AIDS: Transmission and Incidence

HIV is not transmitted by casual contact; transmission requires a direct exchange of body fluids, such as blood or blood products, breast milk, semen, or vaginal secretions, most commonly as a result of sexual activity or the sharing of needles among drug users. Such a transmission may also occur from mother to baby during pregnancy or at birth. Saliva, tears, urine, feces, and sweat do not appear to transmit the virus. Since 2010 several studies have shown that transmission of HIV is significantly reduced to individuals who take antiretroviral drugs prophylactically. In 2012 the Food and Drug Administration approved a pill that combines two antiretroviral drugs, tenofovir and emtricitabine, for use in preventing HIV infection, and in 2014 the Centers for Disease Control and Prevention called for the regimen to be prescribed to individuals at risk for infection.

By 2015 it was estimated that some 36.7 million people were infected with HIV worldwide, the great majority in Third World countries; more than 30 million had died from AIDS. The disease in sub-Saharan Africa, which has been especially hard hit, in the main has been transmitted heterosexually and has been exacerbated by civil wars and refugee problems and less restrictive local mores with regard to sex. Some 25.5 million people were infected with HIV in this region, where, in many countries, the prevalence of AIDS has lowered the life expectancy. Nonetheless, the spread of the disease had slowed somewhat during the previous decade; an estimated 3.2 million new HIV infections occurred in 2001, but only 2.1 million in 2015.

In the United States, the demographics of AIDS have changed over time. In the 1980s it was seen mainly in homosexual and bisexual men and was one of the spurs to the gay-rights movement , as activists lobbied for research and treatment monies and began education and prevention programs. Also in the early years, before careful screening of blood products was deemed necessary, the virus was contracted by an estimated 9,000 hemophiliacs (see hemophilia ), and a small number of people were infected by surgical or emergency blood transfusions. Before long, however, the majority of new HIV infections were seen in drug users who contracted the disease from shared needles or unprotected sex; a large proportion of infected women were drug users or partners of drug users. Since the early 21st cent., however, the majority of new cases again have been in homosexual and bisexual men. Nearly a third of the infants born to HIV-infected women are infected with the virus. (Some of these infants test positive for AIDS only because of the mother's antibodies and later test negative.) In general, the number of new infections in the United States has diminished significantly since the mid-1980s, when they were estimated at 130,000 a year. Although annual infections increased somewhat during the late 1990s from the lows reached in early 90s, they subsequently leveled off and again began decreasing, to less than 40,000 in 2015.

The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.

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