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Issues

Women and AIDS

Women living with HIV/AIDS often place the needs of their families ahead of their own, including health care. Ryan White outreach and primary care programs empower these women to live longer, healthier lives and HRSA works to better educate providers to address the unique needs of this population.

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Gay Men

Gay men have been heavily impacted by HIV/AIDS since the beginning of the epidemic. Gay men have helped lead the way towards creating high standards of culturally competent care and integral to the creation and direction of the Ryan White HIV/AIDS Program.

Cultural Competency

Culturally competent service providers are crucial to recruiting and retaining people living with HIV/AIDS into primary care, particularly when they are members of historically disenfranchised communities and populations such as people of color, gay men, women, and substance users.

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Confidentiality

Ryan White confidentiality guidelines have helped allay the fears that many people living with HIV have around unwanted disclosure and HIV discrimination.

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Treatment Advances

The Ryan White HIV/AIDS Program ensures people living with HIV/AIDS have access to the latest treatments, including life-saving AIDS medications. Advances in vaccine and pharmaceutical research promise new ways to treat, and perhaps halt, HIV infection in the future.

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African-Americans

African-Americans are the racial and ethnic group most disproportionately affected by the HIV/AIDS epidemic. By providing culturally competent, comprehensive care the Ryan White HIV/AIDS Program is committed to turning this tide.

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Aging

Wonderful advances in treatment have brought with them the promise of longer life for people living with HIV. The Ryan White HIV/AIDS Program has been there, growing with the people it serves and ensuring that the program’s aging patients have many years of good health and happiness to look forward to, every step of the way.

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HIV/AIDS Stigma

Stigma represents one of the most complex and pervasive barriers to health care for people living with HIV/AIDS. From the beginning, the Ryan White HIV/AIDS Program has fought against the discrimination and isolation that stigma creates, a commitment that helps more people engage and remain in care.

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Rural Challenges

In rural America, unique challenges add to the complexity of providing care for people living with HIV/AIDS. The Ryan White HIV/AIDS Program is, thus, a critical source of support in remote areas, helping patients overcome barriers to care as well as providing technical assistance for providers.

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Gay Men and the History of the Ryan White HIV/AIDS Program

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Within that first year, it became apparent that something new was happening, and we were of course, as it turned out, sort of at Ground Zero of the AIDS Epidemic.

—Dr. Jay Dobson, New York-Presbyterian Hospital

It Begins

Gay men were disenfranchised sexual minorities and by the late 1970s and early 1980s they began requesting—and requiring—equal rights. This equality became available in some large urban areas especially in New York and San Francisco, affording gay men a new sense of freedom. Gay men flocked en masse to these locales where they could live and love as they chose. The joy of this moment was short-lived.

A disease suddenly began to spread and that, at first, made no sense, seemed to have no clear cause, and had no immediate or direct treatment. In 1980, physicians working in gay enclaves began to see men presenting symptoms of what appeared to be the flu, but often became a deadly case of Pneomocystis carinii pneumonia (PCP). Others had rashes on their skin—later diagnosed as Kaposi’s sarcoma, a rare cancerous tumor of the connective tissue previously seen most often in older men of Italian or Eastern European Jewish origin.1  PCP and Kaposi’s sarcoma were among the earliest opportunistic infections of HIV disease, though clinicians didn’t know it yet. HIV compromises the immune system creating “opportunities” for pathogens to infect and creating a whole host of health issues in HIV-positive persons. So what had seemed like isolated and unexplainable occurrences quickly became something more.

In June 1981, an entry in the U.S. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report captured the attention of the medical community the world over:

In the period October 1980-May 1981, five young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at three different hospitals in Los Angeles, California. Two of the patients died.2

This was the first official scientific documentation of what would shortly thereafter be termed gay cancer or the gay plague in the media,3,4 and gay-related immune deficiency (GRID) by the CDC.5,6,7 The illness continued appearing with increasing frequency. The medical community and scientific researchers had no idea how it was spread, or why gay men appeared to be carrying such a disproportionate level of burden of the new disease.

In 1982, the CDC re-named the disease Acquired Immune Deficiency Syndrome (AIDS) to reflect the evidence that it was impacting various populations, including injection drug users, Haitians, and hemophiliacs.8 Still there was no question that this disease was claiming the lives of gay men in staggering numbers, as it would for decades to come. At the end of 1983:

  • 71 percent of the 3,064 reported AIDS cases were among gay and bisexual men;
  • 42 percent of all cases were in New York City, 12 percent in San Francisco, and 8 percent in Los Angeles.9

Of course, the story of HIV/AIDS among the gay community is about far more than the numbers. It is the tale of a community jolted by fear, shunned by many, and awakened to its own deep sense of compassion. This story of individual and collective suffering and bravery is inextricably tied to the Ryan White HIV/AIDS Program itself and, of course, the efforts of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) in launching the first Federal efforts to combat this disease and ensure access to care and services for people living with HIV/AIDS who had nowhere else to turn.

 

AIDS Diagnoses among MSM Compared to Other Groups 1982 to 2009 Bar Graph
View as a table
AIDS Diagnoses Among MSM Compared To Other Groups, 1982-2009
Year MSM MSM/IDU Other
1982 339   63
1983 1,848   814
1984 3,354   1,189
1985 5,391 576 2,127
1986 8,554 954 3,502
1987 13,047 1,438 5,943
1988 17,993 2,055 11,680
1989 19,652 2,138 12,808
1990 23,738 2,295 16,524
1991 23,960 2,366 18,497
1992 23,936 2,429 19,970
1993 49,963 6,098 49,929
1994 34,974 3,853 40,847
1995 30,671 3,425 39,284
1996 27,316 2,967 39,190
1997 21,260 2,374 36,527
1998 16,642 1,984 29,261
1999 15,464 1,806 28,867
2000 13,562 1,548 26,850
2001 13,265 1,502 28,216
2002 14,545 1,510 27,895
2003 15,859 1,695 27,257
2004 15,607 1,696 27,312
2005 14,819 1,742 25,339
2006 13,775 1,603 23,538
2007 14,383 1,514 22,400
2008 17,940 1,729 18,281
2009 17,171 1,608 7,323
*MSM= men who have sex with men (term used in data source)
**IDU= injection drug users
Source: CDC HIV/AIDS Surveillance Year-end Reports 1982-2008
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