AIDS Flashcards
Gilman, 1987
On the construction of AIDS
argues that aids is partly a ‘social construction’, influenced by the Media.
‘people have been stigmatised as much by the “idea” of AIDS as by its reality’
iconographical ‘set’ for each disease
History of AIDS
- 1979, A. F. Kein identifies Kaposi’s sarcoma (KS)
- June 1981, CDC report 26 cases
- Concurrently, cases of Pneumocystis Carinii (PCP) identified in some of these patients
Constructing the AIDS patient in the 80s
Gilman 1987
- Those suffering from KS/PCP were urban dwelling, young, homosexual, male.
MMWR (CDC journal) began to note the syndrome among hemophilacs/IV Drug users from 1982, sexuality continued to be at forefront
Seen as as an STI, not a viral disease - thought it is in reality more similar to Hep B
- The more it becomes apparent that AIDS is not solely an STI/Homosexual disease, the more it becomes necessary for ‘hetrosexuals to retain the image of AIDS as a disease of socially marginal groups’
- -> ‘black isolated gay man’ becomes icon
The Iconography of AIDS
Gilman, 1987
Influenced by the construction of the iconography of STIs (eg syphilis) - isolation, labelling women as the source of disease
Distance
- NYT, 1985, doctors distanced from ‘act of healing’ - this was typical of reporting which created and reflected an anxiety about ‘polluting’ contact with PWAs/STI sufferers
The changing image of AIDS in the late 1980s
Gilman, 1987
- By March 1987, majority of patients in AIDS clinics in NY/San Fran were heterosexuals
- Despite change ‘the attempt is made to maintain definite boundaries so as to limit the public’s anxiety about their own potential risk.’
Fee and Krieger, 1993
Significance of AIDS as a subject of interest
- ‘offers a complex and vivid example of the ways in which people create multiple, contested explanations of health and illness.’
Fee + Krieger (1993) on the construction of AIDS
Three paradigms
Paradigm One: ‘gay plague’, analogy with epidemics of the past
Paradigm Two: a normalised, chronic disease
–> Both inadequate, they propose: ‘a collective chronic infectious disease and persistent pandemic, manifested through myriad specific diseases associated with human immunodeficiency virus (HIV) infection
Fee + Krieger (1993) on social and political context of AIDS
- ‘its course cannot be understood or altered without attention to its social and political context.’
Fee and Kreiger (1993), Paradigm One: AIDS as a Gay Plague
Early identification of AIDS with homosexuality
GRID: Gay-Related Immunodeficiency Disease
- sudden and widespread epidemic
- Gay men - ‘promiscuity’, poppers, anal sex - risk group
Fee and Kreiger (1993), Paradigm One: AIDS as a Gay Plague
How was the Aids as Gay Plague paradigm challenged at the time? How did the paradigm develop as a result?
- contradictory evidence, eg that women/users of drugs were getting AIDS (initially it was suggested they’d had contact with gay men)
- also blood transfusion recipients, hemophiliacs, Haitian immigrants
–> 4 Hs: Homosexual, Hatians, Hemophiliacs, Heroin Addicts
Fee and Kreiger (1993), Paradigm One: AIDS as a Gay Plague
How were risk groups characterised?
- Contagious
- Culpable: stories of ‘innocent victims’ like hemophiliacs and children implied others were ‘guilty’
Fee and Kreiger (1993) - AIDS as infectious?
The significance of HIV identification
- 1983, HIV virus identified and AIDS is seen as an infectious disease
- vague notions of ‘virus’ and spread by ‘bodily fluids’ increased fear
- refusal to wear/touch clothes previously worn by AIDS patients
- Shift in focus from risk groups to risk behaviours
Public health measures to combat HIV
Fee and Kreiger (1993)
- Condoms, which were opposed by the right wing
‘made the public health approach to AIDS prevention an especially difficult and frustrating task’
- needle exchange, seen as encouraging drug use
- individuals encouraged to refrain from donating blood if they may have HIV; individuals encouraged to store own blood
HIV testing - benefits and weaknesses
Fee and Kreiger (1993)
- opened up possibility of traditional identification and quarantine.
- However, ‘exposed the individual to considerable social risk while offering no medical benefit’ eg discrimination in insurance, housing, jobs
Paradigm two: AIDS as a chronic disease
Fee and Kreiger (1993)
Why did AIDS come to be seen as a chronic disease?
- estimates for numbers infected were ‘revised down’ - ‘heterosexual explosion’ did not materialise
- AIDS has a long time frame and would not quickly disappear
- Dying with AIDS < living with AIDS
How did the treatment of AIDS change when it came to be seen as chronic?
Patient’s efforts?
Fee and Kreiger, 1993
- etiology > pathology
- Palliative Treatment: azidothymidine (AZT) for people with AIDS/HIV positive people
- ‘from the point of view of health service delivery, AIDS was becoming just another expensive disease, like cancer…’
- change in focus from prevention to detection and treatment
Alternative therapies pioneered by patients (buyers’ clubs, Chinese medicine)
What criticisms do Fee and Kreiger offer of their first two paradigms of AIDS?
Fee and Kreiger (1993)
- Gay plague ignores long-term perspective
- ‘In accepting the chronic disease model’s emphasis on pathology and treatment, many scientists and health care professionals have lost signt of the fact that AIDS is both infectious and preventable.’
Fee and Kreiger’s criticisms of the biomedical model of disease
Fee and Kreiger (1993)
- reductionist, ignore social factors, as irrelevant of unethical
- objective, scientific - ignores the stance of patients. Physicians can bestow knowledge, but not vice versa - mechanisms of transmission considered more important than social determinants
- profoundly ahistorical
Fee and Kreiger’s alternative paradigm: AIDS as a Collective, Chronic Infectious Disease and Persistent Pandemic
Fee and Kreiger (1993)
- ‘Aids is, in essence, a social disease’ - importance of social/personal relationships (collective)
- prolonged disease requiring long-term management (chronic)
- long term, global impact (persistent pandemic)
New research questions:
- how do social relationships of class, race, and gender affect people’s working and living conditions?
- how are patterns of risks socially shaped?
- understanding popular conceptions of AIDS to create targeted education campaigns.
eg
- needle exchanges
- gay communities eroticising safer sex to change collective social mores
Women with AIDS
Fee and Kreiger (1993)
- ‘women with AIDS do not represent one homogenous group’
- particular treatments (gynecologic opportunistic infections, maternal-fetal transmittion
Berridge, Strong (2009)
British Policy Response to AIDS
1981-6 - ‘surprise and shock’
1986-7 - ‘high-level national emergency’
1987 - ‘normalisation’: a calmer period has ensued
(chronic>epidemic)
How did the modelling of AIDS change in the 1980s?
BEFORE
- AIDS (renamed) seen as a novel disease
- focus on risk groups, not risk acts heterosexual population came to be seen as a potential risk group, changing this
- Historical analogies to AIDS were smallpox, cholera, not TB, which would have raised to mind rather different policies issues, involving problems of housing, poverty and community care.’
AFTER
- ‘plague’ –> chronic: isolation of HIV meant AIDS became ‘a set of biomedical problems open to chemical resolution’
- ‘cure’ –> ‘management’ of disease with drugs like AZT
- Health education campaign launched 1986 when threat to heterosexual community was recognised
Ewan Ferlie, The NHS Responds to HIV/AIDS
Aids as a ‘crisis’?
- AIDS was seen as a ‘crisis’ as Britain looked to America and considered itself to be only four years behind their state of crisis –. education campaign, media interest.
VIRGINIA BERRIDGE and PHILIP STRONG*
AIDS and the Relevance of History
- Sir Donald Acheson, Chief Medical Officer in the DoH, made sure historians were listened to:
- Historians of past epidemics like cholera
- History of ‘moral panic’, stigmatisation of past STIs
