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The HIV epidemic is driven by sexual contact and is heavily concentrated among certain key populations, in particular gay men and other men who have sex with men. African Americans are worse affected across all key population groups. Despite condoms being widely available, their use is falling, even among people who are at heightened risk of acquiring HIV. Increasing levels of injecting drug use, linked to an epidemic of opioid misuse, are threatening the gains made on reducing HIV among people who use drugs.

HIV-related stigma remains a huge barrier to preventing HIV, and is linked to a low level of people testing for HIV, as well as poor adherence to treatment, particularly among young people. Nearly one in seven of these people are unaware they have HIV. This was updated in , to run until , and is structured around four core aims: These key affected populations can be grouped by transmission category for example, men who have sex with men but also by race and ethnicity, with people of colour having significantly higher rates of HIV infection over white Americans.

A complex set of economic and socioeconomic factors drive risk to these populations, including discrimination, stigma, poverty and a lack of access to care. Between and , new HIV infections among men who have sex with men remained stable at about 26, a year.

However, trends vary greatly by age and ethnicity. If current diagnosis rates continue, one in six American men who have sex with men will be diagnosed with HIV in their lifetime. Every three years, the CDC studies sexual risk behaviours among men who have sex with men in selected cities.

The latest data from this survey suggests the number of men who have sex with men having anal sex without a condom is increasing, with The survey found around one-third One in six were unaware of their status.

Language, cultural factors and fear of being deported are all key barriers. Around 1 million adults identify as transgender in the USA.

Transgender people who took an HIV test in were 3 times more likely to have received a new HIV diagnosis than the rest of the population who tested. The USA has the largest incarcerated population in the world, with 2. HIV prevalence is estimated to be 1. Of these 3, were in the later stages of infection and had been diagnosed with AIDS. Most prisoners are HIV positive before they are incarcerated, with one study estimating that one in seven people living with HIV in the USA go through the prison system every year.

A huge contributing factor to this is prescription opioid misuse, which has seen an increasing number of people turn to injecting drug use, particularly in non-urban areas where previously injecting drugs had not been a significant issue.

This coincides with an increase in hepatitis C infections and new outbreaks of HIV. However, the level at which this reduction occurred has slowed and there are concerns that it may stagnant or reverse due to increased levels of injecting. Eighty percent of those diagnoses occurred in people aged 20 to This age group is also the least likely to be receiving HIV treatment. In , Medicare coverage was expanded to include annual HIV testing for beneficiaries aged , regardless of their risk, as well as pregnant women and people outside of this age range who are at increased risk.

This means that people with health insurance — both public and private — currently have good access to testing, often at no cost. For those without insurance or those wishing not to use their insurance, HIV testing can often be obtained at little or no cost. Between then and , approximately 1. HIV related stigma, socially conservative communities, and low HIV risk perception all serve as barriers to testing.

Even among groups at high risk for HIV infection, testing rates are low. According to a survey, relatively few men who have sex with men report testing regularly. In , an estimated 37, people became newly infected with HIV. Running from and , these grants will be awarded to health departments that can demonstrate that they are providing HIV prevention services to those with the greatest need.

To be eligible, services also have to show that they use an approach that combines behavioural, medical and structural HIV prevention strategies. One of key requirements for health departments receiving CDC prevention funding was to establish and maintain condom distribution programmes for people with HIV and people at high risk of acquiring it. Between and , the programme distributed over million condoms. Despite this, CDC reports a long-term decline in condom use among men who have sex with men, from as early as among some groups of men who have sex with men.

The status of sexual health education varies substantially throughout the USA and is insufficient in many areas. In most states, fewer than half of high schools teach all 16 topics CDC recommends for effective sex education. Many also argue that sex education is not starting early enough. Conservative support for abstinence only sex education in the USA has also been a major barrier to progress, and has been shown to be associated with increased HIV rates among adolescents.

As of , 37 states require that information on abstinence be provided, 26 of which require for abstinence to be emphasised, with the 11 remaining states requiring that abstinence is covered. Of these, 9 states require that discussion to be inclusive, while 3 only allow negative information on sexual orientation to be discussed. The most recent include:. Stop HIV campaign, launched in This seeks to reduce HIV infections among gay men and other men who have sex with men by encouraging open discussion between sex partners and friends about a range of HIV prevention strategies.

It aims to address stigma by showing that people with HIV are mothers, fathers, friends, brothers, sisters, sons, daughters, partners, wives, husbands, and co-workers. In , an estimated infants acquired HIV at birth, which is equivalent to 4. Progress on harm reduction has been driven by concerted and persistent pressure from people who use drugs and other HIV, health and human rights activists but is inconsistent across the country as a whole.

For example, a national survey of NSPs found half reported their clients experienced police harassment on at least a monthly basis. Prior to the election, experts reported signs of growing government support for harm reduction. However, President Trump announced in March a move away from harm reduction in favour of an approach to drug use that priorities punishment rather than treatment, even proposing to introduce the death penalty for those found selling drugs.

This includes HIV-negative people in a sexual relationship with a person living with HIV, people who inject drugs, and men who have sex with men who do not consistently use condoms. Of these, 60, were men and 18, were women. It is estimated that increasing PrEP coverage in the USA could prevent around 48, new infections within five years, and up to , new infections in the same period if increased coverage were combined with expanded testing and treatment.

In December , the USA released guidelines recognising the benefits of early treatment for someone living with HIV, as well as the benefits treatment can have on preventing HIV being transmitted to others. Despite this, for every people living with HIV in the USA in , only 62 initiated care treatment, 48 were retained in care, and 49 achieved viral suppression.

Young people living with HIV are the least likely out of any age group in the USA to be linked to care and have a suppressed viral load.

This is thought to be due to HIV-related stigma leading to low rates of testing among this age group. This aims to help health systems across all states identify individuals who have dropped out of care. In an effort to re-engage these people the initiative will enlist the help of non-traditional care providers such as community based organisations.

In , thousands of additional people living with HIV in the USA were enrolled in comprehensive health insurance through the implementation of the Affordable Care Act. As a result, people with long-term chronic conditions such as HIV are likely to see their health insurance costs rise. It serves a community of some of the most vulnerable populations in the country, most of whom live in poverty and are either uninsured or underinsured.

The clinic is leading the way in providing comprehensive co-located services for patients with HIV. It offers financial counselling, support around mental health and substance misuse, as well as nutritional and acute care along with other services. The clinic is able to provide a more holistic approach to supporting patients - not only providing treatment but also helping them to stabilise their lives in other respects too.

In the early days of the response, HIV activism was closely associated with gay communities in USA and other industrialised Western nations.

To some extent, grassroots activism in many parts of the USA has declined as antiretroviral treatment became more available in the late s and the early s.

During the early s, activists began to channel their engagement less into activism and more into providing HIV prevention and treatment programmes for people most affected by HIV. As of , only findings from Michigan were published. Uneven healthcare provision is also a major barrier to effective services, with the quality of HIV prevention and care received varying greatly across the country depending on location and socio-economic group.

People of colour in the South experience the worst clinical outcomes after being diagnosed with HIV. Factors that contribute towards this include poverty and poor access to healthcare relative to the rest of the country. This culminated in when President Obama lifted the ban on entry into the country for all HIV-positive people. An analysis by CDC and Department of Justice researchers found that, by , a total of 67 laws explicitly focused on persons living with HIV had been enacted in 33 states.

If 'transgender' ceases to exist as a term in official government documents, we, too, begin to vanish. It is easier for a cisgender administrator, who we might hope to have as an ally, to forget about our concerns when the government mandates that we be forgotten ourselves.

Funding for the HIV response has increased significantly over the course of the epidemic. Primarily, this growth has been driven by increased spending on mandatory domestic care and treatment programmes, as more people are living with HIV in the USA, as well as by greater investments to combat HIV in low and middle-income countries.

The letter was released shortly after a report by the ONE Campaign which found the proposed funding reductions are likely to reduce the global number of people added to treatment each year by a third and trigger a resurgence of the epidemic. In order to break the cycle of transmission among key affected populations in the USA, increasing the impact of targeted HIV prevention and treatment campaigns towards people in these groups is vital.

Expanding access and uptake to HIV testing, and increasing the number of people who are aware of their status and who are using condoms, will also go a long way to controlling the epidemic in the USA. Please let us know any comments you have about the content on this page. Please note that we are unable to respond to any questions, or offer advice or information in relation to personal matters. We will not hold your personal data or use it for any other purpose. We are not able to acknowledge receipt of emails.

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Adolescent sexuality in the United States - Wikipedia

It indicates a behavior that transmits HIV infection, not how individuals self-identify in terms of their sexuality. This fact sheet uses the term gay and bisexual men. Viral suppression having less than copies of HIV per milliliter of blood is based on the most recent viral load test. Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content.

Questions and Answers Fact Sheet: Enter ZIP code or city. HIV in the United States: Recommend on Facebook Tweet Share Compartir. After years of sharp increases, diagnoses among young African American gay and bisexual men aged 13 to 24 stayed about the same. African Americans have the highest rate of HIV diagnoses compared to other races and ethnicities. Young people were the most likely to be unaware of their infection. From the first year HIV was listed as a cause of death on death certificates through , , people died from HIV disease.

In , 6, people died from HIV disease. Expand All Collapse All. Dailey AF et al. Human immunodeficiency virus testing and diagnosis delays—United States. Morbidity and Mortality Weekly Report ; After the wedding, the newlyweds feed each other a piece of the cake. At Jewish funerals, fish, usually smoked or pickled, and eggs may be served as symbols of life's continuation.

Some Americans, particularly in the South, eat hopping john, a dish made with black-eyed peas, to bring good luck in the New Year. Americans have many fixed food rituals to accompany events and occasions not generally considered ceremonial. Waking up is accompanied by coffee. Social occasions usually include alcohol. Hot dogs and beer are ubiquitous at sporting events, and popcorn and candy are consumed at movie theaters. The United States has an advanced industrial economy that is highly mechanized.

The gross national product is the largest in the world. The country more than meets its own economic needs and is the world's leading exporter of food. Moreover, it is a dominant force in world finance. The major challenges facing the economy are to maintain profits by keeping production costs low and to increase consumer markets. Besides mechanizing production to reduce labor costs, firms sub-contract production to less developed countries where those costs are much lower.

At the same time, advertising firms that help market these goods to consumers at home and in other countries now constitute one of the biggest industries in the country. Land Tenure and Property. Land tenure is based largely on private ownership, but the government owns an enormous amount of land. Private property is culturally valued, and this is best expressed in the high rate of home ownership. Historically, the United States was an agricultural nation, and it culturally has a romantic image of the small, independent farm family battling the elements on the prairie.

The ways in which federal lands were apportioned to settlers and developers constitutes a mixed legacy. Land grants made to pioneer families and the public universities in every state point to a democratic apportionment of land. However, many private companies gained access to large tracts of public lands. For example, federal land grants made to railroads in the nineteenth century resulted in the consolidation of wealth by railroad company directors who sold parcels of that land and by timber companies that bought large tracts of forested land from the railroads at low prices.

Contemporary patterns of landholding in the Pacific Northwest reflect this legacy of land accumulation by a few large timber firms. The vast majority of businesses are clustered within the service industry, including finance, advertising, tourism, and various professions. Important manufacturing industries include petroleum, steel, motor vehicles, aerospace, telecommunications, chemicals, electronics, food processing, lumber, and mining.

The family farm is clearly on the decline. Most people who claim farming as their occupation work for an agricultural firm and do not own their own land. Since , the United States has been the world's largest producer of wheat, corn, and soybeans, it produces over 40 percent of the world's corn and 45 percent of its soybeans. However, between and , the number of farms fell from over six million to just over two million.

Although occasional attention is paid to the "plight of the family farm," the growth of agribusiness has not resulted in major overt conflicts because most Americans see corporate growth as the fair outcome of free enterprise and competition. Tension arises in cases where property is publicly owned.

During the nineteenth century, the federal government reserved large tracts of western land for federal and common uses. Logging or grazing on these lands is regulated and requires permits. During the sagebrush rebellion of the s, private developers and ranchers who wanted free access to Overview of a summertime baseball game between the Chicago Cubs and the Colorado Rockies at Chicago's Wrigley Field.

Baseball is often referred to as the "national pastime. The language of this rebellion resonated with westerners in poor rural areas who believed that the federal government was usurping valuable land at their expense.

Many environmental conflicts become battles between private developers and companies and the federal government. For example, endangered species are protected under federal rules. In the Pacific Northwest, this legislation mandated the protection of the spotted owl habitat, prohibiting logging in areas with owl nests. Loggers regarded owl protection as an assault on their livelihood and their constitutional right to private property.

The labor force has always been divided on the basis of race, ethnicity, and gender. Skilled jobs in manufacturing and management jobs typically have been more accessible to white men than to black men or women of any race. Within the service industries, there is a technological divide. Blacks and other minorities fill low-skill jobs such as food service and are found less often in managerial positions or the growing hi-tech industries.

Most Americans do not believe that theirs is a "class" society. There is a strong cultural belief in the reality of equal opportunity and economic mobility.

Rags to riches stories abound, and gambling and lotteries are popular. However, there is evidence that mobility in most cases is limited: Moreover, the top 1 percent of the population has made significant gains in wealth in the last few years.

Similar gains have not been made by the poorest sectors. In general, it appears that the gap between rich and poor is growing. Symbols of Social Stratification. Stratification is visible in many facets of daily life. The social segregation of blacks and whites in cities mirrors their separation in the labor force. The crumbling housing stock of blacks in the inner cities contrasts with giant homes in gated suburbs all across the country.

Speech, manners, and dress also signal class position. With some exceptions, strong regional or Spanish accents are associated with working-class status. The United States is a federal republic composed of a national government and fifty state governments. The political system is dominated by two parties: One of the features of American democracy is low voter turnout. On the average, less than half the eligible voters participate in federal elections.

Also referred to as conservatives and liberals, respectively, Republicans and Democrats differ on certain key social issues. Republicans are generally conservative on social spending and moral issues. They support cuts in federally-sponsored social programs such as welfare. They believe in strengthening institutions such as marriage and the traditional family and usually are opposed to abortion and gay rights.

Democrats tend to support federal funding for social programs that favor minorities, the environment, and women's rights. However, critics argue that these two parties set a very narrow range for political debate. Third parties that have emerged on both the left and the right include the Green, Socialist, Farm-Labor, Reform, and Libertarian parties. The powers and responsibilities of the Federal government are set out in the Constitution, which was adopted in The national government consists of three branches that are intended to provide "checks and balances" against abuses of power.

These branches are the executive, the legislative, and the judicial. The executive branch includes the President and federal agencies that regulate everything from agriculture to the military. The legislative branch includes members elected to the upper and lower houses of Congress: The judicial branch consists of the Supreme Court and the U.

At the state level, government is designed along the same lines, with elected governors, senators, and assemblymen and state courts. The smallest unit of government is the county, which has an elected board, but not all states have a system of county governments. With the exception of the President, officials are elected directly, on the basis of popular vote. The President is elected by the electoral college.

Each state has as many electors as it has senators and representatives, the latter of which are awarded according to population. Electors vote as a bloc within each state. This means that all electoral votes in a state go to the candidate with the plurality of the popular vote within that state.

A candidate must win electoral votes to win the election. This system is controversial because it is possible for a President to win a national election without winning a national majority of the popular vote, as happened in the presidential election of Leadership and Public Officials. With the exception of local-level offices, politics is highly professionalized: Running for a high-level political office is extremely expensive; many politicians in the House and the Senate are wealthy.

The expense of winning campaigns requires not only personal wealth, but corporate sponsorship in the form of donations. Social Problems and Control. Although crime rates have decreased, the United States remains the most violent industrialized nation in the world. The capital city, Washington, D. In the nation as a whole, African-Americans, the poor, and teenagers are the most common victims of violent and nonviolent crime.

The country has more people in prison and more people per capita in prison than any other industrialized nation. The prison population is well over one million. These numbers have increased since as a result of mandatory sentences for drug-related crimes.

Although African-Americans make up only about 12 percent of the population, they outnumber white inmates in prison. Both African-American and Hispanic men are far more likely to be imprisoned than are white men. Although rates of imprisonment are on the rise for women, women are far less likely to be imprisoned than men of any race or ethnicity. The United States is also the only Western industrialized nation that allows capital punishment, and rates of execution for African-American men are higher than those of any other group.

Cities are perceived to be very dangerous, but crime rate is not consistently higher in urban areas than in rural areas. The elderly tend to be the most fearful of crime but are not its most common victims. Tough penalties for violent crime are often perceived to be a solution, and it is on this basis that the death penalty is defended.

Interestingly, Florida and Arizona, which have the death penalty, have the highest rates of violent crime in the country. The vast majority of crimes in all categories are committed by white males, but in popular culture and the popular imagination, violent criminal tendencies are often associated with African-American and Hispanic males. Historically, immigrant groups that constituted the urban "rabble" of their day were the subject of intense policing efforts and were believed to have propensities for vice and crime.

The country has officially been at peace since World War II but has unofficially been in almost continuous military conflict. During the period between the end of World War II and the breakup of the Soviet Union , military interventions frequently involved Cold War motivations.

Since that time, the country has used its military forces against Iraq and has supported efforts by other governments to fight the drug war in Central America. The Great Depression, which lasted from until World War II, posed a real threat to the legitimacy of the American economic model in the eyes of citizens.

During that period, President Franklin Delano Roosevelt established a series of social programs collectively known as the New Deal. Many of those programs, including government-backed pension programs, banking insurance, and unemployment benefits, are still in place. These programs, which were intended to provide a buffer against the inevitable downturns of economic cycles, were also a response to serious social unrest, including strikes and socialist organizing.

Americans generally are not opposed to social benefits such as social security pensions and the insurance of bank deposits. However, general relief programs for the poor, known popularly as welfare, have been very controversial. In a country that believes that all its citizens have an equal chance, where opportunity is unlimited, and where only the lazy are poor, programs for mothers and children and the indigent have been vulnerable to cutbacks.

Recently, the federal government made sweeping reforms to the welfare laws that require mothers on welfare to work in order to receive benefits. Nongovernmental organizations NGOS are not as influential as they are in less wealthy nations.

Among the NGOs that operate within the country, the most notable is Amnesty International, which has made both political prisoners and torture within American prisons major issues in recent years. More influential than NGOs are the many nonprofit institutions.

These groups are not associated with government agencies or corporate interests. They include a wide spectrum of advocacy and public interest groups that deal with consumer, environmental, and social justice issues. Nonprofits are a main locus for alternative views and left-wing politics. Division of Labor by Gender. Although most women work outside the home, household and child-rearing responsibilities are still overwhelmingly the responsibility of women. The "double day" of women consists of working and then returning home to do domestic chores.

This situation persists in spite of the cultural belief that men and women are equal. Studies carried out in middle-class homes, in which couples claim to share household duties, show that women still do the vast majority of domestic work.

Although young women as a whole spend much less time on domestic chores than their mothers did, this is attributable not to the fact that men do a significant share of domestic work, but to the fact that women spend less time cooking, cleaning, and caring for children than they did in the past. Women are paid seventy cents to every male dollar for comparable jobs.

Occupations continue to be defined along gender lines. Secretarial or low-level administrative jobs are so overwhelmingly female that they have been termed pink-collar jobs. In the white-collar world, women often occupy middle-management positions. With a few exceptions, the "glass ceiling" keeps women out of high management positions. This situation is justified on the grounds that women take time from their working lives to raise children and therefore do not spend the same amount of time developing their working careers that men do.

Occupations requiring nurturing skills, such as teaching and nursing, are still predominantly female. Within the blue-collar sector, women are underrepresented in jobs considered to require physical strength, such as the construction industries and firefighting. Women often fill low-paid positions in industry, such as assembly-line work, sewing, and electronics assembly. This is justified on the basis that women are by nature more dextrous and that their small hands suit them to assembly-line work.

It is more likely that the low wages offered by these factories explains the recruitment of female laborers, whose other options may include even less desirable seasonal and temporary work. The Relative Status of Women and Men. In legal terms, women have the same formal rights as men. They can vote, own property, choose to marry or divorce, and demand equal wages for equal work. They also have access to birth control and abortion.

The status of women in relation to men is very high compared to the situation in many other countries. However, women as a whole do not receive the same social and economic benefits as men. Women are greatly underrepresented in elected political offices and are more likely to live in poverty.

Female occupations both in the home and in the workplace are valued less than men's. Women are more likely than men to suffer from a sense of disempowerment and to have a distorted or low self-image. Marriage is formally a civil institution but is commonly performed in a church. Statistically, marriage appears to be on the decline. Half of all adults are unmarried, including those who have never married and those who are divorced.

Rates of marriage are higher among whites than among blacks. With the exception of Vermont, civil unions are legal only between heterosexual adults. However, gay marriages are increasingly common whether or not they are formally recognized by the state.

Some religious denominations and churches recognize and perform gay marriages. The high rate of divorce and remarriage has also increased the importance of stepfamilies. The typical model of the family is the nuclear family consisting of two parents and their children.

Upon marriage, adult couples are expected to form their own household separate from either of their biological families.

The nuclear family is the cultural ideal but is not always the reality. Immigrant groups have been reported to rely on extended family networks for support. Similarly, among African-American families, where adult males are often absent, extended kin ties are crucial for women raising children.

Americans trace their ancestry and inherit through both the maternal and paternal lines. Surnames are most commonly adopted through the paternal line, with children taking the father's name. Women usually adopt the husband's surname upon marriage, but it is increasingly common for women to keep their own surnames and for the children to use both the father's and the mother's last names. Family can refer to a nuclear family group or an extended kin group.

The "ideal" family consists of a mother, a father, and two or three children. Americans often distinguish between blood relatives and relatives through marriage; blood relatives are considered more important. Ties among nuclear families generally are closer than ties among extended family members. Adoption is common, but reproductive technologies that allow infertile couples and gay couples to reproduce are highly valued.

This reflects the importance of the concept of biological kinship in the culture. Alternative models of family life are important in American life.

A great deal of scholarship has addressed the historical and economic conditions A snow-capped mountain rises above an old barn in the Mission Range Valley, Montana. The landscape of the U. However, these trends are on the rise in the population as a whole. A significant number of Americans of all ethnic backgrounds live in nontraditional families. These families may consist of unmarried couples or single parents, gay couples and their children, or gay families without children.

Infant care varies by class. Wealthy people often employ nannies to care for infants. Nannies, who often have children of their own, may have to rely on family members or their older children to watch over their infants. Wealthy or poor, the majority of mothers work outside the home. This, coupled with the fact that many people cannot rely on their extended families to help care for their newborns, makes infant care a challenge.

Some employers offer short maternity leaves for mothers and increasingly, paternity leaves for fathers who are primary caregivers. Child Rearing and Education. Child rearing practices are diverse, but some common challenges apply to all families. It is common to put children in day care programs at an early age.

For wealthy families, this entails finding the most elite day care centers; for less wealthy families, it may involve finding scarce places in federally-funded programs. For all working families, day care can be a cause of anxiety and guilt. Negative media stories about child abuse at these centers spoke more to these anxieties than to the actual quality of care.

The country makes few provisions for the care of young children considering the fact that most mothers work outside the home. From age five to age eighteen, public schooling is provided by the state and is universally available. School is mandatory for children until the age of sixteen. Public school education in suburban areas and small cities and towns is usually adequate or excellent. Inner-city schools are underfunded and have a high proportion of minority students.

This reflects a history of white flight to the suburbs and a system in which schools are funded through local property taxes. Thus, in cities abandoned by wealthier whites, both tax bases and school funding have declined. The reputation of inner-city schools is so poor that families that live in cities send their children to private schools if they can afford it. Private schools are mostly white enclaves. Access to equal education has long been an issue for African-Americans.

Until the Supreme Court struck down the doctrine of "separate but equal" in , all educational institutions in the South were segregated on the basis of race. However, the legally permitted segregation of the past has been replaced by the de facto segregation of the present. The level of educational achievement is high. Most Americans complete high school, and almost half receive at least some college education.

Almost one-quarter of the population has completed four or more years of college. Rates of graduation from high school and college attendance are significantly lower for African-Americans and Hispanics than for whites.

The quality and availability of colleges and universities are excellent, but a university education is not funded by the state as it is in many Western industrialized nations. The cost of higher education has soared and ranges from a few thousand dollars annually at public institutions to more than ten thousand dollars a year at private institutions.

Among the middle classes, paying for college is a source of anxiety for parents from the moment their children are born. Students from middle-income and low-income families often pay for college with student loans, and the size of these debts is on the increase.

Personal comportment often appears crass, loud, and effusive to people from other cultures, but Americans value emotional and bodily restraint. The permanent smile and unrelenting enthusiasm of the stereotypical American may mask strong emotions whose expression is not acceptable.

Bodily restraint is expressed through the relatively large physical distance people maintain with each other, especially men. Breast-feeding, yawning, and passing gas in public are considered rude. Americans consider it impolite to talk about money and age.

The overwhelming majority of the people are Christian. Catholicism is the largest single denomination, but Protestants of all denominations Baptist, Methodist, Lutheran, Presbyterian, and others outnumber Catholics. Judaism is the largest non-Christian faith, followed by Islam, which has a significant African-American following. Baptism, the largest Protestant sect, originated in Europe but grew exponentially in the United States, especially in the South, among both whites and blacks.

Aside from the many Christian movements from England and Europe that reestablished themselves early in the nation's history, a few religious sects arose independently in the United States, including Mormons and Shakers. Although religion and the state are formally separated, religious expression is an important aspect of public and political life.

Nearly every President has professed some variety of Christian faith. One of the most significant religious trends in recent years has been the rise of evangelical and fundamentalist sects of Christianity.

Another trend is the growth in New Age religions, which blend elements of Eastern religions and practices, such as Buddhism, with meditation, yoga, astrology, and Native American spirituality. In addition to the practitioners of world religions such as priests, ministers, and rabbis, the United States has a tradition of nonordained and nontraditional religious practitioners.

These people include evangelical lay preachers, religious leaders associated with New Age religions, and leaders of religious movements designated as cults. Women are increasingly entering traditionally male religious positions. There are now women ministers in many Protestant denominations and women rabbis. Rituals and Holy Places.

The country does not have religious rituals or designated holy places that have meaning to the population as a whole. There are many shared secular rituals and places that have an almost religious importance. Secular rituals include baseball and football games.

Championship games in these sports, the World Series and the Super Bowl, respectively, constitute major annual events and celebrations. Death and the Afterlife. Americans have an uncomfortable relationship with their own mortality.

Although most residents are Christian, the value placed on youth, vigor, and worldly goods is so great that death is one of the most difficult subjects to talk about.

Death is considered a sad and solemn occasion. At funerals, it is customary to wear black and to speak in hushed tones. Graveyards are solemn and quiet places.

Some people believe in an afterlife or in reincarnation or other form of continuity of energy or spirit. The dominant approach to medicine is biomedical, or Western. Although many people are interested in alternative approaches such as acupuncture, homeopathic medicine, and other therapies, the United States continues to be less medically diverse than most other countries.

Biomedicine is characterized by the frequent use of invasive surgeries such as cesarean sections and high doses of psychotropic drugs. With the exception of limited government care for the elderly and the disabled, health care is private and profit-based.

This makes the United States distinct from other wealthy, industrial nations, nearly all of which provide universal health-care coverage. A number of secular national holidays are celebrated but are regarded less as celebrations of patriotism than as family holidays. The fireworks displays of the Fourth of July mark the Declaration of Independence from Britain in , but this is also a time for summer outings such as picnics and camping trips with friends and family members.

Thanksgiving is part of the national history that is understood by every schoolchild. This annual feast celebrates the hardships of the early colonists, who were starving in their new environment. According to the legend, American Indians came to their aid, sharing indigenous foods such as maize and turkey. Thanksgiving is important not primarily because of its symbolism but because it is the most significant family holiday of the year, one of the few large and elaborate meals that families prepare.

Support for the Arts. The level of public support for the arts is much lower than it is in other wealthy nations. Patronage for unknown individual artists, writers, and performers is scarce.

The National Endowment for the Arts NEA has a very small operating budget with which it funds everything from public broadcasting to individual artists.

In recent years, the NEA has been under attack from Congress, whose conservative members question the value and often the morality of the art produced with NEA grants. Support also comes from private donations. These donations are tax-deductible and are a popular hedge among the wealthy against income and estate taxes. Generous gifts to prestigious museums, galleries, symphonies, and operas that often name halls and galleries after their donors are essential means of subsidizing the arts.

Much of American literature revolves around questions of the nature or defining characteristics of the nation and attempts to discern or describe the national identity. American literature found its own voice in the nineteenth century.

In the early decades of that century, the essayists Henry David Thoreau and Ralph Waldo Emerson set out the enduring themes of personal simplicity, the continuity between man and nature, individualism, and self-reliance. Walt Whitman celebrated democracy in his free verse poems. Other nineteenth-century writers, such as Herman Melville, Emily Dickinson, Nathaniel Hawthorne, and Mark Twain, articulated moral and ethical questions about the new country and were particularly influential for their critique of American puritanism.

Turn-of-the-century writers such as Edith Wharton, Henry James, and Theodore Dreiser picked up on those themes but were particularly concerned with social class and class mobility. They explored the nature of American culture and the tensions between ideals of freedom and the realities of social conditions. In the early decades of the twentieth century, writers such as F. Scott Fitzgerald and Ernest Hemingway began to question the values earlier writers had represented.

Fitzgerald questioned the reality of the American dream by highlighting the corrupting influence of wealth and casting doubt on the value of mobility and success. Hemingway, like other modernists, addressed the issue of how one ought to live once one has lost faith in religious values and other social guidelines. Other early twentieth-century writers, such as Zora Neil Hurston, Nella Larsen, and William Faulkner, introduced race and racism as central themes in American literature.

Their novels romanticized the hard work of poor rural whites. Implicit in these novels is a critique of the wealth and excess of the urban metropolis and the industrial system that supported it. Although these novels are permeated with multiethnic characters and themes, Anglos are generally the focal point.

Issues of identity and race were explored by earlier American black writers. A generation of black authors after World War II made these permanent themes in American literature, illustrating the poverty, inequality and racism experienced by American blacks. Many black writers explored the meaning of living inside a black skin in a white nation with a legacy of slavery.

Perhaps the most influential contemporary writer who deals with these themes is Toni Morrison. An important literary school known as Southern Gothic discussed the nature of rural southern A tractor harvesting crops in the western United States. Writers such as Truman Capote, Tennessee Williams, Carson McCullers, and Shirley Jackson explored the contradictions between privileged whiteness and a culturally deficient southernness.

These novels feature lonely, grotesque, and underprivileged white characters who are the superiors of their black playmates, servants, and neighbors but cultural inferiors in America as a whole. Beginning in the late s and s, a generation known as the Beats challenged the dominant norms of white American masculinity. They rejected conventions of family and sexuality, corporate success, and money.

Starting in the s, women writers began to challenge the notion that women's place was in the home. Early feminist writers who critiqued the paternalism of marriage include the nonfiction writer Betty Friedan, the novelist Marge Piercy, and the poets Anne Sexton and Sylvia Plath. Feminist themes, along with issues of ethnicity and otherness, continue to be important in American literature.

Novels by Louise Erdrich and Leslie Marmon Silko illustrate how Native American families attempt to survive and reclaim their traditions amid poverty and discrimination.

Other contemporary novels try to deconstruct the experience of the "norm" in American culture. Ann Tyler's characters are often empty and unhappy but cannot locate the sources of those feelings. Don Delillo writes about the amoral corporate world, the American obsession with consumer goods, and the chaos and anxiety that underlie the quietness of suburban life.

Joyce Carol Oates is attracted to the sinister aspects of social conformity. These novels are not the most widely read looks in the United States. Much more popular are genres such as crime and adventure, romance, horror, and science fiction. These genres tend to repeat valued cultural narratives.

For example, the novels of Tom Clancy feature the United States as the moral victor in cold war and post—Cold War terrorist scenarios. Harlequin romances idealize traditional male and female gender roles and always have a happy ending.

In horror novels, violence allows for catharsis among readers. Much science fiction revolves around technical-scientific solutions to human problems. The most influential visual artists are from the modern period. Much early art was imitative of European styles. Important artists include Jackson Pollack and Andy Warhol. Warhol's art documented icons of American life such as Cambell's soup cans and Marilyn Monroe. His work was deliberately amusing and commercial.

Most graphic art is produced for the advertising industry. Performance arts include many original genres of modern dancing that have influenced by classical forms as well as American traditions, such as jazz. Theaters in every town that once hosted plays, vaudeville, and musicals now show movies or have closed.

In general, performance arts are available only in metropolitan areas. The United States has produced several popular music genres that are known for blending regional, European, and African influences. The best known of these genres are the African-American inventions blues and jazz.

Although now considered classics, blues and jazz standards were the popular music of their day. Music fits into "black" and "white" categories. Popular swing jazz tunes were standardized by band leaders such as Glenn Miller, whose white band made swing music hugely popular with young white people. Rock 'n' roll, now a major cultural export, has its roots in these earlier popular forms.

Although rock 'n' roll is primarily white, soul and Motown, with singers such as Aretha Franklin, the Supremes, and the Temptations, produced a popular black music. Country music, another popular genre, has its roots in the early American folk music of the Southeast now termed country or bluegrass.

This genre reworked traditional gospel songs and hymns to produce songs about the everyday life of poor whites in the rural Southeast. Popular music in the United States has always embodied a division between its commercial and entertainment value and its intellectual or political values.

Country and folk, blues, rock 'n' roll, rap, and hip-hop have all carried powerful social and political messages. As old forms become standard and commercialized, their political edge tends to give way to more generic content, such as love songs.

The United States is a leading producer and exporter of scientific knowledge and technology. Major areas of scientific research include medicine, energy, chemicals, weapons, aerospace technology, and communications. Funding for research comes from government agencies and universities as well as the private corporate sector.

The role of private corporations in research is controversial. Pharmaceutical companies often fund research that leads to cures and treatments for diseases. One consequence is a dearth of research on diseases particular to poor countries. Another consequence is that medicines are marketed at costs that are prohibitive to the poor both inside and outside of the country. In the face of technology and science as being culturally valued, an increasing cause of social concern is the fact that American schoolchildren do not do well on standardized tests in the sciences.

Medical Anthropology and the World System: A Critical Perspective, The Phoenix Rises from the Ashes. Bury My Heart at Wounded Knee: An Indian History of the American West, Federal Land, Western Anger: The Sagebrush Rebellion and Environmental Politics, Chan, Sucheng, et al. Conklin, Nancy Faires, and Margaret A.

A Host of Tongues: Language Communities in the United States, Rethinking the Human Place in Nature, The Cambridge Encyclopedia of Language, , revised edition Excavating the Future in Los Angeles, The Rise and Fall of Suburbia, The Nine Nations of North America, Ginsberg, Faye, and Anna Lowenhaupt Tsing, eds.

Negotiating Gender in American Culture, Timelines of Native American History, Hibbard, Michael, and James Elias.

We partnered with women's funds and foundations across the United States as part of a national campaign to research, prevent and end domestic minor sex. No matter what those, ahem, movies might suggest, in the United States, the to 59, women have an average of four sex partners during their lifetime; men have. The sex trafficking of women has received attention by the U.S. social work profession as a contemporary human-rights abuse. However.