Anthony is a postgraduate Law student, with a background in Human Sciences. He writes on Policy, Bioethics, Medicine, Public Health and society.
Can history inform our views and subsequently our approach to problems brought forward by the AIDS Epidemic?
This question poses no certain answer, not least because there is no clear consensus on the construction of disease history. Societal responses to disease are guided by values routed in cultural, social and moral institutional precepts. This is perhaps most evident in AIDS, where our understanding has been warped by structures of identity, oppression, subversion and fear. Far from figurative, the fabrication of our perceptions have terribly important consequences – not only for the way we frame, approach and conceptualise disease policy – but also for the way in which social actors build a risk narrative in relation to their own proximity to morbid outcomes. Venereal disease is often unique in that the victims are seen as the cause and the embodiment of the disease. This builds a narrative of – ‘them and us’ – where there is a tendency to disengage from the pertinent problems at hand. In searching for groups to blame, do we pervert policy with ineffective social and cultural frames that hinder progression? In response let us consider three ages of venereal disease.
Gonorrhoea – The Pathogenic Immigrant
The turn of the 20th century marks a particularly useful time in terms of characterising and assembling this article’s demonstration. At this point in history, medical practioners had begun to accurately describe and define gonococcus – the bacteria primarily responsible for gonorrhoea. To a large extent, the growing problem of venereal disease was framed within the institution of family, with up to 25% of blindness in the United States caused by the disease in new-borns. The late 19th century also happened to mark the most extensive period of immigration in the USA, with over half a million immigrants reaching US shores annually. Uncertain doctors and socially influential commenters argued and disseminated the idea that only the influx of immigrants could of course be responsible, despite clear evidence to the contrary. Although systematic investigations and examinations on arriving immigrants at the ports failed to establish a significant incidence of venereal disease, they continued to be implicated in the medical vicissitudes and burdens of native, middles class, Anglo Saxon Americans. You see, in a desperate plea to ascribe blame, competent doctors (insofar as they demonstrated a basic understanding of disease aetiology) abandoned rationality and reasonability to make sense of misfortune, inventing incredulous models of venereal transmission. At first, transmission was centred on immigrant prostitutes, which later evolved to a catalogue of other transmission theories, stretching from the use of stationary, doorknobs and linen – to the rather desperate suggestion that the disease could be transmitted through ‘simple communication’.
Syphilis – The ‘Coloured Disease’ of Black Promiscuity and Sexuality
For a large part of the 20th century syphilis was also labelled as a black problem created by black sexuality. Biased statistics reported inaccurate rates of incidence and exaggerated racial differences in infection. Of course, disease prevalence was generally higher in many black communities, but the effects of poverty, squalor and overcrowding in ghettos adequately accounted for this social gradient. In essence, and at best, syphilis was an economic and social condition that reproduced within the sphere of the socially excluded. It was not, and is not, a condition inherent to blackness. Why then – was blackness so heavily implicated? Why did whiteness so readily perceive blackness as characteristically highly sexual, feral and uninhibited perpetuators of the disease? Ordinary conceptions of syphilis were undoubtedly coloured by social and cultural perceptions. At the centre of venereal disease aetiology was the clear stamp indicating the key cause of ‘immorality’. The condition of ‘them’ – both in its immigrant and blackness form, allowed society to discharge blame away from ‘us’, even though that is where the problem is partly localised.
Disappointingly, the tendency to turn to hierarchical dynamics in time of human insecurity is a common facet of history. The way in which we perceive, reflect, and navigate contagions is ultimately rooted in our culturally approved fears and anxieties on sexuality and being. These sexually transmitted diseases are in every way a trope for anxieties that arise from real and physical sociocultural standards – an anxiety so strong that it has, in the past, divided victims into those considered to be innocent (us), and those which are not (them). This distinction has been reconciled by the way we moralise modes of infection. When damaging social and cultural ideas are widely shared, their presence within medical knowledge is not easily conceded. History, I argue, therefore lends itself as an incredibly useful tool in understanding the way we frame a disease.
Deconstructing the Relationship Between AIDS and Homosexuality
The AIDS epidemic has presented manifest similarities to the previous examples – not only in raising fear-based theories of transmission, but also in returning to the emphasis on hierarchical dynamics. In the contemporary age of non-communicable diseases, such a seemingly unassailable threat of endemic infection has worked once more to re-centre a ‘them and us’ narrative. Medical insecurity drives the desire to understand and hereafter cope with fears and anxieties constructed through these sociocultural perceptions and normative values. Sadly, the level of stigma in Western society in relation to AIDS has been of a similar level of inaccuracy to that which existed in fallacious representations of earlier accounts of venereal disease. Over the years, we have bore witness to numerous reports of medical professionals whom have refused to treat patients because of fear and morality. Equally, the question concerning whether children with AIDS should attend school was actually entertained as one of reasonable debate, despite an accurate appreciation for the standard of threat. Why do we allow this narrative to persist when it is so clearly rooted in fear and not in understanding? Why do we allow individuals to engage in discourse that imputes a disease to an identity marker?
As most people probably recognise, AIDS was first conceptualised as a disease belonging largely to males who have sex with males (MSM). And yes, in many countries within the Western world it has been a significant source of transmission. However, ‘homosexuals’, as a unitary group, are not at risk of AIDS; instead, it is those that practice unsafe sex. There is a nuanced distinction in this statement that is particularly important to my point and my attempt to deconstruct the common conflation between homosexuality and the disease. It is commonplace for the public to perceive AIDS as belonging and originating in the LGBT community. But I am sorry – it does not. I challenge this portrayal because the distinction between homosexual identity and behaviour is of great policy importance. When we attach homosexuality to AIDS in this manner, a number of concerns arise: Firstly, it gratuitously encourages discrimination and homophobia through the understanding that AIDS will threaten heterosexuality through homosexual contamination; it allows others outside of this group to engage in high-risk behaviour without fear of or even thought for HIV infection, and; it permits us to view the disease as a phenomenon facing only a select demographic. When we have an understanding that AIDS is a problem belonging to a particular group of people, we limit our humanity. We subscribe to a story that tells us that homosexuality and not HIV causes AIDS. Some in turn fear homosexuality as if it is in itself pathogenic. Well, it is not. And believe it or not, HIV is a problem for all of us.
We must understand this – AIDS cannot be completely understood strictly from a biological standpoint. It is unquestionably entangled with social and cultural considerations. Does the HIV virus cause AIDS – or – is AIDS caused by promiscuous sexual behaviour? The answer ultimately depends on the reader and whether they subscribe to a social or biological paradigm. Policy approaches in the future will need to thoroughly consider the intersection of these paradigms as they both guide disease outcomes. History is not objective, and we cannot use it to accurately make predictions about the outcome of AIDS. Nevertheless, I am certain that the progression of AIDS will not be wholly determined by the disease’s biological personality. We must endeavour to understand the effects of moral opprobrium and social ‘otherising’.
When we discuss these issues, we must do our best to keep the tragedy of AIDS at the forefront of our minds.
The disease, like many before it, has revealed a great deal about society, illness and the process of dying. AIDS is and has always been a disease that affects us all. Gonorrhoea has never belonged to immigrants, and syphilis has never belonged to blackness. If we are to conquer AIDS as we have these, we must also accept that HIV does not belong to homosexuality – it belongs to humanity.