HIV/AIDS
HI 176: Lecture Week 13
Dr. Howard Chiang
Historical Chronology
- Human immunodeficiency virus (HIV) – HIV-1 & HIV-2
- 1960s and 1970s: ‘silent’ decades
- SIVcpz (simian immunodeficiency virus) – apes
- 1981-2: ‘gay’ disease
- reported clusters of (1) Kaposi’s sarcoma and (2)
Pneumocystis carinii pneumonia (PCP)
- 1982: acquired immune deficiency syndrome (AIDS)
- 1983-9: growing public awareness
- azidothymidine (AZT): first anti-HIV drug
- December 1, 1988 – the first World AIDS Day
- 1990s
- main cause of death in 25-44 age group in USA
- 4th biggest global cause of death in 1999
Princess Diana gave Jonathan Grimshaw, director
of a new AIDS centre in London and HIV positive, a
firm handshake (1989)
https://www.youtube.com/watch?v=ATn-8Nvowgk
AIDS Activism and Testimonials
- Getting people living with HIV to testify publicly about
being HIV positive is difficult, because HIV and
discrimination went hand-in-hand (HIV was identified
with specific social groups) – a stigmatizing force
- Activist movement: community-based prevention and
care approaches + more government attention
- AIDS exceptionalism: the response to the epidemic
must differ from other public health interventions
- AIDS movement – broad based; myriad constituents;
the first social movement to accomplish the mass
conversion of disease ‘victims’ into activist-experts
- built on the foundation of the gay and lesbian
movement and borrowed from its strengths!
AIDS Activism and Testimonials
- AIDS movement:
- ‘cultural capital’ (Bourdieu)
- played a part in treatment breakthroughs through
the forceful lobbying of the pharmaceuticals industry,
putting pressure on regulatory authorities to fasttrack the licensing of drugs (‘to get drugs into
bodies’), and mobilizing patients to participate in
clinical trials
- Medicalization: the increasing impetus, beginning in
the 1960s and 1970s, for many aspects of life to be
framed in biomedical terms as ‘diseases’ requiring
intervention (e.g., depression, addiction, etc.)
- social environment: ambivalence about biomedicine
AIDS Activism and Testimonials
- ACT-UP: AIDS Coalition to Unleash Power
- http://www.actupny.org
- the model of self-organizing in the gay community
- from New York to the rest of the world?
- ‘Coming out’ – logical extension of the experience
with the epidemic in North America and Europe
- ‘testimonials’ – closest to the ‘realities’ of HIV
- Paris World AIDS Summit in November 1994, where
the Greater Involvement of People with AIDS (GIPA)
initiative was ratified by countries attending
- Vinh-kim Nguyen’s ‘confessional technologies’
- techniques deployed to get people talking
- self as substrate – confession, truth, good life
The China-UK Project
A. Historical Background: Changing Paradigms of
Health Care
- 1997, Limu township, Liangshan, Sichuan,
Southwest China: China’s first case of HIV infection
by drug injection – Nuosu (Yi), an ethnic minority
- Sponsored by the Department for International
Development, an official British aid agency, in
cooperation with the Chinese government
- Why did this well-intended and well-funded AIDS
intervention project fail to improve local health
conditions?
- ‘failed’ state intervention
The China-UK Project
A. Historical Background
- Bringing biomedicine to Liangshan was both a
necessity and a pragmatic strategy for the People’s
Liberation Army
- Cultural Revolution (1966-76): Mao Zedong’s national
health care programs led to a mass mobilization of
China’s health personnel and resources
- the state forced medical personnel to relocate from
cities to the countryside, where they served as
health workers, paramedics, or other types of
workers, a policy that was associated with the
training of over a million so-called barefoot decades
- Deng’s era – redistribution of professionals
The China-UK Project
A. Historical Background
- Last 2-3 decades: the disparity between rural and
urban areas, the overall malfunction of the health
care delivery system, and the ineffectiveness of the
health care apparatus for epidemic control
B. Case Study 1: Needle Exchange Program
- Needle exchange – Amsterdam in 1984; New York
- Limu: one week’s planning in April 2005
- First wave opposition – family members of drug
users
- Second opposition – whose responsibility for deaths?
- traditional Nuosu judicial concerns
- 2 peer educators arrested by police
The China-UK Project
C. Case Study 2: The Antiretroviral Treatment Program
-The Project’s last undertaking in Limu
-2 patients based on CD 4 cell counts (an essential part
of the human immune system)
- woman migrated to Chengdu
- man – arrested for heroin possession
-These problems are traceable to interwoven structural
problems rooted in China’s health care
-The prioritizing of private interests over public health
may explain the lack of interagency coordination +
inadequate local footing of the top-down policy
planning and implementation in the Limu programs
http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf