Why HIV Patients Still Need Health Equity 40 Years After the First Diagnoses

Cases of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) were first reported in the United States in June of 1981. At the time, HIV/AIDS was shrouded in fear and shame, and its victims were ostracized because of their deadly condition. Forty years later, medical progress has transformed HIV from a death sentence to a manageable disease. Still, the stigmas of an HIV diagnosis remain, and the disparities associated with infection live on.

At the beginning of the crisis, first-hand knowledge about transmission and coordinated medical activism helped vulnerable people avoid contracting HIV as authoritative resources struggled to understand the disease. As early as June of 1982, gay activists in San Francisco published thousands of pamphlets encouraging safer sex. One year later, gay men speaking on a national stage in Denver asked policymakers to address the unfurling crisis and treat AIDS patients with dignity.

In the decades since, improved HIV prevention and treatment have limited the disease’s spread and reduced the risk of infection-associated death. Pre-exposure prophylactic (PrEP) medications like Truvada, Descovy, and Apretude have minimized the risk of contracting HIV. And under the Affordable Care Act, PrEP is often free or offered at a reduced cost.

Every year, more people live longer with HIV in the United States as treatments get the virus under control and allow individuals to extend their lifespans. Modern drugs, including antiretroviral therapies such as Ziagen, Epivir, and Retrovir, reduce the viral load in infected individuals to a point where it is undetectable in blood and unlikely to transmit through sexual contact. As of 2022, FDA approval exists for more than 30 medicines to treat HIV infection.

However, without equitable access to healthcare, communities of color and the LGBTQI+ community have been marginalized and restricted from obtaining crucial testing and treatment resources.

In the United States, the probability of a person contracting HIV is mainly dependent on their race, ethnicity, and sexual orientation. CDC data from 2020 found that 68% of new HIV diagnoses were attributed to the Black/African American and Hispanic/Latino populations. Around 71% of infections were also attributed to gay, bisexual, or other men who reported male-to-male sexual contact.

In a World AIDS Day proclamation, President Biden wrote, “We still have a hard road ahead, especially in addressing racial and gender gaps in our health systems, which have long driven inequitable HIV outcomes at home and abroad. But as we today honor the 700,000 Americans and 40 million lives lost worldwide to AIDS-related illnesses over the years, we have new hope in our hearts.”

Hope stems from plans like the CDC's that aims to decrease annual HIV diagnoses to 3,000 by 2030, expecting that HIV can one day be eradicated in the United States. Currently, government estimates suppose that 1.2 million people in the US have HIV, and 13% are unaware and need testing. Of that 1.2 million people, only 66% have received HIV care. The disproportionate impact and incidence of HIV across the country indicate that the stigma surrounding the disease still bars people from readily seeking testing, treatment, and prophylaxis.

To make HIV a relic of the past, these at-risk populations will need empathy, compassion, and equity in addition to medical treatments.