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As I write, the cumulative total number of reported AIDS cases in the United States hovers at about 400,000. By the end of 1993, about 61 percent of all individuals who had been diagnosed with AIDS since its biomedical identification were dead (CDC1994a).AIDSisthe third leading cause of death among U.S. men and women aged twenty-five to fortyfour ; it is the ninth leading cause overall (CDC1993d). Most of the people who are now suffering from AIDS were infected years ago with Human Immunodeficiency Virus (HIV), the virusassociated withAIDS. Today, between 550,000 and 1,000,000 U.S. residents are HIV positive (infected). The higher estimate, itself a downward correction for a 1986 Public Health Service estimate that up to 1,500,000 individuals harbored the virus, was arrived at during a workshop in 1989 (CDC 1990), and will remain the "official" Centers for Disease Control and Prevention (CDC) figure until the results of a 1994 workshop are announced. The lower estimate comes from an analysis of the first three years of data collected in a six-yearnational household surveycarried out between 1988 and 1994 under the auspices of the National Center for Health Statistics (NCHS). The survey, called the National Health and Nutrition Examination Survey, collects data on numerous health topics using blood testsand other techniques (McQuillan et al. 1994). The NCHS finding, which is about half the official CDC estimate, suggested to manyresearchers that HIV infections—and soAIDScases— are not increasing as quickly as experts originally thought they would. But others point out that the surveydid not cover people who do not live in private households, so prisoners, the homeless, and people who were hospitalized at the time of the study—people who are generally at an increased risk for HIV infection —are not represented in the figure given. Geraldine McQuillan, who oversawthe HIVdata collection and analyses, suggests that, had these people been included, the figure might have been 600,000 rather than 550,000 (personal communication). She also Chapter 2 Women andAIDS in the United States notes that the NCHS figure of 550,000 represents a mid-range point in a carefully calculated interval estimate, and points out that confidence limits were large enough so that the top margin of the interval or range hit the CDCone-million mark (see McQuillan et al. 1994). When the results of the 1994 HIVprevalence workshop are made public , it is expected that the official CDC estimate will be lowered (Ron Wilson, NCHS, personal communication). For now,however, abest guess might place the number of HIV-positiveindividuals in the United States somewhere between the current CDC estimate and the NCHS figure. That is,perhaps about 750,000 U.S. residents, orjust under one in three hundred andfifty,are infectedwith HIV. But because of the nature of the pandemic it isvery hard to know for sure. HIV-positive U.S. residents currently account for about 5 percent of the fifteen million individuals worldwide who, according to a report issued by the World Health Organization (WHO) in early 1994, are infected with HIV (one million of these infections are in children). U.S. AIDS cases represent only 13 percent of the three million people worldwide who have AIDS or have died from it (WHO 1994). This chapter briefly describes the pandemic that has caused somuch death and suffering , focusing in particular on the effects that AIDS has on U.S. women's lives. (For an overview of the global situation for women, see De Bruyn 1992; Gupta and Weiss 1993; see also Mann et al. 1992.) HeightenedAIDS Risks Social-Structural Factors: An Overview History has shown that HIV is not a discriminating virus: one human body is as good as the next as long as there is an easy wayto enter it.Once: an individual has been infected and has seroconverted (become HIV positive), the virus slowly effects the collapse of the immune system, resulting in AIDS. Upon being diagnosed with AIDS, the average remaining life span for whites is between eighteen and twenty-fourmonths; for Blacks it is six months (Lester and Saxxon 1988). This discrepancy suggests that, unless the inbuilt immune systems of Blacks are radically different from those ofwhites,which they do not appear to be, AIDSis more than just a biological event. Biologically, all HIVwants is awarm human body in which to thrive and reproduce. So, conceptually at least, every human being is at risk for HFV infection and AIDS. Nonetheless, behavioral, environmental, and gender-linked...

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