HIV/AIDS

HIV/Aids

HIV/Aids

Introduction

AIDS (acquired immune deficiency syndrome) was viewed as a social problem 1 as soon as epidemiologic reports about a “gay plague” appeared in the United States. Like other sexually transmitted diseases, AIDS was associated with people “who had the misfortune to fit into rather distinct classes of outcasts and social pariahs” (Shilts 1987). The first social pariah to be named in the AIDS epidemic was the white, gay man whose lifestyle was assumed to be an efficient conduit for HIV (human immunodeficiency virus) transmission. AIDS, in fact, was known as the “gay white man's disease” well past the time when the accuracy of this characterization should have been questioned, and certainly past the time when heterosexual citizens in developing countries were being infected at an alarming rate. This chapter will address the concept of AIDS as a social problem along two dimensions: first, in its creation of social pariahs through discourse about who was infected and, second, in the subsequent problems of this representation for responding to the epidemic.

Definitions

HIV infection is a syndrome that takes the form of opportunistic diseases such as Kaposi's sarcoma, Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV), toxoplasmosis, and the virulent forms of thrush, herpes, and hives. HIV infection can be transmitted through unprotected sexual intercourse, contaminated hypodermic needles, and untreated blood products. HIV infection has a latency period of 5 to 15 years but is usually fatal if an untreated infection has progressed to AIDS. Antiretroviral medicines developed for the treatment of HIV infection can significantly prolong the life of “people with HIV” (PWH). HIV infection may be deadly in societies in which lifesaving medicines are unavailable and chronic (manageable) in wealthy nations in which antiviral regimens are the standard of medical care.

An Epidemic of Inequality

The United States

In the United States, the demography of HIV/AIDS has undergone substantial change since the early days of the epidemic. While white middle-class men in major urban areas in the Northeast and Pacific West were among the first to be afflicted, HIV infection is now associated with ethnicity and poverty. African Americans and Hispanics account for 54 percent and 19 percent of new infections in the United States, respectively, even though they make up only 12 percent and 9 percent of the population (CDC 2002a; U.S. Census Bureau 2001). This epidemiologic pattern is similar to other sexually transmitted infections (STI) such as syphilis, gonorrhea, chlamydia, and genital herpes (CDC 2001a), all of which disproportionately affect minorities.

Most new infections occur in the southeastern states. African Americans in particular are at risk of HIV transmission. In Alabama, for example, 72 percent of new cases occurs among African Americans, who represent 26 percent of the state population (Alabama Department of Public Health 2002). Similar patterns occur in Mississippi, Georgia, Florida, and South Carolina (CDC 2001b). The gap between the number of infected men and women is narrowing for African Americans, meaning that the AIDS iconography of the gay white man in the 1980s is no longer a primary referent in the 21st ...