High-income countries

In high-income nations, HIV infections have historically been concentrated principally among injecting drug users and gay men. These groups are still at high risk, but heterosexual intercourse accounts for a growing proportion of cases. In the United States, more than a quarter of people diagnosed with HIV in 2006 were female, and more than three quarters of these women were probably infected as a result of heterosexual sex. In several countries in Western Europe, including the United Kingdom, heterosexual contact is the most frequent cause of newly diagnosed infections.

Very early in the epidemic, once information and services for prevention had been made available to most of the population, the level of unprotected sex fell in many countries and the demand rose for reproductive health services, HIV counselling and testing and other preventive services. However prevention activities are now lagging behind as the epidemics move beyond their traditional at-risk groups.

Prevention work in high-income countries has declined, and sexual-health education in schools is still not universally guaranteed, in spite of the fact that the risks of HIV are well-known to governments. Political factors have been allowed to control the HIV prevention work that is done, and politicians are commonly keen to avoid talking about any sexual issues. Furthermore, it is very hard to show that a number of people are not HIV positive who otherwise would be – and politicians like the electorate to see results.

Among gay men, the virus had spread widely before it was even identified and had established a firm grip on the population by the early 1980s. With massive early prevention campaigns targeted at gay communities, risk behaviour was substantially reduced and the rate of new infections dropped significantly during the mid- and late 1980s. Recent information suggests, however, that risky behaviour may be increasing again in some communities. People think that the danger is over because of lack of media coverage of the issues around HIV and AIDS - and many new infections continue to occur.

Some communities and countries have initiated aggressive HIV prevention efforts, particularly among high-risk groups such as injecting drug users. But in many places the political cost of implementing needle exchange and other prevention programmes has been considered too high for them to be started or maintained. As a result, there are continuing high prevalence rates among injecting drug users in many high-income countries, particularly Italy, Spain and Portugal.

Many high-income countries suffer from the belief that HIV is something that affects other people, not their own populations. On a national level, this belief prevents policy makers and budget setters from seeing the epidemic on their own doorsteps, looking instead to the situation in areas such as Africa. Some high-income countries fund medication provision for low-income countries whilst failing to provide medicines for their own citizens who have AIDS. For example, many people cannot afford HIV treatment in America.