The AIDS epidemic, caused by the emergence and spread of the human immunodeficiency virus (HIV), developed in the United States between the 1970s and 1980s. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. Treatment of HIV/AIDS is primarily via the use of multiple antiretroviral drugs, and education programs to help people avoid infection. Initially, infected foreign nationals were turned back at the United States border to help prevent additional infections. The number of United States deaths from AIDS has declined sharply since the early years of the disease's presentation domestically. According to 2023 data, there was a 12% decrease in the amount of new HIV infections compared to 2018. 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. African Americans, Hispanic/Latino Americans, homosexual and bisexual men, transgender women, and intravenous drug users remain the most disproportionately affected populations in the United States.
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. With improved treatments and better prophylaxis against opportunistic infections, death rates have significantly declined. The overall death rate among persons diagnosed with HIV/AIDS in New York City decreased by sixty-two percent from 2001 to 2012.
Containment After the HIV/AIDS outbreak in the 1980s, various responses emerged in an effort to alleviate the issue. These included new medical treatments, travel restrictions, and new public health policies in the United States.
Medical treatment
Great progress was made in the US following the introduction of three-drug anti-HIV treatments ("cocktails") that included antiretroviral drugs. David Ho, a pioneer of this approach, was honored as Time magazine 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.
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. 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. 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. 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. 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. 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". 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. In August 2007, Congresswoman Barbara Lee of California introduced H.R. 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 Congress. In July 2008, President George W. Bush signed H.R. 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. 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. The Department of Health and Human Services also crafted regulation that would end the HIV Travel and Immigration Ban, effective in January 2010. 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 travel visas, disallowing HIV status from among the diseases that could prevent people who were not US citizens from entering the country.
Public health policies
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