Why is the AIDS Epidemic So Severe in the United States?

Michael Hobbes is a human rights consultant living in Berlin.

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Last May I wrote an article for The New Republic about how the AIDS epidemic has been way more severe in the United States than the rest of the developed world. More people have died of AIDS in New York City, for example, than Spain, Italy, the Netherlands, and Switzerland combined.

I know, it sounds like I’m making this up, that I’m reading the numbers wrong. I spent months trying to figure out what explained this huge gap.

Writing the article didn’t get me un-obsessed with this, and this winter, I started working on a video that put all the numbers and reasons in one place.

The nice thing about videos is that you can present a ton of information without having to explain each data point. Here’s the differences in death rates between US states, for example. I could only mention a few of these in my story, but I put all of them in my video.

US HIV Death Rates

And here’s one of the most major, most obvious reasons we do so poorly in keeping people with HIV alive in this country: We don’t get them on treatment early or consistently enough.

Treatment Rates cropped

But it’s not just our health care system. The virus arrived here earlier, and it spread faster. By 1995, when anti-retroviral therapy became available, the U.S. had more than 750,000 people living with HIV. Germany and Britain had fewer than 40,000.

Anyway, I’m getting carried away, it’s probably quicker if you just watch the video. One of the challenges of these explainers is that it’s easier to present data, but harder to present caveats. HIV surveillance systems differ pretty significantly across countries, and even the term ‘AIDS death’ means something different depending on which country is reporting it.

All the epidemiologists I talked to for this story told me to think of the numbers as a range, subject to updates and re-estimations as more data comes in. I don’t think I did a great job expressing that in the video. Luckily, it’s on YouTube, so I’m sure we’ll have a sophisticated methodological discussion in the comments.


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You can read more from Michael Hobbes over at his blog, Rotten in Denmark.