What is the history of the AIDS epidemic in the United States?

Last reviewed: September 21, 2026

The first recognized U.S. report of what became known as AIDS appeared on June 5, 1981, when CDC described five young men with Pneumocystis pneumonia. CDC adopted the term AIDS in 1982; the first commercial HIV antibody test followed in 1985, AZT in 1987 and the Ryan White CARE Act in 1990. Combination treatment, PrEP and later long-acting medicines greatly improved treatment and prevention. With effective, sustained treatment, people with HIV can live long, healthy lives.^{[1][2][11][12]}

1981–1985: naming a new epidemic

The first five cases were reported June 5, 1981^[1]. Cases climbed quickly: by August 28, 1981, CDC had 108 reported cases, 107 in men, with 40% already dead. By December 31, 1981, the U.S. had 337 reported cases of severe immune deficiency — 321 adults and adolescents and 16 children under 13 — and 130 deaths^[2].

On September 24, 1982, CDC used the term AIDS (Acquired Immune Deficiency Syndrome) and published a surveillance case definition. Its September 9, 1983 prevention guidance described the major routes of transmission then recognized and distinguished them from casual contact. FDA licensed the first commercial HIV antibody blood test on March 2, 1985, enabling blood-donor screening. Stigma persisted alongside these advances: the federal timeline records a December 1985 poll in which a majority supported quarantining people with AIDS.^[2]

1987–1995: AZT, ACT UP, and the Ryan White CARE Act

FDA approved AZT (zidovudine), the first medicine approved to treat HIV, on March 19, 1987. ACT UP formed in New York City on March 12 and held its first Wall Street demonstration on March 24, 1987. On October 11, 1988, an ACT UP protest at FDA led to 176 arrests. FDA announced faster drug-approval rules eight days later.^[2][3]

Ryan White, an Indiana teenager with hemophilia who had been excluded from school, died on April 8, 1990, aged 18. The Ryan White CARE Act became law on August 18, 1990; its first-year funding was $220.5 million. The program supports HIV medical care and essential services for people with low incomes. HRSA reports 601,853 clients served by funded providers in 2024.^[13] AIDS became the leading cause of death among Americans aged 25–44 in 1994, and 500,000 U.S. AIDS cases had been reported by October 31, 1995.^[2][4]

1995–2012: combination therapy, the ACA, and PrEP

FDA approved saquinavir (Invirase), the first protease inhibitor, on December 6, 1995.^[11] Protease inhibitors helped make effective combination treatment possible. New U.S. AIDS diagnoses declined in 1996; highly active antiretroviral therapy (HAART) became standard care in 1997. The federal timeline reports that AIDS-related deaths fell 47% in 1997 compared with 1996.^[2]

The Affordable Care Act expanded protections against denial or loss of coverage because of HIV and other pre-existing conditions in plans subject to those rules, prohibited lifetime dollar limits on essential health benefits, and created insurance Marketplaces. In states adopting Medicaid expansion, eligible low-income adults can qualify through income-based rules without first becoming disabled. An AIDS diagnosis was never the only route to Medicaid eligibility, and expansion does not apply in every state. The U.S. HIV travel and immigration ban ended January 4, 2010, and the first comprehensive National HIV/AIDS Strategy appeared July 13, 2010. FDA approved Truvada for PrEP on July 16, 2012.^[5][2]

2019–today: EHE, U=U, and long-acting medicines

The Ending the HIV Epidemic in the U.S. (EHE) initiative launched February 5, 2019, with goals of cutting new HIV infections 75% by 2025 and 90% by 2030 across four pillars — diagnose, treat, prevent, respond — starting with 57 priority jurisdictions^[6].

Evidence for Undetectable = Untransmittable (U=U) accumulated across studies: HPTN 052 reported interim results in 2011 and final results in 2016; PARTNER reports followed in 2016 and 2019. NIH publicly explained the U=U evidence in January 2019. Current NIH guidance states that maintaining a viral load below 200 copies/mL prevents sexual HIV transmission.^{[14][15][16][17][18]} Long-acting options later broadened care: Cabenuva, a complete injectable HIV treatment regimen for eligible patients, was approved January 21, 2021; Apretude, injectable PrEP given every two months after initiation, on December 20, 2021; and Sunlenca (lenacapavir) on December 22, 2022. Sunlenca is used with other antiretrovirals for certain heavily treatment-experienced adults with multidrug-resistant HIV, rather than as a complete twice-yearly treatment regimen. Yeztugo, twice-yearly lenacapavir for PrEP, was approved June 18, 2025.^{[12][19][20][21]}

HIV.gov reports an estimated 1.2 million U.S. residents aged 13 or older living with HIV at year-end 2022, including people whose infection was undiagnosed. Estimated new infections in 2022 were 31,800, 12% below 2018. Separately, CDC’s 2024 surveillance release reports 38,793 diagnoses and 4,296 HIV-related deaths among people aged 13 or older in the United States and seven territories and freely associated states. Diagnoses are not the same measure as newly acquired infections, and HIV-related deaths exclude deaths from other causes. The 2024 death data are preliminary.^[7][8]

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