INTRODUCTION

The HIV/AIDS pandemic has now been with us for over four decades, and in that span of time, at least 32 million lives have been lost. The pandemic continues to expand in Eastern Europe, Central Asia, the Middle East, and North Africa (Beyrer, 2021).

A Historical Perspective

In 1981, the U.S. Centers for Disease Control and Prevention (CDC) described cases of a rare lung infection and other unusual infections that indicated immune system deficiency in five men, marking the first official reporting of what would later become known as acquired immunodeficiency syndrome (AIDS). By the end of that year, there were a total of 337 cases of individuals with severe immune deficiency in the United States—321 adults/adolescents and 16 children under age 13. Of those people, 130 were dead by the end of the year.

In 1982, the CDC used the term AIDS (acquired immunodeficiency syndrome) for the first time and released the first case definition of AIDS: “A disease at least moderately predictive of a defect in cell-mediated immunity, occurring in a person with no known cause for the diminished resistance to the disease.”

In 1983, the retrovirus human T cell lymphotropic virus type III (later known as human immunodeficiency virus, or HIV) was discovered to be the cause of AIDS. And in 1984 the first diagnostic blood test was developed, the enzyme-linked immunoassay (ELISA).

By the end of 1985, the United Nations stated that at least one HIV case had been reported from each region of the world.

In 1987, the U.S. Food and Drug Administration (FDA) approved the first medication for treatment for AIDS: AZT (zidovudine), an antiviral drug developed for cancer treatment. In that same year, a new, more specific test for HIV was developed, the Western blot, and in that same year, Universal Precautions were introduced for all healthcare settings.

In 1992, AIDS became the number one cause of death for men in the United States ages 25–44, and in 1995, a world total of 1 million cases of AIDS and an estimated total of 18 million HIV+ adults and 1.5 million HIV+ children were reported globally. The estimated global death toll from AIDS was 9 million.

By 2009, there was a significant decline in new infections during the previous decade, and in 2010, the U.S. National Institutes of Health (NIH) announced that a daily dose of HIV drugs reduced the risk of HIV infection, supporting the idea of pre-exposure prophylaxis (PrEP) in a target population.

At the end of 2012, 2.3 million people were newly infected with HIV and 1.6 million died of AIDS. That same year the U.S. FDA approved the first at-home HIV test as well as the use of Truvada for PrEP.

By 2020, an estimated 36.3 million people had died from AIDS-related illness since the start of the epidemic (HIV.gov, 2023a; KFF, 2021; CDC, 2022a).

HIV/AIDS in the United States and Dependent Areas Today

As of 2021 in the United States and its six dependent areas, there were more than 1.2 million people living with HIV. In 2020, 30,635 people received an HIV diagnosis—a 17% decrease from the previous year. Among 28,422 persons with HIV infection diagnosed during 2020 in the 46 jurisdictions with complete reporting of laboratory data to the CDC, viral load was suppressed in 67.8% of persons within 6 months of HIV diagnosis.

In 2020, there were 18,489 deaths among adults and adolescents diagnosed with HIV, attributable to any cause, including COVID-19.

Among those who received an HIV diagnosis during 2020, more than 1 in 5 persons (21.6%) received a late-stage diagnosis (AIDS). The highest percentages of late-stage diagnoses occurred among:

• Persons ages 55 and older (37.1%)
• Asians (27.7%)
• Females (23.2%)

The lowest percentages were among:

• Transgender men (5.0%)
• Persons ages 13–24 years (9.1%)
• Black/African Americans (20.0%)
• Native Hawaiian/other Pacific Islanders (20.0%)

The percentage among injection drug users were:

• Females (78.1%)
• Males (77.8%)

(CDC, 2022a)

Rates of people with diagnosed HIV in the United States and dependent areas by region of residence, 2021, per 100,000 people. (Source: CDC.)

HIV/AIDS in Washington State

In 2020, there were 14,303 people living with HIV in Washington, and of these, 10,697 (77.1%) were virally suppressed. Of these cases:

• 84.3% male
• 15.7% female
• 16.8% Black
• 16.5% Hispanic/Latinx
• 54.8% White
• 39.1% ages 55 and older

In 2020, there were 421 new HIV diagnoses, the lowest number since 1994. Of these new cases:

• 82.9% male
• 17.1% female
• 19.5% Black
• 17.8% Hispanic/Latinx
• 48% White
• 35.2% ages 25–34

Also in 2020, there were 88 new late-stage HIV infections (AIDS), and of these 20.9% were also newly diagnosed HIV. Of these:

• 83% female
• 17% male
• 23.2% Black
• 17.3% Hispanic/Latinx
• 20.8% White
• 28% ages 25–34

During the year 2020, there were 185 deaths among person with HIV in Washington. Of these:

• 83% male
• 16.3% female
• 10.9% Black
• 13.0% Hispanic/Latinx
• 61.4% White
• 57.6% ages 55 and older

(AIDSVu, 2023; WA DOH, 2021a)