An acronym for Acquired Immune Deficiency Syndrome, AIDS describes an illness that attacks and weakens the body’s immune system, making it difficult to fight off diseases.

Thus, people with AIDS can become very ill with diseases that are rarely life-threatening for people with strong immune responses.

AIDS is caused by the Human Immunodeficiency Virus (HIV), along with probable other factors (e.g. alcohol, recreational drugs, other diseases or viruses) that lead to symptomatic illness and death. Although survival rates have increased, most HIVpositive individuals eventually develop AIDS. Individuals, however, may be infected for years without showing symptoms and may still be capable of transmitting HIV through unprotected sexual intercourse, blood-to-blood contact from sharing drug needles or blood transfusions, or from mother to child during pregnancy, labor and/or breastfeeding.

HIV cannot be transmitted through casual contact such as hugging, shaking hands or sharing cups and utensils.

In 1981, physicians in New York City and Los Angeles noted they were treating gay men for previously rare infections, calling the illness GRID (Gay-Related Immune Deficiency). The name AIDS was created in 1982 as public-health officials realized that AIDS was linked to 1970s “junkie pneumonia” deaths reported in US urban areas and was, thus, a bloodborne illness that damaged the immune system and not simply a disease of gay men.

By the 1990s, AIDS was a leading cause of death in the US. Increasing numbers of people in the US are infected through male-female sexual activity; heterosexual transmission (from men to women and from women to men) already represents the overwhelming risk factor for HIV infection in most of the world. By 1998, more than half-a-million US citizens had been diagnosed with AIDS and about 50 percent of them had died. Almost 2 million Americans are already infected with HIV. In the year 2000, there are more than 200 million HIV-infected people worldwide.

Even though first identified in the US, the vast majority of the world’s HIV-infected people live in the developing world. Studies indicate that more than 10,000 people worldwide are infected with the virus every single day. More cases of AIDS developed between 1998 and 2000 alone than the total number during the entire history of the epidemic to date. It is, therefore, clear: the decade to come will be significantly more difficult than the already difficult decade past.

The AIDS epidemic flourishes by exploiting existing societal inequalities and discrimination. Thus, the people hardest hit by the epidemic have frequently been already marginalized populations (e.g. gay men and IV drug users in the US; migrant laborers, sex workers and the poor worldwide). The epidemic’s impact only exacerbates the discrimination and marginalization experienced.

Research throughout the 1990s indicates that a vaccine against HIV infection is a long way off. Even if a vaccine becomes available, it is doubtful whether it will be widely distributed in the developing world. Additionally, there remain significant questions of legal liability for any vaccinerelated injury. Prevention strategies addressing behavior change are, therefore, absolutely imperative to stop the spread of the epidemic. In the US and worldwide, however, governments have been exceedingly slow to accept the importance of prevention to change risky sexual and drug-related behaviors. While a number of African countries, for example, have implemented government-supported condom marketing programs on radio and television, the US government and national mass media consistently reject any frank public discussion of condoms or sexual behavior.

Rock Hudson’s death from AIDS in 1985 brought the disease to the attention of the mainstream American public. Despite the ravages of the epidemic both in the US and globally however, it was not until 1987—more than six years after the disease was identified—that US President Ronald Reagan even uttered the word “AIDS” in public.

Clearly, a disease that primarily affected stigmatized populations was not worthy of significant government attention—or funding. Earvin (Magic) Johnson’s disclosure in 1992 that he was HIV-positive helped to increase popular awareness of the extent of the epidemic; political will, however, has yet to follow.

AIDS has been the galvanizing force behind a new generation of political and social activists. Building on the foundations of the women’s movement and gay and lesbian activism, ACT UP (the AIDS Coalition to Unleash Power) used dramatic demonstrations and civil disobedience to call attention to the epidemic and force the government—and the medical and pharmaceutical establishments—to be more responsive to those with HIV and those at risk of infection. In the early 1990s, the US Supreme Court ruled that laws preventing discrimination based on disability include people with AIDS.

Despite political resistance, a lasting positive legacy of the epidemic may be increased societal openness in discussing sex, sexual decision-making, and gay and lesbian life.

With the increased visibility of gay people, however, has come an increase in reported anti-gay hate crimes. The generation of young gay people coming out in the age of AIDS has the advantages that come with increased visibility and acceptance, coupled with a life-threatening illness and escalating rates of anti-gay violence.

Intense political and social debates continue around issues such as: mandatory testing for HIV; government reporting of names of HIV-infected individuals; contact tracing for partners of HIV-infected individuals; criminal punishment of HIV-positive individuals who engage in behavior that could transmit the virus; public and private insurance coverage for AIDS-related medications and illnesses; access to approved and experimental treatments; and the continued inadequacy of government funding for AIDS treatments and prevention. In the late 1990s, improved treatments became available which, for the first time, slowed the epidemic’s death rate in the US. These treatments are, however, very expensive and often not within the reach of the poor in the US or worldwide.