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 , 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 , 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 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
Since the beginning of the HIV/AIDS epidemic, several US presidents have attempted to implement a national plan to control the issue. In 1987, Ronald Reagan created a Presidential Commission on the HIV Epidemic. This commission was recruited to investigate what steps are necessary for responding to the HIV/AIDS outbreak in the country, and the consensus was to establish more HIV testing, focus on prevention and treatment as well as expanding HIV care throughout the United States. However, these changes were not implemented during this time, and the commission recommendations were largely ignored.
Another attempt to respond to the HIV/AIDS outbreak took place in 1996, when Bill Clinton established the National AIDS Strategy, which aimed to reduce the number of infections, enhance research on HIV treatment, increase access to resources for people affected by AIDS, and also alleviate the racial disparities in HIV treatment and care. In Vancouver, the 11th International AIDS Conference highlighted the effectiveness of highly active antiretroviral therapy (HAART), thus creating a new period of optimism. 1996 would mark the first year since the beginning of the epidemic that the number of new HIV/AIDS cases would decline. AIDS was now no longer the leading cause of death in Americans aged 25-44, although it remained the leading cause of death for African Americans in this age group. The AIDS Memorial Quilt would be displayed in its entirety for the last time on the National Mall in October 1996. 1997 would mark the first time that the number of AIDS-related deaths would substantially decline, with the US Centers for Disease Control and Prevention (CDC) reporting a 47% decline in AIDS-related deaths compared to the previous year. The effectiveness of drug therapy such as HAART would be credited for this significant decline in new cases and deaths.
In 2010, Barack Obama created the National HIV/AIDS Strategy for the United States (NHAS), with its three main objectives being to reduce the annual number of HIV infections, reduce health disparities, and increase access to resources and HIV care. However, this new strategy differs in that it includes an Implementation Plan, with a timeline for achieving each of the three goals, as well as a document outlining the specific action plan that will be used.
In 2019, Donald Trump announced a plan in his State of the Union Address to stop new HIV infections in the United States by 2030, though critics pointed to the President's policies reducing access to health insurance, anti-immigrant and anti-transgender policies as undermining this goal. The Department of Health and Human Services issued grants to 32 HIV "hotspots" in 2019, and Congress earmarked over $291 million for the president's plan in FY2020.
In February 2019, US District Court Judge Leonie Brinkema issued a temporary order barring the US military for discharging or denying officer commissions to personnel based on HIV status. Judge Brinkema's order became permanent in April 2022.
Funding for HIV initiatives has been reduced by 25%, amounting to $2 billion in 2025, as a consequence of diminished support under the Trump administration. This allocation represents the lowest level of funding since 2007 and may contribute to a potential resurgence of the virus.
Public health response in California California has been one of the leading states when it comes to addressing the AIDS epidemic. Since the early 1980s, it has been one of the first to implement statewide policies to fund testing, education, and treatment. In 1985, the state established the Office of AIDS under the California Department of Health Services to coordinate prevention and care efforts statewide. By 1999, California had expanded the Medi-Cal coverage to include a broader range of HIV-related treatments, which also made it one of the first states to do this. California's investment in the syringe exchange programs and different harm reduction services also has contributed to the declines in HIV transmission among intravenous drug users.
Demographics and health disparities Despite there being major public health funding, disparities in HIV/AIDS rates continue to rise across racial and socioeconomic lines in California. According to the California Department of Public Health, only 6% of the state's population is made up of African American individuals, yet they accounted for 17% of new HIV diagnoses in 2022. Similarly, Latino communities, mainly in Southern California, face very high infection rates. Many public health officials attribute this to the limited access to healthcare that is culturally appropriate, barriers in language, and low rates of viral suppression. Rural areas in California, like the Central Valley, have persistent HIV disparities, including higher rates of new cases and lower viral suppression. This is due to barriers in access to care, limited provider access, and socioeconomic challenges. Public health professionals and advocates are arguing that to close these gaps, especially in communities as described prior, it requires sustained investment in outreach that is culturally competent, expanded access to PrEP, and an increased use of telehealth services that can reach these populations who may have limited provider access, like the Central Valley.
Localized efforts
Local health educators found it upon themselves to promote modes of safe sex amongst gay men, bisexual men, and other men who have sex with men (MSM) to combat the HIV/AIDS epidemic. In 1987, Les Pappas, an educator from the San Francisco AIDS Foundation (SFAF), spoke at a conference encouraging gay and bisexual men to use condoms during sexual intercourse. In Pappas' speech, he takes it as the community's responsibility to educate men on using condoms, alluding to the degree of educating gay men as if they had no idea how to use condoms or were even aware of the existence of condoms at all.