HIV/AIDS in Society: Global Health Crisis and Societal Response

Introduction: HIV/AIDS as a Global Sociological Challenge

Twenty-five years after having first been discovered as a lethal and incurable disease, HIV/AIDS continues to be a worldwide health crisis (Furniss, 2006). This incurable, fast-spreading, sexually transmitted disease remains the nemesis of scientists, physicians, and the millions around the world who are afflicted with it. Numerous theories and myths have sprung up around the disease, many of them associated with doomsday philosophies or biblical plagues. The fact is that this is a human retrovirus that has evaded scientific resolution because of its ability to rapidly mutate as an evasive maneuver against treatments or remedies. As Robert Gallo explains: "Retroviruses are not thoroughbreds. When two or more infect the same cell, they often mix their proteins and sometimes even their genes in several different ways. They may also mutate by making erroneous substitutions of some of their own nucleotides, partly due to mistakes made by the enzyme RT during DNA synthesis" (Gallo, 1991).

Whether individual understanding or conviction about the cause or nature of the disease rests with faith or science is not the central question here. The question is: in a world where more than a million people are currently estimated to be afflicted with the virus, how does society respond to the disease and to the needs of the people who suffer from it?

From the sociologist's perspective, setting aside myths and moral judgments allows us to move forward in dealing with the problems of human affliction in the best way possible. In the early years of AIDS, Susan Sontag urged that, once the malady came to be understood medically and had become treatable, we should dismiss the dangerous metaphors that were stigmatizing its sufferers and open the way for a tolerant climate of care and caring (Alcabes, 2006). In the United States, progress has moved in that direction; however, there is much more road to be traveled on the journey to the place that Sontag envisioned. In the United States, what was once epidemic has ceased to be—as far as HIV/AIDS goes—because people responded to precautions, preventions, and treatments. But that progress came at an enormous cost in human lives.

The suggestion here is that while various geographical governments are charged with dealing with the health crisis that is HIV/AIDS, those geographical distinctions do not prevent other locales from having to address the issue or be concerned with the epidemic elsewhere in the world. HIV/AIDS is a world problem, one which has brought together social scientists, physicians, and researchers in symposium from the onset of the epidemic. Just because the problem has been addressed and contained at some level in one locale does not mean that any nation can shift responsibility for dealing with the problem onto another.

HIV/AIDS in Africa and the Developing World

In still other places around the world, particularly in Africa, the journey toward a climate of care and caring—and certainly toward a climate where the disease is halted, if not by cure then at least by prevention and precaution—has barely begun. In many African nations wracked by civil wars and conflict, HIV/AIDS is not the first priority of the government or the insurgents, though it does serve their purposes in various ways. As Bond and colleagues observe, "AIDS in Africa is different from AIDS in the West; in Africa it is a heterosexual, not homosexual, epidemic" (Bond et al., 1997). Whereas the disease initially afflicted the homosexual population on a large scale in the Western epidemic before quickly spreading to the heterosexual community, in Africa the epidemic was never categorized in terms of sexual preference—it was simply epidemic in proportion from the outset.

The disease spread more rapidly in Africa than in the West, in part because, as Bond et al. note, risk behaviors were widespread among diverse population groups including truck drivers, bureaucrats, prostitutes, and businessmen (Bond et al., 1997). While these same risk groups contributed to the spread in the West, there are traditional and cultural differences between Western and African nations that facilitated the disease's spread with little consideration of the risks of sexual promiscuity. In other words, where the West adjusted sexual behavior in ways conforming to the risk represented by the disease, this adjustment did not occur as quickly in African nations as the epidemic began spreading there.

In other developing communities, such as those in South America, the spread of HIV/AIDS has renewed the epidemic in the United States among the Hispanic community, because it flows across the border virtually unhindered through undocumented immigrants and migrant farm workers entering the United States (Conner, Magana, and Mishra, 1996). This has brought the epidemic conditions of South American countries directly to the doorstep of the United States in a very real and significant way.

As of 2005, approximately 29 million people across Africa were estimated to be living with HIV/AIDS (Seckinelgin, 2005). That number is overwhelming and far exceeds the capacity of philanthropic and charitable organizations to meet the demands of care and treatment. Organizations such as UNICEF, the World Food Programme (WFP), the United Nations Development Programme (UNDP), and other entities and charities all contribute and take proactive steps to bring the issue of HIV/AIDS in Africa to the world political arena and to maintain focus on the problem at a global level.

Another serious problem arising from the HIV/AIDS crisis in Africa is the large number of orphaned children left behind when mothers, fathers, and family members have succumbed to the disease. Many of these young children and infants are themselves suffering from the disease (Seckinelgin, 2005). The problems of HIV/AIDS in Africa cannot be addressed by any single source. It requires world attention and coordinated world action, with countries that have the funds and treatments coming together in a major effort to help. Unfortunately, the religious and political environments of some African nations make collective efforts extremely difficult, and to that extent the world has sadly witnessed the ongoing carnage of the disease.

The Three Phases of the HIV/AIDS Epidemic

In studying the HIV/AIDS epidemic from a sociological perspective, researchers categorize it in three phases (Levitt and Rosenthal, 1999). The first phase, or "wave," began in 1981 at the onset of the identification of the disease as a new "plague" (Levitt and Rosenthal, 1999). The disease might have been contained sooner but for some serious misimpressions, misinformation, and misguided intentions (Gallo, 1991). Initially deemed a "gay" disease, there was little preparation for or reaction to the disease as it regarded the heterosexual community (Levitt and Rosenthal, 1999). Thus it quickly spread, and the rest, as we say, is history.

The second phase, or "wave," is identified as having come about around 1986, when the governments of America and other Western and European nations acknowledged HIV/AIDS as something that was not merely a sexually transmitted disease—it was an epidemic requiring government initiatives in the areas of prevention, precaution, information, and treatment (Levitt and Rosenthal, 1999). However, acknowledging the need for intervention is a far cry from taking the initiative and putting it into action. In America, the government of former President Ronald Reagan was slow to acknowledge the disease and America's responsibility to address it at a governmental level (Levitt and Rosenthal, 1999). The disease spread throughout Africa, South America, the Middle East, the Far East, and Europe; no spot on the globe with a human population has been left untouched by HIV/AIDS.

It was during this second phase—perhaps the longest phase of the epidemic—that when governments around the world finally began acting on their initiatives, the death toll in the United States alone was well over 400,000 people (Levitt and Rosenthal, 1999). The second phase also witnessed a growth of outreach and grassroots organizations aimed at educating communities on prevention and precaution, and especially at dispelling the myth that HIV/AIDS was a disease of sexual preference and that certain sectors of society might be immune. Indeed, by the second phase there was little to support the myths surrounding the disease, since it had spread widely within the heterosexual community.

In the United States, the focus was twofold: mourning the loss of friends, lovers, and relatives claimed by the disease, and filling the void left by those hundreds of thousands through philanthropic efforts, scientific research, and community awareness programs. By the end of President Reagan's second term in office, he had finally acknowledged HIV/AIDS as an epidemic, and the slow wheels of government began turning toward funding research and treatment for those suffering from the disease (Levitt and Rosenthal, 1999).

As the 1980s drew to a close, the socially constructed image of the disease—shaped as it had been initially by fear of those infected—was being softened by awareness ribbons and the creation of a giant national AIDS Memorial Quilt, with one square representing each life lost to AIDS (Levitt and Rosenthal, 1999). What the quilt revealed for those who had refused to believe otherwise was that the disease was indiscriminate, taking the wealthy and influential as well as the impoverished and lesser known. "Equally important, the epidemiology of the disease changed sufficiently after 1989 to diffuse the gay image with which it had been strongly associated from the start" (Levitt and Rosenthal, 1999).

One of the losses who became famous for his struggle against the disease was a young Midwestern boy named Ryan White (Levitt and Rosenthal, 1999). A hemophiliac, Ryan had contracted the disease through blood transfusions that had long served as his life force; and then that life force, infected with HIV, failed him (Levitt and Rosenthal, 1999). As the young boy bravely faced the ravages of the disease, friends, relatives, and outpourings of public support and love marked his journey. Surrounded by his family and new friends such as rock star Elton John, Ryan, like so many others, lost his battle to AIDS.

Sociologically devastating, HIV/AIDS has—through its recession from a pandemic affliction in the United States to a condition that responds to treatment, though treatment does not constitute a cure—left a new condition in its wake. This new condition is what persists in the present and third phase of the disease: hundreds of thousands afflicted with an illness that, because of treatments, allows people to live longer, but does little to improve the quality of their lives (Levitt and Rosenthal, 1999).

Conclusion: A Global Disease Requiring Global Action

No other problem in the history of mankind has brought so many nations, communities, and governments together in a single-minded goal: to provide treatment of this tragic and destructive disease, and to find a cure for it. HIV/AIDS is a world problem that transcends political borders, cultural differences, and economic disparities. From the grassroots AIDS Memorial Quilt to international legislative and organizational frameworks, humanity has demonstrated the capacity to respond collectively to this crisis. What remains is the sustained will to do so—through research funding, equitable access to treatment, robust public education, and the continued dismantling of the stigma that has too long hampered an effective societal response.

Works Cited

Alcabes, Philip. "The Ordinariness of AIDS: Can a Disease That Tells Us So Much about Ourselves Ever Be Anything but Extraordinary?" American Scholar, Summer 2006, p. 18+.

Bond, George C., John Kreniske, Ida Susser, and Joan Vincent, eds. AIDS in Africa and the Caribbean. Westview Press, 1997.

Furniss, Charlie. "AIDS Crisis: 25 Years On—Forget Bird Flu. The World Is Already Gripped by a Health Crisis of Catastrophic Proportions." Geographical, Jan. 2006, p. 47+.

Gallo, Robert. Virus Hunting: AIDS, Cancer, and the Human Retrovirus: A Story of Scientific Discovery. Basic Books, 1991.

Levitt, Miriam, and Donald B. Rosenthal. "The Third Wave: A Symposium on AIDS Politics and Policy in the United States in the 1990s." Policy Studies Journal, vol. 27, no. 4, 1999, p. 783.

Mishra, Shiraz I., Ross F. Conner, and J. Raul Magaña, eds. AIDS Crossing Borders: The Spread of HIV among Migrant Latinos. Westview Press, 1996.

Seckinelgin, Hakan. "A Global Disease and Its Governance: HIV/AIDS in Sub-Saharan Africa and the Agency of NGOs." Global Governance, vol. 11, no. 3, 2005, p. 351+.