Current trends and the future of HIV/AIDS services: a social work perspective.

Abstract

Due in large part to grassroots efforts begun in the early 1980s, the U.S. government has responded to HIV/AIDS through regulations, laws, and policies that have resulted in domestic and global health and social programs. Social workers have worked on both the frontline and the policy level since the early days of HIV/AIDS (Aronstein & Thompson, 1998). During the ensuing decades of the pandemic, the social work profession has responded to changes in the epidemiology, treatment, and funding of HIV/AIDS research. Current economic concerns and health trends find HIV/ AIDS no longer on the radar screen of concerns, replaced by personal and national economic concerns such as terrorism and homeland security. Yet the necessary and ongoing response to HIV/AIDS continues to require a diverse range of social work practice skills THE CURRENT PICTURE OF HIV/AIDS IN THE UNITED STATES As of 2001, it was estimated that 850,000 to 950,000 people were living with HIV/AIDS; 890,000 are between ages 15 and 49. Approximately 362,000 of these people were living with AIDS (the advanced stage of HIV). This represents a 14 percent increase in the number of people living with AIDS since 1999 (Centers for Disease Control and Prevention [CDC], 2003a). During the past two decades, the demographics of HIV/AIDS has changed, moving from an illness that (primarily) affected white gay men to a disease that increasingly affects women, Latinos, men of color who have sex with men, and older adults. Communities of Color AIDS prevalence rates among African American men and women increased by 150 percent between 1993 and 2001 compared with a 68 percent rate increase among white people (Kaiser Family Foundation [KFF], 2003a). Rates of HIV/ AIDS among communities of color were significantly higher than those for white people when considering their percentage of the total population (for example, African Americans make up 12 percent of the U.S. population, yet account for 76.3 percent of individuals with AIDS) (KFF, 2003a) (see Figure 1). African American teenagers (ages 13 to 19) make up only 15 percent of U.S. teenagers, but account for almost two-thirds (61 percent) of new AIDS cases reported among teenagers in 2001 (KFF, 2003a). Women Overall, women represent an increasing proportion of new AIDS cases, but African American women represent a greater number of AIDS cases than white women. There were 7,113 newly reported AIDS cases among African American women in 2001 compared with 1,981 among white women (KFF, 2003b). The majority of women in all groups are most likely to have been infected by heterosexual contact (67 percent African American, 59 percent white) than through injection drug use (30 percent African American, 38 percent white). Heterosexual contact accounts for 75 percent of HIV infection among women ages 13 to 24 (KFF, 2003b). Latina women are also overrepresented among women infected with HIV. Although Latina women make up only 13 percent of the U.S. female population, they account for 18 percent of the new HIV infections among women. Similarly, African American women make up 12 percent of the U.S. female population but account for 64 percent of new HIV infections among women (KFF, 2003b). Adolescent girls (ages 13 to 19) accounted for more than one-half (57 percent) of new HIV infections in 2001 that occurred in this age group. Two-thirds of AIDS diagnoses among women since the epidemic's start were among ages 30 to 49, one-fifth (21 percent) were diagnosed in their 20s, and about one in 10 women was diagnosed with AIDS at age 50 or older (KFF, 2003b). Older Adults According to CDC estimates, in 2002, 42,104 people ages 55 and older were living with AIDS, including 8,902 people 65 and older (CDC, 2003b). In contrast, the figure for people 24 and younger was 8,677 (CDC, 2003b). In addition, people over age 50 living with HIV/AIDS are more likely to experience cognitive impairments (University of California, San Francisco [USCF], Center for AIDS Prevention Studies, 1997). …