Ensnared by AIDS. David K. Beine

prominent that many were just getting tired of hearing about AIDS and being afraid of it. Couple that with the cultural model change of AIDS as a deadly, infectious disease, to a chronic manageable condition, and you have a problem. Time magazine then reported that although death rates were lower, “the numbers of new HIV infections is holding steady at over forty thousand per year, and researchers reported a surge in unsafe sex practices” (Time 1998). This was a stark contrast to a report published in Time magazine in 1994 which cited fear of contracting AIDS as the biggest concern of youths between the ages of nine and seventeen (Giblin 1995:184). It seemed that fear of contracting AIDS was just not as strong of an issue anymore. This AIDS fatigue trend began in the late 1990s and continues to the present. It is so prevalent today that Wikipedia (2012) dedicates a page to discuss the topic, AIDS activists blame it for decreasing contemporary media coverage of related issues (Bjerk 2012), and Peter Piot (the former head of UNAIDS) accuses it of affecting ongoing AIDS funding (Bloomberg 2010).

      At the thirtieth anniversary of HIV and AIDS we can clearly define two specific cultural models evenly dividing the thirty-year span. According to Dr. Michael Saag:

      If we divide the 30 years in half—literally, 15 years—the first half was death, dying, huge stigma, isolation and, to some degree, hopelessness. Through this remarkable investment—in particular, by the NIH and our government and pharmaceutical companies working together—within a very short period of time, the virus was discovered, drugs were identified that actually worked dramatically well, such that by 1996, we had what we now call HAART or triple drug therapy that totally transformed the face of AIDS. Such that over the last 15 years, HIV has been converted from a death sentence to a chronic manageable condition that someone diagnosed today can live a normal lifespan if they take the medicines regularly and they get the virus in check. That’s remarkable. (NPR 2011)

      So the evolution of this cultural model is clear—from AIDS as a death sentence, characterized by death and dying (1981–1986)—to the time of ART, where AIDS is viewed as a chronic manageable disease (1997–2012), and is perhaps best characterized as a time of hope.40 One must wonder, with the possibility of a cure at the doorstep, if another shift in the cultural model of AIDS is just around the corner; a cultural model of “being cured of AIDS,” or of the possibility of the elimination of the AIDS epidemic altogether?

      2.2.3 Aids as socioeconomic disease—the continuing gap

      As we have seen, AIDS is a biomedical reality and it is a sociocultural construction. Because of the statistics, we must conclude that AIDS is a socioeconomic disease as well. At the time of the first edition of this book, the inner cities of the U.S. as well as the African American and Hispanic populations had been hit hardest by the epidemic (Flynn and Lound 1995:56; Singer 1999) and it had been predicted that the world’s underdeveloped nations would likely bear the brunt of the AIDS epidemic in the future (Flynn and Lound 1995:60; Singer 1999). Prospects of declining interest in the subject (due to the advent of new treatments and the phenomenon of AIDS fatigue) in the West had AIDS experts worried that there would be a growing gap between the rich and poor nations of the world in regard to AIDS. This “growing gap between rich and poor nations” was even the focus of the World AIDS conference held in Geneva (1998). In Europe and North America, AIDS treatments (ART) were developed that cut the death rate significantly, but the spread of HIV and AIDS in the third world continued unabated. It seemed that AIDS was quickly becoming a disease of the poor, both internationally and within nations. Merrill Singer (1999) asked the appropriate question: “How do we ensure that the new AIDS treatments are not the exclusive property of people in rich countries and rich people in other countries?” As I alluded to earlier, the cost of AIDS treatment was outside the realm of possibilities for many third-world governments and individuals at that time. The Economist reported (1997) the expectation that these new therapies would cost over ten thousand dollars yearly, and that “nine out of ten people who contract AIDS live in countries where $10,000 a year exceeds by many times the gross domestic product per head.”

      A newspaper article from that time (The Register-Guard 1997) demonstrated another facet of this socioeconomic issue: profits. In a South African court, U.S. pharmaceutical companies (with U.S. government assistance) were seeking to block a new law that allowed generic versions of AIDS drugs (generic copies of those that were available in America) to be manufactured locally or imported without permission of the patent holder. The U.S. companies challenged the law on the grounds of patent infringement. The goal of the law was to reduce the cost of the AIDS-fighting drugs, making them more affordable for their populace. The drug companies argued that the law “undermines their industry’s multibillion dollar research efforts and could hinder the development of new AIDS-fighting medicines.” Critics charged that the move was all about profits, a charge that seems warranted. The companies claimed sensitivity to the dire epidemic in the third world, but insisted that the pharmaceutical industry “must protect the rights of its companies to profit from their research.”

      So ten years later where do we stand? Around the world overall HIV infection rates are mostly in decline (as noted previously).41 Despite that fact, it was acknowledged recently at the International AIDS Conference (2012) that hunger and malnutrition are now significant obstacles to the global fight against HIV (World Food Program 2012).42 And hunger and malnutrition are generally problems of poverty. Likewise, the Center for Disease Control (CDC 2012) continues to report that “Poverty can limit access to health care, HIV testing, and medications that can lower levels of HIV in the blood and help prevent transmission. In addition, those who cannot afford the basics in life may end up in circumstances that increase their HIV risk.”

      So on the global level, socioeconomic disparity would seemingly still play a role in the unequal success of treatment. And if cuts to global ART subsidies spoken of earlier become a reality, only the rich countries and the rich in poor countries will continue to benefit from the medical advances available.

      And even in the developed world, socioeconomics still creates an obvious divide in the epidemic as well. In Washington D.C., America’s capital, the HIV prevalence rate is higher than the third world countries of Gambia, the Democratic Republic of Congo, and Senegal (Boseley 2012a).43 If the city were its own nation it would tie with Togo as the twenty-second worst nation in the world in regard to its estimated HIV infection rate; this at a time when the nation’s overall infection rate (0.6%) would place it at number sixty-four overall in the world.44 So, what explains the discrepancy? Poverty (The Guardian 2012). And in 2011 Dr. Michael Sagg, Director of the Center for AIDS Research at University of Alabama was asked, if despite the progress mentioned earlier, there was still any particular American population remaining in the “bulls-eye” of the epidemic. Dr. Sagg responded, “It’s mostly people of lower income and especially minorities. And in Alabama, in rural areas, there is a large number of people who are HIV-infected and don’t know it, and that’s the tragedy” (NPR 2011). So, even with the ability to treat HIV and AIDS in the West, it is the poor, mostly minorities who continue to suffer the most. It seems as if the socioeconomic gap noted ten years ago remains a reality even into the present.

2.3 Chapter conclusion

      Between the time of the first discovery of a handful of AIDS cases in the USA (1981) and the early 1990s, AIDS had become one of the worst epidemics the world had ever known. By then over four million people had died, several million more were living with HIV, and it seemed as if AIDS was spreading like “wildfire.”45 Prevalence rates in some countries of Southern Africa were estimated to be near 30–40 percent and predictions for the future were dire (Knight 2008). In response, the United Nations established the Joint United Nations Programme on HIV and AIDS (UNAIDS) in 1996 in an effort to more effectively deal with the growing pandemic. However, by the early 2000s, mostly due to better surveillance, the original figures for Sub-Saharan Africa began to be revised downward (Asamoah-Odei et al. 2004). And since 70 percent of the cases presumed to exist at that time were in that region, the prediction for the overall size of the epidemic was adjusted significantly as well. Although still very significant—nine of forty-one countries in the region still list prevalence rates of between 11 percent and 25 percent as of 2010 (UNAIDS Global Report 2010)—prevalence rate figures are now half of what they once were. The overall prevalence for the region is now listed at around 5 percent (UNAIDS 2011).

      As estimates were