Public AIDS Policy -- And the Band Played on, for Republicans and Democrats alike, during this public health crisis of the 1980's
Today, it hard to remember a day before 'AIDS Walks' through Central Park, before television advertisements in the voice of Whoopi Goldberg proclaimed that "AIDS affects everyone," before AIDS became a public health enemy 'Number One.' But one must look back to the days when AIDS was a disease of secrecy and shame to truly learn from the illness, as it exists today. Most of us of Generation Y mercifully cannot even remember a time when AIDS was not even a name, but something called 'the gay cancer.' During America of the 1980's the disease of Acquired Immune Deficiency Disorder, it was thought only to affect those marginalized by society because of their sexuality.
Randy Shilt's book And the Band Played On acts as an important journalistic and contemporary historical document of the early history of AIDS in America. However, it has relevance even today now that AIDS is no longer a death sentence and 'drug cocktails' can prolong the life of sufferers, to say nothing of the importance of preventative techniques. The book and film And The Band Played On, as well as text Aids & The Policy Struggle In the U.S. both paint a vivid portrait of how stigma and political concerns, regardless of medical need, affect the treatment of disease and public health issues. The treatment of a disease is never pure and without outside influence of public and political consequences of the moment when the disease becomes an epidemic.
Politically speaking, AIDS could not have come along at a worse time in American history. America was hard hit by the recession of the early 1980's. President Reagan was more interested in putting forth his conservative economic agenda of supply side economics, which required increasing defense spending, cutting taxes on the wealthy and corporations, and decreasing government spending. Both the U.S. Senate and the U.S. House of Representatives were under Republican control, so the Reagan administration was especially concerned about 'seizing the political day' and pushing the administration's agenda through as quickly as possible. Also, Reagan was a social conservative, and wished to make government less of a force in individual's lives in terms of health concerns, yet also did not want to take the side of gays and lesbians whom were often persecuted by local ordinances. Reagan wanted the federal government to stay out of the state governments, which often gave states a great deal of leeway to enact prohibitive statues against homosexuality.
Reagan's initial hostility to spending government money in favor of tax cuts and curtailing inflation combined with the conservative Republican administration's cultural hostility gays and lesbians as a group meant that when AIDS first came to the public health spotlight, little was budgeted to allow for the federal government to make contributions to research and release public health measures to curtail the epidemic. The social stigma affected the development of polices related to HIV as well because gay lobbying groups had little voice in Republican-dominated Washington, and commanded little pubic sympathy in voters minds and hearts all over the nation. Gay and lesbian votes tended to be concentrated in specific areas of the country, and thus many politicians could be blissfully unaware or resistant to the lobbying efforts of pro-gay organizations and organizations that wished to raise awareness regarding the disease.
The government demonstrated the social stigma against gays and lesbians first by ignoring these individuals as practicing a legitimate lifestyle or engaging in worthy lives in general, and then ignoring the voices of those who represented the community. Power in Washington affects the development of the future of HIV awareness, prevention, and treatment program because of the groups affected, and also because the disease was initially spread through sexual contact, when the administration was particularly desiring to limit sexual education in schools and to return to so-called traditional family and religious values.
Thus the concept of a 'stigma' can exist both on a social level, in terms of how many heterosexual people refused to care about Aids because it was a 'gay cancer' and also on a political level, in terms of how the United States government reacted. Rather than reacting to such hostility though education, awareness, and compassion, the government merely confirmed this narrow public, heterosexual majority prejudice against a minority group. Of course, illness is notably nondiscriminatory and nonpolitical, and eventually the disease was to branch out and affect both Republicans and Democrats alike.
It would be tempting to blame Republican conservatives alone for the AIDS epidemic. However, gay activists in New York and San Francisco often engaged in equally ineffective public health measures to combat the epidemic. Because of the prejudice they had experienced in their lives, any attempt to address public health aspects of gay life with prohibitions were met with anger and hostility in the eyes of gays and those who represented them in government. For instance, during a public health epidemic, one of the most necessary and important things to do is to close the sites where the disease is spread. (For instance, an analogous example might be to close the slaughterhouses where mad or 'downer' cattle' are sold during the mad cow epidemic.) However, when the bathhouses of New York and San Francisco were closed, where unprotected sexual acts were frequently engaged in with multiple partners, thus spreading the epidemic widely, the gay community reacted to it as a manifestation of homophobia in government and an assault upon the gay lifestyle, rather than as a public health measure. This expressed community anger at the closing of what was once an important part of the open, gay sexual lifestyle of a substantial minority of the gay population, but certainly not all of the gay population, further created in the public's mind an image of the gay lifestyle as an unhealthy lifestyle, full of multiple sexual partners and unhealthy life practices overall.
Continued homophobia in the city community and the unwitting and unproductive efforts of pro-bathhouse activists also caused many heterosexuals to attribute the 'gay cancer' (or even 'AIDS,' as it was eventually known in the common political and cultural dialogue after much effort by activists such as Larry Kramer) to see AIDS as transmitted by the 'gay lifestyle' rather than through sexual contact, most notably through blood. For instance, 'poppers' and drugs were blamed for the spread of AIDS, even though taking these recreational drugs (though not exactly healthy) had no effect. A heterosexual IV drug user would be far more at risk for AIDS than a gay man who never engaged in risky or unprotected sex but took poppers, for instance, but few homosexual or heterosexual politicians knew this at the beginning of the epidemic. A false causality because of the singularity of the group initially affected contributed to the disease's spread as other issues were blamed.
The significance of blood, however, rapidly came to the forefront as the corruption of the blood banks and using potentially contaminated blood came to the cultural light -- finally, after many frequent users of such blood as hemophiliacs where targeted. Sadly, only after so-called innocent victims of AIDS, such as hemophiliacs, children born to IV-drug using mothers, and prominent individuals such as Arthur Ashe, a tennis player who received the virus only after needing a blood transfusion during an operation, came to light did the public begin to react to the growing health epidemic.
Unfortunately, the first reaction to the fact that AIDS was not a gay illness was fear. Homophobia, one of the causes of the severity and spread of the epidemic initially grew and intensified in its anger, rather than abated. AIDS became recast as something only those on the margins of society suffered,…