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HIV Since the first AIDS cases were reported in 1981, through mid-1994 more than 402,000 AIDS cases and more than 241,000 deaths have been reported in the United States alone. This is only the tip of the iceberg of HIV infection, however. It is estimated that nearly 1 million Americans had been infected with the virus through the mid-1990s but had not yet developed clinical symptoms. In addition, although the vast majority of documented cases have occurred in the United States, AIDS cases have also been reported in almost every country in the world. Sub-Saharan Africa in particular appears to suffer a heavy burden of this illness. No cure or vaccine now exists for AIDS. Many of those infected with HIV may not even be aware that they carry and can spread the virus. Combating it is a major challenge to biomedical scientists and health-care providers. HIV infection and AIDS represent among the most pressing public-policy and public-health problems worldwide. COSTS I think that the AIDS epidemic is having a profound impact on many aspects of medicine and health care. The U.S. Public Health Service estimates that in 1993, the lifetime cost of treating a person with AIDS from infection to death is approximately $119,000. Outpatient care, including medication, visits to doctors, home health aids, and long-term care, accounted for approximately 32 percent of the total cost. Persons exposed to HIV may have difficulty in obtaining adequate health-insurance coverage. Yearly AZT expenses can average approximately $6,000, although in 1989 the drug's maker did offer to distribute AZT freely to HIV-infected children. The yearly expense for DDI is somewhat less at $2,000. Therefore, if the AIDS epidemic is not controlled, its cost to American taxpayers will become overwhelming. I feel that the effects of the epidemic on society at large are increasingly evident. AIDS tests are now required in the military services. Various proposals have been made for mandatory screening of other groups such as health-care workers. A number of nations, including the United States, have instituted stringent rules for testing long-term foreign visitors or potential immigrants for AIDS, as well as testing returning foreign nationals. In the United States one frequent phenomenon is the effort to keep school-age children with AIDS isolated from their classmates, if not out of school altogether. Governmental and civil rights organizations have countered restrictive moves with a great deal of success. There is little doubt in my mind that the ultimate physical toll of the AIDS epidemic will be high, as will be its economic costs, however the social issues are resolved. Concerted efforts are under way to address the problem at many levels, and they offer hope for successful strategies to combat HIV-induced disease. Politics and AIDS In the United States, I feel that AIDS provoked a grass-roots political response, as well as government action. First evident in urban gay men, AIDS moved an already politically organized gay community to create service, information, and political organizations, such as Gay Men's Health Crisis (GMHC) and AIDS Coalition to Unleash Power (ACT UP). Those groups have lobbied the federal government for funding and favorable policies. ACT UP was formed in 1987 to urge speed in drug approval and to protest high prices for AIDS drugs. By successfully promoting reforms, ACT UP and other advocates have provided a model for other disease groups, particularly breast cancer advocates. During the 1980s, AIDS groups accused the government of neglecting its duty in responding to AIDS. Critics cite government reluctance to promote condom use as a prevention method, and the fact that President Ronald Reagan did not mention AIDS publicly until April 1987, six years after the epidemic began. The epidemic's spread to people of color, often drug users and their intimates, introduced race into the politics of AIDS. Competition for funding and influence arose between gay and minority groups. Disagreements emerged about prevention methods, in particular needle exchange

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