The HIV/AIDS Epidemics of the Americas

Abstract

What eventually became termed the HIV epidemic was first detected in 1981 in 11 homosexual men in the United States with very aggressive and rare malignancies (Kaposi’s Sarcoma). The initial case reports of mostly men who had sex with men to the U.S. Centers for Disease Control (CDC) showed geographic clusters in Belle Glade, Florida, New York City, Los Angeles and San Francisco. Soon this mixed group of patients with severely compromised immune systems became colloquially referred to as the “Four H Disease” by the CDC, as it primarily involved homosexuals, heroin addicts, hemophiliacs, and Haitians. Naturally, Haitians were later found to have the same behavioral risks as all others infected with HIV, but the die was cast. The sad and discriminating legacy of the early stages of the nascent HIV epidemic in the United States forced the poorest nation in the Americas and one of the least economically developed in the world into an economic freefall that compounded an otherwise chaotic political situation in Haiti in the mid-1980s. With virtually no economic resources, political instability and international discrimination, one would have predicted a disastrous, expanding HIV epidemic in this island nation of the Caribbean. Nothing could be farther from the truth, and the Haitian response to their HIV epidemic offers useful lessons for other nations. With an estimated 130,000 new infections in the Americas in 2007, the region has basically experienced a plateau in HIV/AIDS for the past decade. In the United States, the high rate of ART among HIV infected patients has led to a dramatic decline in mortality associated with AIDS. While this is the case in Canada and Brazil as well, many of the poorer nations in Central and South America and in the Caribbean have not yet been able to scale up ARTs to those in need. Racial and ethnic minorities in the U.S. bear the brunt of the epidemic, although they represent a small fraction of the population. Among its neighbors,