AIDS, Sexual Behavior, and Intravenous Drug Use (1989) / Chapter Skim
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7 Social Barriers to AIDS Prevention
7 Social Barriers to AIDS Prevention
Pages 372-402
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From page 372... ...
Sum sequently, from a more conjectural perspective, it considers ways in which an understanding of these conflicts may be informed by a historical view of stigmatization as it has characterized other epidemics. SOCIAL RESPONSE TO EPIDEMICS It is important to clarify our use of the word epidemic, which is now commonly associated with the presence of HTV infection in the U.S.
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From page 373... ...
Similarly, cluring the cholera and yellow fever epidemics of nineteenth-century America, business and commercial interests moved to control the disaster (Rosenberg, 1962~. In almost all major epidemics, community life has been seriously disrupted by the presence of a mass of seriously ill and dying people.
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From page 374... ...
The following section offers examples that illustrate some of the ways in which social barriers have already impeded effective responses to the AIDS epidemic an(l ways in which such barriers will hinder attention to the disease in the future if AIDS becomes endemic.
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From page 375... ...
In addition, the United States has a long history of institutional barriers to communication about (as well as treatment of) sexually transmitted diseases.
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From page 376... ...
176~. In the past several years, a number of examples reveal how potentially effective AIDS education activities were prohibited or delayed because of similar social barriers.
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From page 377... ...
Yet despite this advertising policy for a sexual prophylaxis, television soap operas and dramatic presentations sometimes involve sexual material that might be judges! inappropriate or offensive by some viewers.
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From page 378... ...
Furthermore, since audiences may be more influenced by the thematic content of programs than by advertising, television shows particularly those whose characters engage in behaviors that risk the transmission of HIV infectioncould perform a public service by dealing frankly with the issue of condom use. Although the major television networks will not accept commercial advertising for condoms,3 ciata from a number of public opinion polls indicate that a substantial majority of American adults would not be offended by condom advertisements (Table 7-1~.
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From page 379... ...
Thus, public discussion of the modes of transmission of, and methods of protection against, HIV infection is marked by omissions and circumlocutions: the omissions include a lack of reference to homosexuals in some messages; the circumlocutions include use of the phrase "exchange of bodily fluids" in early discussions as a euphemism for sexual intercourse with ejaculation, among other things (Check, 1987~. The problem of explicit language is undeniably complex.
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From page 381... ...
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From page 382... ...
Similarly, cluring the last three years, countries around the world have provided their populations with an assortment of explicit messages on ways to reduce the risk of HIV infection (WorId Health Organization Special Programme on AIDS, 1988~. For instance, a Brazilian poster follows many of the recommendations offered by the committee in Chapter 4.
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From page 383... ...
abstinence from sexual activity outside of a monogamous marriage; and (2) abstinence from the use of illegal intravenous drugs."5 This amendment crystallized in public law one side of a continuing public debate over the content of federally sponsored AIDS education.
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From page 384... ...
(1987:9) The Department of Education brochure also paid considerable attention to the risk of condom failure, which was highlightec7 in a sidebar explaining that "condoms can and do fail." Similar conflicts within the federal government have produced extensive delays in the approval of several high-visibility products of AIDS eclucation efforts.
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From page 385... ...
Efforts to educate IV drug users have suffered from similar problems. For example, the National Institute on Drug Abuse prepared a pamphlet to inform drug users about AIDS and the risks posed by needle-sharing; the pamphlet stressed the importance of sterilizing injection equipment before use (if the drug user was unable to discontinue the use of drugs)
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From page 386... ...
Some of the federal guidelines regarding AIDS education in schools require that programs be consistent with the moral values of parents and the community; others require that the values presented in the programs correspond to those stated in the previous section 9Results are taken from five national survey measurements made in the General Social survey during 1974-1983. Measurements were not made after 1983 using this question.y The survey asked the question "Do you think birth control information should be available to teenagers who want it, or not?
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From page 387... ...
Estimates are derived from surveys of probability samples of the noninstitutional adult population of the continental United States, conducted by the General Social Survey program of the National Opinion Research Center (University of Chicago; see J
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From page 388... ...
The (disproportionate percentage of AIDS cases among blacks and Hispanics is thought to reflect higher rates of HTV infection among black and Hispanic IV drug users, their sex partners, and their infants (Allen and Curran, 1988; Curran et al., 1988~.1° It has 1OOf 12,721 cases of AIDS reported among IV drug users (as of July 18, 1988) , 6,454 were diagnosed among blacks, and 3,721 were diagnosed among Hispanics.
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From page 389... ...
{V drug users often have mixed feelings about entering the health care system, feelings that may be fed, in part, by a fear of detection of criminal activity. Those {V drug users that do gain access to health cases among children under five years of age, 728 were diagnosed in black and Hispanic children.
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From page 390... ...
Some people, including various political and social leaders, have already stigmatized the victims of AIDS, seeking to exclude them from society as lepers were once driven out (e.g., Sabatier, 1988~. Others have complained that, because gays, minorities, anti drug users were already stigmatize<]
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From page 391... ...
The stigma becomes a predominant description of members of the group, effectively hilling most of their real features.- Stigma thus becomes not merely a cliche but a menacing, mean cliche. Effects of Stigmatization Throughout history, stigmatization, in the modern sense of designating a group or social class as blameworthy and dangerous, has frequently appeared in times of epidemic disease.
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From page 392... ...
institutional dimensions so necessary to sound public health measures. To blame the victim is to absolve social institutions of their responsibilities.
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From page 393... ...
The fact that infection has been largely confined to mate homosexuals and IV drug users has made stigmatization almost inevitable, for these groups were already the objects, to a greater or lesser degree, of the deprecating judgments that constitute stigmatization. The AIDS epidemic has adcled to opinions already held about these groups the new belief that they are dangerous to the whole society, not only because they exist, are different, or are outlaws but because they can infect people outside their group with a lethal disease.
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From page 394... ...
" SOURCE: Tabulated from the General Social Surveys conducted by the National Opinion Research Center (University of Chicago)
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From page 395... ...
Supreme Court justices, as in the opinion of the public, there is a cleavage in attitudes toward private sexual behaviors that depends on the sexual orientation of the participants. The Court's decision as recognized in both the minority iiThe statute (Georgia Code Annotated at 16-6-2, 1984)
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From page 396... ...
Efforts at education, prevention, and the formation of policy may be fragmented as a result. If the AIDS epidemic taxes the health care system as heavily in the future as is now predicted, the public, already lacking in 12A heterosexual couple joined in the original case, stating that they wished to engage in the proscribed sexual behaviors but were "chilled and deterred" by the statute and the arrest of the homosexual plaintiff.
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From page 397... ...
In addition to widely shared humanitarian reasons for helping those at risk of disease, utilitarian purposes and self-interests are also served by establishing a suitable social climate for preventive action. In the AIDS epidemic, fears that the disease would spread from high-risk groups into the general population stimulated concern and, eventually, the mobilization of resources, as ShiTts described so forcefully in his 1987 book And the Band Played On.
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From page 398... ...
; similarly, mental retardation anti psychiatric disease may be on the way to destigmatization as a result of professional definition and advocacy (Volinn, 1983~. The media also bear a particular responsibility because the stories they choose to portray and the language and images they choose to use may reinforce or counteract stigma.
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From page 399... ...
to protect the rights and confidentiality of infected persons. Efforts to enact the most extreme forms of constraint, such as quarantine or isolation, have failed; at the same time, the usual principles of criminal and civil law have been invoked to restrain harmful behavior by infected persons.
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(1988) Epidemiology of HIV infection and AIDS in the United States.
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From page 401... ...
(1988) Final Report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic.
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