A Social Link Production (1998)


 
HIV/AIDS
from a Social Perspective

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Demographic Development


               THE WORLD SCENE

The cumulative global number of HIV infections among adults has more than doubled since the beginning of the decade, from about 10 million in 1990 to almost 27.9 million by mid-1996. Of these, 58 percent were men, and 42 percent were women.
68 percent of the global total of individuals ever infected with HIV were in sub-Saharan Africa, totaling 19 million. 18 percent of the global total, totaling 5 million, were in South and Southeast Asia. That means that the majority of HIV infections- 24 million (93 percent) -have occurred in the developing world.

More than 6 million adults have developed AIDS from the beginning of the pandemic to July 1996. By July 1996, 5.8 million people (4.5 million adults and 1.3 million children), 75 percent of all people with AIDS, are estimated to have died from AIDS worldwide. 4.5 million (close to 75 percent) were in sub-Saharan Africa; 0.4 million were in Latin America and the Caribbean (7 percent); and 0.75 million were in North America, Europe and North and South Pacific combined (12 percent). In South and Southeast Asia, where the pandemic gained intensity more recently, it is estimated that 330,000 adults have developed AIDS.

In summary, the HIV/AIDS pandemic is as powerful as ever. Reports show that the pandemic is now composed of distinct epidemics each with their own features and force, and disproportionately impacting on the developing world. As the HIV/AIDS epidemics within each region and country have become increasingly diverse and fragmented, they have created a multifaceted, devastating pandemic.


THE LOCAL PICTURE

Since the start of the epidemic from 1 to 1.5 million cumulative HIV infections have occurred in North America, and HIV infection has been one of the major causes of death for individuals between the ages of 25 and 44. Among men in this age group, it was the leading cause of death in the U.S. and the second leading cause of death in Canada in 1994. In the same year, HIV infection was the third leading cause of death among 25- to 44-year-old women in the U.S.

North America has seen the HIV epidemic slow in recent years; new infections have started to level off. This has been largely due to the decline in sexual transmission between men as a result of behavior change.

Along with an overall slowing in AIDS incidence, there has been substantive shift in the populations affected. From one point of view there has been a certain “mainstreaming” of the illness; AIDS cases related to heterosexual contact represent an increasing proportion of newly diagnosed cases in North America. But there has also been a certain marginalization of the illness; in 1995 AIDS incidence was 6.5 times greater for blacks and 4 times greater for Hispanics than for whites, 20 percent of persons diagnosed with AIDS were women. 15 percent were infected heterosexually. AIDS among prisoners was 7 times the rate of the non-incarcerated population, and AIDS was the second leading cause of death among prisoners. In short, although male-to-male sexual contact remains a leading cause of infection, the shift has been toward women and people of color, and especially toward intravenous drug users of both sexes and any colors.

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Social Inequities

Homophobia

Piggybacking on the human rights struggles of the 50's and 60's, and in the wake of the sexual revolution of the 60's and 70's counterculture, tolerance was growing throughout society. The overall hostility of mainstream society towards gays had given way to pockets of tolerance and queer culture. Watershed's in gay history, such as the Stonewall Riot, had increased gay visibility.  From the moment when medical professionals first began to recognize the syndrome which we would later call AIDS, it was understood that this disease had a special affinity for gay men. Initially it was referred to as GRID -- Gay-Related Immune Deficiency. (Even though the percentage of gay persons with HIV/AIDS has been steadily decreasing, gay men still account for more than half of all cases.) It would be difficult to know what it means to say that AIDS has slowed the progress of this acceptance, but in some ways it surely has. At the very least, many of the gay community's most noteworthy spokesman have succumbed to the illness. Much of this has however found lasting voice in the historical chronicles and artistic reflections with which the community has responded.  The struggle continues. HIV/AIDS still affects the shape that struggle takes. Prejudice against gays, by and large the norm anyway, took on a renewed vigor as people could associate this awful disease with these "bad" people.

This plague struck in the early 1980's, when homosexuals in general, gay men in particular, had been making some gains toward social acceptance. However in many ways, and with many exceptions, the rising wave of gay culture followed the shorelines of other inequities. The gay culture acceded to the white and male focus of mainstream culture. So although this struggle for human rights continues, it has only begun to expand into the non-white and non-male communities.

Ironically, the devastation wrought by HIV/AIDS  highlights both gay and mainstream prejudice; but it also has provoked at least some positive developments in making the movement more inclusive. Not everywhere, but more than ever, the banner of gays, lesbians, bisexuals and transgendered people flies as one.
But as the day dawns where gay and bisexual men will no longer make up the majority of new cases, the demographics of HIV/AIDS are flowing into other socially disenfranchised populations.



 
Women and HIV
By 1997, women accounted for almost 20% of all diagnosed AIDS cases in the United States and more than 50% worldwide. The U.S. numbers may underrepresent the real percentage since many women are not tested for HIV unless they become pregnant or ill. Over the past several years, the clinician and researcher perception of individuals "at risk" for HIV infection has only begun to change to include women. However, this change in thinking is a slow one and research specific to and inclusive of women with HIV is  just starting in many arenas.
One of the greatest social challenges of HIV is the fact that women's particular reaction to HIV and HIV medication has been understudied. Women comprise at least 20% of people diagnosed with AIDS, but less than 12% of AIDS Clinical Trial participants. Women's participation in studies leading to the approval of protease inhibitors was, in certain cases as few as 3% of all trial participants.
Fortunately, there are many similarities in the treatment and care of both men and women, and many of the recent advances in our understanding of HIV and the disease process apply equally well to both. Nevertheless, women are one of the fastest growing populations of people living with HIV/AIDS, and dying at evermore disproportionately higher rates.
Much of the testing done on women has focussed on "vertical transmission" (mother to fetus transmission). AZT has for some time now been known to prevent such transmission (while other parts of combination therapy are considered "too trying" on pregnant women and potentially damaging to the developing fetus. So to prevent perinatal, women have often been given what is for them suboptimal care-for the sake of the developing fetus supposedly. Less well known is that AZT has been shown to cause vaginal tumors.  Moreover, viral load may be a predictor of perinatal  transmission with or without AZT, and monotherapy causes resistance. There are many issues left to be worked out, and a certain outrage about the way women have been neglected in the pandemic seems appropriate.


Race and HIV
The other striking demographic change is the phenomenal rise in the number of people of color living with HIV and dying of AIDS. That is to say that not only has the number of infections continued to rise at dramatic rates, the survival rates for people of color is dramatically lower. Whereas many gay white men with HIV are profitting from combination therapy, this is not in general true for other populations. We must ask ourselves why this is so.
 


Economy of privilege and mortality
$$$  $$$
The preceeding discussion of women and HIV, coupled with these remarks, should make it no surprise that the single fastest growing demographic group with HIV is women of color.
A common rumor is that women with AIDS die faster than men. Many have suggested that the way in which people of color are disproportionately affected supports the urban legend that AIDS was invented as a disease to wipe out populations of color.
Both of these are probably not true. What is true is that, in general, people with HIV who do not access services and lack competent medical care die faster than people who take an active role in their health care and work with a doctor or health care provider experienced in managing HIV disease. In fact, in the study  that originally showed this difference, women and people of color appeared to die faster until the researchers went back and figured out who had access to health care and other services. Those (men and women, white or non-white) who had health care and support services were less  likely to become ill or die, primarily because they knew their HIV status earlier and were able to prevent illness rather than treat it.
The good news here is that, biologically, women and people of color are not at greater risk for progressing to AIDS or dying. Women and people of color can and should have the same chance to survive and thrive as white men living with HIV and AIDS; it is a question of accessing care.
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  HIV/AIDS Awareness & Education

Abstinence...?
State and local health agencies and public education programs took up the challenge of HIV/AIDS and youth conservatively. Many school systems were slow to respond at all. Much of the rest responded with a renewed emphasis the value and importance of sexual abstinence.
It was not until 1987 that the President's Domestic Policy Council set principles for HIV prevention. They looked to the States to determine the scope and content of public AIDS education "consistent with parental values." They emphasized only that educators should encourage "responsible sexual behavior, based on fidelity, commitment, and maturity, placing sexual behavior within the context of marriage."

... vs. Harm reduction!
Experts in epidemiology, behavioral and social sciences, evaluation research, and health planning have found a variety of insufficiencies in this policy. For example, the "context of marriage" as a framework denies the reality of pre-marital adolescent sexuality. And how can a gay teen, often already isolated through his or her difference from the mainstream, make use of this prescription.
But the most important thing to mention about "abstinence" as the focus of HIV/AIDS prevention, is that it is simply not working well enough. Despite almost a decade of using this focus, HIV infections continue to rise in dramatic numbers for people in there early twenties. They have risen by 25% in the last five years! Given that teen's in general are apparently not accepting the notion of deferring sexual exploration, there seem to be obvious problems with a philosophy of education that refuses to offer a spectrum of prevention. Between the extreme's of absolutely unsafe behavior of frequent and unprotected sex on the one hand, and total abstinence on the other, are a variety of means of risk reduction. The use of condoms and knowledge of the methods of sterilizing needles could provide more realistic means of reducing the number of infections.
 
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Getting around this page
Social Inequities      Demographic Development     Education     Treatment     Activism

Getting around this site
Home Page      Biology Page      Psychology Page       Dictionary     Bibliography     Links 
A Social Link Production (1998)