HIV/AIDS in the United States

From Wikipedia, the free encyclopedia

The AIDS epidemic, caused by HIV (Human Immunodeficiency Virus), found its way to the United States as early as 1960, but was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in gay men in Los Angeles, New York City, and San Francisco in 1981. Treatment of HIV/AIDS is primarily via a "drug cocktail" of antiretroviral drugs, and education programs to help people avoid infection.

Initially, infected foreign nationals were turned back at the U.S. border to help prevent additional infections. The number of U.S. deaths from AIDS have declined sharply since the early years of the disease's presentation domestically. In the United States, 1.2 million people live with an HIV infection, of whom 15% are unaware of their infection. Gay and bisexual men, African Americans, and Latinos remain disproportionately affected by HIV/AIDS in the U.S.

Mortality and morbidity

As of 2016, about 675,000 people have died of HIV/AIDS in the U.S. since the beginning of the HIV epidemic.

With improved treatments and better prophylaxis against opportunistic infections, death rates have quite significantly declined.

The overall death rate among persons diagnosed with HIV/AIDS in New York City decreased by sixty-two percent from 2001 to 2012. 

Containment

Medical treatment

A chart of AIDS deaths in the United States from 1987 to 1997.

 

 

A chart of AIDS deaths in the United States from 1998 to 2002.

 

Great progress was made in the U.S. following the introduction of three-drug anti-HIV treatments ("cocktails") that included antiretroviral drugs. David Ho, a pioneer of this approach, was honored as Time Magazine Man of the Year for 1996. Deaths were rapidly reduced by more than half, with a small but welcome reduction in the yearly rate of new HIV infections. Since this time, AIDS deaths have continued to decline, but much more slowly, and not as completely in black Americans as in other population segments.

Travel restrictions

The second prong of the American approach to containment has been to maintain strict entry controls to the country for people with HIV or AIDS. Under legislation enacted by the United States Congress in 1993, patients found importing anti-HIV medication into the country were arrested and placed on flights back to their country of origin.

Some HIV-positive travelers took to sending anti-HIV medication through the post to friends or contacts in advocacy groups in advance. This meant that the traveller would not be discovered with any medication. However, the security clampdown following the September 11 attacks in 2001 meant this was no longer an option.

The only legal alternative to this was to apply for a special visa beforehand, which entailed an interview at an American Embassy, confiscation of the passport during the lengthy application process, and then, if permission were granted, a permanent attachment being made to the applicant's passport. This process was condemned as intrusive and invasive by a number of advocacy groups, on the grounds that any time the passport was later used for travel elsewhere or for identification purposes, the holder's HIV status would become known. It was also felt that this rule was unfair because it applied even if the traveller was covered for HIV-related conditions under their own travel insurance. 

In early December 2006, President George W. Bush indicated that he would issue an executive order allowing HIV-positive people to enter the United States on standard visas. It was unclear whether applicants would still have to declare their HIV status. However, the ban remained in effect throughout Bush's Presidency. In August 2007, Congresswoman Barbara Lee of California introduced H.R. 3337, the HIV Nondiscrimination in Travel and Immigration Act of 2007. This bill would have allowed travelers and immigrants entry to the United States without having to disclose their HIV status. The bill died at the end of the 110th Congress.

In July 2008, then President George W. Bush signed H.R. 5501 that lifted the ban in statutory law. However, the United States Department of Health and Human Services still held the ban in administrative (written regulation) law. New impetus was added to repeal efforts when Paul Thorn, a UK tuberculosis expert who was invited to speak at the 2009 Pacific Health Summit in Seattle, was denied a visa due to his HIV positive status. A letter written by Mr. Thorn, and read in his place at the Summit, was obtained by Congressman Jim McDermott, who advocated the issue to the Obama administration's Health Secretary.

On October 30, 2009 President Barack Obama reauthorized the Ryan White HIV/AIDS Bill which expanded care and treatment through federal funding to nearly half a million. He also announced that the Department of Health and Human Services crafted regulation that would end the HIV Travel and Immigration Ban effective in January 2010; on January 4, 2010, the United States Department of Health and Human Services, Centers for Disease Control and Prevention removed HIV infection from the list of "communicable diseases of public health significance," due to it not being spread by casual contact, or by air, food or water, and removed HIV status as a factor to be considered in the granting of travel visas, disallowing HIV status from among the diseases that could prevent people who are not U.S. citizens from entering the country.

Public perception

The number of people living with HIV in the United States, and the total cumulative number of deaths.

 

One of the best known works on the history of HIV is 1987's book And the Band Played On, by Randy Shilts. Shilts contends that Ronald Reagan's administration dragged its feet in dealing with the crisis due to homophobia, while the gay community viewed early reports and public health measures with corresponding distrust, thus allowing the disease to infect hundreds of thousands more. This resulted in the formation of ACT-UP, the AIDS Coalition to Unleash Power by Larry Kramer. Galvanized by the federal government's inactivity, the movement by AIDS activists to gain funding for AIDS research, which on a per-patient basis out-paced funding for more prevalent diseases such as cancer and heart disease, was used as a model for future lobbying for health research funding.

The Shilts work popularized the misconception that the disease was introduced by a gay flight attendant named Gaëtan Dugas, referred to as "Patient Zero," although the author did not actually make this claim in the book. However, subsequent research has revealed that there were cases of AIDS much earlier than initially known. HIV-infected blood samples have been found from as early as 1959 in Africa (see HIV main entry), and HIV has been shown to have caused the death of Robert Rayford, a 16-year-old St. Louis male, in 1969, who could have contracted it as early as 7 years old due to sexual abuse, suggesting that HIV had been present, at very low prevalence, in the U.S. since before the 1970s. 

An early theory asserted that a series of inoculations against hepatitis B that were performed in the gay community of San Francisco were tainted with HIV. Although there was a high correlation between recipients of that vaccination and initial cases of AIDS, this theory has long been discredited. HIV, hepatitis B, and hepatitis C are bloodborne diseases with very similar modes of transmission, and those at risk for one are at risk for the others.

Activists and critics of current AIDS policies allege that another preventable impediment to stemming the spread of the disease and/or finding a treatment was the vanity of "celebrity" scientists. Robert Gallo, an American scientist involved in the search for a new virus in the people affected by the disease, became embroiled in a legal battle with French scientist Luc Montagnier, who had first discovered such a virus in tissue cultures derived from a patient suffering from enlargement of the lymphnodes (an early sign of AIDS). Montagnier had named the new virus LAV (Lymphoadenopathy-Associated Virus).

Gallo, who appeared to question the primacy of the French scientist's discovery, refused to recognize the "French virus" as the cause of AIDS, and tried instead to claim the disease was caused by a new member of a retrovirus family, HTLV, which he had discovered. Critics claim that because some scientists were more interested in trying to win a Nobel prize than in helping patients, research progress was delayed and more people needlessly died. After a number of meetings and high-level political intervention, the French scientists and Gallo agreed to "share" the discovery of HIV, although eventually Montagnier and his group were recognized as the true discoverers, and won the 2008 Nobel Prize for it.

Publicity campaigns were started in attempts to counter the incorrect and often vitriolic perception of AIDS as a "gay plague". These included the Ryan White case, red ribbon campaigns, celebrity dinners, the 1993 film version of And the Band Played On, sex education programs in schools, and television advertisements. Announcements by various celebrities that they had contracted HIV (including actor Rock Hudson, basketball star Magic Johnson, tennis player Arthur Ashe and singer Freddie Mercury) were significant in arousing media attention and making the general public aware of the dangers of the disease to people of all sexual orientations.

By race/ethnicity

African Americans continue to experience the most severe burden of HIV, compared with other races and ethnicities. Black people represent approximately 13% of the U.S. population, but accounted for an estimated 43% of new HIV infections in 2017. Furthermore, they make up nearly 52% of AIDS-related deaths in America. While the overall rates of HIV incidences and prevalence have decreased, they have increased in one particular demographic: African American gay and bisexual men (a 4% increase). In America, black households were reported to have the lowest median income, leading to lower rates of insured individuals. This creates cost barriers to antiretroviral treatments.

Hispanics/Latinos are also disproportionately affected by HIV. Hispanics/Latinos represented 16% of the population but accounted for 21% of new HIV infections in 2010. Hispanics/Latinos accounted for 20% of people living with HIV infection in 2011. Disparities persist in the estimated rate of new HIV infections in Hispanics/Latinos. In 2010, the rate of new HIV infections for Latino males was 2.9 times that for white males, and the rate of new infections for Latinas was 4.2 times that for white females. Since the epidemic began, more than 100,888 Hispanics/Latinos with an AIDS diagnosis have died, including 2,155 in 2012.

American Indian/Alaskan Native Communities in the United States also see a higher rate of HIV/AIDS in comparison to whites, Asians, and Native Hawaiians/other Native Pacific Islanders. Although AI/AN sufferers of HIV/AIDS only represent roughly 1% of all sufferers in the U.S.^[16], the number of diagnoses amongst AI/AN gay and bisexual men rose by 54% between 2011 and 2015. Additionally, the survival rate of diagnosed AI/AN was the lowest of all races in the United States between 1998 and 2005 . In recent years, the Centres for Disease Control and Prevention (CDC) have put in place a “high impact prevention approach” in partnership with the Indian Health Service and the CDC Tribal Advisory Committee to tackle the growing rates in a culturally appropriate way. The higher rate of HIV/AIDS cases amongst AI/AN people have been attributed to a number of factors including socioeconomic disadvantages faced by AI/AN communities, which may result in difficulty accessing healthcare and high-quality housing. It may be more difficult for gay and bisexual AI/AN men to access healthcare due to living in rural communities, or due to stigma attached to their sexualities. AI/AN people have also been reported to have higher rates of other STIs, including chlamydia and gonorrhea, which also increases likeliness of contracting or transmitting HIV. Furthermore, as there are over 560 federally recognised AI/AN tribes, there is some difficulty in creating outreach programmes which effectively appeal to all tribes whilst remaining culturally appropriate. As well as fear of stigma from within AI/AN communities, there may also be a fear amongst LGBTQ+ AI/AN of a lack of understanding from health professionals in the United States, particularly amongst Two Spirit people. A 2013 NASTAD report calls for the inclusion of LGBT and Two Spirit AI/AN in HIV/AID program planning and asserts that “health departments should utilize local experts to better understand regional definitions of “Two Spirit” and incorporate modules on Native gay men and Two Spirit people into cultural sensitivity courses for public health service providers”.

"Down-Low" culture amongst Black MSM

Down-low is an African American slang term that typically refers to a subculture of Black men who usually identify as heterosexual, but who have sex with men; some avoid sharing this information even if they have female sexual partner(s) married or single.

According to a study published in the Journal of Bisexuality, "[t]he Down Low is a lifestyle predominately practiced by young, urban Black men who have sex with other men and women, yet do not identify as gay or bisexual".

In this context, "being on the Down Low" is more than just men having sex with men in secret, or a variant of closeted homosexuality or bisexuality—it is a sexual identity that is, at least partly, defined by its "cult of masculinity" and its rejection of what is perceived as White culture (including white LGBT culture) and terms. A 2003 New York Times Magazine cover story on the Down Low phenomenon explains that the Black community sees "homosexuality as a White man's perversion." 

The CDC cited three findings that relate to African-American men who operate on the down-low (engage in MSM activity but don't disclose to others):

• African American men who have sex with men (MSM), but who do not disclose their sexual orientation (nondisclosers), have a high prevalence of HIV infection (14%); nearly three times higher than nondisclosing MSMs of all other races/ethnicities combined (5%).
• Confirming previous research, the study of 5,589 MSM, aged 15–29 years, in six U.S. cities found that African American MSM were more likely not to disclose their sexual orientation compared with White MSM (18% vs. 8%).
• HIV-infected nondisclosers were less likely to know their HIV status (98% were unaware of their infection compared with 75% of HIV-positive disclosers), and more likely to have had recent female sex partners.

Risk Factors contributing to the Black HIV rate

Accessibility to healthcare is very important in preventing and treating HIV/AIDs. It can be affected by health insurance which is available to people through private insurers, Medicare and Medicaid which leaves some people still vulnerable. Historically, African Americans have faced discrimination when it comes to receiving healthcare. During the time of slavery, slave owners would get medical attention for slaves because they were deemed as property, while slaves that the slave owners believed were not able to recover were sent to be experimented on. In the late eighteenth century and early nineteenth century, universities dug up African American bodies to autopsy, and some night doctors would snatch people off the streets to examine. African Americans have been experimented on and exploited for centuries. The Tuskegee Syphilis study experimented vulnerable men in the South who had syphilis. They kept treatment from these men to see what would happen. Henrietta Lacks was also exploited when researchers took her cancerous cells and grew them to experiment on them.

Homosexuality is viewed negatively in the African American Community. "In a qualitative study of 745 racially and ethnic diverse undergraduates attending a large Midwestern university, Calzo and Ward (2009) determined that parents of African-American participants discussed homosexuality more frequently than the parents of other respondents. In analyses of the values communicated, Calzo and Ward (2009) reported that Black parents offered greater indication that homosexuality is perverse and unnatural".

Homosexuality is seen as a threat to the African American empowerment. Masculinity is seen as important for the African American community because it shows that the community is in control of their own destiny. Since the stigma circling homosexuality is that it is “effeminate”, then homosexuality is seen as a threat to masculinity. “Black manhood, then, depends on men's ability to be provider, progenitor, and protector. But, as the Black male performance of parts of this script is thwarted by economic and cultural factors, the performance of Black masculinity becomes predicated on a particular performance of Black sexuality and avoidance of weakness and femininity. If sexuality remains one of the few ways that Black men can recapture a masculinity withheld from them in the marketplace, endorsing Black homosexuality subverts the cultural project of reinscribing masculinity within the Black community." This critical view is influenced by Internalized homophobia. “Internalized homophobia is defined as the lesbian, gay, or bisexual individual's inward direction of society's homophobic attitudes (Meyer 1995)."

The African American community's social norms regarding homosexuality have influenced a higher percentage of African Americans with internalized homophobia. This homophobic culture is sustained within the African American community through the church because religion is a vital part of the African American community: "As reported by Peterson and Jones (2009), AA MSM tended to be more involved with religious communities than NHW MSM." Because the church reiterates this stigma of homosexuality, the African American community has higher rates of internalized homophobia. This internalized homophobia causes a lower chance of HIV/AIDS education on prevention and care within the African American community.

Sex education varies throughout the United States and in some areas could use more informative measures. African-Americans and Hispanic/ Latinos experience higher rates of lower socioeconomic statuses and fewer opportunities than white people. This causes limited access to (higher) education in lower socioeconomic areas. Sex education on HIV prevention has decreased from 64% (2000) to 41% (2014). Out of the 50 states, 26 put a larger emphasis on abstinence sex education. Abstinence only sex education is correlated to increasing rates of HIV especially in teenagers and young adults.

With mass incarceration of the African American community, HIV has been spreading rapidly throughout jails and prisons. “Among jail populations, African American men are 5 times as likely as white men, and twice as likely as Hispanic/Latino men, to be diagnosed with HIV.” Since most people contract HIV before being incarcerated, it is hard to know who has the disease and to keep it from spreading. A lack of hygiene in prisons perpetuates these problems. Many inmates do not disclose their high-risk behaviors, such as anal sex or injection drug use, because they fear being stigmatized and ostracized by other inmates.There is also a lack of educational programs on disease prevention for inmates. Because “nine out of ten jail inmates are released in under 72 hours which makes it hard to test them for HIV and help them find treatment,” the problem persists outside of prison.

Activism and response

Starting in the early 1980s, AIDS activist groups and organizations began to emerge and advocate for people infected with HIV in the United States. Though it was an important aspect of the movement, activism went beyond the pursuit of funding for AIDS research. Groups acted to educate and raise awareness of the disease and its effects on different populations, even those thought to be at low-risk of contracting HIV. This was done through publications and “alternative media” created by those living with or close to the disease.

Activist groups worked to prevent spread of HIV by distributing information about safe sex. They also existed to support people living with HIV/AIDS, offering therapy, support groups, and hospice care. Organizations like Gay Men's Health Crisis, the Lesbian AIDS Project, and SisterLove were created to address the needs of certain populations living with HIV/AIDS. Other groups, like the NAMES Project, emerged as a way of memorializing those who had passed, refusing to let them be forgotten by the historical narrative. One group, the Association for Drug Abuse Prevention and Treatment (ADAPT), headed by Yolanda Serrano, coordinated with their local prison, Riker's Island Correctional Facility, to advocate for those imprisoned and AIDS positive to be released early, so that they could pass away in the comfort of their own homes.

Both men and women, heterosexual and queer populations were active in establishing and maintaining these parts of the movement. Because AIDS was initially thought only to impact gay men, most narratives of activism focus on their contributions to the movement. However, women also played a significant role in raising awareness, rallying for change, and caring for those impacted by the disease. Lesbians helped organize and spread information about transmission between women, as well as supporting gay men in their work. Narratives of activism also tend to focus on organizing done in coastal cities, but AIDS activism was present and widespread across both urban and more rural areas of the United States. Organizers sought to address needs specific to their communities, whether that was working to establish needle exchange programs, fighting against housing or employment discrimination, or issues faced primarily by people identified as members of specific groups (such as sex workers, mothers and children, or incarcerated people).

Present day activism

An effective response to HIV/AIDS requires that groups of vulnerable populations have access to HIV prevention programs with information and services that are specific to them. In the present day, some activist groups and AIDS organizations that were established during the height of the epidemic are still present and working to assist people living with AIDS. They may offer any combination of the following: health education, counseling and support, or advocacy for law and policy. AIDS organizations also continue to call for public awareness and support through participation in events like pride parades, World AIDS Day, or AIDS walks. Newer activism has appeared in advocacy forPre-Exposure Prophylaxis (PrEP), which has shown to significantly limit transmission of HIV. While PrEP appears to be extremely successful in suppressing the spread of HIV infection, there is some evidence that the reduction in HIV risk has led to some people taking more sexual risks, specifically, reduced use of condoms in anal sex.

Current status

The CDC estimates that 1,122,900 U.S. residents aged 13 years and older are living with HIV infection as of 2016, including 162,500 (15%) who are unaware of their infection. Over the past decade, the number of people living with HIV has increased, while the annual number of new HIV infections has declined to about 40,000 new HIV infections. Within the overall estimates, however, some groups are affected more than others. MSM continue to bear the greatest burden of HIV infection, and among races/ethnicities, African Americans continue to be disproportionately affected.

An estimated 15,807 people with an AIDS diagnosis died in 2016, and approximately 658,507 people in the United States with an AIDS diagnosis have died overall. The deaths of persons with an AIDS diagnosis can be due to any cause—that is, the death may or may not be related to AIDS.

In California alone, 184,429 HIV cases (including children) were reported by December 2008. Of those, 85,958 have died, with 31,076 in Los Angeles County, 18,838 in San Francisco, and 7,135 in San Diego County.

In 2015, 48,824 people were living with HIV (not AIDS) in the state of New York, with 38,441 in New York City alone.

Washington, D.C. has a particularly high incidence of HIV/AIDS, with 177 new cases annually per 100,000 people as of 2012, more than nine times higher than any state.

In the United States, men who have sex with men (MSM), described as gay and bisexual, make up about 55% of the total HIV-positive population, and 67% of new HIV cases and 83% of the estimated new HIV diagnoses among all males aged 13 and older, and an estimated 92% of new HIV diagnoses among all men in their age group (2014 report). 1 in 6 gay and bisexual men are therefore expected to be diagnosed with HIV in their lifetime if current rates continue. Gay and bisexual men accounted for an estimated 54% of people diagnosed with AIDS, with 39% being African American, 32% being white, and 24% being Hispanic/Latino. The CDC estimates that more than 600,000 gay and bisexual men are currently living with HIV in the United States. A review of four studies in which trans women in the United States were tested for HIV found that 27.7% tested positive.

In a 2008 study, the Center for Disease Control found that, of the study participants who were men who had sex with men ("MSM"), almost one in five (19%) had HIV and "among those who were infected, nearly half (44 percent) were unaware of their HIV status." The research found that white MSM "represent a greater number of new HIV infections than any other population, followed closely by black MSM—who are one of the most disproportionately affected subgroups in the U.S." and that most new infections among white MSM occurred among those aged 30–39 followed closely by those aged 40–49, while most new infections among black MSM have occurred among young black MSM (aged 13–29).

In 2015, a major HIV outbreak, Indiana's largest-ever, occurred in two largely rural, economically depressed and poor counties in the southern portion of the state, due to the injection of a relatively new opioid-type drug called Opana (oxymorphone), which is designed be taken in pill form but is ground up and injected intravenously using needles. Because of the lack of HIV cases in that area beforehand and the youth of many but not all of those affected, the relative unavailability in the local area of safe needle exchange programs and of treatment centers capable of dealing with long-term health needs, HIV care, and drug addiction during the initial phases of the outbreak, it was not initially adequately contained and dealt with until those were set up by the government, and acute awareness of the issue spread. Such centers have now been opened, and short-term care is beginning to be provided; once the scope of the outbreak became clear, Governor Mike Pence, despite some initial reservations, approved a legislative measure to allow safe, clean needle exchange programs and treatment for those affected, which could end up being instituted statewide.

Sexual revolution

From Wikipedia, the free encyclopedia

Sexual revolution

Part of the Counterculture of the 1960s
Buttons from the Sexual revolution
Date	1960s - 1980s
Location	Worldwide
Participants	Regional Sexual revolution in 1960s United States Social/commercial movements Free love Gay liberation Golden Age of Porn
Outcome	Wider acceptance of sexuality and contraception

The sexual revolution, also known as a time of sexual liberation, was a social movement that challenged traditional codes of behavior related to sexuality and interpersonal relationships throughout the United States and subsequently, the wider world, from the 1960s to the 1980s. Sexual liberation included increased acceptance of sex outside of traditional heterosexual, monogamous relationships (primarily marriage). The normalization of contraception and the pill, public nudity, pornography, premarital sex, homosexuality, masturbation, alternative forms of sexuality, and the legalization of abortion all followed.

Previous sexual revolutions

Several other periods in Western culture have been called the "first sexual revolution", to which the 1960s revolution would be the second (or later). The term "sexual revolution" itself has been used since at least the late 1920s.

When speaking of sexual revolution, historians make a distinction between the first and the second sexual revolution. In the first sexual revolution (1870–1910), Victorian morality lost its universal appeal. However, it did not lead to the rise of a "permissive society". Exemplary for this period is the rise and differentiation in forms of regulating sexuality.

Classics professor Kyle Harper uses the phrase "first sexual revolution" to refer to the displacement of the norms of sexuality in Ancient Rome with those of Christianity as it was adopted throughout the Roman Empire. Romans accepted and legalized prostitution, bisexuality, and pederasty. Male promiscuity was considered normal and healthy as long as masculinity was maintained, associated with being the penetrating partner. On the other hand, female chastity was required for respectable women, to ensure integrity of family bloodlines. These attitudes were replaced by Christian prohibitions on homosexual acts and any sex outside marriage (including with slaves and prostitutes).

History professor Faramerz Dabhoiwala cites the Age of Enlightenment—approximately the 18th century— as a major period of transition in the United Kingdom. During this time the philosophy of liberalism developed and was popularized, and migration to cities increased opportunities for sex and made enforcement of rules more difficult than in small villages. Sexual misconduct in the Catholic Church (called the "Whore of Babylon" by some Protestant critics) undermined credibility of religious authorities, and the rise of urban police forces helped distinguish crime from sin. Overall, toleration increased for heterosexual sex outside marriage, including prostitution, mistresses, and pre-marital sex. Though these acts were still condemned by many as libertine, infidelity became more often a civil matter than a criminal offense receiving capital punishment. The rate of out-of-wedlock births went from about 1% in 1650 to about 25% in 1800, with about 40% of brides being pregnant. Masturbation, homosexuality, and rape were generally less tolerated. Women went from being considered as lustful as men to passive partners, whose purity was important to reputation.

Commentators such as history professor Kevin F. White have used the phrase "first sexual revolution" to refer to the Roaring Twenties. Victorian Era attitudes were somewhat destabilized by World War I and alcohol prohibition in the United States. At the same time the women's suffrage movement obtained voting rights, the subculture of the flapper girl included pre-marital sex and "petting parties".

Formative factors

Youngsters participating in Wet T-shirt contest during spring break 2004, in Panama City Beach, Florida

 

Indicators of non-traditional sexual behavior (e.g., gonorrhea incidence, births out of wedlock, and births to teenagers) began to rise dramatically in the mid to late 1950s. It brought about profound shifts in attitudes toward women's sexuality, homosexuality, pre-marital sexuality, and the freedom of sexual expression.

Psychologists and scientists such as Wilhelm Reich and Alfred Kinsey influenced the changes. As well, changing mores were both stimulated by and reflected in literature and films, and by the social movements of the period, including the counterculture, the women's movement, and the gay rights movement. The counterculture contributed to the awareness of radical cultural change that was the social matrix of the sexual revolution.

The sexual revolution was initiated by those who shared a belief in the detrimental impact of sexual repression, a view that had previously been argued by Wilhelm Reich, D. H. Lawrence, Sigmund Freud, and the Surrealist movement.

The counterculture wanted to explore the body and mind, and free the personal self from the moral and legal sexual confines of modern America, as well as from 1940s-50s morals in general. The sexual revolution of the 1960s was grew from a conviction that the erotic should be celebrated as a normal part of life and not repressed by family, industrialized sexual morality, religion and the state.

The development of the birth control pill in 1960 gave women access to easy and reliable contraception. Another likely cause was a vast improvement in obstetrics, greatly reducing the number of women who died due to childbearing, thus increasing the life expectancy of women. A third, more indirect cause was the large number of children born in the 1940s and early 1950s all over the western world—the "Baby Boom Generation"—many of whom would grow up in relatively prosperous and safe conditions, within a middle class on the rise and with better access to education and entertainment than ever before. By their demographic weight and their social and educational background they came to trigger a shift in society towards more permissive and informalized attitudes. 

The discovery of penicillin led to significant reductions in syphilis mortality, which, in turn, spurred an increase in non-traditional sex during the mid to late 1950s.

There was an increase in sexual encounters between unmarried adults. Divorce rates were dramatically increasing and marriage rates were significantly decreasing in this time period. The number of unmarried Americans aged twenty to twenty-four more than doubled from 4.3 million in 1960 to 9.7 million in 1976. Men and women sought to reshape marriage by instilling new institutions of open marriage, mate swapping, swinging, and communal sex.

The Freudian school

Sigmund Freud of Vienna believed human behavior was motivated by unconscious drives, primarily by the libido or "Sexual Energy". Freud proposed to study how these unconscious drives were repressed and found expression through other cultural outlets. He called this therapy "psychoanalysis". 

While Freud's ideas were sometimes ignored or provoked resistance within Viennese society, his ideas soon entered the discussions and working methods of anthropologists, artists and writers all over Europe, and from the 1920s in the United States. His conception of a primary sexual drive that would not be ultimately curbed by law, education or standards of decorum spelled a serious challenge to Victorian prudishness, and his theory of psychosexual development proposed a model for the development of sexual orientations and desires; children emerged from the Oedipus complex, a sexual desire towards their parent of the opposite sex. The idea of children having their parents as their early sexual targets was particularly shocking to Victorian and early 20th century society. 

According to Freud's theory, in the earliest stage of a child's psychosexual development, the oral stage, the mother's breast became the formative source of all later erotic sensation. Much of his research remains widely contested by professionals in the field, though it has spurred critical developments in the humanities.

Anarchist Freud scholars Otto Gross and Wilhelm Reich (who famously coined the phrase "Sexual Revolution") developed a sociology of sex in the 1910s to 1930s in which the animal-like competitive reproductive behavior was seen as a legacy of ancestral human evolution reflecting in every social relation, as per the freudian interpretation, and hence the liberation of sexual behavior a mean to social revolution.

The role of mass media

Mead's Coming of Age in Samoa

The publication of anthropologist Margaret Mead's Coming of Age in Samoa brought the sexual revolution to the public scene, as her thoughts concerning sexual freedom pervaded academia. Published in 1928, Mead's ethnography focused on the psychosexual development of adolescents in Samoa. She recorded that their adolescence was not in fact a time of "storm and stress" as Erikson's stages of development suggest, but that the sexual freedom experienced by the adolescents actually permitted them an easy transition from childhood to adulthood. Mead called for a change in suppression of sexuality in America, and her work directly resulted in the advancement of the sexual revolution in the 1930s. 

Mead's findings were later criticized by anthropologist Derek Freeman, who investigated her claims of promiscuity and conducted his own ethnography of Samoan society.

Kinsey and Masters and Johnson

In the late 1940s and early 1950s, Alfred C. Kinsey published two surveys of modern sexual behaviour. In 1948 Alfred C. Kinsey and his co-workers, responding to a request by female students at Indiana University for more information on human sexual behavior, published the book Sexual behaviour in the Human Male. They followed this five years later with Sexual behaviour in the Human Female. These books began a revolution in social awareness of, and public attention given to, human sexuality. 

It is said that public morality severely restricted open discussion of sexuality as a human characteristic, and specific sexual practices, especially sexual behaviours that did not lead to procreation. Kinsey's books contained studies about controversial topics such as the frequency of homosexuality, and the sexuality of minors aged two weeks to fourteen years. Scientists working for Kinsey reported data which led to the conclusion that people are capable of sexual stimulation from birth. Furthermore, Kinsey's method of researching sexuality differs significantly from today's methods. Kinsey would watch his research subjects engage in sexual intercourse, sometimes engaging with his subjects as well. He would also encourage his research team to do the same, and encouraged them to engage in intercourse with him, too. 

These books laid the groundwork for Masters and Johnson's life work. A study called Human Sexual Response in 1966 revealed the nature and scope of the sexual practices of young Americans.

The Playboy culture

Playboy Bunnies aboard US Navy ship (USS Wainwright (CG-28)), 1971

 

In 1953, Chicago resident Hugh Hefner founded Playboy, a magazine which aimed to target males between the ages of 21 and 45. The coverpage and nude centerfold in the first edition featured Marilyn Monroe, then a rising sex symbol. Featuring cartoons, interviews, short fiction, Hefner's "Playboy Philosophy" and unclothed female "Playmates" posing provocatively, the magazine became immensely successful.

In 1960, Hefner expanded Playboy Enterprises, opening the first Playboy Club in Chicago, which grew to a chain of nightclubs and resorts. The private clubs offered relaxation for members, who were waited on by Playboy Bunnies.

While Hefner claimed his company contributed to America's more liberal attitude towards sex, others believe he simply exploited it.

Erotic novels

In the United States in the years 1959 through 1966, bans on three books with explicit erotic content were challenged and overturned. This also occurred in the United Kingdom starting with the 1959 Obscene Publications Act and reaching a peak with the LCL court case.

Prior to this time, a patchwork of regulations (as well as local customs and vigilante actions) governed what could and could not be published. For example, the United States Customs Service banned James Joyce's Ulysses by refusing to allow it to be imported into the United States. The Roman Catholic Church's Index Librorum Prohibitorum carried great weight among Catholics and amounted to an effective and instant boycott of any book appearing on it. Boston's Watch and Ward Society, a largely Protestant creation inspired by Anthony Comstock, made "banned in Boston" a national by-word. 

In 1959 Grove Press published an unexpurgated version of Lady Chatterley's Lover by D. H. Lawrence. The U.S. Post Office confiscated copies sent through the mail. Lawyer Charles Rembar sued the New York City Postmaster, and won in New York and then on federal appeal.

Henry Miller's 1934 novel, Tropic of Cancer, had explicit sexual passages and could not be published in the United States; an edition was printed by the Obelisk Press in Paris and copies were smuggled into the United States. In 1961 Grove Press issued a copy of the work, and dozens of booksellers were sued for selling it. The issue was ultimately settled by the U.S. Supreme Court's 1964 decision in Grove Press, Inc. v. Gerstein. 

In 1963 Putnam published John Cleland's 1750 novel Fanny Hill. Charles Rembar appealed a restraining order against it all the way to the U.S. Supreme Court and won. In Memoirs v. Massachusetts, 383 U.S. 413, the court ruled that sex was "a great and mysterious motive force in human life", and that its expression in literature was protected by the First Amendment.

By permitting the publication of Fanny Hill, the U.S. Supreme Court set the bar for any ban so high that Rembar himself called the 1966 decision "the end of obscenity". Only books primarily appealing to "prurient interest" could be banned. In a famous phrase, the court said that obscenity is "utterly without redeeming social importance"—meaning that, conversely, a work with any redeeming social importance or literary merit was arguably not obscene, even if it contained isolated passages that could "deprave and corrupt" some readers.

Nonfiction

The court decisions that legalised the publication of Fanny Hill had an even more important effect: freed from fears of legal action, nonfiction works about sex and sexuality started to appear more often. These books were factual and in fact educational, made available in mainstream bookstores and mail-order book clubs to a mainstream readership, and their authors were guests on late-night talk shows. Earlier books such as What Every Girl Should Know (Margaret Sanger, 1920) and A Marriage Manual (Hannah and Abraham Stone, 1939) had broken the silence and, by the 1950s, in the United States it had become rare for women to go into their wedding nights not knowing what to expect.

The open discussion of sex as pleasure, and descriptions of sexual practices and techniques, was revolutionary. There were practices which, perhaps, some had heard of. But many adults did not know for sure whether they were realities, or fantasies found only in pornographic books. The Kinsey report revealed that these practices were, at the very least, surprisingly frequent. These other books asserted, in the words of a 1980 book by Dr. Irene Kassorla, that Nice Girls Do — And Now You Can Too.

In 1962, Helen Gurley Brown published Sex and the Single Girl: The Unmarried Woman's Guide to Men, Careers, the Apartment, Diet, Fashion, Money and Men.

 

In 1969 Joan Garrity, identifying herself only as "J.", published The Way to Become the Sensuous Woman, with information on exercises to improve the dexterity of one's tongue and how to have anal sex.

The same year saw the appearance of Dr. David Reuben's book Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask). Despite the dignity of Reuben's medical credentials, this book was light-hearted in tone.

In 1970 the Boston Women's Health Collective published Women and Their Bodies, reissued a year later as Our Bodies, Ourselves). Though not an erotic treatise or sex manual, the book included frank descriptions of sexuality, and contained illustrations that could have caused legal problems just a few years earlier.

Alex Comfort's The Joy of Sex: A Gourmet Guide to Love Making appeared in 1972. In later editions, Comfort's exuberance was tamed in response to AIDS.

In 1975 Will McBride's Zeig Mal! (Show Me!), written with psychologist Helga Fleichhauer-Hardt for children and their parents, appeared in bookstores on both sides of the Atlantic. Appreciated by many parents for its frank depiction of pre-adolescent sexual discovery and exploration, it scandalised others and was pulled from circulation in the United States and some other countries. The book was followed in 1989 by Zeig Mal Mehr! ("Show Me More!").

Pornographic film

In 1969, Blue Movie, directed by Andy Warhol, was the first adult erotic film depicting explicit sex to receive wide theatrical release in the United States. The film helped inaugurate the "porno chic" phenomenon in modern American culture. According to Warhol, Blue Movie was a major influence in the making of Last Tango in Paris, starring Marlon Brando, and released a few years after Blue Movie was made.

In 1970, Mona the Virgin Nymph became the second film to gain wide release. The third, Deep Throat, despite being rudimentary by the standards of mainstream filmmaking, achieved major box office success, following mentions by Johnny Carson on The Tonight Show, and Bob Hope on television as well. In 1973, the far-more-accomplished (though still low-budget) The Devil in Miss Jones was the seventh-most-successful film of the year, and was well-received by major media, including a favorable review by film critic Roger Ebert.

In 1976, The Opening of Misty Beethoven (based on the play Pygmalion by George Bernard Shaw) was released theatrically and is considered by Toni Bentley the "crown jewel" of "the golden age of porn."

By the mid-1970s and through the 1980s, newly won sexual freedoms were being exploited by big businesses looking to capitalize on an increasingly permissive society, with the advent of public and hardcore pornography.

Explicit sex on screen and stage

Swedish filmmakers like Ingmar Bergman and Vilgot Sjöman contributed to sexual liberation with sexually themed films that challenged conservative international standards. The 1951 film Hon dansade en sommar (She Danced One Summer AKA One Summer of Happiness) displayed explicit nudity, including bathing in a lake.

This film, as well as Bergman's Sommaren med Monika (The Summer with Monika, 1951) and Tystnaden (The Silence, 1963), caused an international uproar, not least in the United States, where the films were charged with violating standards of decency. Vilgot Sjöman's film I Am Curious (Yellow), also was very popular in the United States. Another of his films, 491, highlighted homosexuality. Kärlekens språk (The Language of Love) was an informative documentary about sex and sexual techniques that featured the first real act of sex in a mainstream film.

From these films the myth of "Swedish sin" (licentiousness and seductive nudity) arose. The image of "hot love and cold people" emerged, with sexual liberalism seen as part of the modernization process that, by breaking down traditional borders, would lead to the emancipation of natural forces and desires. In Sweden and nearby countries at the time, these films, by virtue of being made by directors who had established themselves as leading names in their generation, helped delegitimize the idea of habitually demanding that films should avoid overtly sexual subject matter. The films eventually progressed the public's attitude toward sex, especially in Sweden and other northern European countries, which today tend to be more sexually liberal than others.

Normalization of pornography

The somewhat more open and commercial circulation of pornography was a new phenomenon. Pornography operated as a form of "cultural critique" insofar as it transgresses societal conventions. Manuel Castells claims that the online communities, which emerged (from the 1980s) around early bulletin-board systems, originated from the ranks of those who had been part of the counterculture movements and alternative way of life emerging out of the sexual revolution.

Lynn Hunt points out that early modern "pornography" (18th century) is marked by a "preponderance of female narrators", that the women were portrayed as independent, determined, financially successful (though not always socially successful and recognized) and scornful of the new ideals of female virtue and domesticity, and not objectifications of women's bodies as many view pornography today. The sexual revolution was not unprecedented in identifying sex as a site of political potential and social culture. It was suggested that the interchangeability of bodies within pornography had radical implications for gender differences and that they could lose their meaning or at least redefine the meaning of gender roles and norms.

In 1971 Playboy stopped airbrushing pubic hair out of its centerfold picture spreads; this new addition caused the magazine to hit its all-time peak circulation of more than seven million copies in 1972 and men started having more choices when it came to magazines.

In 1972 Deep Throat became a popular movie for heterosexual couples. The movie played all over America and was the first porn movie to earn a gross of a million dollars.

Pornography was less stigmatised by the end of the 1980s, and more mainstream movies depicted sexual intercourse as entertainment. Magazines depicting nudity, such as the popular Playboy and Penthouse magazines, won some acceptance as mainstream journals, in which public figures felt safe expressing their fantasies. 

Some figures in the feminist movement, such as Andrea Dworkin, challenged the depiction of women as objects in these pornographic or "urban men's" magazines. Other feminists such as Betty Dodson went on to found the pro-sex feminist movement in response to anti-pornography campaigns. 

In India, an organization named Indians For Sexual Liberties is advocating the legalization of the porn business in India. The organization's founder, Laxman Singh, questioned the reasoning behind deeming as illegal the depiction of legal acts.

Modern revolutions

The Industrial Revolution during the nineteenth century and the growth of science and technology, medicine and health care, resulted in better contraceptives being manufactured. Advances in the manufacture and production of rubber made possible the design and production of condoms that could be used by hundreds of millions of men and women to prevent pregnancy at little cost. Advances in chemistry, pharmacology, and biology, and human physiology led to the discovery and perfection of the first oral contraceptives, popularly known as "the Pill." 

All these developments took place alongside and combined with an increase in world literacy and decline in religious observance. Old values such as the biblical notion of "be fruitful and multiply" were cast aside as people continued to feel alienated from the past and adopted the lifestyles of progressive modernizing cultures. 

Another contribution that helped bring about this modern revolution of sexual freedom were the writings of Herbert Marcuse and Wilhelm Reich, who took the philosophy of Karl Marx and similar philosophers. 

"No-fault" unilateral divorce became legal and easier to obtain in many countries during the 1960s, 1970s, and 1980s. 

The women's movement redefined sexuality, not in terms of simply pleasing men but recognizing women's sexual satisfaction and sexual desire. "The Myth of the Vaginal Orgasm" by Anne Koedt illustrates an understanding of a women's sexual anatomy, arguing against Freud's "assumptions of women as inferior appendage to man, and her consequent social and psychological role." The women's movement was able to develop lesbian feminism, freedom from heterosexual act, and freedom from reproduction. Feminist Betty Friedan published the Feminine Mystique in 1963, concerning the many frustrations women had with their lives and with separate spheres which established a pattern of inequality. 

1997 LGBT poster, New York City

 

The Gay Rights Movement started when the Stonewall Riots of 1969 crystallized a broad grass-roots mobilization. New gay liberationist gave political meaning to "coming out" by extending the psychological-personal process into public life. During the 1950s the most feared thing of the homosexual culture was "coming out", the homosexual culture of the 1950s did everything they could to help keep their sexuality a secret from the public and everyone else in their lives, but Alfred Kinsey's research on homosexuality alleged that 39% of the unmarried male population had had at least one homosexual experience to orgasm between adolescence and old age. The "coming out" phenomenon helped mobilize people to live full-time as a homosexual, they no longer had to live in secret. They no longer had to sneak around and occasionally receive the sexual attention that they desire or force themselves into a heterosexual relationship in which they had no interest, and was full of lies. Brad Gooch wrote in the "Golden Age of Promiscuity" that the gay male community finally had reached a rich culture of "easy sex", sex without commitment, obligation or long-term relationships.

Feminism and sexual liberation

Coinciding with second-wave feminism and the women's liberation movement initiated in the early 1960s, the sexual liberation movement was aided by feminist ideologues in their mutual struggle to challenge traditional ideas regarding female sexuality and queer sexuality. Elimination of undue favorable bias towards men and objectification of women as well as support for women's right to choose her sexual partners free of outside interference or judgement were three of the main goals associated with sexual liberation from the feminist perspective. Since during the early stages of feminism, women's liberation was often equated with sexual liberation rather than associated with it. Many feminist thinkers believed that assertion of the primacy of sexuality would be a major step towards the ultimate goal of women's liberation, thus women were urged to initiate sexual advances, enjoy sex and experiment with new forms of sexuality.

The feminist movements insisted and focused on the sexual liberation for women, both physical and psychological. The pursuit of sexual pleasure for women was the core ideology, which subsequently was to set the foundation for female independence. Although whether or not sexual freedom should be a feminist issue is currently a much-debated topic, the feminist movement overtly defines itself as the movement for social, political, and economic equality of men and women. Feminist movements are also involved the fight against sexism and since sexism is a highly complex notion, it is difficult to separate the feminist critique toward sexism from its fight against sexual oppression. 

The feminist movement has helped create a social climate in which LGBT people and women are increasingly able to be open and free with their sexuality, which enabled a spiritual liberation of sorts with regards to sex. Rather than being forced to hide their sexual desires or feelings, women and LGBT people have gained and continue to gain increased freedom in this area. Consequently, the feminist movement to end sexual oppression has and continues to directly contribute to the sexual liberation movement.

Nevertheless, among many feminists, the view soon became widely held that, thus far, the sexual freedoms gained in the sexual revolution of the 1960s, such as the decreasing emphasis on monogamy, had been largely gained by men at women's expense. In Anticlimax: A Feminist Perspective on the Sexual Revolution, Sheila Jeffreys asserted that the sexual revolution on men's terms contributed less to women's freedom than to their continued oppression, an assertion that has both commanded respect and attracted intense criticism. In the late 1970s and early 1980s, feminist sex wars broke out due to disagreements on pornography, on prostitution, and on BDSM, as well as sexuality in general.

Contraception

As birth control became widely accessible, men and women began to have more choice in the matter of having children than ever before. The 1916 invention of thin, disposable latex condoms for men led to widespread affordable condoms by the 1930s; the demise of the Comstock laws in 1936 set the stage for promotion of available effective contraceptives such as the diaphragm and cervical cap; the 1960s introduction of the IUD and oral contraceptives for women gave a sense of freedom from barrier contraception. The Catholic Church under Pope Paul VI (1968) published Humanae vitae (Of Human Life), which was a declaration that banned the use of artificial contraception. Churches allowed for the rhythm method, which was a natural method of regulating fertility that pushed men and women to take advantage of the "natural cycles" of female fertility, during which women were "naturally infertile." The opposition of Churches (e.g. Humanae vitae) led people who felt alienated from or not represented by religion to form parallel movements of secularization and exile from religion. Women gained much greater access to birth control in the Griswold "girls world" decision in 1965. 

The landmark Griswold v. Connecticut case ruled that the prohibition of contraception was unconstitutional on the grounds that it violated peoples' rights to marital privacy. In addition, in the 1960s and 1970s the birth control movement advocated for the legalization of abortion and large scale education campaigns about contraception by governments. The Griswold v. Connecticut case and subsequent birth control movements created a precedent for later cases granting rights to birth control for unmarried couples (Eisenstadt v. Baird, 1972), rights to abortion for any woman (Roe v. Wade, 1973), and the right to contraception for juveniles (Carey v. Population Services International, 1977). The Griswold case was also influential in and cited as precedent for landmark cases dealing with the right to homosexual relations (Lawrence v. Texas, 2003) and the right to same-sex marriage (Obergefell v. Hodges, 2015).

Free love

Beginning in San Francisco in the mid-1960s, a new culture of "free love" emerged, with thousands of young people becoming "hippies", inspired by Indian culture, who preached the power of love and the beauty of sex as part of ordinary life. This is part of a counterculture that continues to exist. By the 1970s, it was socially acceptable for colleges to permit co-ed housing.

Free love continued in different forms throughout the 1970s and into the early 1980s, but its more assertive manifestations ended abruptly (or at least disappeared from public view) in the mid-1980s when the public first became aware of AIDS, a deadly sexually-transmitted disease.

Non-marital sex

Premarital sex, heavily stigmatised for some time, became more widely accepted. The increased availability of birth control (and the legalisation of abortion in some places) helped reduce the chance that pre-marital sex would result in unwanted children. By the mid-1970s the majority of newly married American couples had experienced sex before marriage.

Central to the change was the development of relationships between unmarried adults, which resulted in earlier sexual experimentation reinforced by a later age of marriage. On average, Americans were gaining sexual experience before entering into monogamous relationships. The increasing divorce rate and the decreasing stigma attached to divorce during this era also contributed to sexual experimentation. By 1971, more than 75% of Americans thought that premarital sex was acceptable, a threefold increase from the 1950s, and the number of unmarried Americans aged twenty to twenty-four more than doubled from 1960 to 1976. Americans were becoming less and less interested in getting married and settling down and as well less interested in monogamous relationships. In 1971, 35% of the country said they thought marriage was obsolete.

The idea of marriage being outdated came from the development of casual sex between Americans. With the development of the birth control pill and the legalization of abortion in 1973, there was little threat of unwanted children out of wedlock. Also, during this time every known sexually transmitted disease was readily treatable.

Swinger clubs were organizing in places ranging from the informal suburban home to disco-sized emporiums that offered a range of sexual possibilities with multiple partners. In New York City in 1977, Larry Levenson opened Plato's Retreat, which eventually shut down in 1985 under regular close scrutiny by public health authorities.

Legacy

Fraenkel (1992) believes that the "sexual revolution" the West supposedly experienced in the late 1960s is a misconception, and that sex is not actually enjoyed freely, rather observed in all the fields of culture, a taboo behavior called "repressive desublimation".

Allyn argues that the sexual optimism of the 1960s waned with the economic crises of the 1970s, the massive commercialization of sex, increasing reports of child exploitation, disillusionment with the counter-culture and the New Left, and a combined left-right backlash against sexual liberation as an ideal. The discovery of herpes escalated anxieties rapidly and set the stage for the nation's panicked response to AIDS.

Among radical feminists, the view soon became widely held that, thus far, the sexual freedoms gained in the sexual revolution of the 1960s, such as the decreasing emphasis on monogamy, had been largely gained by men at women's expense. In Anticlimax: A Feminist Perspective on the Sexual Revolution, Sheila Jeffreys asserted that the sexual revolution on men's terms contributed less to women's freedom than to their continued oppression, an assertion that has both commanded respect and attracted intense criticism. In the late 1970s and early 1980s, feminist sex wars broke out due to disagreements on pornography, on prostitution, and on BDSM, as well as sexuality in general. 

Although the rate of teenage sexual activity is hard to record, the prevalence of teenage pregnancy in developed nations such as Canada and the UK have seen a steady decline since the 1990s. For example, in 1991 there were 61.8 children born per 1,000 teenage girls in the United States. By 2013, this number had declined to 26.6 births per 1,000 teenage girls.

Women and men who lived with each other without marriage sought "palimony" equal to the alimony. Teenagers assumed their right to a sexual life with whomever they pleased, and bathers fought to be topless or nude at beaches.