The human immunodeficiency virus (HIV) is the leading cause of infectious disease deaths worldwide. As of 2013, approximately 36 million patients died of HIV-related illnesses, and an estimated 35.3 million people were living with HIV infection/acquired immunodeficiency syndrome (AIDS). Although HIV exists everywhere, the vast majority of new infections (95%) occur in individuals living in low- and middle-income countries. As an example, in sub-Saharan Africa, which is the world's most affected region, nearly 1 in every 20 adults are living with HIV.1
Despite the global burden, the number of new HIV infections is falling annually, as are deaths. These improvements result from a global health strategic approach.2 In 2013, an estimated 1.3 million U.S. citizens had HIV.3 Despite the overall promising trends, the challenge of reducing new infections persists, with approximately 50,000 new cases occurring each year in the United States.
Risks associated with acquiring HIV infection include homosexuality or bisexuality, injection drug use, heterosexual exposure, receipt of a blood transfusion prior to 1985, and maternal HIV infection (risk for vertical and horizontal maternal–neonatal transmission). Rates of HIV attributable to male-to-male sexual contact increased from 55% in 2008 to 62% in 2011. Heterosexual contact accounts for approximately 28% of transmissions, followed by about 8% for injection drug use and 3% for male-to-male sexual contact and IV drug use. New HIV infection rates continue to rise among young disadvantaged minority populations (many of whom use the ED for both primary and emergency care). Although African Americans represent only 14% of the total U.S. population, this group accounted for almost half (44%) of new HIV infections in the year 2010. The rate of new infections among black men was the highest of any group by race and sex, notably in men having sex with men. Hispanics also have a higher proportion of new infections (21%) than accounted for by their relative size in the population (14%). Factors associated with the ethnic disparities in HIV include the overall higher prevalence of disease in minority populations, economic barriers that decrease access to testing and treatment, higher rates of incarceration (associated with increased concurrent relationships and higher levels of sexually transmitted infections, both of which increase likelihood of transmissions), and homophobia, which may impede HIV prevention.4 ED visits by HIV-infected individuals occur at rates higher than the general population5 due to the characteristics of the populations who use the ED, which are the same groups disproportionately affected by HIV/AIDS.
HIV is a cytopathic retrovirus that kills infected cells. The virus is labile and is neutralized easily by heat and common disinfecting agents such as 50% ethanol, 35% isopropyl alcohol, 0.3% hydrogen peroxide, or a 1:10 solution of household bleach. There are two major subtypes of HIV; HIV-1 is the predominant subtype worldwide and is the cause of AIDS. HIV-2 causes a similar immune syndrome but is restricted primarily ...