On June 5, 1981, the Centers for Disease Control and Prevention reported a rare lung disease as the cause of death in five, seemingly healthy, gay men in Los Angeles. Today, we know with the virus that made them susceptible to that type of pneumonia—it became a hallmark symptom of AIDS—and the story of the 30 years that followed. But during the first nine years of the U.S. AIDS epidemic, as many as 150,000 people were newly infected with HIV per year as public-health experts and government alike struggled to understand what they were up against.
As now, there was no vaccine then to prevent the incurable infection that destroys the immune system. But beginning in the 1990s, researchers began developing the dozens of drugs that have transformed HIV from a death sentence into a chronic but manageable infection. And in recent months, the same drugs have been shown to help prevent infection.
It was not until passage of the Ryan White CARE Act of 1990 that significant federal legislation took aim at HIV. The measure is named after a teenage boy who was expelled from school after contracting HIV through a blood transfusion and went on to become the poster child for an epidemic that was breaching demographics. The legislation pumped $220.5 million into community-based treatment facilities across the country.
John Peller, vice-president of policy at the AIDS Foundation of Chicago, watched the effect of the initial CARE Act as it “absolutely transformed people’s lives.” Since then, however — through three CARE Act reauthorizations, allocations for research funding, federal programs, and creation of a Presidential Advisory Council on HIV/AIDS — Peller said he has witnessed little change in the rate of new infection. CDC estimates that 56,000 Americans will contract the disease this year, roughly the same number it's been reporting since 1996.
What’s more, as treatments help HIV-positive patients live longer, the number of Americans living with the disease has risen -- up 46 percent from 1996 to 2006. CDC estimates more than a million Americans are infected – and nearly a quarter do not even know it, because they have not been tested.
Some legislation may have hurt prevention efforts. The late Sen. Jesse Helms, R-N.C., worked to ban any efforts in schools to teach HIV prevention that may “promote or encourage, directly or indirectly, homosexual activities.” Social conservatives have battled efforts to education about the use of condoms, which can greatly reduce the chance of infection through sexual contact if used consistently. And controversy over needle-exchange programs prevented federal funding from reaching the streets of Washington, home of the highest AIDS rate, until 2009.
President Obama’s most recent initiative, the National HIV/AIDS Strategy Plan, is the most comprehensive approach targeting the disease to date, but many like Peller say it lacks the funding to be effective.
It may also be that, try as Congress might, human behavior is the biggest predictor of infection rates. The graphic below tracks countless federal efforts to curb HIV infection rates over the course of the 30 years America has known the disease.