A Social Link Production (1998)
HIV/AIDS
from a Social Perspective
Getting around this page
Demographic Development
Social Inequities
Education
Treatment
Activism
Getting around this site
Home Page
Biology Page Psychology
Page Dictionary
Bibliography Links
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.
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.
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.
(Treatment and Activism section still under construction. Please
visit again.)
Top of Social Page
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)