Sociology of HIV/AIDS: Global and U.S. Experiences of Epidemic
SC077: Spring 2010
Tuesdays/Thursdays 9:00-10:20
Lyons 207
Instructor: Shelley White
Office: McGuinn 410D
Email: mlwhite@bc.edu
Office Hours: Thursdays 10:30-12:00
And by appointment
Course Description
This course explores the social dimensions of global and U.S. experiences of HIV/AIDS. We examine the
social forces that impact and determine the course and experience of the epidemic as we also explore the
impact that the epidemic has had on communities and cultures worldwide. The course surveys 1) the
history and epidemiology of the epidemic; 2) the social construction of the disease; 3) the impact upon
and response from particularly affected communities and social groups; 4) social issues in testing,
treatment and prevention; and 5) the politics of governmental, non-governmental and grassroots responses
to the disease.
As a core course, the class will include the following:
Perennial Questions: The HIV/AIDS epidemic teaches us a great deal about society and about ourselves
as global citizens. Through our readings, research, class discussions, and personal reflections, we will be
challenged to consider the following questions: How do we understand HIV, disease, and related social
phenomenon within the broad social system of structural determinants (i.e. social, political, economic,
and environmental)? How is HIV/AIDS socially constructed in society and what role have governments,
health organizations, educational systems, religious institutions, health activists, citizens and others
played in shaping and challenging these understandings of disease? What obligations do societies and
individuals have to respond to HIV/AIDS and other epidemic diseases? How do we understand the
concepts of innocence, morality, blame, stigma and bystanding in the context of global disease? Finally,
what are the possibilities for change, and how might governments, non-governmental institutions,
communities, and individuals shape effective responses to HIV/AIDS?
Historical Perspective: In order to create deep understandings of the contemporary picture of HIV/AIDS,
we must employ a lens that is, in the words of Paul Farmer, “historically deep and geographically broad.”
We begin our course by exploring an in-depth history of the HIV/AIDS epidemic in the U.S. and
globally. We consider how early responses and key decisions by those in power shaped the future course
of HIV/AIDS. We also consider the rich history of social movements which have challenged and shaped
not only HIV/AIDS, but deeply entrenched cultural understandings of difference and disease.
Cultural Diversity: Culture has a tremendous influence on disease transmission, prevention approaches,
understandings of health and illness, and personal and political responses to disease. HIV/AIDS, as an
infectious disease long associated with taboo topics of sexuality and drug use, has been deeply
stigmatized and surrounded by cultural myths and misperceptions. In this course, we attempt to
disentangle these, and to understand the various ways in which culture shapes and is shaped by the
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HIV/AIDS epidemic. We also, contrary to the early, oft-repeated mantra that “AIDS does not
discriminate,” aim to understand HIV/AIDS as a disease of inequality. We explore how existing class,
gender, sexuality, race and other inequalities have shaped diverse experiences of HIV/AIDS around the
world, and how HIV/AIDS has disproportionately affected those already disadvantaged in our domestic
and global social systems.
Personal Philosophy: This course continually grapples with the question of how a largely preventable
disease has evolved to be one of the most catastrophic epidemics of our times. In 1998, shortly before his
death, Jonathan Mann challenged us, stating: "Our opportunity is historic. For when the history of AIDS
and the global response is written, our most precious contribution may well be that at a time of plague we
did not flee, we did not hide, we did not separate ourselves." Many have called for global action on
AIDS, and at many historical moments, global and U.S. efforts have fallen short. In exploring this
complex history and the contemporary global epidemic, students will be asked to consider their own
personal and moral commitments, their understandings of human rights obligations, and their values
around concepts of global citizenship. Through our readings, research, class discussions, and written
assignments, students are also encouraged to develop their own skills of critical analysis, in questioning
existing understandings of epidemic and response, and imagining new approaches to change.
Methodology: Through our readings and research, this course exposes us to various methodological
approaches employed in sociology, public health, economics, and political science. These include both
qualitative and quantitative approaches, including epidemiological studies, ethnographic and interviewbased research, case studies, household survey research, cross-cultural and comparative analyses, policy
analyses and others. We will examine the ways in which various theoretical approaches shape the
perspectives of our authors, and will consider the limits of academic knowledge production.
Writing component: Students will be encouraged to develop their writing and critical analysis skills
through two written paper assignments. The first will allow students to research HIV/AIDS in a
particular country, and to analyze the factors that have shaped local experiences of epidemic and
response. In the second paper, students will explore a topic of interest related to the social, political,
and/or economic aspects of HIV/AIDS. Students will also produce occasional short, written homework
assignments and personal written reflections that engage the reading materials and course content.
Required Texts
Ryan White: My Own Story (1992) by Ryan White and Ann Marie Cunningham.
Race Against Time (2006) by Steven Lewis.
AIDS in the 21st Century: Disease and Globalization (2006) by Tony Barnett and Alan Whiteside.
Global AIDS: Myths and Facts (2003) by Alexander Irwin, Joyce Millen and Dorothy Fallows.
HIV and AIDS in Africa: Beyond Epidemiology (2004) by Ezekiel Kalipeni, Susan Craddock, Joseph R.
Oppong, and Jayati Ghosh.
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Course Requirements and Grading
Paper 1: Country Study
Mid-Term Exam (In-Class)
Paper 2: Issue Analysis
Final Exam (Take Home)
Short Homework Assignments & Quizzes
Attendance and Course Preparation*
Due February 25th
On March 30th
Due May 4th
Due by May 11th at 12:30 PM
Assigned Periodically
20%
20%
20%
20%
10%
10%
*Please note that there is one required evening session for the course, on March 17th from 7:30-9:30.
Attendance for this session will be counted as double.
Policy on Papers and Exams
Papers are due on the date indicated above, at the start of the class session. Extensions are granted only
on rare occasions, and with proper documentation (i.e. medical note, Dean’s note). For late papers, one
full grade is deducted for each week the paper is late (i.e. for the first week late, the maximum grade is
B+). If a paper is due Tuesday, it is considered one week later if it is not collected during the class
session, whether it is passed in on Wednesday, Thursday, Friday or any day until the following Tuesday.
Please print out your papers, review them for quality, and hand them in during class. Papers will be
accepted by email only in unusual circumstances, and with prior permission. The Final Take Home Exam
should be printed and passed in to my mailbox in McGuinn 410 any time prior to May 11th at 12:30 PM.
If you plan to leave campus prior to May 11th, it is your responsibility to ensure that you have passed in a
paper copy of your exam prior to your departure. Exams will be collected promptly at 12:30 on May 11th
and late exams will not be accepted.
Please ensure that your travel plans for the Easter Break allow you to take the Mid-Term Exam in class on
March 30th. Make-up exams are scheduled only in extenuating circumstances.
Academic Integrity
Students should be familiar with the Boston College Policy on Academic Integrity, found at:
http://www.bc.edu/offices/stserv/academic/resources/policy.html#integrity. When writing papers, be sure
to cite any material that is not your own (or material you have previously written), whether direct quotes
or concepts and ideas.
Academic Support
Students requiring accommodations for success in this course should see me, and should contact the
Office of Disability Services: http://www.bc.edu/offices/odsd/disabilityservices.html. The Connors
Family Learning Center is also available for tutoring and academic support:
http://www.bc.edu/libraries/help/tutoring.html
Readings and Class Schedule
Readings are assigned on a weekly basis. Please come to class each week, on Tuesday, having read the
material for the week. Our tentative course schedule is provided below, though this schedule may change
as we move through our semester.
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Tentative Schedule of Readings and Assignments
Part I: History and Overview of Epidemic
September 19 and 21
Introduction and Course Overview
Overview of HIV/AIDS Epidemic; Basics of HIV Transmission
Readings:
• Barnett/Whiteside – Chapters 1 & 2 (67 pgs)
• Irwin, et al – HIV/AIDS Basics (4 pgs)
September 26 and 28
A History of the Epidemic: Creating a Timeline
Readings:
• Ryan White – Entire Text, through Afterword (287 pgs)
February 2 and 4
Understanding Stigma
AIDS in Africa
Readings:
• Barnett/Whiteside – Chapter 5 (32 pgs)
• Irwin, et al – Myth One: AIDS and Africa (18 pgs)
• Kalipeni, et al – Chapter 23 (5 pgs)
• Lewis – Chapters 1 & 2 (36 pgs; 34 pgs)
• Herek, Gregory M. 2005. “AIDS and Stigma.” Pp.121-129 in The Sociology of Health and
Illness: Critical Perspectives. 7th ed. Edited by Peter Conrad. New York, NY: Worth Publishers.
[E-Reserve] (6 pgs)
Part II: Social Causation and Social Construction
February 9 and 11
Understanding Impact/ Measuring an Epidemic
Social Causation of Disease
Readings:
• Barnett/Whiteside – Chapters 3 & 6 (30 pgs; 28 pgs)
• Kalipeni, et al – Intro & Chapter 3 (11 pgs; 9 pgs)
• Lewis – Chapter 3 (38 pgs)
• Link, Bruce G. and Phelan, Jo. 1995. “Social Conditions as Fundamental Causes of Disease.”
Journal of Health and Social Behavior 35: 80-94. [E-Reserve] (14 pgs)
• Ecological Model of Health [Hand-Out] (2 pgs)
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February 16 and 18
Identity and Inequality: Race, Class and Gender
Social Constructions of Disease
Readings:
• Kalipeni, et al – Chapters 1, 6, & 8 (14 pgs; 15 pgs; 12 pgs)
• Lewis – Chapter 4 (36 pgs)
• Farmer, Paul. 1999. “Invisible Women.” Pp. 59-93 in Infections and Inequalities: The Modern
Plagues. Berkeley and Los Angeles, CA: University of California Press. [E-Reserve] (35 pgs)
• CDC. 2008. “HIV/AIDS Among Women.” Available on-line at:
http://cdc.gov/hiv/topics/women/resources/factsheets/pdf/women.pdf (7 pgs)
• CDC. 2009. “HIV/AIDS Among African Americans. Available on-line at:
http://cdc.gov/hiv/topics/aa/resources/factsheets/pdf/aa.pdf (2 pgs)
• Kaiser Family Foundation. 2001. “African Americans’ Views of the HIV/AIDS Epidemic at 20
Years: Findings from a National Survey.” Available on-line at:
http://www.kff.org/hivaids/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13866
(16 pages)
February 23 and 25
Identity and Inequality: Sexuality and Drug Use
Social Constructions of Disease
Readings:
• Irwin, et al – Myth Two: Dangerous Behavior (22 pgs)
• Kalipeni, et al – Chapters 9, 11, & 20 (11 pgs; 12 pgs; 12 pgs)
• Donovan, Mark C. 1996. “The Politics of Deservedness: The Ryan White Care Act and the Social
Constructions of People with AIDS.” Pp. 68-85 in AIDS: The Politics and Policy of Disease,
Edited by Stella Z. Theodolou. Upper Saddle River, NJ: Prentice Hall. [E-Reserve] (17 pgs)
• Brier, Jennifer. 2009. “Marketing Safe Sex: The Politics of Sexuality, Race and Class in San
Francisco 1983-1991.” Pp. 45-77 in Infectious Ideas: U.S. Political Responses to the AIDS
Crisis. Chapel Hill, NC: University of North Carolina Press. [E-Reserve] (32 pgs)
• CDC. 2009. “HIV and AIDS among Gay and Bisexual Men.” Available on-line at:
http://www.cdc.gov/NCHHSTP/newsroom/docs/FastFacts-MSM-FINAL508COMP.pdf (3pgs)
• Avert. “Injecting Drugs, Drug Users and HIV and AIDS.” Available on-line at:
http://www.avert.org/injecting.htm (7 pgs)
• CDC. 2005. “Access to Sterile Syringes.” Available on-line at:
http://www.cdc.gov/idu/facts/aed_idu_acc.htm (3 pgs)
• CDC. 2005. “State and Local Policies Regarding IDUs Access to Sterile Syringes.” Available online at: http://www.cdc.gov/idu/facts/aed_idu_pol.htm (3 pgs)
• CDC. 2005. “Syringe Exchange Programs.” Available on-line at:
http://www.cdc.gov/idu/facts/aed_idu_syr.htm (3 pgs)
• Egelko, Bob. 2009. “U.S. Repeals Funding Ban for Needle Exchanges.” San Francisco
Chronicle, December 18. Available on-line at: http://articles.sfgate.com/2009-1218/news/17331688_1_needle-exchange-programs-needle-exchanges-clean-needles (2 pgs)
Due February 25: Paper 1 – Country Study
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March 2 and 4: NO CLASS/SPRING BREAK
Part III: Human Rights, Development and Economy
March 9 and 11
HIV/AIDS and Human Rights
Readings:
• Kalipeni, et al – Chapter 18 (11 pgs)
• Gruskin, Sofia and Daniel Tarantola. 2005. “Health and Human Rights.” Pp. 3-49 in
Perspectives on Health and Human Rights, edited by Sofia Gruskin, Michael A. Grodin, George
J. Annas, and Stephen P. Marks. New York: Routledge. [E-Reserve] (46 pgs)
• Farmer, Paul. 2005. “On Suffering and Structural Violence: Social and Economic Rights in the
Global Era.” Pp. 29-50 in Pathologies of Power: Health, Human Rights, and the New War on the
Poor. Berkeley and Los Angeles, CA: University of California Press. [E-Reserve] (21 pgs)
• AIDS.org. “HIV Travel/Immigration Ban: Background/Documentation.” Available on-line at:
http://www.aids.org/atn/a-128-03.html (12 pgs)
• UNAIDS. 2010. “UN Secretary-General applauds the removal of entry restrictions based on
HIV status by United States of America and Republic of Korea.” January 4. Available on-line at:
http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2010/20100104_tr
avelrestrictions.asp (2 pgs)
• Universal Declaration of Human Rights. Available on-line at:
http://www.un.org/Overview/rights.html (2 pgs)
• Declaration of Alma Ata. Available on-line at:
http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf (3 pgs)
March 16 and 18
Households, Families and Children
Readings:
• Barnett/Whiteside – Chapters 7 & 8 (13 pgs; 28 pgs)
• Kalipeni, et al – Chapters 14, 19, & 22 (13 pgs; 20 pgs; 11 pgs)
• de Bruyn, Maria. 2002. “Reproductive Choice and Women Living with HIV/AIDS.” Ipas.
Available on-line at: http://www.ipas.org/Publications/asset_upload_file116_3009.pdf (25 pgs)
***March 17th: Required Evening Session: 7:30-9:30***
March 23 and 25
Labor and the Economics of HIV
HIV/AIDS and Development
Readings:
• Barnett/Whiteside: Chapters 9, 10 & 11 (24 pgs; 28 pgs; 25 pgs)
• Irwin, et al – Myth Three: Corruption (18 pgs)
• Kalipeni, et al – Chapters 15 & 21 (11 pgs, 13 pgs)
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•
Rosen, Sydney and Simon, Jonathon L. 2003. “Shifting the Burden: The Private Sector’s
Response to the AIDS Epidemic in Africa.” Bulletin of the World Health Organization 81(2):
131-137. Available on-line at:
http://info.worldbank.org/etools/docs/library/57496/Shifting%20the%20burden%20of%20HIV%
20-%20AIDS.pdf (11 pgs)
March 30: In-Class Mid-Term Exam
April 1: NO CLASS/EASTER BREAK
Part IV: Politics of Response
April 6 and 8
Approaches to Prevention and Care
Readings:
• Barnett/Whiteside – Chapters 12 (26 pgs)
• Irwin, et al – Myth 4: Prevention vs. Treatment? (14 pgs)
• Lewis – Chapter 5 (46 pgs)
• Global Fund. “About the Global Fund.” Available on-line at:
http://www.theglobalfund.org/en/about/ (1 pg)
• Global Fund. “History.” Available on-line at: http://www.theglobalfund.org/en/history/?lang=en
(1 pg)
• Global Fund. “How the Global Fund Works.” Available on-line at:
http://www.theglobalfund.org/en/how/?lang=en (1 pg)
• Kaiser Family Foundation. 2009. “Fact Sheet: The Ryan White Care Act.” Available at:
http://www.kff.org/pullingittogether/080309_altman.cfm (2 pgs)
• Kaiser Family Foundation. 2009. “Fact Sheet: AIDS Drug Assistance Programs.” Available online at: http://www.kff.org/hivaids/upload/1584_10.pdf (2 pgs)
• Altman, Drew. 2009. “Pulling it Together: Small $ for HIV Prevention.” Kaiser Family
Foundation. Available on-line at: http://www.kff.org/pullingittogether/080309_altman.cfm (1 pg)
• Kaiser Family Foundation. 2009. “Views on the U.S. Role in Global Health Update.” Available
on-line at: http://kff.org/globalhealth/upload/8013.pdf
• Porpora, Douglas V. 1992. “The Banality of Evil.” Pp. 15-38 in How Holocausts Happen: The
United States in Central America. Philadelphia: Temple University Press. [E-Reserve] (18 pgs)
April 13 and 15
Prevention and Behavior Change
Readings:
• Kalipeni, et al – Chapter 13 (16 pgs)
• Skolnik, Richard L. 2007. “Culture and Health.” Pp. 97-112 in Essentials of Global Health.
Sudbury, Massachusetts: Jones and Bartlett. [E-Reserve] (15 pgs)
• Siplon, Patricia D. 2002. “Dueling Models of AIDS Prevention: Harm Reduction and
Abstinence.” Pp. 67-92 in AIDS and the Policy Struggle in the U.S. Washington, DC:
Georgetown University Press. [E-Reserve] (23 pgs)
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•
•
•
•
•
•
Lindberg, Laura Duberstein, John S. Santelli, and Susheela Singh. 2006. “Changes in Formal Sex
Education: 1995-2002.” Perspectives on Sexual and Reproductive Health 38(4): 182-189. [EReserve] (7 pgs)
Human Rights Watch. 2005. “Summary” (pp.1-5) and “Recommendations” (pp.6-12) in The
Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda. March 25.
Available on-line at:
http://www.crin.org/docs/resources/treaties/crc.40/Uganda_hrw_aids_ngo_report.pdf
Kirby, Douglas. 2008. “Success in Uganda: An Overview of Uganda’s Campaign to Change
Sexual Behaviors and Decrease HIV Prevalence, 1986-1995.” ETR Associates. Available online at: http://programservices.etr.org/base/documents/Uganda-ExecSummary.pdf (21 pgs)
The United States President’s Emergency Plan for AIDS Relief. 2009. “PEPFAR Overview”
Available on-line at: http://www.pepfar.gov/press/81352.htm (2 pgs)
Center for Health and Gender Equity. 2008. “Press Release: Statement of Center for Health and
Gender Equity Executive Director Serra Sippel in Response to President Bush Signing Bill to
Reauthorize PEPFAR.” Available on-line at:
http://pepfarwatch.org/images/PEPFAR/pr2008.bushpepfar.pdf (2 pgs)
Avert. “President’s Emergency Plan for AIDS Relief.” Available on-line at:
http://www.avert.org/pepfar.htm (15 pgs)
April 20 and 22
Treatment and Medication Access
Readings:
• Irwin, et al – Myth Six: Vaccines & Myth Seven: Profits vs. Health (18 pgs)
• Bond, Patrick. 1999. “Globalization, Pharmaceutical Pricing, and South African Health Policy:
Managing Confrontations with U.S. Firms and Politicians.” International Journal of Health
Services 29(4): 765-792. [E-Reserve] (28 pgs)
• Brekke, Kurt R. and Odd Rune Straumef. 2009. “Pharmaceutical Patents: Incentives for
Research and Development or Marketing?” Southern Economic Journal 76(2): 351-374. [Ereserve] (23 pgs)
• Greene, Melissa Fay. 2006. “Chapter 28.” Pp. 183-206 in There Is No Me Without You. New
York, NY: Bloomsbury. [E-Reserve] (15 pgs)
• Egilman, David and Emily Ardolino. 2010. “The Pharmaceutical Industry.” In The Bottom Line
or Public Health: Corporate Strategies to Influence Health Policy and What We Can Do To
Counter Them, edited by Bill Wiist. Oxford: Oxford University Press. [E-Reserve]
• Conrad, Peter. 2005. “The Meaning of Medications: Another Look at Compliance.” Pp.150-162
in The Sociology of Health and Illness: Critical Perspectives. 7th ed. Edited by Peter Conrad.
New York, NY: Worth Publishers. [E-Reserve] (10 pgs)
• WTO. 2001. “Declaration on the TRIPS Agreement and Public Health.” Available on-line at:
http://www.wto.org/english/thewto_e/minist_e/min01_e/mindecl_trips_e.htm (2 pgs)
• Wallach, Lori and Deborah James. 2006. “Why the WTO Doha Round Talks have Collapsed –
and a Path Forward.” Common Dreams. Available on-line at:
http://www.commondreams.org/cgi-bin/print.cgi?file=/views06/0814-33.htm (6 pgs)
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Part V: Social Movements and Social Change
April 27 and 29
Social Movements and Social Change
Readings:
• Irwin, et al – Myth Ten: Nothing We Can Do (18 pgs)
• Stockdill, B.C. AIDS, Multiple Inequalities, and Activism. In Activism against AIDS: At the
Intersections of Sexuality, Race, Gender, and Class. pp. 1-24. [E-Reserve] (23 pgs)
• Gamson, Josh. 1989. “Silence, Death, and the Invisible Enemy: AIDS Activism and Social
Movement ‘Newness.’” Social Problems, 36(4): 351-367. [E-Reserve] (16 pgs)
• Epstein, Steven. 1995. “The Construction of Lay Expertise: AIDS Activism and the Forging of
Credibility in the Reform of Clinical Trials.” Science, Technology, & Human Values, 20(4): 408437. [E-Reserve] (29 pgs)
• Mbali, Mandisa. “The Treatment Action Campaign and the History of Rights-Based, PatientDriven HIV/AIDS Activism in South Africa.” Center for Civil Society, University of KwaZuluNatal. Available on-line at: http://www.ukzn.ac.za/CCS/files/RReport_29.pdf (23 pgs)
May 4 and 6
Global Commitment
Readings:
• Barnett and Whiteside – Chapters 13 & 14 (33 pgs; 17 pgs)
• Irwin, et al – Myth Eight: Limited Resources & Myth Nine: Nothing to Gain (18 pgs; 16 pgs)
Due May 4: Paper 2 – Issue Analysis
Due on or before May 11 at 12:30 PM: Final Take-Home Exam
Useful Websites
Kaiser Family Foundation
http://www.kff.org
http://www.kaisernetwork.org
UNAIDS
www.unaids.org
The Global Fund
http://www.theglobalfund.org/
World Health Organization
http://www.who.int/en/
HIV InSite
http://hivinsite.ucsf.edu/
The Body
www.thebody.com
AIDS Education Global Information System
(AEGiS)
http://www.aegis.com/
Centers for Disease Control and Prevention
www.cdc.gov
Health Resources and Services Administration:
HIV/AIDS Bureau
http://hab.hrsa.gov/aboutus.htm
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