Plagues in World History (31 page)

themselves disposed to believe in erroneous conspiracy theories about AIDS, such as that the disease was manufactured in government laboratories as an instrument in racial or biological warfare, perhaps because their faith in institutional medicine has been compromised by such real scandals as the Tuskegee syphilis experiment.19 Meanwhile, research on heterosexual transmission, such as that conducted by Nancy Padian in San Francisco, suggests that women are up to twenty times more susceptible to HIV transmission than men due to a combination of factors: greater presence of the virus in semen as opposed to vaginal secretions, prolonged exposure of the vagina to semen ejaculations, and higher incidences of the vaginal wall being compromised through STDs (which are more likely to remain undetected in women as opposed to men) and through violent or prolonged penetrative intercourse as occurs during sexual assaults and recreational drug use.20 Even when drug use is not of the intravenous variety that can directly transmit HIV, it can act as a cofactor of sexual transmission of AIDS by impairing the cognitive ability to select safe sex behaviors—and also, in the case of certain drugs such as cocaine, methamphetamine (“crystal meth”), and ecstasy, by enhancing sexual performance and thus the likelihood of epithelial trauma during “dry sex.”21

Many of the issues identified in AIDS transmission among black and female populations in the United States serve as a microcosm for the larger tragedy unfolding in sub-Saharan Africa.

The gay community, which originally bore the brunt of the AIDS epidemic in the United States and continues to do so to this day, is faced with an ongoing ambivalent legacy from its close association with the disease. On the one hand, the AIDS epidemic threatened to set back by at least a decade greater public acceptance of and civil rights for gays. Early in the epidemic, for example, some despicable comments were made by conservative commentator Patrick Buchanan and Moral Majority leader Jerry Falwell that suggested AIDS was a just punishment for the gay lifestyle, all of which were very much in the mode of medieval pronouncements about plague as divine retribution for humanity’s sinful behavior. (Indeed, a popular acronym used by the political right at this time for the disease was wrath of God syndrome, or WOGS.) Even though most church congregations tried to balance their moral and humanitarian impulses in their responses to AIDS patients, violent assaults on gays were on the rise, and the political climate seemed ripe for discrimination, if not outright oppression, under the guise of preserving the public health. Yet, we would be less than honest if we failed to point out that at least some of the harm was self-inflicted. There is a certain amount of nihilistic disregard for one’s own bodily health in indulging in hundreds of anonymous sexual partners every year, as the patrons of bathhouses were allegedly doing (just as there is in injecting drugs into one’s veins), and even before the advent of AIDS, an astonishingly high incidence of STDs in the gay AIDS y 153

community was already laying the groundwork for the emergence of a more fear-some disease. But the moral opprobrium expressed by the Christian right never saved any lives, and it had long before proved its impotence against syphilis, when the target had been prostitutes. One also has to understand that, for the gay community, promiscuity was a sign of its liberation and “coming out” in the face of an adversarial society during the 1970s. And yet AIDS could equally well be said to have opened the door of opportunity to gays in the United States in terms of galvanizing them for civil rights advocacy in a way that still eludes that other major victim group of the disease, drug users. Perhaps as a result of the necessity of changing risk behaviors in response to AIDS and caring for sick loved ones, the gay community seems to have shifted its agenda in recent years to agitating for recognition of partner benefits and same-sex unions and marriages.

While some, even in the gay community, may deplore this domestic agenda as depriving gays of their distinctive identity, it does seem to be facilitating greater acceptance of gays in mainstream society, even as the old political fault lines still seem to apply. My home state of Vermont was the first to recognize civil unions that extended full partner benefits and rights to same-sex couples (although a more watered-down version of “reciprocal beneficiary registration” had been available since 1997 in Hawaii), and Vermont is now one of five states that allow same-sex marriage, in spite of the federal Defense of Marriage Act that restricts marriage to members of the opposite sex. These achievements, it could be argued, might not have come about if not for AIDS.

A final aspect to consider in the so-called third phase of AIDS policy in the United States is the greater emphasis upon surveillance and coercion toward HIV-positive individuals since at least 1997. This coincided with the year of the Nushawn Williams case in New York, where an HIV-positive man was reported to have infected thirteen women, most of them teenage girls, out of some fifty to seventy-five sexual contacts over a two-year period, despite allegedly knowing of his own seropositive status. This led to the adoption in New York and in least twenty-six other states of laws requiring names reporting, contact tracing, or even criminalization of sexually active people who test HIV-positive. Further impelling this change of policy was the stated motive of improving access to new and improved treatments and more accurate monitoring of new AIDS cases. Yet, accepting public assistance now meant that AIDS patients had to submit to far greater surveillance and control. From 2003, the CDC announced that HIV

testing of at-risk populations would from now on be the focus of its prevention efforts, and it pressured community-based organizations receiving its funding to “elicit number of partners and contact information” when providing counseling and referral services. It should come as no surprise that the George W. Bush administration’s assault upon civil liberties during its so-called war on terror 154 y Chapter 6

should extend to people with AIDS, but AIDS advocacy groups also seemed to surrender the initiative and abandon the stance on AIDS exceptionalism. The push for an abstinence-only approach to sex education and a continued ban on needle exchange programs were also criticized for being counterproductive and against all the evidence on HIV/AIDS prevention.22

AIDS also has a very personal resonance with me, for its social history in the United States that I have just outlined above happens to almost exactly coincide with my own most socially and sexually active years and experience. I remember that when I graduated from college and first entered the workforce as a journalist in 1985, AIDS was simultaneously cresting in public awareness and paranoia in the United States. Fears about this new disease were almost palpable, largely due to the big unknowns stil surrounding AIDS and the fact that medical authorities at this point made only qualified statements with regard to its transmission and spread. What was especial y terrifying was that here was an invariably fatal disease but one that liked to linger, drawing out its death sentence into a long, exquisite torture. (Unlike our medieval ancestors, we seem to prefer the mercifully quick kill.) Particularly tragic and heartrending were victims who had to tell their families for the first time that they were gay and then immediately inform them that they had AIDS, exposing themselves to a double indemnity of prejudice. As I helped prepare a monograph on
AIDS: The Workplace Issues
, I heard stories of people refusing to touch coffee cups or sweaty keyboards used by an office mate rumored to be infected with HIV, or of a disgruntled fired employee kissing co-workers good-bye with the words “I just gave you AIDS.”23 (We now know, of course, that AIDS cannot be communicated by casual contact.) Even if we did not get AIDS or know someone who did, it seemed we were all somehow indelibly marked by it, should we wish to remain in any way sexually active. It seemed cruel when my mother, echoing surgeon general C. Everett Koop, warned me that “if you sleep with someone, you’re sleeping with all their other past partners,”

which certainly did not make the venture very appealing. If AIDS was a punishment for “deviant” behaviors, then we were al in bed together, gay as wel as straight. I resented the earlier generation that got to enjoy a guilt-and worry-free sexual revolution, while I felt that I now had to pay for the pleasures of my parents’ generation. At the same time, I almost envied the old, who with their dimin-ished sex drives and stable relationships, could no longer be touched by AIDS.

Later, when I finished grad school and started my first teaching job in the mid-to late 1990s, I noticed a dramatic shift occurring in cultural attitudes toward AIDS within my local community here in Vermont. When I mentioned AIDS to my students, their eyes glazed over as if they had no idea what I was talking about (as they do so even more now). I tried to draw parallels in my history classes between Giovanni Boccaccio’s three psychological responses to the Black Death in AIDS y 155

Florence of isolation, denial, or moderation and sexual responses to AIDS of either abstinence, unprotected sex, or wearing a condom, but the analogy seemed to fall flatter and flatter as the years went by. I must confess that I myself had unprotected intercourse with a few (female) sexual partners, but later my future wife did insist that we both get tested before we commenced intimate relations.

(Both of us tested HIV-negative. A couple of states such as Il inois and Louisiana have in fact tried, and ultimately failed, to make AIDS testing mandatory before marriage.) When I had the campus nurse come in to my first-year seminar class at a local Vermont col ege to talk about sex education, she dwel ed on the dangers posed by STDs such as genital warts and herpes, but not AIDS. Meanwhile, my local church wrestled with becoming an “open and affirming” congregation that would allow for civil unions to be performed by our pastor.

Nowadays, it seems our society has come to a stalemate, or a kind of equilib-rium, with AIDS. It remains stubbornly incurable, unlike syphilis, but then what viral disease, even the common cold, has been cured? Instead, we seem reconciled to just living with it, both collectively and individually, as just another chronic, largely sexually transmitted disease that, like herpes, forever marks one with the taint of a moral lapse, however undeserved, but that refuses to kill its victims outright and keeps them in an agonizing pathogenic limbo. For most of us in the West, AIDS now exists on the margins of our consciousness—a disease of the “other” that perpetually hovers but never quite fully emerges into the light of day.

The other tale of AIDS that we need to tell is set primarily in sub-Saharan Africa and other unfortunate theaters of the third world. Even though awareness of the existence of AIDS in Africa came after its discovery in the United States, it is now thought that an epidemic had been incubating on that continent for far longer, since at least the late 1950s, with an epidemic fully emerging at the virus’s most likely place of origin, west equatorial Africa, during the 1970s. To be even more specific, one can point to the year 1975 in Kinshasa, the capital city of the Democratic Republic of Congo, where hospital records point to large numbers of case definition conditions of AIDS, such as Kaposi’s sarcoma and severe wasting disease, occurring at this time.24 Currently, sub-Saharan Africa contains the vast majority of AIDS cases and newly emerging HIV infections, to the point that AIDS is now widely regarded as a distinctly “African disease.” As of 2008, two-thirds of people living with AIDS and three-quarters of AIDS-related deaths occurred in Africa; 2 million Africans were newly infected with HIV in that year out of 2.7 million worldwide (bringing its total to approximately 22.4 million out of 33.4 million worldwide), and 1.4 million Africans died that year of the disease out of 2 million worldwide. Out of the twenty-five million deaths to date around the world from AIDS, most of these are thought to have occurred in Africa. Africa also had fourteen million “AIDS orphans” or children who lost one 156 y Chapter 6

or both parents to the disease, as of 2008, and considerably more women than men in the region are infected by HIV, at a ratio of 60 to 40 percent, or 1.5 to 1. However, there are also signs that Africa’s AIDS epidemic is by now maturing or leveling off. For example, in the worst-hit part of the continent, southern Africa, country after country is reporting substantially lower HIV prevalence rates in their adult populations as of 2007, compared to four years earlier, in 2003. Among the most dramatic drops are those in Swaziland at 26.1 percent, down from 38.8 percent in 2003; Botswana at 23.9 percent, down from 37.3

percent; Lesotho at 23.2 percent compared to 28.9 percent; South Africa at 18.1

percent from 21.5 percent; Zimbabwe at 15.3 percent from 24.6 percent; Namibia at 15.3 percent from 21.3 percent; and Malawi at 11.9 percent from 14.2

percent. Overall, HIV prevalence throughout Africa has declined slightly from 5.8 percent in 2001 to 5.2 percent in 2008. Since newly emerging infections continue to outpace deaths, these declining prevalence rates seem to be due primarily to the slowly declining infection rates that have been achieved in sub-Saharan Africa—as of 2008, new HIV infections throughout the continent declined 25 percent from the height of the epidemic in the mid-1990s. Greater access to antiretroviral treatment has meant that fewer people in Africa are now dying of AIDS, but this also means they are living longer, so that in absolute numbers the figure of people living with AIDS continues to rise, despite declining infection rates or prevalence. Indeed, the fact that such high proportions of the population in some countries continue to live with the disease means that the AIDS epidemic will persist as a major health crisis in Africa for some time to come. South Africa, with nearly six million people living with AIDS as of 2007, remains the country with the largest AIDS population in the world.25