HIV/AIDS – Unsettled Feeling & Critical Insight

December 31, 2019January 2, 2020

It Was like Living Through the End of the World

by David Marchionni

https://blogs.commons.georgetown.edu/cctp-802-spring2018/2018/05/04/the-art-of-the-aids-crisis-cautionary-oeuvres-from-the-1980s/

In all the history of homosexuality we have never been so close to death and extinction before. Many of us are dying or dead already.
Larry Kramer, 1983¹

It came out of nowhere. When the Centers for Disease Control published its June 5, 1981 Morbidity and Mortality Weekly Report (MMWR), it unintentionally inaugurated one of the darkest periods in American history: the AIDS crisis. The report, written by UCLA’s Michael Gottlieb, noted that between October 1980 and May 1981 five cases of the rare (and usually fatal) illness pneumocystis carinii pneumonia (traditionally found only in extremely immunosuppressed patients, and often referred to by the acronym PCP) appeared in what had previously been healthy young men in the Los Angeles area.² Gottlieb and the CDC further observed that all the young men in question were homosexual. Rechristened as “gay pneumonia”, PCP helped cement Acquired Immunodeficiency Syndrome (AIDS) as an exclusively gay issue in the national consciousness. While AIDS affected many, it utterly decimated gay America.³ It has killed hundreds of thousands (448,060 by the year 2000 alone), claimed the lives of much of the gay rights movement’s leadership, triggered widespread anti-gay violence, and opened the door to entirely new forms of government-sponsored oppression and discrimination.⁴ Yet amidst such suffering, AIDS sparked a mass revolution. It radicalized gay activism, triggering a newfound wave of homosexual unity and mass protestation.

With the release of the July 3^rd 1981 MMWR, the CDC acknowledged a new, rarely diagnosed illness (aside from PCP) was predominantly affecting homosexuals.⁵ Kaposi’s Sarcoma (abbreviated to KS) quickly became a media darling.⁶ Christened by the media as the “gay cancer,” KS caught the eye of the public due to its distinctive (and repulsive) skin lesions and its association with sex and homosexual deviancy. Few stories sell better than sex or fear, and the mysterious new GRID (Gay-related Immune Deficiency) offered both in equal measure. Media organizations large and small happily sensationalized the topic, claiming that the new malady would befall all who engaged in “risky” or immoral behavior. None other than The New York Times helped lead the charge, running numerous articles reporting that all infected patients were promiscuous homosexuals having sex with between fifteen and twenty anonymous men per night, and that the infamous gay bathhouses were the epicenter of the “Gay Plague.”⁷ The media frenzy only grew worse in 1983 following the realization that HIV could be transmitted via infected blood.⁸ Heterosexual Americans, now in the line of fire, feared for their safety. Conservative state legislatures profited from the media panic, using the momentum generated to pass draconian HIV-specific criminal laws. In total, thirty-three states would pass such targeted felony ordinances.⁹

HIV/AIDS truly could not have come at a worse time. Ronald Reagan’s election in 1980 heralded a sweeping victory for the New Right’s Christian conservatism. Incensed by the progressivism of the 1960’s and 1970’s, the Right claimed the Presidency and the Senate in the 1980 election, a year before American homosexuals began dying in droves. The New Right wasted no time ascribing blame. Consider Lawrence Lockman’s widely circulated 1986 book The AIDS Epidemic: A Citizen’s Guide to Protecting your Family and Community from the Gay Plague. The conservative columnist (and eventual member of Maine’s House of Representatives) not only held “the gay lifestyle” responsible for bringing AIDS to American shores – reiterating the popular notion that homosexuals are “extremely filthy and disgusting as well as unhealthy” – but went further and attacked heterosexual patients as well, accusing them of cavorting with homosexuals and living sinful, debased lives.¹⁰ Alternatively, revisit the work of paleoconservative (traditionalist conservatives reacting against the rise of neoconservatism in the Republican Party) Patrick Buchanan.¹¹ The Republican columnist, commentator, and politician authored the widely-circulated “AIDS Disease: It’s Nature Striking Back”. Buchanan’s piece echoed many of his fellows in calling homosexuals both a moral and public health menace. He then boldly pushed onward, articulating a policy of nationwide segregation, one that would forcibly remove suspected AIDS patients from public life so as to protect ‘innocent’ heterosexual America.¹² The widespread (and completely debunked) belief that AIDS could be spread by casual contact only made it easier for local and state governments to encourage blatantly discriminatory practices. Individuals with HIV/AIDS (and homosexuals more broadly) could be barred from public facilities and transport, expelled from their schools, evicted from their homes, fired from their work, profiled and quarantined by the police, discharged from the Armed Forces, and barred from donating blood. Meanwhile, the CDC understood as early as 1983 that AIDS was not transmissible via simple contact, proximity, or shared use of daily items.¹³ Yet regardless of both CDC and activist attempts to spread awareness within the general population, these novel forms of discrimination intensified.¹⁴

Arguably, the worst effects of AIDS-based discrimination were experienced within the healthcare industry, the one realm of life exceedingly vital to people living with HIV. Physicians and nurses refused to treat or even touch patients. Orderlies refused to wash patients or change their clothes and dressings, leaving them to lie in their own filth and misery. Should a patient find their way to a clinic or emergency room, staff would simply ignore them until they either left out of frustration and shame, or simply expired. When patients did succumb to AIDS-related complications, morgue technicians and undertakers refused to handle their bodies, instead opting to throw corpses (dressings, bedsheets, and all) into heavy-duty garbage bags before requiring the friends or family of the deceased to remove them on their own.¹⁵ The paranoia reached such a level that medical facilities across the country refused to treat any individual of an “at-risk” group (often summarized as the 4Hs: homosexuals, heroin users, hemophiliacs, and Haitians).¹⁶ Due to the effects of media-sponsored paranoia, as well as hate speech, the 1980’s saw rates of violence against gay men and lesbians skyrocket.¹⁷ Spurred on by AIDS-related panic and homophobia, the storming of gay neighborhoods and gay-aligned events grew more common.¹⁸ Take a quiet Sunday afternoon in San Francisco, for example. That day bore witness to a gang of twenty-odd drunken teenagers gather at the edge of Sigmund Stern Grove. Wielding bats, sticks, and rocks, the mob screamed and shouted “Faggots got AIDS”, “Unclean” and “You’re diseased” whilst brutally assaulting gay and lesbian attendees of a community picnic organized by Dignity (a gay Catholic organization).¹⁹ Some Conservatives openly advocated for abhorrent measures of controlling the potentially-infected population. Conservative author William Buckley proposed that every HIV-positive American be mandatorily tattooed so as to make their status readily apparent.²⁰ Meanwhile, Californian multimillionaire Lyndon LaRouche went one step further, organizing his Prevent AIDS Now Initiative Committee (PANIC) to promote an initiative on California’s 1986 ballot.²¹ He and his seven hundred thousand supporters sought to forcibly inter all people with AIDS in quarantined concentration camps, much the same way the nation had done to Americans of Japanese descent forty-four years earlier.

AIDS defined an entire generation. The specter of death hung like a cloud over the head of every LGBT American during the crisis years.²² Facing death and discrimination, impassioned activists such as Larry Kramer rose and tackled the problems born of the Crisis.²³ By 1982, he found a number of similarly-minded allies.²⁴ Bold new confrontational organizations such as ACT UP, the Gay Men’s Health Crisis, and the AIDS Network all promoted revolutionary programs, ranging from caring for people with AIDS to engaging in campaigns of mass civil disobedience.²⁵ They looked after their own, and took the veritable life-and-death struggle gays faced on a daily basis into the homes of the nation through orchestrated church and television station invasions.²⁶ In the face of not just their own mortality, but also the risk of reprisal at the hands of their neighbors or government, six hundred thousand gays and lesbians from all across the country gathered in the nation’s capital on October 11, 1987.²⁷ The Second National March on Washington for Lesbian and Gay Rights saw the grief and rage of the community on full display, mourning the loss of over forty-one thousand fellow gays and lesbians to AIDS, and to protest a government that did nothing but watch them die.²⁸ The unveiling of the AIDS Quilt at the National Mall on live television made for a stirring, lasting moment that exemplifies the best of civil resistance. The AIDS generation lived through one of the worst epidemics in modern history. All who survived have been scarred by it, but came out the other side more resilient and stronger as a community.²⁹ While many had perished, their sacrifices would be remembered, and the survivors have continued to resist Christian conservative AIDS-related policies well into the modern day.

Bibliography

Altman, Dennis. AIDS in the Mind of America. First ed. Garden City, NY: Anchor Press/Doubleday, 1986.

Bright, Gina M. Plague-Making and the AIDS Epidemic: A Story of Discrimination. First ed. New York, NY: Palgrave Macmillan, 2012.

Faderman, Lillian. “Chapter 23: The Plague.” In The Gay Revolution: The Story of the Struggle, First Simon & Schuster hardcover ed. New York, NY: Simon & Schuster, 2015.

Francis, Samuel. “The Paleo Persuasion.” The American Conservative, December 16, 2002. https://www.theamericanconservative.com/articles/the-paleo-persuasion/.

Greer, William R. “VIOLENCE AGAINST HOMOSEXUALS RISING, GROUPS SEEKING WIDER PROTECTION SAY.” The New York Times. The New York Times, November 23, 1986. https://www.nytimes.com/1986/11/23/us/violence-against-homosexuals-rising-groups-seeking-wider-protection-say.html.

Gregg, Michael B, ed. “Kaposi’s Sarcoma and Pneumocystis Pneumonia Among Homosexual Men – New York City and California.” Morbidity And Mortality Weekly Report 30, no. 25 (July 3, 1981): 305–16. https://history.nih.gov/nihinownwords/assets/media/pdf/publications/MMWRJuly31981.pdf.

Halkitis, Perry N. The AIDS Generation: Stories of Survival and Resilience. New York City, NY: Oxford University Press, 2014.

“HIV and AIDS — United States, 1981–2000.” HIV and AIDS — United States, 1981–2000. Centers for Disease Control and Prevention, June 1, 2001. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5021a2.htm.

Institute of Medicine (US) Committee to Study HIV Transmission Through Blood and Blood Products. “History of the Controversy.” HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking. U.S. National Library of Medicine, January 1, 1995. https://www.ncbi.nlm.nih.gov/books/NBK232419/.

Ocamb, Karen. “Larry Kramer’s Historic Essay: AIDS At 30.” Larry Kramer’s Historic Essay: AIDS At 30. The Bilerico Project, June 14, 2011. http://bilerico.lgbtqnation.com/2011/06/larry_kramers_historic_essay_aids_at_30.php.

Wiltz, Teresa. “HIV Crime Laws: Historical Relics or Public Safety Measures?” Pew Stateline. The Pew Charitable Trusts, September 6, 2017. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/06/hiv-crime-laws-historical-relics-or-public-safety-measures.

December 31, 2019January 2, 2020

Suffering in Silence: African-Americans and the Modern HIV Epidemic

by David Marchionni

https://minorityaidssupport.org/ending-hiv-will-only-happen-if-black-america-leads/

It is difficult to escape the shadow of history. This is as true for disease as it is for people. Take Yersinia Pestis, for example; centuries later it is still associated primarily with the Black Death of Medieval Europe. Bubonic Plague seared itself into the West’s collective memory, yet the bacterium remains a very real concern for millions across the world. A 1994 mass outbreak in Surat, India forced hundreds of thousands to flee their homes, infected 693 residents, and caused 54 fatalities.¹ This same issue plagues the Human Immunodeficiency Virus (colloquially referred to by the acronym HIV). HIV has remained a highly stigmatized illness since the AIDS crisis of the 1980’s and has been inextricably linked to homosexual promiscuity in popular culture. This connection has proven useful in some respects. For example, it fostered eventual support and funding for HIV-related aid programs in the metropolitan areas where much of the “Out” American LGBTQ Community resides. Yet, it has also proven highly detrimental to at-risk and HIV-positive populations who do not fit this traditional perception. HIV’s continued association with urban homosexual enclaves has proven particularly harmful to African-Americans living with HIV, especially within impoverished communities in the southern United States, which currently faces a veritable AIDS crisis of its own.

As the nation slowly confronted the AIDS epidemic between the late 1980’s and early 2000’s, a combination of governmental intervention, targeted prevention efforts, increased access to quality medical care and education, and more potent (and non-toxic) treatment options have markedly slowed down the rate of infection within the United States.² A welcome sign of such progress is the reported 19% drop in the number of new diagnoses between 2005 and 2014.³ The Centers for Disease Control (CDC) estimates that there are approximately 1.1 million Americans currently living with HIV, and of that number, only 15% are currently unaware of their HIV-positive status.⁴ Unfortunately, these numbers mask a bleak reality. While it is certainly true that White America has experienced significant progress in the campaign against HIV/AIDS, this has not been mirrored in Black America. African-Americans account for the highest proportion of both new HIV diagnoses and of people living with HIV, encompassing more than any other American race or ethnicity. Currently, within the African-American community, the 2017 “Diagnoses of HIV Infection in the United States and Dependent Areas” CDC report noted that while African-Americans account for just 13% of the U.S. population, they comprise 42% of all new HIV diagnoses.⁵ Breaking these numbers down slightly, 73% of diagnosed patients were men, while 26% were women. Beyond gender, it is apparent that sexual identity continues to be closely tied to HIV. Roughly 60% of newly diagnosed African-American men identified themselves as gay or bisexual, with male-to-male sexual contact remaining the primary vector of HIV transmission, with 80% of all new male infections occurring this way. African-American women, on the other hand, primarily listed heterosexual sexual contact as their primary means of disease transmission, occurring in 91% of new female cases.⁶ All told, there are approximately 468,800 African-Americans currently living with HIV. Yet even with these statistics, it remains difficult to visualize the whole picture. The figures listed above reflect national averages; in so doing they fail to demonstrate where HIV transmission and mortality rates have grown the most prevalent (and the least treated): the American south.⁷

Amidst the AIDS crisis of the 1980’s, HIV was concentrated in urban metropolitan areas. While the concentrated infection proved horrifically devastating in the early years of the crisis, the relative proximity of patients has since allowed for far easier cataloguing of transmission vectors, as well as ensured greater infrastructure and financial support to benefit affected communities. In the South, however, the population is far less concentrated, and is dispersed across rural, semi-rural, and small-scale metropolitan spaces. While only approximately 36% of the U.S. population resides in the south, American southerners comprised 51% of all new HIV infections in 2015.⁸ Also, the 2010 census reported that of the roughly 38.9 million African-Americans living in the country, 55% of them resided in a southern state.⁹ Of these southern States, the traditional “Deep South” (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South, Carolina, Tennessee, and Texas) has been particularly hard-hit by HIV/AIDS.¹⁰ These States have not only struggled with the highest HIV diagnosis rates in the nation, but also the highest associated mortality rates, standing at between 1.5 and 3 times the national average.¹¹ This reporting may also not fully reflect the true severity of this ongoing epidemic, as underreporting remains a very real concern.

Several factors work together to fuel the southern HIV crisis: geographic constraints (the large space necessary to travel in order to access healthcare), concentrated poverty (the clustering of extremely poor populations within poor communities), the prevalence of abstinence-based sex education, lack of adequate training within the medical community on HIV-related health issues, the criminalization of HIV-related risk behaviors (such as draconian anti-drug laws), White-controlled state and local governments that readily ignore issues predominantly affecting their African-American constituencies, and widespread stigmatization within the African-American community. It is difficult to ascribe primary culpability to any one of these factors, as they all play a part in this theatre of misery. Concentrated poverty leaves already low-income families saddled with additional burdens (including poor access to public facilities, poor access to quality healthcare, poor health outcomes, and poor educational opportunities) that make it effectively impossible to afford, let alone regularly receive, proper treatment. Homophobia and criminalization, meanwhile, help foster a culture of fear that disincentivizes potential HIV-positive individuals from getting tested, risking further transmission. Persistent stigmatization of HIV in the Deep South has in effect forced individuals with HIV to remain hidden in the proverbial closet. Those that do choose to “out” themselves run many of the same risks that HIV/AIDS patients did back at the height of the original AIDS crisis. Southern individuals living with HIV continue to experience familial, workplace, healthcare, and governmental discrimination, as well as risk violence and harassment.¹² If their HIV-positive status is discovered, they may be denied or fired from work, removed from their homes, denied medical care, or be abandoned by their families. In addition to southern-associated issues including concentrated poverty and HIV-specific criminal laws, the culture of silence within African-American communities also plays a role. As summarized by Phil Wilson (of the Black AIDS Institute), “you don’t tell other folks that there’s a gay son and that someone else in the family has AIDS.”¹³ This general lack of communal admission or acceptance is complicit in the thousands of new infections each year. It should be no surprise that the old “Silence = Death” slogan has slowly begun to circulate amongst impacted Southern communities. For those continuing to live with HIV but who do not or cannot seek treatment, the lack of community-wide African-American discourse on HIV places thousands more at significantly increased risk of complications and disease progression. The silence also incentivizes those with HIV to keep their status a secret from everyone, including sexual partners. This prospect may help explain how 91% of African-American women with HIV reportedly contracted it from heterosexual intercourse. Black “Respectability Politics” also plays a central role in fueling the stigmatization of African-Americans with HIV. Mirroring the cultural norms of the White mainstream, middle-class and wealthy African-American communities, which still remain organized around religious congregations, continue to characterize homosexuals and individuals living with HIV as immoral or degenerate.¹⁴

The American struggle against HIV has been ongoing for nearly forty years. For much of that time, efforts to combat HIV/AIDS by activists, policymakers, and health care providers took place along the coasts. Yet it has become increasingly apparent that all the while, the epidemic has proliferated freely across rural America. The deep south now stands as the current battlefield in a modern AIDS crisis, one that has primarily ravaged the African-American community. While NGO’s and the Federal Government slowly move to confront HIV in the south, stigmatization and homophobia, geographic constraints, concentrated poverty, and the criminalization of HIV-related risk behavior continue to hamper (if not render impossible) efforts to provide adequate medical care. The continued stigmatization of HIV, both in White and Black America, makes accurate testing and reporting unduly difficult. This, coupled with high rates of poverty and southern State governments that have refused to expand their Medicaid programs (which would have covered uninsured HIV patients), exacerbates the situation.¹⁵ Given ongoing discrimination against African-Americans, as well as the continued stigmatization that comes with HIV’s close association with homosexuality and transgenderism, it appears unlikely that meaningful progress toward lowering infection rates and raising treatment levels among African-Americans will occur in the near future.

Bibliography

Anderson, Bebe J. “HIV Stigma and Discrimination Persist, Even in Health Care.” AMA Journal of Ethics: Illuminating the Art of Medicine. American Medical Association, December 1, 2009. https://journalofethics.ama-assn.org/article/hiv-stigma-and-discrimination-persist-even-health-care/2009-12.

Centers for Disease Control and Prevention. “HIV and African Americans.” Centers for Disease Control and Prevention. Centers for Disease Control, November 12, 2019. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html.

Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. Published November 2018. Accessed December 22, 2019. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

Centers for Disease Control and Prevention. “U.S. Statistics.” HIV.gov, September 25, 2019. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics.

Endgame: AIDS in Black America. Directed by Renata Simone. Boston: Renata Simone Productions, Inc, 2012. https://www.pbs.org/wgbh/frontline/film/endgame-aids-in-black-america/.

Moore, Mark. “President Trump Calls for Eradicating AIDS and HIV in 10 Years.” New York Post, December 1, 2019. https://nypost.com/2019/12/01/president-trump-calls-for-eradicating-aids-and-hiv-in-10-years/.

Pallipparambil, Godshen. “The Surat Plague and Its Aftermath.” Montana State University. Accessed December 8, 2019. http://www.montana.edu/historybug/yersiniaessays/godshen.html.

Reif, Susan, C. Micha Belden, Elena Wilson, and Carolyn McAllaster. “HIV/AIDS in the U.S. Deep South: Trends from 2008-2016.” Southern HIV/AIDS Strategy Initiative. Duke University, June 2019. HIV/AIDS in the U.S. Deep South: Trends from 2008-2016. https://southernaids.files.wordpress.com/2019/06/sasi-report-hiv-aids-in-the-u.s.-deep-south-trends-from-2008-2016-final.pdf.

Reif, Susan. “State of HIV in the US Deep South.” HIV/AIDS Policy Clinic. Duke University. Accessed December 22, 2019. https://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/13807/State of the Deep Southrevised online2.pdf?sequence=4.

Sangaramoorthy, Thurka, and Joseph B. Richardson. “Why the South Still Has Such High HIV Rates.” The Conversation, June 29, 2019. http://theconversation.com/why-the-south-still-has-such-high-hiv-rates-76386.

US Census Bureau Public Information Office. “2010 Census Shows Black Population Has Highest Concentration in the South.” Newsroom Archive. United States Census Bureau, May 19, 2016. https://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn185.html.

Wiltz, Teresa. “Southern States Are Now Epicenter of HIV/AIDS in the U.S.” Pew Stateline. The Pew Charitable Trusts, September 8, 2014. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2014/09/08/southern-states-are-now-epicenter-of-hivaids-in-the-us.