefing on HIV/AIDS in Indian Country - Fall 2017 |url=https://www.nihb.org/docs/10022017/NIHB%20HIV%20BRIEFING_NTHC_FINAL.pdf |url-status=live |archive-url=https://ghostarchive.org/archive/20221009/https://www.nihb.org/docs/10022017/NIHB%20HIV%20BRIEFING_NTHC_FINAL.pdf |archive-date=2022-10-09 |access-date=December 4, 2018 |website=nihb.org |publisher=National Indian Health Board}}</ref> 

In recent years, the [[Centers for Disease Control and Prevention]] (CDC) have put in place a "high impact prevention approach"<ref>{{Cite web |date=August 21, 2018 |title=HIV among American Indians and Alaska Natives in the United States |url=https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |access-date=December 4, 2018 |website=cdc.org |archive-date=December 4, 2018 |archive-url=https://web.archive.org/web/20181204102152/https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |url-status=live }}</ref> in partnership with the Indian Health Service and the CDC Tribal Advisory Committee to tackle the growing rates in a culturally appropriate way.
The higher rate of HIV/AIDS cases among Native Americans have been attributed to a number of factors, including socioeconomic disadvantages faced by Native American communities, which may result in difficulty accessing healthcare and high-quality housing. It may be more difficult for Native American gay and bisexual men to access healthcare due to living in rural communities, or due to stigma attached to their sexualities. Native Americans have been reported to have higher rates of [[Sexually transmitted infection|other STIs]], including [[chlamydia]] and [[gonorrhea]], which also increases likeliness of contracting or transmitting HIV.<ref>{{Cite web |date=August 21, 2018 |title=HIV in American Indians and Alaska Natives in the United States |url=https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |access-date=December 4, 2018 |website=cdc.org |publisher=Centre for Disease Control and Prevention |archive-date=December 4, 2018 |archive-url=https://web.archive.org/web/20181204102152/https://www.cdc.gov/hiv/group/racialethnic/aian/index.html |url-status=live }}</ref> 

As there are over [[List of federally recognized tribes in the contiguous United States|570 federally recognized Native American tribes]], there is some difficulty in creating outreach programs which effectively appeal to all tribes whilst remaining culturally appropriate. As well as fear of [[social stigma]] from within Native American communities, there may also be a fear among LGBTQ+ Native Americans of a lack of understanding from health professionals in the United States, particularly among [[Two-Spirit]] Native Americans. A 2013 NASTAD report calls for the inclusion of LGBTQ+ and Two-Spirit Native American peoples in HIV/AIDS program planning and asserts that "health departments should utilize local experts to better understand regional definitions of "Two Spirit" and incorporate modules on Native gay men and Two Spirit people into cultural sensitivity courses for public health service providers".<ref>{{Cite web |title=Issue Brief: Native Gay Men and Two Spirit People |url=https://www.nastad.org/sites/default/files/resources/docs/Issue-Brief-Two-Spirit-Final-03-14-13.pdf |url-status=live |archive-url=https://ghostarchive.org/archive/20221009/https://www.nastad.org/sites/default/files/resources/docs/Issue-Brief-Two-Spirit-Final-03-14-13.pdf |archive-date=2022-10-09 |access-date=December 4, 2018 |website=nastad.org |publisher=National Alliance of State and Territorial AIDS Directors}}</ref>

=== Racial disparities related to HIV/AIDS treatment ===
{{Main|Race and health in the United States}}
{{Further|Management of HIV/AIDS|Prevention of HIV/AIDS}}

While there is no cure for HIV/AIDS as of yet, prevention methods and access to medical care are major ways to know one's [[HIV status]], become virally undetectable, and [[Prevention of HIV/AIDS|prevent transmission of HIV/AIDS]]. There are prevention methods to help reduce HIV rates in the United States but these methods are not equally available or accessed.<ref name="Latino HIV Crisis" /> A 2020 study published on the ''[[American Journal of Public Health]]'' reported that the [[social stigma]] associated with HIV diagnosis is a "major barrier" that prevents many [[Risky sexual behavior|at-risk]] and HIV-positive patients from accessing services of HIV prevention and treatment.<ref name="Latino HIV Crisis" /> One prevention method is [[Pre-exposure prophylaxis|PrEP]], which is a medication taken orally or an injection that [[HIV prevention|prevents HIV transmission]]. According to the CDC, [[Pre-exposure prophylaxis|Pre-exposure prophlyaxis or PrEP]] usage rates varied significantly by reported race and ethnicity in 2019.<ref name=":4">{{Cite web |last=CDC |date=2022-04-14 |title=HIV in the United States by Race/Ethnicity: PrEP Coverage |url=https://www.cdc.gov/hiv/group/racialethnic/other-races/prep-coverage.html |access-date=2022-10-30 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=February 16, 2024 |archive-url=https://web.archive.org/web/20240216024131/https://www.cdc.gov/hiv/group/racialethnic/other-races/prep-coverage.html |url-status=live }}</ref> For example, out of all the total number of individuals on PrEP, 63% of them identified as [[White Americans]], 8% identified as [[African Americans]], 14% identified as [[Hispanic and Latino Americans]], and 9% identified as other.<ref name=":4" />

[[Healthcare in the United States|Healthcare access]] varies greatly by race and ethnicity in the United States.<ref name="Black-HIV/AIDS"/><ref name="Latino HIV Crisis" /><ref name="Am. J. Health Behav.">{{Cite journal |last1=Lee |first1=S. |last2=Martinez |first2=G. |last3=Ma |first3=G. |last4=Hsu |first4=C. E. |last5=Robinson |first5=E. S. |last6=Bawa |first6=J. |last7=Juon |first7=H.-S. |date=January–February 2010 |editor-last=Glover |editor-first=Elbert D. |editor-link=Elbert Glover |title=Barriers to Health Care Access in 13 Asian American Communities |journal=[[American Journal of Health Behavior]] |publisher=PNG Publications and Scientific Research Limited |volume=34 |issue=1 |pages=21–30 |doi=10.5993/AJHB.34.1.3 |issn=1945-7359 |pmc=6628721 |pmid=19663748 |s2cid=31669071}}</ref><ref name="Med. Care" /> Out of those living with HIV/AIDS who received medical care only 63% of [[Native Americans in the United States|Native Americans]], 61% of [[African Americans]], 65% of [[Hispanic and Latino Americans]], and 85% of [[Native Hawaiians]] and other [[Pacific Islander Americans]] were virally suppressed in 2019.<ref name=":3" /> This is in comparison to 71% of [[White Americans]] who were virally suppressed in 2019 according to the CDC.<ref name=":4" /> African–American, Hispanic/Latino, and [[Multiracial Americans|multiracial]] populations were significantly more likely to miss at least one medical appointment in the past year compared with White American populations.<ref name=":3" /> African–American, Hispanic/Latino, and multiracial populations that were diagnosed with HIV/AIDS in the United States in 2019 all experienced higher need of dental care, SNAP or WIC benefits, shelter or housing services, and/or mental health services than White American populations according to the CDC.<ref name=":3" />

==== National HIV/AIDS strategy ====
The 2022–2025 National HIV/AIDS strategy "recognizes racism as a serious public health threat that drives and affects both HIV outcomes and disparities", and while every part of the U.S. is threatened with the HIV/AIDS epidemic, "certain populations bear most of the burden signaling where our HIV prevention, care, and treatment efforts must be focused."<ref name=":5">{{Cite web |title=Impact on Racial and Ethnic Minorities |url=https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities |access-date=17 December 2022 |website=HIV.gov |language=en |archive-date=February 20, 2024 |archive-url=https://web.archive.org/web/20240220094542/https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities |url-status=live }}</ref> The 2022–2025 National HIV/AIDS strategy focuses on five priority populations including: [[gay men]], [[Bisexuality|bisexual men]], and other [[men who have sex with men]] (MSM), in particular African–American, Hispanic/Latino, and Native American men; African–American women; [[Trans woman|transgender women]]; youth aged 13–24 years; and people who [[Drug injection|inject drugs]].<ref name=":5" />

[[Sex education in the United States|Sex education varies throughout the United States]] and in some areas could use more informative measures. Sex education on [[HIV prevention]] has decreased from 64% (2000) to 41% (2014). Out of the 50 states, 26 put a larger emphasis on abstinence sex education. [[Abstinence-only sex education]] is correlated to increasing rates of HIV/AIDS infections, especially among teenagers and young adults.<ref>{{Cite news |date=July 21, 2015 |title=HIV and AIDS in the United States of America (USA) |url=https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa |access-date=May 11, 2018 |work=AVERT |language=en |archive-date=May 13, 2018 |archive-url=https://web.archive.org/web/20180513084659/https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa |url-status=live }}</ref>

== Activism and response ==
{{Main|AIDS education and training centers|HIV/AIDS activism}}
{{Further|Discrimination against people with HIV/AIDS}}

Starting in the early 1980s, [[HIV/AIDS activism|HIV/AIDS activist groups]] and organizations began to emerge and advocate for people infected with HIV in the United States. Though it was an important aspect of the movement, activism went beyond the pursuit of funding for [[HIV/AIDS research]]. These groups acted to educate and raise awareness of the disease and its effects on different populations, even those thought to be at low-risk of contracting HIV/AIDS. This was done through publications and "alternative media" created by those living with or close to the disease.<ref>{{Cite book |last=Juhasz |first=Alexandra |title=AIDS TV: Identity, Community, and Alternative Video |publisher=Duke University Press |year=1995 |isbn=978-0-8223-1695-4 |location=Durham, North Carolina}}</ref>

In contrast to this "alternative media" created by activist groups, mass media reports on HIV/AIDS were not as prevalent, most likely due to the stigma surrounding the topic. The general public was therefore not exposed to information regarding the disease. In addition, the federal government and laws in place essentially prevented individuals affected by HIV/AIDS from getting sufficient information about the disease. Risk reduction education was not easily accessible, so activist groups took action in releasing information to the public through these publications.<ref>{{Cite journal |last=HEREK |first=GREGORY M. |date=1999 |title=AIDS and Stigma |journal=American Behavioral Scientist |language=en-US |volume=42 |issue=7 |pages=1106–1116 |doi=10.1177/0002764299042007004 |issn=0002-7642 |s2cid=143610161}}</ref>

AIDS activist groups worked to prevent spread of HIV by distributing information about [[safe sex]]. They also existed to support people living with HIV/AIDS, offering therapy, support groups, and hospice care.<ref name=":0">{{Cite book |last=Ross |first=Loretta |title=Reproductive Justice: An Introduction |publisher=University of California Press |year=2017 |isbn=978-0-520-28820-1 |location=Oakland, California}}</ref> Organizations like [[Gay Men's Health Crisis]], [[People With AIDS]], [[Proyecto ContraSIDA por Vida]], the Lesbian AIDS Project, and SisterLove were created to address the needs of certain populations living with HIV/AIDS. Other groups, like the [[NAMES Project AIDS Memorial Quilt|NAMES Project]], emerged as a way of memorializing those who had passed, refusing to let them be forgotten by the historical narrative. One group, the Association for Drug Abuse Prevention and Treatment (ADAPT), headed by [[Yolanda Serrano]], coordinated with their local prison, [[Rikers Island Correctional Facility|Riker's Island Correctional Facility]], to advocate for those imprisoned and HIV positive to be released early, so that they could die in the comfort of their own homes.<ref>{{Cite magazine |last=Carter |first=Zoe |date=May 9, 1988 |title=ADAPT and Survive |url=https://books.google.com/books?id=U-UCAAAAMBAJ&q=yolanda+serrano+and+adapt&pg=PA35 |magazine=[[New York (magazine)|New York]] |access-date=October 17, 2020 |archive-date=March 21, 2023 |archive-url=https://web.archive.org/web/20230321053509/https://books.google.com/books?id=U-UCAAAAMBAJ&q=yolanda+serrano+and+adapt&pg=PA35 |url-status=live }}</ref>

Both men and women, heterosexual and LGBTQ+ populations were active in establishing and maintaining these parts of the movement. Because HIV/AIDS was initially thought only to impact [[gay men]], most narratives of activism focus on their contributions to the movement. However, women also played a significant role in raising awareness, rallying for change, and caring for those impacted by the disease. [[Lesbian women]] helped organize and spread information about transmission between women, as well as supporting gay men in their work. Narratives of activism also tend to focus on organizing done in coastal cities, but AIDS activism was present and widespread across both urban and more rural areas of the United States. Organizers sought to address needs specific to their communities, whether that was working to establish [[Needle exchange programme|needle exchange programs]], fighting against housing or employment discrimination, or issues faced primarily by people identified as members of specific groups (such as [[sex worker]]s, mothers and children, or [[Incarceration in the United States|incarcerated people]]).

During the HIV/AIDS epidemic of the 1980s, LGBTQ+ communities were further [[Stigmatization|stigmatized]] as they became the focus of [[mass hysteria]], suffered [[Social isolation|isolation]] and [[Social exclusion|marginalization]], and were targeted with [[Violence against LGBT people|extreme acts of violence]] in the United States.<ref name="Westengard 2019">{{Cite book |last=Westengard |first=Laura |title=Gothic Queer Culture: Marginalized Communities and the Ghosts of Insidious Trauma |publisher=[[University of Nebraska Press]] |year=2019 |isbn=978-1-4962-0204-8 |location=[[Lincoln, Nebraska]] |pages=99–103 |chapter=Monstrosity: Melancholia, Cannibalism, and HIV/AIDS |lccn=2018057900 |chapter-url=https://books.google.com/books?id=b5unDwAAQBAJ&pg=PA99 |access-date=July 8, 2022 |archive-date=April 16, 2023 |archive-url=https://web.archive.org/web/20230416153435/https://books.google.com/books?id=b5unDwAAQBAJ&pg=PA99 |url-status=live }}</ref> Initially when the HIV/AIDS epidemic surfaced in the United States, a large proportion of patients were members of the [[LGBTQ+ community]], leading to further stigmatization of the disease.<ref name="Westengard 2019" /> Because of this, the AIDS activist groups took initiative in testing and experimenting with new possible medications for treating HIV, after researchers outside of the community refused. This research originally done by early AIDS activist groups contributed to treatments still being used today.<ref>{{Cite book |last=Corburn, Jason. |title=Street science : community knowledge and environmental health justice |date=2005 |publisher=MIT Press |isbn=0-262-03333-X |oclc=58830060}}</ref>

Among the landmark legal cases in the history of [[LGBT rights in the United States]] on the topic of HIV/AIDS is ''[[Braschi v. Stahl Associates Co.|Braschi vs. Stahl]]''. Litigant [[Miguel Braschi and Leslie Blanchard|Miguel Braschi]] sued his landlord for the right to continue living in their rent controlled apartment after his gay partner Leslie Blanchard died of AIDS.<ref>{{Cite news |last=Gutis |first=Philip S. |date=July 7, 1989 |title=New York Court Defines Family To Include Homosexual Couples |url=https://www.nytimes.com/1989/07/07/nyregion/new-york-court-defines-family-to-include-homosexual-couples.html |access-date=August 7, 2020 |work=[[The New York Times]] |language=en-US |issn=0362-4331 |archive-date=October 10, 2020 |archive-url=https://web.archive.org/web/20201010234523/https://www.nytimes.com/1989/07/07/nyregion/new-york-court-defines-family-to-include-homosexual-couples.html |url-status=live }}</ref> The NY Court of Appeals became the first American appellate court to conclude that same-sex relationships are entitled to legal recognition.<ref>{{Cite web |title=From the Closet to the Courtroom |url=https://ucmweb.rutgers.edu/magazine/archive1013/features/winter-2011/from-the-closet-to-the-courtroom |access-date=August 7, 2020 |website=Rutgers Magazine |archive-date=September 29, 2021 |archive-url=https://web.archive.org/web/20210929014108/https://ucmweb.rutgers.edu/magazine/archive1013/features/winter-2011/from-the-closet-to-the-courtroom |url-status=live }}</ref> The case was litigated at the height of the AIDS crisis and the plaintiff himself died only a year after his groundbreaking court victory. The case focused on emotional and economic interdependency rather than on the existence of legal formalities; the verdict made it more difficult for government officials to reject the notion that [[Same-sex relationship|same-sex couples]] could constitute families and that they were entitled to at least some of the protections afforded by law.<ref>{{Cite web |date=September 12, 2019 |title=The Braschi Breakthrough: 30 Years Later, Looking Back on the Relationship Recognition Landmark |url=https://history.nycourts.gov/the-braschi-breakthrough-30-years-later-looking-back-on-the-relationship-recognition-landmark/ |access-date=August 7, 2020 |website=Historical Society of the New York Courts |language=en-US |archive-date=October 29, 2020 |archive-url=https://web.archive.org/web/20201029044841/https://history.nycourts.gov/the-braschi-breakthrough-30-years-later-looking-back-on-the-relationship-recognition-landmark/ |url-status=live }}</ref>

=== Response from the Catholic Church ===
{{Main|Catholic Church and HIV/AIDS}}
[[File:StVincents.jpg|thumb|300px|right|[[Saint Vincent's Catholic Medical Centers|St Vincent's Hospital and Medical Center of New York]] was one of many Catholic health institutions to pioneer medical treatment for people infected with HIV/AIDS.]]

The [[United States Conference of Catholic Bishops]] was the first church body to address the HIV/AIDS pandemic in 1987 with a document entitled "[[s:On "The Many Faces of AIDS"|The Many Faces of AIDS: A Gospel Response]]."<ref>{{Cite book |last=Gravend-Tirole |first=Xavier |title=The World's Religions after September 11 |date=30 November 2008 |publisher=ABC-CLIO |isbn=978-0-275-99622-2 |editor-last=Sharma, Arvind |page=120 |chapter=Catholicism and the AIDS Pandemic |access-date=8 May 2020 |chapter-url=https://books.google.com/books?id=uZNxDwAAQBAJ&pg=RA1-PA123 |archive-date=February 28, 2024 |archive-url=https://web.archive.org/web/20240228143414/https://books.google.com/books?id=uZNxDwAAQBAJ&pg=RA1-PA123 |url-status=live }}</ref><ref>{{Cite web |title=Statement: The Many Faces of Aids, November 14, 1987 |url=https://www.usccb.org/resources/statement-many-faces-aids-november-14-1987 |access-date=26 January 2023 |archive-date=May 30, 2023 |archive-url=https://web.archive.org/web/20230530020023/https://www.usccb.org/resources/statement-many-faces-aids-november-14-1987 |url-status=live }}</ref> In the document they stated that the [[Catholic Church]] must provide [[pastoral care]] to those infected with HIV/AIDS as well as medical care.<ref name="smith164">{{Cite book |last=Smith |first=Raymond A. |url=https://books.google.com/books?id=Ats3BQAAQBAJ&pg=PA164 |title=Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic |date=27 August 1998 |publisher=Routledge |isbn=978-1-135-45754-9 |page=164 |access-date=21 May 2020 |archive-date=February 28, 2024 |archive-url=https://web.archive.org/web/20240228143448/https://books.google.com/books?id=Ats3BQAAQBAJ&pg=PA164#v=onepage&q&f=false |url-status=live }}</ref> It called discrimination against people with AIDS "unjust and immoral".<ref name=smith164/> The document also rejected extra-marital sex and the use of condoms, and reiterated the Church's teaching that human sexuality was a gift and was to be used in monogamous marriages.<ref name=smith164/>

The Catholic Church, with over 117,000 health centers, is the largest private provider of HIV/AIDS care.<ref name="mercury" /> Individual dioceses around the United States began hiring staff in the 1980s to coordinate AIDS ministry.{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139-140}}  By 2008, Catholic Charities USA had 1,600 agencies providing services to patients with AIDS, including housing and mental health services.<ref name="journalism.nyu.edu" /> The [[Archdiocese of New York]] opened a shelter for AIDS patients in 1985.{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139}} In the same year, they opened a hotline for people to call for resources and information.{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139}} The [[Missionaries of Charity]], led by [[Mother Teresa]], opened hospices in the [[Greenwich Village]] neighborhood of New York, Washington D.C., and San Francisco in the 1980s.<ref name=urges/>{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139}} Individual parishes began opening hospices for AIDS patients, with the first being in New Orleans in 1985.{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139}}<ref name=orleans/>

The bishops of the United States issued a pastoral letter in the 1980s, titled ''A Call to Compassion'', saying those with AIDS "deserve to remain within our communal consciousness and to be embraced with unconditional love."<ref name=fore/> In [[Pastoral care for gay Catholics#Always Our Children|Always Our Children]], their 1997 pastoral letter on homosexuality, the American bishops noted "an importance and urgency" to minister to those with AIDS, especially considering the impact it had on the gay community.<ref>{{Cite web |date=1997 |title=Always Our Children |url=https://www.usccb.org/resources/Always%20Our%20Children.pdf#page=8 |access-date=December 2, 2023 |website=United States Conference of Catholic Bishops |archive-date=December 25, 2023 |archive-url=https://web.archive.org/web/20231225020941/https://www.usccb.org/resources/Always%20Our%20Children.pdf#page=8 |url-status=live }}</ref> They encouraged church ministers to include prayers at Mass for those with AIDS and those who care for them, those who have died from AIDS, and all of their friends, families, and companions.<ref name=":6">{{Cite web |date=1997 |title=Always Our Children |url=https://www.usccb.org/resources/Always%20Our%20Children.pdf#page=11 |access-date=December 2, 2023 |website=United States Conference of Catholic Bishops |archive-date=December 25, 2023 |archive-url=https://web.archive.org/web/20231225020941/https://www.usccb.org/resources/Always%20Our%20Children.pdf#page=11 |url-status=live }}</ref> They recommended special masses be said for healing with [[anointing of the sick]] or other events to take place around the time of [[World AIDS Day]].<ref name=":6" />

In 1987, the bishops of [[California]] issued a document saying that just as Jesus loved and healed lepers, the blind, the lame, and others, so too should Catholics care for those with AIDS.{{sfn|Commission on Behavioral and Social Sciences and Education|1993|p=139}} The year before, they publicly denounced [[1986 California Proposition 64|Proposition 64]], a measure pushed by [[Lyndon H. LaRouche]] to forcibly quarantine those with AIDS, and encouraged Catholics to vote against it.<ref name=urges/> [[Joseph L. Bernardin]], the Archbishop of Chicago, issued a 12-page policy paper in 1986 that outlined "sweeping pastoral initiatives" his archdiocese would be undertaking.<ref name=urges/>

=== Present-day activism ===
An effective response to HIV/AIDS requires that groups of vulnerable populations have access to HIV prevention programs with information and services that are specific to them.<ref>{{Cite web |date=July 24, 2015 |title=Key Affected Populations, HIV and AIDS |url=https://www.avert.org/professionals/hiv-social-issues/key-affected-populations |website=Avert: Global Information and Education on HIV and AIDS |access-date=April 16, 2018 |archive-date=January 26, 2022 |archive-url=https://web.archive.org/web/20220126191930/https://www.avert.org/professionals/hiv-social-issues/key-affected-populations |url-status=live }}</ref> In the present day, some AIDS activist groups and organizations that were established during the height of the epidemic are still present and working to assist people living with HIV/AIDS.<ref name=":0" /> They may offer any combination of the following: health education, counseling and support, or advocacy for law and policy. AIDS activist groups and organizations also continue to call for public awareness and support through participation in events like [[Pride parade|LGBT pride parades]], [[World AIDS Day]], and [[AIDS Walk]]s.

== Current status ==
{{main|Prevention of HIV/AIDS}}
{{further|HIV adult prevalence rate|HIV-positive people}}

The [[Centers for Disease Control and Prevention]] estimates at the end of 2019, there were 1,189,700 people aged 13 or older with diagnosed HIV infections in the [[Territories of the United States|United States and dependent areas]].<ref name="CDCBasicStats" /> Since 2010, the number of [[HIV-positive people|people living with HIV/AIDS]] has increased, while the annual number of new HIV infections has declined over the past few years. In 2021, 36,136 people were newly diagnosed with HIV/AIDS, compared to 37,832 diagnosed in 2018.<ref name="CDCBasicStats" /> 67% of 2021 diagnoses were among [[men who have sex with men]] (MSM), 56% were among American early adolescents and young adults between the ages of 13 and 34, 40% were from the [[African Americans|African-American population]], and 7% were [[Drug injection|intravenous drug users]].<ref name="CDCBasicStats" />

The 2021 CDC HIV Surveillance Report estimates that 36,136 new cases of HIV infections were diagnosed in the United States in 2021, a rate of 11.3 per 100,000 population.<ref name=":1">{{Cite web |date=November 7, 2019 |title=HIV Surveillance {{!}} Reports{{!}} Resource Library {{!}} HIV/AIDS {{!}} CDC |url=https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html |access-date=November 21, 2019 |website=www.cdc.gov |language=en-us |archive-date=December 1, 2019 |archive-url=https://web.archive.org/web/20191201113159/https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html |url-status=live }}</ref> This rate is an increase from the previous year's estimates, which indicated 30,585 new infections and a rate of 9.5 per 100,000 population.<ref name=":1" /> This increase has been peculiar among epidemiologists, since over the past few years before 2021, rates of HIV infections were decreasing over time. Due to the [[COVID-19 pandemic in the United States]] (2019–2022), many barriers have made getting tested for HIV/AIDS more difficult, with many who are racially and economically disadvantaged to have reduced resources in terms of [[Diagnosis of HIV/AIDS|testing]].<ref>{{Cite journal |last1=Beltran |first1=Raiza M. |last2=Holloway |first2=Ian W. |last3=Hong |first3=Chenglin |last4=Miyashita |first4=Ayako |last5=Cordero |first5=Luisita |last6=Wu |first6=Elizabeth |last7=Burris |first7=Katherine |last8=Frew |first8=Paula M. |date=February 2022 |title=Social Determinants of Disease: HIV and COVID-19 Experiences |journal=Current HIV/AIDS Reports |language=en |volume=19 |issue=1 |pages=101–112 |doi=10.1007/s11904-021-00595-6 |issn=1548-3568 |pmc=8808274 |pmid=35107810}}</ref>  

Individuals in the 25–29 age range had the highest rates of new HIV infections, with a rate of 32.9 per 100,000.<ref name=":1" /> With regard to race and ethnicity, the highest rate of new HIV infections in 2017 occurred in the [[African Americans|African-American population]], with a rate of 4.5 per 100,000. This more than doubled the next highest rate of new HIV infections for a racial or ethnic group, which was the [[Hispanic and Latino Americans|Hispanic/Latino population]], with a rate of 3.2 per 100,000.<ref name=":1" /> The lowest rate of new HIV infections in 2021 occurred in the [[Asian Americans|Asian American population]], with a rate of 2.3 per 100,000.<ref name=":1" />

According to CDC estimates, the most common transmission category of new HIV infections remained [[Sexual practices between men|male-to-male sexual contact]], which accounted for roughly 79% of all new infections in the United States in 2021.<ref name=":1" /> Among the proportion of new [[HIV-positive people|HIV-positive]] [[Gay men|gay]] and [[Bisexual men|bisexual]] men in 2021, 40% are [[African Americans]], 29% are [[Hispanic and Latino Americans|Hispanic/Latino Americans]], and 25% are [[White Americans]].<ref name="GnBMen" /> With regard to region of residence, the highest rates of new infections in 2021 occurred in the [[Southern United States]], with about 52% of new total cases being from the American South.<ref name=":1" /> The region identified as "American South" includes [[Alabama]], [[Arkansas]], [[Delaware]], [[District of Columbia]], [[Florida]], [[Georgia (U.S. state)|Georgia]], [[Kentucky]], [[Louisiana]], [[Maryland]], [[Mississippi]], [[North Carolina]], [[Oklahoma]], [[South Carolina]], [[Tennessee]], [[Texas]], [[Virginia]], and [[West Virginia]].<ref name=":1" /> The city of [[Atlanta]] has the highest HIV infection rate in the country.<ref>{{Cite web |url=https://www.fox5atlanta.com/news/hiv-aids-fulton-county-prep-hiv-testing |title=Metro Atlanta has one of the highest HIV rates in the world {{!}} What can be done to prevent the spread |date=October 12, 2023 |access-date=July 14, 2024 |archive-date=July 14, 2024 |archive-url=https://web.archive.org/web/20240714072439/https://www.fox5atlanta.com/news/hiv-aids-fulton-county-prep-hiv-testing |url-status=live }}</ref>

According to CDC estimates, the majority of new HIV infections among [[White Americans]] occurred among adult [[men who have sex with men]] (MSM) aged 30–39, followed closely by those aged 40–49, while the majority of new HIV infections among [[African Americans]] have occurred predominantly among early adolescent and young adult [[men who have sex with men]] (aged 13–29).<ref name="2010sept_cdc">{{Cite web |title=CDC Fact Sheet – HIV and AIDS among Gay and Bisexual Men – Sept 2010 |url=https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf |url-status=live |archive-url=https://ghostarchive.org/archive/20221009/https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf |archive-date=2022-10-09 |access-date=July 10, 2020}}</ref><ref name="kaiser_2010gaymale_hiv">{{Cite web |date=September 24, 2010 |title=CDC: One In Five Gay Men HIV-Positive |url=http://www.kaiserhealthnews.org/Daily-Reports/2010/September/24/AIDS-gay-men.aspx |publisher=Kaiser Health News |access-date=October 6, 2010 |archive-date=February 1, 2014 |archive-url=https://web.archive.org/web/20140201204507/http://www.kaiserhealthnews.org/Daily-Reports/2010/September/24/AIDS-gay-men.aspx |url-status=live }}</ref> In the United States, [[men who have sex with men]] (MSM), described as [[Gay men|gay]] and [[Bisexual men|bisexual]] men,<ref name="GnBMen">{{Cite web |date=February 27, 2018 |title=Gay and Bisexual Men – HIV by Group |url=https://www.cdc.gov/hiv/group/msm/ |website=www.cdc.gov |access-date=January 2, 2017 |archive-date=January 26, 2024 |archive-url=https://web.archive.org/web/20240126150505/https://www.cdc.gov/hiv/group/msm/ |url-status=live }}</ref> make up about 55% of the total [[HIV-positive people|HIV-positive population]], and 83% of the estimated new HIV/AIDS diagnoses among all males aged 13 and older, and approximately 92% of new HIV/AIDS diagnoses among all men in their age group. 1 in 6 gay and bisexual men are therefore expected to be diagnosed with HIV/AIDS in their lifetime if current rates continue. The CDC estimates that more than 600,000 gay and bisexual men are [[HIV-positive people|currently living with HIV/AIDS]] in the United States.<ref name="GnBMen" /> A review of four studies in which [[trans women]] in the United States were tested for HIV/AIDS found that 27.7% tested positive.<ref>{{Cite journal |last1=Herbst |first1=J. H |last2=Jacobs |first2=E. D |last3=Finlayson |first3=T. J |last4=McKleroy |first4=V. S |last5=Neumann |first5=M. S |last6=Crepaz |first6=N |last7=HIV/AIDS Prevention Research Synthesis Team |date=Jan 2008 |title=Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: A Systematic Review |url=https://hal.archives-ouvertes.fr/hal-02319357/file/Poster%20Olga%20L%20Gonzalez%202019.pdf |url-status=live |journal=AIDS Behav |volume=12 |issue=1 |pages=1–17 |doi=10.1007/s10461-007-9299-3 |pmid=17694429 |s2cid=22946778 |archive-url=https://ghostarchive.org/archive/20221009/https://hal.archives-ouvertes.fr/hal-02319357/file/Poster%20Olga%20L%20Gonzalez%202019.pdf |archive-date=2022-10-09}}</ref>

In 2015, a major HIV infection outbreak, [[Indiana]]'s largest-ever, occurred in two largely rural, economically depressed and poor counties in the southern portion of the state, due to the injection of a relatively new [[opioid]]-type drug called Opana ([[oxymorphone]]), which is designed be taken in pill form but is ground up and [[Drug injection|injected intravenously using needles]]. Because of the lack of HIV cases in that area beforehand and the youth of many but not all of those affected, the relative unavailability in the local area of treatment centers capable of dealing with long-term therapies, [[Management of HIV/AIDS|HIV/AIDS healthcare]], and [[drug addiction]] during the initial phases of the outbreak, and political opposition to [[needle exchange programs]], the outbreak expanded for months, resulting in up to 127 preventable cases. Under pressure, officials eventually declared a [[state of emergency]], but much of the damage had already been done.<ref>{{cite magazine |last1=Gonsalves |first1=Greg |last2=Crawford |first2=Forrest |date=March 2, 2020 |title=How Mike Pence Made Indiana's HIV Outbreak Worse |url=https://www.politico.com/news/magazine/2020/03/02/how-mike-pence-made-indianas-hiv-outbreak-worse-118648 |url-status=live |magazine=[[Politico]] |location=[[Arlington County, Virginia]] |publisher=[[Axel Springer SE]] |archive-url=https://web.archive.org/web/20200312124136/https://www.politico.com/news/magazine/2020/03/02/how-mike-pence-made-indianas-hiv-outbreak-worse-118648 |archive-date=March 12, 2020 |access-date=October 16, 2025}}</ref> In March 2025, the [[Second presidency of Donald Trump|second Trump administration]] has cut much of the federal funding for [[HIV/AIDS research]], [[Prevention of HIV/AIDS|prevention]], and [[Management of HIV/AIDS|medication]] as part of the broader [[2025 U.S. Department of Health and Human Services reorganization|reorganization of the U.S. Department of Health and Human Services]] announced by U.S. President [[Donald Trump]].<ref>{{cite news |author-last=Hellmann |author-first=Jessie |date=March 19, 2025 |title=Trump's policies threaten his 2019 vow to end HIV, experts say |url=https://rollcall.com/2025/03/19/trumps-policies-threaten-his-2019-vow-to-end-hiv-experts-say/ |url-status=live |work=[[Roll Call]] |location=[[Washington, D.C.]] |publisher=[[The Economist Group|CQ Roll Call]] |oclc=44314138 |archive-url=https://web.archive.org/web/20250428211140/https://rollcall.com/2025/03/19/trumps-policies-threaten-his-2019-vow-to-end-hiv-experts-say/ |archive-date=April 28, 2025 |access-date=October 16, 2025}}</ref>

== See also ==
* [[Adult Industry Medical Health Care Foundation]]
* [[AIDS Education and Training Centers]]
* [[AIDS Project Los Angeles]]
* [[Criminal transmission of HIV in the United States]]
* [[Hank M. Tavera]]
* [[Healthcare and the LGBT community]]
* [[HIV/AIDS and African Americans]]
** [[African-American LGBT community#HIV/AIDS]]
* [[Men who have sex with men]] (MSM)
** ''[[Bugchasing]]'', sexual subculture of HIV/AIDS fetishists
** ''[[Down-low (sexual slang)|Down-low]]'', sexual subculture of African-American MSM
** [[HIV and men who have sex with men]]
** [[Sexual practices between men]]
* [[President's Emergency Plan for AIDS Relief]]

'''International:'''
* [[AIDS education and training centers]]
* [[Elton John AIDS Foundation]]
* [[Joint United Nations Programme on HIV/AIDS]]
* [[:Category:HIV/AIDS activism|HIV/AIDS activism]]
* [[:Category:HIV/AIDS activists|HIV/AIDS activists]]
* [[HIV/AIDS global epidemic]]
* [[HIV/AIDS in North America]]
** [[HIV/AIDS in Atlanta]]
** [[HIV/AIDS in Canada]]
** [[HIV/AIDS in New York City]]

== References ==
<references>
<ref name="mercury">{{Cite news |date=December 1, 2010 |title=Catholic AIDS workers: Pope echoing us on condoms |url=https://www.mercurynews.com/2010/12/01/catholic-aids-workers-pope-echoing-us-on-condoms/ |access-date=May 5, 2020 |work=The Mercury News |agency=Associated Press |archive-date=June 9, 2022 |archive-url=https://web.archive.org/web/20220609211558/https://www.mercurynews.com/2010/12/01/catholic-aids-workers-pope-echoing-us-on-condoms/ |url-status=live }}</ref>

<ref name="journalism.nyu.edu">{{Cite web |title=AIDS and the Catholic Church - Pavement Pieces |url=http://journalism.nyu.edu/publishing/archives/pavement/city/aids-and-the-catholic-church/index.html |url-status=dead |archive-url=https://web.archive.org/web/20130603202752/http://journalism.nyu.edu/publishing/archives/pavement/city/aids-and-the-catholic-church/index.html |archive-date=June 3, 2013 |access-date=February 7, 2013}}</ref>

<ref name="urges">{{Cite news |last=Hyer |first=Marorie |date=October 31, 1986 |title=Bishop Urges Church Action On AIDS Care |url=https://www.washingtonpost.com/archive/politics/1986/10/31/bishop-urges-church-action-on-aids-care/109f0a4d-ac6b-46c7-8ddb-e9012eabe979/ |access-date=May 25, 2020 |newspaper=The Washington Post |archive-date=November 14, 2020 |archive-url=https://web.archive.org/web/20201114195021/https://www.washingtonpost.com/archive/politics/1986/10/31/bishop-urges-church-action-on-aids-care/109f0a4d-ac6b-46c7-8ddb-e9012eabe979/ |url-status=live }}</ref>

<ref name="fore">{{Cite news |last=Reinhld |first=RObert |date=September 17, 1987 |title=AIDS Issue at Fore as Pope Visits San Francisco Today |url=https://timesmachine.nytimes.com/timesmachine/1987/09/17/183887.html?pageNumber=33 |access-date=May 8, 2020 |work=The New York Times |page=33 |archive-date=February 27, 2021 |archive-url=https://web.archive.org/web/20210227031833/https://timesmachine.nytimes.com/timesmachine/1987/09/17/183887.html?pageNumber=33 |url-status=live }}</ref>

<ref name="orleans">{{Cite news |last=Finney Jr. |first=Peter |date=May 4, 2019 |title=New Orleans priest founded first Catholic AIDS hospice |url=https://cruxnow.com/church-in-the-usa/2019/05/new-orleans-priest-founded-first-catholic-aids-hospice/ |access-date=May 21, 2020 |publisher=Crux |agency=Catholic News Service |archive-date=October 6, 2023 |archive-url=https://web.archive.org/web/20231006180039/https://cruxnow.com/church-in-the-usa/2019/05/new-orleans-priest-founded-first-catholic-aids-hospice |url-status=live }}</ref>
</references>

== Bibliography ==
# {{Cite book |last=Cante |first=Richard C. |title=Gay Men and the Forms of Contemporary US Culture |date=March 2008 |publisher=Ashgate Publishing |isbn=978-0-7546-7230-2 |location=London}}
# {{Cite journal |last1=Bogart |first1=Laura |last2=Thorburn |first2=Sheryl |date=February 2005 |title=Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? |journal=J. Acquir. Immune Defic. Syndr. |volume=38 |issue=2 |pages=213–8 |doi=10.1097/00126334-200502010-00014 |pmid=15671808 |s2cid=9659696 |doi-access=free}}
# {{Cite book |last=Walker |first=Robert Searles |title=AIDS: Today, Tomorrow : an Introduction to the HIV Epidemic in America |publisher=Humanities Press Intl |year=1994 |isbn=978-0-391-03859-2 |edition=2nd |location=Atlantic Highlands, New Jersey |oclc=30399464}}
# {{Cite book |last=Siplon |first=Patricia |title=AIDS and the policy struggle in the United States |publisher=Georgetown University Press |year=2002 |isbn=978-0-87840-378-3 |location=Washington D.C. |oclc=48964730}}
# {{Cite book |last1=National Research Council |url=https://books.google.com/books?id=h_udx9hESKgC |title=The Social Impact of AIDS in the United States |last2=Division of Behavioral and Social Sciences and Education |last3=Commission on Behavioral and Social Sciences and Education |last4=Panel on Monitoring the Social Impact of the AIDS Epidemic |date=February 1, 1993 |publisher=National Academies Press |isbn=978-0-309-04628-2 |ref={{harvid|Commission on Behavioral and Social Sciences and Education|1993}} |access-date=May 21, 2020}}

==Further reading==
* {{Cite book |last=Buso, Michael Alan |url=https://researchrepository.wvu.edu/cgi/viewcontent.cgi?article=6332&context=etd |title="Here There Is No Plague": The Ideology and Phenomenology of AIDS in Gay Literature AIDS in Gay Literature |publisher=[[University of West Virginia]] |year=2017 |access-date=June 18, 2020 |archive-url=https://web.archive.org/web/20200318223229/https://researchrepository.wvu.edu/cgi/viewcontent.cgi?article=6332&context=etd |archive-date=March 18, 2020 |url-status=dead}} - [https://web.archive.org/web/20200623075119/https://researchrepository.wvu.edu/etd/5291/  Document ID 5291]

== External links ==
{{Commons category}}
* [http://www.aids.gov/ AIDS.gov – The U.S. Federal Domestic HIV/AIDS Resource]
* [http://www.aidsvu.org/ AIDSVu.org – Interactive Map Illustrating HIV Prevalence in the United States]
* [https://asteria.fivecolleges.edu/findaids/sophiasmith/mnsss291.html Finding Aid – Voices of Feminism Oral History Project, 1990–2006] {{Webarchive|url=https://web.archive.org/web/20170519190706/http://asteria.fivecolleges.edu/findaids/sophiasmith/mnsss291.html |date=May 19, 2017 }}

{{North America topic|HIV/AIDS in}}
{{HIV/AIDS}}
{{LGBT in the United States}}

{{DEFAULTSORT:Hiv Aids In The United States}}
[[Category:HIV/AIDS in the United States| ]]
[[Category:1960 establishments in the United States]]
[[Category:LGBTQ history in the United States]]
[[Category:Race and health in the United States]]