The modern acquired immunodeficiency syndrome (AIDS) epidemic was first recognized in the United States in early June 1981, when clusters of rare opportunistic infections were reported in young gay men in Los Angeles and other cities. Before the cause was understood, it was commonly called “GRID” (gay-related immune deficiency). In popular and some medical discussions, it was also referred to as the “gay plague,” “gay cancer,” and similar gay-specific labels. The term AIDS was adopted by the Centers for Disease Control and Prevention (CDC) in 1982.

According to data compiled by the U.S. CDC, the World Health Organization (WHO), and the Joint United Nations Programme on HIV/AIDS (UNAIDS), just over 774,000 new AIDS cases were reported in the United States from 1981 through 2000. Incidence and mortality increased rapidly through the 1980s, peaked in the early 1990s, and then declined as better treatments and preventative programs emerged. However, approximately 1.2 million people in the U.S. are still living with human immunodeficiency virus (HIV), and about one in eight do not know it.

Globally, new HIV infections also peaked in the mid-1990s at about 3.4 million per year and then declined to about 1.3 million by 2024. In 2022 and 2023, about 630,000 individuals died of AIDS-related causes. As in Western countries, the decline in world deaths reflected improved prevention and better treatments.

In 2023, there were 39,200 new HIV diagnoses among people aged 13 and older in the U.S. plus six territories, with half of these diagnoses in the lower-population states of the American Southeast. About 4,500 individuals died of HIV that year, again concentrated in the American Southeast.

Comparisons to measles

Now let us compare numbers with the measles “epidemic.” From January 1 to March 19, 2026, 1,487 confirmed measles cases were reported in the United States. Five states accounted for most of these cases:

• South Carolina (several hundred)
• Utah (>100)
• Texas (>>100)
• Florida (“dozens”)
• Arizona (“several dozen”)

These numbers project approximately 7,000 yearly total cases compared to about 30,000 for HIV. Interestingly, these states are both among the lower-population U.S. “red” states of the Southeast, and among those where vaccine resistance of all kinds is highest. This association does not appear to the author to be coincidental.

It says something quite profound about stigma and public attitudes toward non-heterosexual individuals, that this epidemic is 40 years later still largely “hidden” from public discussion in mainstream media, and from government investment support in many jurisdictions. These trends are evident from any search of published literature on the subject. From multiple sources, for instance, we learn that:

• Mainstream U.S. news outlets devote far less attention to HIV/AIDS today than they did at the height of the epidemic in the 1980s and early 1990s, even though the disease persists.
• A large content analysis for the Kaiser Family Foundation found that HIV/AIDS coverage in major U.S. newspapers and television (TV) news “increased during the early 1980s, peaked in 1987, and declined steadily through 2001,” dropping from over 5,000 stories in 1987 to fewer than 1,000 in 2002 in the outlets studied. Another longitudinal study of mainstream press reported that the average monthly number of HIV/AIDS news stories fell from about 578 per month in 1993 to about 140 per month in 2007, roughly a 76 percent decrease in coverage. In 2024 to 2025, there has been a continuing sharp decline in HIV representation in scripted media, with only one lesbian, gay, bisexual, transgender, and queer (LGBTQ) character living with HIV on prime-time television during the 2023 to 2024 season, down from eight in the previous year.
• Researchers and analysts have suggested that declining news coverage paralleled, and likely contributed to, a drop in the share of Americans who saw HIV/AIDS as the nation’s most urgent health problem, from about two-thirds in 1987 to well under one-fifth by the early 2000s. Compared with the intense, front-page, nightly-news presence HIV/AIDS had in the 1980s, today it appears far less often in mainstream coverage, even though new infections and deaths continue globally and in the U.S.

SYNC-2026: Synchronicity

The author recently spent three days at SYNC-2026, the largest harm reduction conference ever held in the U.S., in Arlington, Virginia, focused on HIV/AIDS and related issues. For three days in March, expert clinicians, patient advocates, and public health activists presented deeply researched papers and shared the history and current trends of this hidden epidemic to an audience of several hundred, including at least one U.S. congressman who is a medical doctor (MD).

At this event, the author also presented an invited paper characterized as follows in the conference schedule: “An Indictment of U.S. Public Health Policy on Pain and Addiction Management,” addresses the intersection of issues in health equity and justice, versus health advocacy and policy, to identify and contradict the significant misdirection and fatal errors of science in recent opioid prescribing guidelines of the U.S. CDC and Veterans Administration, with a critical review of published clinical and demographic data on safety and effectiveness of prescription opioid pain relievers.

The presentation offered a focused emphasis on the contrasts between official U.S. government public health policy versus validated and highly contradictory science from multiple published sources. It also filled a 60-seat studio to standing-room-only capacity for a 20-minute presentation followed by 30 minutes of interactive questions and answers. Observations of this presentation and from the author’s other published work can be condensed to three bottom lines:

• The incidence of moderate to severe opioid use disorder (OUD) among patients managed for pain by a clinician in an ongoing face-to-face relationship, is reliably estimated at one to two patients per thousand who are treated with opioid pain relievers.
• In the relatively rare cases where a clinical patient is hospitalized for overdose or attempts or succeeds in suicide, mental health factors are from four to 24 times more significant as predictors of elevated risk within the first year following treatment, than is exposure to prescription opioids.
• Clinicians prescribing to their own patients were never responsible for the so-called “opioid crisis,” and are not now sustaining it. This role properly belongs to illegally imported, manufactured, or diverted drugs purchased in street markets. Thus, the entirety of current U.S. health care agency policy, founded on fundamental misinformation and scientific errors, is both scientifically and ethically wrong.

During the presentation, many audience heads nodded in agreement. During questions and answers (Q&A), not one uninformed or hostile question was offered. The same has likewise been true during the past 10 years of the author’s advocacy on behalf of patients and their doctors.

Comparing policy for chronic pain versus harm reduction for HIV

Parallels between the hidden epidemic of HIV/AIDS and a similarly hidden epidemic of chronic pain in America cannot be escaped. Over 20 million Americans live with daily high-impact pain. But clinical and popular literature are saturated with stigmatizing messages to the effect that opioid pain relievers are instantly addictive for a high percentage of patients and should be eliminated from medical practice. It is frequently but falsely claimed by law enforcement authorities that doctors who prescribe opioid pain relievers are violating accepted practice standards and should be sent to prison (paraphrased from multiple sources).

None of these stigmatizing messages are accurate to science.

From the HIV/AIDS side of this comparison, similar anti-scientific misinformation and stigma also prevail. We now know that HIV is not a disease of only gay men, lesbians, transgender people, and prostitutes, and it never was. Nor is it a consequence of immoral sexual practices. Mother Nature and Father Time program human beings for diversity, not uniformity. Evidence from genetics, twin studies, evolutionary biology, and large population surveys all point to human sexuality being naturally diverse, not genetically “designed” for uniform heterosexuality.

Finally, we know that in an age of pre-exposure prophylaxis (PrEP; medication taken before possible exposure to HIV to greatly reduce the chance of becoming infected) and effective post-infection medications that drive viral counts to zero, that contracting HIV from someone who has it is no longer inevitable. Nor is death inevitable for those who have contracted HIV. With modern antiretroviral therapy (ART), many people with HIV now live into their 70s and 80s, especially if they are diagnosed early and stay on effective treatment.

Thus, as the author has written in many other contexts, present U.S. health care agency policy on both HIV and chronic pain are simply insane. And it is time for the madness to end.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.