About 107 million copies of a booklet were sent to American households 25 years ago, the initial act of the first official HIV/AIDS education campaign coordinated by the U.S. Surgeon General.
That same year, the first needle-exchange program was established in Tacoma, Wash., and the National Institutes of Health created the Office of AIDS Research, according to aids.gov.
It's been 25 years since World AIDS Day was established as Dec. 1. Since then, the treatment has drastically increased for a disease that was first reported in the U.S. in 1981. The prognosis has shifted from a death sentence to manageable with treatment.
"Today, a person with HIV infection who is on treatments can expect to live a fairly normal lifespan, so that's a tremendous difference," said Colin Flynn, the Maryland Department of Health and Mental Hygiene chief of the center for HIV surveillance, epidemiology and evaluation.
But there's more that can be done, a message that's intrinsic in this year's World AIDS Day theme, Shared Responsibility: Strengthening Results for an AIDS-Free Generation.
There are several problems that need to be addressed to get closer to this goal, Flynn said. The first begins with diagnosing those infected, as nearly 1 in 5 people with HIV don't know they have it, according to the Centers for Disease Control and Prevention.
In Maryland, more than 28,000 people are living with HIV or AIDs as of Dec. 31, 2012, and an additional 6,250 state residents are unaware that they have the virus, according to DHMH. And unbeknownst to them, they may be infecting others.
After testing, the next step is treatment. Medicine can reduce the amount of the virus that circulates through one's blood, which essentially suppresses the amount of the virus in the body. Thus, the person is healthier, and their risk of infecting others is smaller, Flynn said.
"Twenty-five years ago, we didn't have good treatment," he said. "Now, we are using treatment as prevention."
In 1994, Baltimore introduced a needle-exchange program, in which residents can receive clean needles in return for old syringes. This helps decrease intravenous transmission of the disease. More than 9 million clean syringes have been distributed - and at least 10 million used ones collected - since the program's inception, according to the Baltimore City Health Department.
In Maryland, the number of AIDS-related deaths dropped dramatically between 1996 and 1998, as a new class of medication was released that expanded life expectancy from months to years, Flynn said.
In a continuing effort to fight HIV's spread nationwide, the White House released the first National HIV/AIDS Strategy in July 2010, the first comprehensive HIV/AIDS plan with measurable targets to be completed by 2015, according to aids.gov. It includes three main goals: decreasing the number of new HIV infections, increasing access to care and reducing HIV-related health disparities.
In Maryland, that's sorely needed, as Washington, D.C., and the Baltimore-Towson region are two of the disease's largest hotspots in the U.S., coming in fifth and sixth, respectively, for highest rate of new diagnoses in a metropolitan area, according to the Centers for Disease Control and Prevention.
The Baltimore-Towson area includes Carroll, Anne Arundel, Baltimore, Harford, Howard and Queen Anne's counties and Baltimore City.
Maryland's rate of diagnosis was almost 31 cases per 100,000 people in 2011, the latest data available. That makes it the third-highest rate among states and territories, behind Washington, D.C., and the Virgin Islands, according to the CDC.
About 124 residents age 13 and older are living with HIV in Carroll as of Dec. 31, 2010, the latest data available, according to DHMH. About 65 of those cases have developed into AIDS, which is the final stage of HIV in which the immune system is badly damaged.
The disease can be transmitted sexually, through unclean needles, from a mother to her unborn child and other such methods, the CDC reports. Because of this, the virus that was, for a time, called GRID - gay-related immunodeficiency - was and still can be looked down upon by society.
"HIV has always been heavily stigmatized," Flynn said, "and that has probably lessened over time, but it has not gone away."
Sometimes, that can prevent people from getting tested.
"What we often hear from people is that they're afraid to find out because they won't be able to let their family or their co-workers know that they're infected," Flynn said.
But testing is important for not only the individual but for the health of the community as well. All adults should be screened at least once in their life, according to Flynn, and annual tests are recommended for those who fall into the risk categories.
The Carroll County Health Department offers free, confidential testing from 9 a.m. to 1 p.m. every Monday. Additionally, it holds HIV-positive clinics for a fee with a Johns Hopkins clinician the first Tuesday and third Wednesday of every moth.
While dramatic medical advances have been made since HIV's introduction to the United States, the spread of the virus hasn't stopped. And treatment and awareness can lead to less transmissions.
"Our message now is that people should get tested, and if they're at risk they should be tested frequently," Flynn said, "and if they are infected then they should get treatment because treatment works."
