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Epidemiologists isolated the human immunodeficiency virus (HIV) that causes acquired immune deficiency syndrome (AIDS) in 1984. Cultural attitudes about this epidemic, sexually transmitted disease and the populations it affects—homosexual men, male and female sex workers, drug addicts, and citizens of underdeveloped countries—subdued the initial response to the crisis. AIDS will continue to destabilize economically and politically vulnerable communities and countries until an HIV vaccine is developed.
The appearance in Western medical literature in 1981 of a strange and inexplicable cluster of clinical manifestations—unusual opportunistic infections, cancers, and metabolic or neurological disorders—marked the emergence of what would become a global pandemic known as acquired immune deficiency syndrome, or AIDS. Efforts to find a cure for AIDS are in full swing at the beginning of the twenty-first century, but initial responses to the onset of the crisis were sluggish. Those responses have been determined by cultural attitudes toward disease (both epidemic and sexually transmitted) and by the socioeconomic disadvantages of the populations most closely associated with AIDS (homosexual males, male and female sex workers, drug users, and citizens of underdeveloped countries).
History of the Epidemic
While epidemiologists who study the origins of disease rely in part on documentation such as medical and autopsy reports, and material evidence such as serum and tissue samples, tracing the history of a disease ultimately requires a certain amount of speculation. In the case of the virus that causes AIDS (human immunodeficiency virus or HIV, first isolated in 1984), a preponderance of evidence suggests it originated among monkeys in western Africa, moving from simian to human populations perhaps as early as the mid-twentieth century. From there it was rapidly transmitted from human to human by means of infected bodily fluids such as blood, semen, or vaginal secretions.
Increased travel between rural and urban Africa in the postcolonial period, as well as travel between Africa and Europe or the United States, helped spread the virus to the developed world. A number of aspects of modern society—including population mobility, relaxed sexual mores, intravenous drug use, and medical innovations like blood transfusion and organ transplantation—have facilitated the spread of HIV, which lives in the body for an extended period before manifesting itself in opportunistic infections.
In the late 1970s, the first documented cases of the medical syndrome occurred among gay men in urban centers of the United States with large gay communities, chiefly Los Angeles, San Francisco, and New York. Official recognition of what would eventually be called AIDS was published by the Centers for Disease Control in June 1981. Physicians in France and England took note of these cases, which were comparable to their own clinical observations during the same period.
A syndrome rather than a disease, AIDS, unlike most bacteriological or viral infections, does not manifest itself in a single symptom or even a small cluster of symptoms. Instead, HIV attacks the cells responsible for the body’s immunological defenses, making the body vulnerable to a wide range of common but normally unthreatening bacteriological and viral agents. Thus, in the early years of the epidemic, a clinical diagnosis occurred only after the appearance of secondary infections, making it difficult for physicians initially to recognize a pattern or even identify the causal agent and its presence in patients. Several years elapsed before a viral cause and a clinical test for antibodies were determined. Slow to cause the immunodeficiency that signaled its presence, HIV had ample opportunity to be spread by those who did not know they were infected. Unlike the causes of past epidemics such as plague, smallpox, or influenza, HIV could survive unnoticed in the infected for months or even years.
Historically, different cultures have responded to epidemic disease in remarkably similar ways. In the ancient and modern worlds, plagues have often been viewed as divine punishment for breaking taboos or committing sins. (For example, both Homer’s Iliad and Sophocles’s Oedipus the King begin with such plague punishments.) Because AIDS was first documented among intravenous drug users, sex workers, and men who were having sex with men, these already stigmatized groups were regarded by many as undeserving of medical treatment, and the culturally or legally proscribed activities that served as modes of transmission were frequently left out of public discussion. Even today, more than twenty years into the epidemic, much of the debate about HIV-prevention training remains mired in conflicts over cultural and religious values rather than discussions about effective public health practices.
In addition, during an epidemic the unaffected can conclude either that only the marginalized group is vulnerable (in which case, no further action is required) or that everyone is vulnerable (so the marginalized group needs to be expelled or contained and regulated). Throughout the first two decades of the AIDS epidemic, governments and communities made both assumptions, in violation of standard public health practices. Heterosexuals in industrialized nations assumed AIDS was a homosexual problem. African-American clergy and leaders assumed it was a white problem. African leaders assumed it was a problem of former French, English, or Belgian colonizers and American hegemonic capitalists. Communist leaders in the People’s Republic of China and the Soviet Union assumed it was a decadent bourgeois problem. The result of this blindness was a lack of AIDS-prevention education and health monitoring worldwide, allowing infection rates to soar.
Recent Trends and Future Prospects
The end of the Cold War and the rise of a more tightly knit global economy have in many ways exacerbated the AIDS problem. Within the old Soviet bloc, the end of communism resulted in economic dislocation and hardship, which in turn increased the rates of poverty, intravenous drug use, and prostitution while reducing the capacity of socialized medicine to respond to the epidemic. Expanded trade in Africa and Asia similarly facilitated HIV transmission among marginalized or migratory workers. The rise of the Internet and the attendant proliferation of online pornography have resulted in new types of sex work as a form of economic subsistence. In addition, airline deregulation has encouraged Western sexual tourism in developing nations.
Furthermore, the development in recent years of effective pharmaceutical treatments to manage HIV infection has brought with it unintended consequences. In Western industrialized nations where such medications are available, some people have become lax about employing AIDS-prevention measures, and infection rates in some populations have risen. In developing nations where AIDS medications are prohibitively expensive, governments and nongovernmental organizations have had to lobby for reduced drug costs.
A rationalist Western scientific worldview will continue to be confronted by a variety of local beliefs and values. To Western medicine, AIDS is simply caused by a virus (HIV) that is commonly transmitted through unprotected sex; the prevention of HIV transmission, therefore, is simply a matter of preventing HIV infection (through sexual abstinence, through sexual fidelity to one partner, or through use of condoms or “safer sex” practices). But sexual behavior is notoriously immune to rational choice. Furthermore, the power to make and enforce decisions about safer sex is often asymmetrical in many cultures, with males having greater power over females or johns having greater power over prostitutes. Misinformation and falsehoods about HIV and AIDS are prevalent in many communities (such as the belief that one can tell by a person’s appearance if they are HIV infected or that an HIV-infected man can be cured by having sex with a virgin). Even HIV/AIDS denialism (rejecting HIV as the cause of AIDS) is not simply the peculiar aberration of a few individuals but can influence public policy, as in the case of former South African president Thabo Mbeki’s opposition of antiretroviral medications in that country.
AIDS will continue to destabilize economically and politically vulnerable communities and countries until an HIV vaccine is developed. Research into a cure for AIDS continues apace; but until researchers develop an effective vaccine, AIDS-prevention education and a commitment by Western nations to provide funds for medical treatment will remain the primary means of limiting this epidemic.
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