Showing papers in "Daedalus in 1989"

What is an epidemic? AIDS in historical perspective.

Abstract: Like the previous essay, this chapter was a product of the academic world's collective response to AIDS. More generally, however, I was intrigued by the challenge of trying to define and describe an epidemic. We have come to use the term so casually and metaphorically that I felt the logical way to think about the root meaning of epidemic was to see it historically, to create an ideal-typical picture of an epidemic based on repetitive patterns of past events. And in the following pages I have tried to abstract and present the narrative structure of an epidemic as historically experienced. In some ways our generation's encounter with AIDS fits nicely into the dramaturgic pattern I suggest; in other ways recent events have evolved so rapidly that it does not. Within the space of a decade America's perception of AIDS as an acute, epidemic phenomenon has shifted subtly but inexorably: the social identity of this novel ailment has shifted into that of chronic and intractable illness, more akin to tuberculosis than cholera, leukemia than plague. In either guise, however, experience with AIDS has precisely reflected the varied realities that constitute the world's health care system as well as the social-structural and attitudinal factors that have interacted to create patterns of social response to the disease.

AIDS in blackface.

Abstract: MY AMBITION IN THE PAGES THAT FOLLOW ?S tO account for why we African-Americans have been reluc tant to "own" the AIDS epidemic, to acknowledge the devastating toll it is taking on our communities,1 and to take responsibility for altering its course. By the end, I hope to convince you that what may appear to the uninitiated to be a crazy, self defeating refusal to stand up and be counted is in fact sane, sensible, and determinedly self-protective. The black community's impulse to distance itself from the epidemic is less a response to AIDS, the medical phenomenon, than a reaction to the myriad social issues that surround the disease and give it its meaning. More fundamentally, it is the predictable outgrowth of the problematic relationship between the black community and the larger society, a relationship character ized by domination and subordination, mutual fear and mutual disrespect, a sense of otherness and a pervasive neglect that rarely feels benign. If I am right, then there is a profound need to reorient the public health enterprise so that it can succeed in a multicultural society. Public health officials cannot simply wander uptown (or wherever the local black ghetto is situated), their expertise in one hand, their goodwill in the other, and expect to slay the disease dragon. They must first discern just who this particular public is and how it sees itself in relation to them. How does the black community see its own

The power of professionalism: policies for AIDS in Britain, Sweden, and the United States.

Abstract: The response to the epidemic of human immunodefi ciency virus infection and related diseases reveals similarities as well as differences in the policy systems of the three countries we examined for this paper?Britain, Sweden, and the United States.1 Both the incidence and therefore the financial and emotional impact of the HIV epidemic have been considerably greater in the United States than in either Britain or Sweden. Moreover, familiar differences in the political cultures of the three countries influence the making of health policy. The politics of health, for instance, is considerably more acrimonious in the United States than in Britain or Sweden.2 Nevertheless, in late 1988, the health policies of all three countries defined AIDS primarily as a professional problem in the management of what was increasingly seen as a chronic condition. As a professional issue, the epidemic was mainly a problem for experts in clinical medicine, research, and public health and was, by and large, an unseemly subject for partisan debate. In each country, some people emphasized moral and emotional issues in the epidemic.

AIDS prevention through effective education.

Abstract: After a regrettable delay in funding, our society is finally devoting considerable resources to educating both the general public and specific "high risk" groups about this risk. But what is the evidence that AIDS education works, and if it does, what makes it effective? Developing effective AIDS-prevention programs must begin with an examination of the behaviors that transmit the HIV virus and the

AIDS in Africa: diversity in the global pandemic.

Abstract: AIDS presents very different challenges for developing countries as compared to more industrialized nations. There are differences in risk factors clinical presentation care for the affected as well as in the social and economic impact of the virus. This article presents key epidemiological differences between AIDS in African countries and AIDS in the US. The authors emphasize the need for a global perspective on the AIDS pandemic. Background conditions that permit and constrain the responses to the epidemic are discussed. Disparate data and both practical and ethical constraints prevent precise determination of the prevalence and distribution of the HIV infection in Africa. However international research efforts support several basic conclusions about the epidemiology of the disease in African countries. The variable distribution of the HIV infection in Africa reflects the cultural social and economic diversity of the continent. The HIV-1 infection is concentrated in the central and eastern parts of the continent. The epidemic has not reached crisis proportions in the other regions in Africa but fear of more widespread dissemination of HIV is well founded. A second virus HIV-2 has been found in some West African countries. HIV-2 could lead to serious levels of AIDS morbidity and mortality in future years. Adolescents and adults between the ages of 15 and 50 and children under 4 are primarily affected worldwide. Data suggests that significantly more women than men are infected and at risk of HIV infection in Africa. With more women who are HIV positive infections in infants is more frequent in affected Africa than in North America and other Pattern I regions. In a discussion about health systems and clinical care several conditions unique to Africa are identified. High rates of sexually transmitted disease which increases the risk of HIV infection are seen in Africa because of limited access to curative services. There is an increased demand for medical services by seropositive individuals because of higher vulnerability to human pathogens. Another confounding issue is the confusion between symptoms associated with malnutrition tuberculosis malaria and other curable diseases and the AIDS related conditions. Unfortunately the definitive diagnosis of AIDS requires HIV seropositivity. These antibody tests are expensive and largely unavailable outside urban centers. This difficulty with diagnosis means that individuals with curable diseases are being mis-diagnosed with the HIV virus and are not receiving proper treatment. The authors point out that striking variations in HIV prevalence are observed at the microlevel. Networks of kinship and lineage tend to define communities in Africa. Additionally traditional healers provide most of the health services in developing countries. Also women in Africa have a particularly low status which restricts their ability to protect themselves from HIV infection. The authors conclude that the complex nature for AIDS points to the need for small- scale projects geared toward culturally homogenous communities where trained staff can translate the information into locally meaningful terms.

Indian Development: Lessons and Non-Lessons

Abstract: I ndependence came to India after decades of economic stagnation and followed the disastrous Bengal famine of 1943. The promise of a rapid enhancement of living standards based on planned economic development was articulated eloquently by the national leaders. Now, more than forty years later, India's achievements look decidedly mixed?creditable in some respects (including the elimination of famine and the expansion of higher education) but terrible in others (including widespread morbidity and illit eracy). Comparisons with other countries, such as China, and also contrasts within India, help to bring out the successes and failures, and why they have occurred.

AIDS in the United States: patient care and politics.

Abstract: THE APPEARANCE ON THE WORLD SCENE of a new and frightening disease?AIDS, the final, fatal manifestation of infection caused by the human immunodeficiency virus (HIV)?has put a spodight on how our society responds to a major threat to its health. Diseases like HIV infection, which spread rapidly through communities, particularly those in which person-to-person transmission is evident, evoke fear, sometimes bordering on panic. Public pressure on both scientific and political leaders to "do some thing quickly" is generally intense. The response results from the play of many forces?science-based knowledge, social values, religious beliefs, local or regional mores, and the political and economic realities of the times. That this has been true down through the ages is well documented in the article by Charles Rosenberg in this issue detailing responses to epidemics in the past. But in the case of HIV infection and AIDS, perhaps to a greater degree than before, unusual circumstances have led to responses in which social attitudes and values have tended to overwhelm science based knowledge. Although most of us would like to believe that we live in a largely rational society, the AIDS epidemic has shown that we do not. This article shows the interplay of social forces, politics, and AIDS as HIV

AIDS, privacy, and responsibility.

Abstract: In AIDS, the most intimate dimensions of human exist ence, often the sources of our deepest pleasure, have been welded to the threat of lethal disease. As an epidemic with roots in private acts, AIDS forces into the social realm matters that liberal societies have increasingly sought to protect from public scrutiny and legal control. That in the United States AIDS is a disease of those who have sought the protective mantle of privacy?drug users because of the illicit nature of their behaviors, gay and bisexual men because of the historical burdens of stigma and criminalization?has indelibly marked the epidemic. Each of these factors has contributed to the extraordinary political context in which public health officials have been compelled to confront the task of altering the epidemic's course and has informed the often bitter controversies over how the interests of public health and of privacy might be balanced and reconciled. In the clashes that have punctuated the first eight years of the American AIDS epidemic, the influence of both individualism?reflected in the ideologies of those who have sought to protect the privacy of persons most at risk for HIV infection?and of the communal perspective?reflected in concern for public health?have been brought to bear. A public health strategy to limit the spread of HIV infection will be effective only if it produces dramatic, perhaps unprecedented,

AIDS, blood banking, and the bonds of community.

Abstract: The relatively small threat of contracting AIDS through blood transfusions in the United States has led to significant improvements in the overall quality of American blood services, nearly all of which could have been achieved without the existence of this new health menace. Nonautologous exposures to blood are always hazardous. Transfusions save lives, but they can also transmit life-threatening diseases, AIDS being only one of them and not the most prevalent. The danger extends beyond transfusion recipients. Health-care professionals are placed at risk through accidental blood spills and needle sticks. However, as blood-banking services have expanded, the handling and use of blood have become incautious. Organizational convenience rather than safety has often guided behavior. But fear of AIDS is so great that attention has galvanized efforts to reduce risk, forcing long-needed changes in medical practice. The number of transfusions, previously increasing in the United States, has declined, for greater care is being taken in prescribing blood. New tests for rare as well as common hazards are being applied to blood. Autologous donations, the safest kind, are up sharply. Research on blood substitutes has expanded. The handling of blood is carefully audited. Health-care professionals rightly worry about their exposure to blood, for accidental blood spills and needle

Social policy: AIDS and intravenous drug use.

Abstract: ITH each passing month, as the human immunode ficiency virus (HIV)?the virus which leads to the ac quired immune deficiency syndrome (AIDS)?continues to spread, it becomes clearer that social policy on AIDS cannot be considered apart from social policy on intravenous drug use (IVDU). Sharing intravenous needles is one means by which AIDS is trans mitted. Although the numbers used to indicate the spread of HIV vary and are controversial, certain facts are clear. While the rate of spread of HIV among both homosexuals and bisexuals has dropped, transmission among intravenous drug users (IVDUs) has increased at a very high rate. Furthermore, transmission among heterosexuals, and therefore among pregnant women, is occurring disproportionately in the minority communities of the unskilled and unemployed?the socially dispossessed.1 This last point is crucial because illicit drug use, including IVDU, is highest within the same social groups. The purpose of this paper is to spell out a new social policy for both illicit drug use and AIDS. To arrive at an effective program, I will first describe and analyze the dilemma inherent in our present policy positions. Next I will discuss the problems that must be confronted in determining policy changes. And finally I will recom

Responding to a pandemic: international interests in AIDS control.

Abstract: The AIDS pandemic is considered an international health problem which strikes developing and developed countries alike with regions like Europe Africa North America and South America being greatly affected. It poses a challenge to scientists politicians physicians public health officials politicians and others concerned about public welfare. Confronting the AIDS problem requires international cooperation which has encountered several obstacles: 1) practical issues 2) diverging national interests 3) lack of consensus on the nature of the problem 4) mutual mistrust among nations and 5) cultural dissonance. These obstacles can be considered complementary ways of conceptualizing and addressing the important issues in global AIDS control. It is noted that international cooperation is usually motivated by the self-interest of the parties involved hence proper institutional and conceptual bases for addressing the international interests in AIDS control should be established.