The Impacts of Aids Essay
Although the AIDS epidemic has occurred in a period when social conservatives have been politically dominant in most Western societies increasing the stigma against homosexuals and homosexuality, it has also translated into much greater recognition of the homosexual community and a homosexual movement, in most Western democracies. As the 1980s progressed, the gay and lesbian community increasingly realized the devastating impact of AIDS on gay men.
The complex of diseases called AIDS was first discovered among gay men in 1981. From the first moment the gay male community became aware of AIDS (which was first called GRID—gay-related immune deficiency), it responded politically. By the end of the summer in 1981, a group of gay men had already met at author Larry Kramer’s apartment in New York City and had established the Gay Men’s Health Crisis (GMHC)—the largest AIDS organization in the country today.
It is not, of course, homosexuals who are at risk for AIDS but rather those who practice certain forms of “unsafe” sex. This distinction between behavior and identity, which often seems academic, is in fact vital to a rational understanding of AIDS. Because the media and the public generally do not make these distinctions, “gay” and “AIDS” have become conflated, so that the public perception of homosexuality becomes largely indistinguishable from its perception of AIDS.
This, in turn, has two consequences: (1) It causes unnecessary discrimination against all those who are identified as gay and lesbians, and (2) it also means that people who are not perceived (and do not perceive themselves) as engaging in high-risk behaviors can deny that they are at risk of HIV infection. As the gay movement matured in the 1970s, however, it made more concrete demands of governments, pressing for antidiscrimination ordinances and for financial support for gay organizations and activities. But, in large part, the gay movement retained an adversarial relationship with the government, a relationship made possible because of the movement’s emphasis on self-assertion (“coming out”) and challenging social stigma. All this changed with the appearance of AIDS.
Demands for government-funded research were first made by New York’s Gay Men’s Health Crisis, the first community-based AIDS organization. And the demands have not stopped there: Governments are asked to support research, patient care, services, and education programs. Inevitably such demands involve gay participation in the processes of government—policy-making, membership on liaison committees, day-to-day contact with bureaucrats, and so forth. But the process has been two-way.
Governments have understood that to research the disease, to provide the necessary services, and to bring about the behavioral changes (primary prevention) believed to be the most effective strategies against the spread of the disease, contact with the most affected groups is required. AIDS has thus forced governments to recognize organizations they had previously ignored, and this has resulted in strengthened gay organizations, often with the help of state resources. As a generalization, the response of gay groups and those working in local AIDS education and advocacy programs has been to stress large-scale education about primary prevention, while conservative medical, political, and religious figures have emphasized widespread testing for the HIV antibody and restrictive legislation.
The issue of testing for HIV antibodies among high-risk populations has been a major debate in most Western countries. AIDS organizations have generally argued that large-scale testing is undesirable and that mandatory testing of high-risk groups will compel those infected with the AIDS virus go underground out of the mainstream of health care and education. As the National Gay and Lesbian Task Force (NGLTF) argued: The experience of the gay community—the only group where significant prevention and risk-reduction programs have taken place—demonstrates that education and counseling, not testing, are critical to changing behavior. Not everyone needs or desires to know his/her antibody status. No one should be forced into that position, particularly given the potentially severe social, legal and economic ramifications of testing.
The NGLTF’s anti-testing position is further strengthened by the fact that test results often obtain false positives for the presence of HIV antibodies. It is easy to portray this dispute over testing as one that pits public health advocates against proponents of gay rights. In reality, the dispute centers on different conceptions of public health: Those who oppose mandatory testing are concerned that the fear of discrimination resulting from seropositive results will force those most at risk to avoid needed testing, counseling, and contact with support services. It is vital to understand the extent to which discrimination (real and perceived) against “AIDS carriers” is a factor, and how it is strengthened every time a politician or religious figure talks of quarantine or isolation.
Certain sorts of discrimination are justified in the interests of public health, and reasonable people can disagree about the balance—as was true in the protracted debate in San Francisco concerning the gay bathhouses. But few diseases in recent history have led to as many stringent proposals to restrict the rights of those affected, and even fewer have led to claims for discrimination against all members of “high-risk” groups, whether or not they were actually ill or contagious. Fear of AIDS has elicited a welter of irrational reactions based on the stereotyping of homosexuals.
The U.S. Justice Department has ruled that persons with AIDS may be dismissed from their jobs because of fear of transmission, even where such fears are not medically supported; some state courts and legislatures, however, have taken an opposite position. Fear of AIDS was invoked by the state of Georgia in its successful defense of its antisodomy law before the Supreme Court in 1986. A number of governments (including the United States) have sought to make evidence of HIV-antibody-free (noncarrier) status a requirement for immigration or even entry; in West Germany this provision has led to a bitter dispute between the Interior and Health ministries.
Fear of and hostility toward those with AIDS most clearly overlaps with more generalized homophobia in the attempts by some politicians and a number of fundamentalists to use the epidemic to argue against homosexual rights. In the eyes of the religious right, AIDS is literally viewed as a God-given opportunity to reverse social attitudes toward homosexuality, which have grown more tolerant over the past decade; in English-speaking countries particularly, fundamentalists have invoked fire-and-brimstone rhetoric to argue that AIDS is evidence of God’s wrath.
Gay groups have quickly learned which aspects of the political system are most amenable to pressure; in the United States, at a national level, this has involved working through the courts (a vast number of AIDS-related cases are already working their way through the judicial system) and, especially, sympathetic members of Congress. Among the groups most affected by AIDS, only the homosexuals have been able to mobilize and articulate political demands. The public’s perception of the disease therefore continues to be more closely linked with homosexuals than its epidemiology suggests.
In the United States this is further complicated by racial divisions and intravenous drug use, as a far higher proportion of AIDS cases that are not sexually transmitted are found among blacks and Hispanics than among whites. Even now one feature of AIDS organizations is the under representation of people of color, including homosexuals. Even in countries where this is not a problem, the dominance of AIDS as an issue makes the gap between gay women and men increasingly more difficult to bridge; although many lesbians are heavily involved in AIDS work, most gay women cannot identify with AIDS as a central issue in the way true for many gay men.
AIDS has mobilized more gay men into political and community organizations, although not into specific demonstrations and marches, than any other event in the short history of the gay movement. In every major city of the United States, Canada, Australasia, and most of northern Europe, the appearance of AIDS has led thousands of gay men (and others) to volunteer in programs of care, support, counseling, and education. But this in turn creates several problems: It reinforces the public’s misperception of the causal link between AIDS and homosexuality; it forces other issues off the gay movement’s agenda and monopolizes its attention; and it creates new tensions as dependence on government and the emergence of a new class of AIDS experts leads to growing strains within the movement.
One could in fact posit that AIDS has created a shift in the leadership of the gay movement, accentuating the trend toward leaders who can claim professional expertise instead of activist credentials—a move already under way during the late 1970s. This has been most obvious in the rise to prominence of openly gay medical doctors, who have been able to use their professional skills and sexual identity to claim a certain legitimacy in the eyes of government; groups like the American Physicians for Human Rights have become prominent within the gay movement largely because of the epidemic. But the new leadership also includes those skilled in legislative and bureaucratic lobbying, and one consequence of this shift has been to reduce the representativeness of leadership in terms of class, race, and age.
Observing the gay movement, AIDS has changed the movement in ways none of us could have anticipated in the much headier days of the 1970s. Obviously the stakes are higher: However important law reform was, it does not compare with the urgent need to respond to an epidemic that in some cities (New York, San Francisco, Houston, Copenhagen, Sydney) was striking nearly every gay man. In response, new people have come into the movement; many gay men who had hitherto regarded gay politics as irrelevant, have become the front-line activists because of AIDS.
But many experienced activists have found that AIDS has turned them into professionals; the people who run the large organizations, such as GMHC, the Terence Higgins Trust, the San Francisco AIDS Foundation, the AIDS Council of New South Wales, and so forth, spend much of their time now dealing with government bureaucrats, health-system managers, and various authorities whom they had once denounced as “the enemy.” Unconsciously, certain forms of co-optation inevitably take place; governments fund jobs, trips, and conferences, and those who take part begin to see things differently. Thus, a new tension develops within the rank-and-file, many of whom came into AIDS work as volunteers concerned to look directly after the sick and dying, who feel estranged from the new bureaucrats their own movement seems to have spawned.
It is difficult to speak of the impact of AIDS without speaking of the changing perceptions of homosexuals, so intertwined are the two in the public imagination. AIDS seems to have heightened both the stigma and the respectability of homosexuals; in unraveling this apparent contradiction, we can come to terms with certain crucial social changes. The common assumption is that AIDS has been responsible for reversing, or at least halting, a gradual social acceptance of homosexuality as an “alternate life-style,” an acceptance that had grown out of changes in sexual mores and the commercialization of sexuality during the 1970s.
It is not hard to point to the hostile rhetoric, increased antigay violence, and the quite considerable discrimination directly linked to AIDS. Evidence of increased violence directed against homosexuals, much of it linked to AIDS, was recognized by a special congressional hearing in late 1986.The reality may well be that the response to AIDS thus far has largely been a reflection of the extent to which preceding gay-rights struggles had achieved a place in the political process for gay organizations; AIDS has thus highlighted a process already under way. The point has often been made that the epidemiology of AIDS would have been very different in most Western countries had it not been for the expansion of gay sexual networks in the 1970s.
Equally, the response of governments would have been very different—and almost certainly slower and more repressive—if this expansion had not also been accompanied by the growth of gay political organizations that provided a basis for the development of community-based groups in response to the epidemic. At the level of conventional liberal political analysis, the case of AIDS bears out the adage that the squeaky wheel gets the oil. AIDS has brought issues of central concern to the gay movement onto the mainstream political agenda: at an enormous price the gay movement has become a recognized actor in the politics of health policymaking. Political will and mobilization can have a large effect on the social impact of the disease.
The growing impact of AIDS on the American population forced activists to broaden their constituency. Some of the groups were also socially stigmatized and had even fewer resources than the gay community. Occasionally, they had segments who voiced their discomfort with or disapproval of homosexuality. When it came to matters of strategy, AIDS activists even had increasing conflicts with gay and lesbian political elites within the community over political priorities. The politics of AIDS activism forced gay and lesbian activists to have increased interaction with federal, state, and local governments, thereby transforming the lesbian and gay community’s relation with the state. Community-based organizations received government funding and participated in policymaking to a much greater extent than ever before.
The AIDS movement has had a significant impact on government research, public health policies, and government funding of treatment, care, and education. This government funding has created large-scale institutions with jobs and career possibilities that did not exist in the lesbian and gay communities before the epidemic. These economic and institutional developments have had two major effects on the gay and lesbian communities. First, they have encouraged lesbian and gay political institutions to engage more with other communities, governmental agencies, and mainstream institutions.
Second, they have transformed the class structure of gay and lesbian leadership. The new jobs and career possibilities attracted a generation of leaders who were upwardly mobile and educated at elite universities and colleges. In the past, gay men such as this might have pursued conventional careers. Now, though, many of them were infected with the virus that causes AIDS and took up AIDS activism to fight for their lives. The older generation of leaders had chosen gay political life as an alternative to mainstream careers. Very early on in the epidemic, however, AIDS devastated the founding generation both physically and emotionally. A new generation soon displaced the older one.
AIDS had decimated the gay male community, had forced it to reach out to other communities, and had seriously undermined its economic and cultural self-sufficiency. The countervailing pressures of gay and lesbian identity politics and of AIDS activism produced a political situation that required a new perspective—one that conceived of identity as stable, but also recognized the incredible diversity within the community. The perspective needed to account for the kinship of all sexual minorities and the range of possible gender roles, ethnic, and racial identities.
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