AIDS turns 20
(CNN) -- Twenty years ago, AIDS made its medical debut in the United States as a disease that primarily struck gay men. The politically organized gay community mobilized against it, stressing education and prevention through safe sex, eventually lowering their transmission rate. But the AIDS virus -- known for its ability to mutate rapidly within its victims -- also managed to alter the demographic profile of those it infects.
"During the past 10 years, the HIV/AIDS epidemic in the United States has undergone a dramatic transformation from one concentrated primarily among homosexual men to an epidemic that is now closely associated with the inner city," said David Bloom, professor of economics and demography at Harvard University's School of Public Health.
"Low levels of education, high levels of multiple sexual partnering, high rates of homosexuality/bisexuality and high rates of injecting drug use account for the relatively high rate of new infections among blacks and Hispanics in the U.S.," Bloom said.
The national Centers for Disease Control and Prevention (CDC) estimates that 800,000 to 900,000 people in the United States are currently infected with HIV, the virus that causes AIDS. Each year, another 40,000 people become infected.
More than 36 million people worldwide are living with HIV or AIDS
Although African-Americans make up 13 percent of the U.S. population, they represent 54 percent of the new HIV infections. Hispanics, who represent about 12 percent of the population, account for 19 percent of the new infections.
"It's devastating," said Teresa Holmes, a spokeswoman for the Balm in Gilead, a New York-based organization that works with African-American churches to provide training and assistance for HIV/AIDS programs.
AIDS is the No. 1 cause of death for African-Americans aged 25-44, according to the CDC.
"One in 160 black women is infected with HIV and one in 50 black men," Holmes said. "It's not just the inner city, and it's not just the poor that are affected. You could almost lose or wipe out generations."
Thirty percent of gay black men in their 20s are infected with HIV, compared to 7 percent of white gay men, according to a recent CDC study of six large U.S. cities.
An African-American woman is 20 times more likely to contract AIDS than a white woman. African-American adolescents accounted for more than 60 percent of AIDS cases reported in 1999 among 13- to 19-year-olds.
Human and economic toll
"AIDS has a huge impact, not just in human terms but also in economic terms," Bloom said. "First, there are lots of AIDS cases. Second, because the lion's share -- 80 percent to 90 percent of all AIDS-related illnesses and mortality -- occurs among people in their 20s, 30s and 40s, which are the years when people are most productive and save for later in their lives. And finally, because the opportunistic infections that accompany AIDS are so very expensive to treat."
While the United States as a whole may be able to absorb the cost of HIV/AIDS in a relatively small percentage of its total population, some countries face a far grimmer prospect.
The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that out of the 36.1 million people infected with HIV worldwide, 26 million of them live in Africa. One fourth of the adults in South Africa are believed to be living with HIV, the highest percentage in the world.
'None of us are insulated'
One fourth of adults in South Africa are believed to be infected with HIV
The rest of the world cannot afford to ignore Africa's problem, Bloom warned.
"In a global economy, none of us are insulated. The African AIDS crisis previews what potentially awaits the businesses and other economies that are more significant in the global economy like India, Brazil, China and Russia."
"The U.S. government now believes that HIV is a security threat," said Mark Feinberg, a professor at Emory University School of Medicine and an AIDS researcher since 1984.
"In sub-Sahara Africa whole generations are basically disappearing. That is going to give rise to substantial disruptions in social interactions and economic structures. Societies can only deal with a certain amount of disruption before they collapse."
U.N. Secretary-General Kofi Annan has called for creation of a "war chest" of $7 billion to $10 billion a year to prevent and treat HIV/AIDS in the developing world.
Even if other countries respond generously to Annan's plea, the HIV/AIDS problem will not disappear soon, experts say.
"It's going to have a long lasting impact on the human race," Feinberg said. "AIDS is going to change the course of human evolution. There's no doubt about that. When you have a disease that affects so many people and some people have systems better able to respond to it, that's how evolution works. It is so enormous that even for someone like myself who's been involved in it for 17 years, it is impossible for me to truly conceive of the magnitude of the epidemic."