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Overview: Impacted Populations



  • Early in the epidemic, AIDS in the developed world was closely associated with the subgroups in which it was initially identified, particularly gay men, injecting drug users, hemophiliacs, and recipients of blood transfusions. However, it is now understood that HIV transmission is related to behaviors rather than to membership in any particular class, category, or group.

  • Nonetheless, because some risk behaviors are disproportionately common among members of certain groups, the level of HIV infection has remained higher in some subpopulations than among the general population.

  • Infection rates also remain higher in certain subpopulations because the members of many of these groups tend to interact with one another more than with those outside the group. Thus, when members of these subpopulations engage in risk behaviors, they are disproportionately likely to encounter sexual or drug-using partners who are HIV-positive.

  • While HIV/AIDS affects every individual differently, certain patterns can be discerned in its overall medical and social impact. These patterns correlate to certain characteristics such as gender, age, race/ethnicity, sexual orientation, occupation, income, and place of residence.


Coverage in the Encyclopedia

The entries on Impacted Populations focus on the major social groupings that have been affected by the HIV/AIDS epidemic in a distinct and identifiable manner. Any given individual may belong to several different categories (e.g., age, gender, race/ethnicity), and many entries discuss important intersections between categories (e.g., African American gay men, Latinas living in poverty, etc.). The entries tend to focus on groups in the United States, but much of what is discussed may be generalized to similar groups elsewhere, particularly in other parts of the developed world. Specific impacted populations outside the United States are discussed in the entries on the various world regions.

Many of the individuals in these populations may be associated with particular behavioral risks for HIV infection, which are covered above in the section on "Transmission and Prevention."

Other entries in this section relate to prejudicial social attitudes toward specific groups. These attitudes may influence the way in which members of these groups experience the HIV/AIDS epidemic and the way in which they are treated by society at large.

Entries on Impacted Populations

African Americans
Asian and Pacific Islander Americans
College and University Students
Developmental Disabilities, People with
Disabilities, People with
Emergency Workers
Gay Men
Health Care Workers
Hemophilia, People with
Heterosexual Men
High School Students
Homeless Populations
Injecting Drug Users
Mental Illnesses, People with
Suburban and Rural Populations
Sex Work
Transgendered People

Entries on Social Attitudes

Gender Roles
Public Opinion


Perspectives on the AIDS Epidemic: Impacted Populations

Life in the Maelstrom: Living and Working Amid the AIDS Epidemic

The landscape of my life, personal history, memories, and dreams are all littered with the corpses and ghosts of loved ones, clients, colleagues, and fellow members of my tribe and community who have died in this plague. Being a middle-aged, HIV-positive gay man living and working as a psychotherapist in Manhattan's Chelsea neighborhood -- a ground zero of the AIDS epidemic in North America -- there is no way it could be any different. I clearly remember that morning in July 1981, walking back to my house in the, unknowingly, already stricken Fire Island Pines, reading that ominous first story about a rare cancer affecting gay men in Los Angeles and New York. My immediate reaction was anger and skepticism. I dismissed the news story as some kind of hysterical, homophobic hype perpetuated by the medical establishment and the media in an attempt to frighten gay men into conforming to mainstream sexual norms.

How naive and oblivious all of us were, not knowing that an infectious agent had already begun its deadly journey, spreading through hundreds of thousands of people, framing our lives. Since the early 1980s, when AIDS began to decimate the gay community, I have been surrounded by illness, death, and grief.

The first few deaths of my friends and clients were terribly traumatic. Even as I grieved and went to the funerals and memorial services, I grew angry and frustrated that these men's lives had been cut short. Some of them were tremendously gifted and creative, and the loss seemed unspeakably tragic. Among those who passed away was my oldest brother, Henry, who died in my apartment in 1984. My best friend and colleague in private practice, Luis, died of AIDS in 1989. Six men in my apartment building died of AIDS in the early 1990s, as have more than 100 of my clients, while dozens more are now symptomatic or in the hospital. In late 1994, four of my closest friends and, hardest to bear, my beloved partner, Lee, died of AIDS. As a 45-year-old AIDS widower who has been infected with HIV since the 1970s but remains healthy on a combination of antiviral drugs, I do not have the luxury of assuming that I am living through the middle, rather than the twilight, of my life.

All this has been nothing like what I had expected when training to be a psychotherapist. Back then, I had certain young and hopeful ideas about the potential of human beings, within a normal lifespan, to grow in self-awareness. My job, as I saw it then, was to help them make changes that would allow them to lead happier lives. But by the mid-1980s, I suddenly found myself with a clientele made up largely of gay men who were either symptomatic with AIDS or anticipating the onset of symptoms, many of them under the age of 40.

This required me to learn a whole new set of coping and clinical skills. All I really knew about counseling clients and their families at the end of life was Elisabeth Kubler-Ross's work on the stages of death and dying. Back then, I remember being surprised and annoyed when my friends or clients refused to follow the predictable, linear pattern she had laid out.

Without realizing it, I romanticized death and unconsciously glorified each of the dying people I knew either personally or professionally. I wanted to see them as noble and worthy of my care because of their nearing death, and I was constantly brought up short because people die in character. I did not yet want to see that a self-involved man who became sick with AIDS might very well handle his illness narcissistically and die the way he had lived, thinking only of himself. I had to learn that I was not going to like someone simply because he was dying, and that death does not necessarily transform people for the better.

Hollywood has pumped us up with a sanitized, sentimental version of death. Everyone is gathered around the dying person's bedside. Fences are mended, old wounds patched up. Then the dying imparts a last jewel of wisdom before a gentle closing of the eyes. There is no shrieking with fear, no groaning from intolerable pain, no dying alone in an impersonal hospital bed, no homophobia. I have seen otherwise supportive families have a hard time with an AIDS-related death. Lee's parents would not come to see him before he died. They could not bear to see their beautiful, 32-year-old son wasting away, so they put their own needs before his. This does not make them bad. It is just a sad fact that we do not always rise to the occasion, even when we are confronted with the finality of death.

Over the years, burnout has turned into gratitude that I am alive. Every day, I seek to be as viscerally and emotionally present as possible. Why waste a minute? I find my work especially meaningful. What a gift it is to be able to connect in this extraordinary way with so many good souls! So instead of feeling in jeopardy of burning out, I am thankful to have had the privilege of accompanying Lee, friends, and clients on the last journey of their lives. I have twice been the last surviving individual coordinating care for a dying friend. Luckily I am making new friends, and a few of my very old friends are not infected. Yet I still worry at times that when my time comes there will not be anybody left to care for me. Is this paranoia, or a completely rational fear in the face of this neverending plague?

When I work with clients with HIV/AIDS, I try to help them find a hope that is balanced by a realistic acceptance of what is happening to their bodies and lives. And this is exactly what I must try to do each day in my own as well.

Michael Shernoff

The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.

Encyclopedia of AIDS $25 US/832 pp/Illustrated

For more about this book, or to order, click here.

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It is a part of the publication The Encyclopedia of AIDS.