HIV/AIDS from an African American Studies Perspective

by

Adam M. Geary

• LAST REVIEWED: 22 May 2023
• LAST MODIFIED: 28 June 2016
• DOI: 10.1093/obo/9780190280024-0041

Introduction

AIDS (acquired immunodeficiency syndrome, or HIV/AIDS) is a global pandemic, affecting most of the world, especially those suffering poverty, social inequality, and marginalization. In the US epidemic, African Americans suffer disproportionately. Although approximately 12 percent of the US population, African Americans accounted for nearly 47 percent of new HIV infections in 2012 and 41 percent of people living with HIV as of 2011; one in sixteen black men and one in thirty-two black women are expected to be infected with HIV in their lifetimes. Over half of all AIDS-related deaths in the United States have been African Americans. Understanding this racially disproportionate disease suffering depends on how one defines AIDS, which, while seemingly technical, is inherently political and contested. Although a few scholars have questioned it in the past, almost all contemporary scholars agree that, most simply, AIDS is the name for the gradual impairment of a person’s cellular immune system by the action of the Human Immunodeficiency Virus (HIV), leaving the infected person increasingly vulnerable to diseases (“opportunistic infections”), many of which can be fatal if untreated. Pharmaceutical treatments exist for suppressing HIV (“anti-retroviral therapies”) and for many of the opportunistic infections, although these treatments are neither universally effective nor universally available. But beyond the individual experience of a virus, defining AIDS depends on how to define an epidemic, or population-level disease phenomenon, given that the AIDS epidemic has affected some more than others. Two major schools of thought have addressed AIDS as an epidemic. In the United States, the dominant model for understanding the epidemic has been biomedicine, which treats epidemics and their dispersion as aggregates of individual transmission events, focusing attention on the biological qualities of HIV transmission from individual to individual and on the behavioral qualities of those who are at risk of infection (“risk behaviors” and “risk groups”). Critiques of biomedicine have emerged from social epidemiology, which has a rich history in African American reflections on health and disease. Rather than focusing exclusively upon the biology of HIV and the behavioral mechanisms of its transmission from individual to individual, social epidemiologists have prioritized the structuring of human populations, including the ways that racism, poverty, sexism, and homophobia have structured vulnerabilities to exposure to HIV (including control over one’s behavioral environment) and embodied susceptibility to infection. Social, political, and cultural responses to the AIDS epidemic in the United States and among African Americans have been shaped by these competing understandings of epidemic disease.

General Overviews of the Global AIDS Pandemic

The African American experience of AIDS displays all of the complexity of the global pandemic, of which it is both part and exemplary. Scholars from different disciplines have worked to describe the complexity of the global pandemic, drawing upon the tools and methods of the disciplines to which they belong. Barnett and Whiteside 2006 provides a standard, text-book overview of the global pandemic, including biological, social, and political dynamics that have fueled it. Krieger 2011 provides an especially helpful overview of different models of understanding disease and health in populations. Grmek 1990 is a history of AIDS through its first decade, weaving together the probable history of the virus with the emerging and shifting medical knowledge about it. Stillwaggon 2006 challenges behavioral explanations of the African pandemic, arguing that extreme poverty has created heightened condition of embodied vulnerability to exposure and infection. Gould 1993 is a geographic account of the US epidemic that demonstrates the importance of urban connectivity in structuring HIV’s dispersion in this country. Patton 1990 and Rowden 2009 contextualize and challenge the manner in which AIDS has been conceptualized and addressed in public policy. Patton 1990 is the definitive study of the cultural construction of AIDS as an object of scientific and political knowledge. Rowden 2009 argues that the global response to AIDS has been shaped by neoliberal capitalism, especially understandings of health care and health-care delivery.

• Barnett, Tony, and Alan Whiteside. AIDS in the Twenty-First Century: Disease and Globalization. 2d ed. New York: Palgrave Macmillan, 2006.

  A standard textbook on the global AIDS pandemic, including the basic biology of HIV, how systems of inequality have structured the pandemic, the roles of economic and cultural globalization, and the political consequences of the pandemic, especially for countries in the developing world.

• Gould, Peter. The Slow Plague: A Geography of the AIDS Pandemic. Oxford: Blackwell, 1993.

  A very useful explanation of how AIDS has moved, or dispersed, using the tools of human and health geography. Geographic analysis demonstrates the central importance of urban structure and urban connectivity to disease dispersion in the United States.

• Grmek, Mirko D. History of AIDS: Emergence and Origin of a Modern Pandemic. Translated by Russell C. Maulitz and Jacalyn Duffin. Princeton, NJ: Princeton University Press, 1990.

  One of the most widely cited histories of AIDS, especially in its first formal decade, as written by a medical historian. The book weaves together the probable history of the two primary strains of HIV with the history of how medical scientists came to develop knowledge about them.

• Krieger, Nancy. Epidemiology and the People’s Health: Theory and Context. New York: Oxford University Press, 2011.

  DOI: 10.1093/acprof:oso/9780195383874.001.0001

  This book surveys the theories of epidemiological science and reasoning, elaborating their distinct ways of understanding population health and illness. It provides a very useful primer in understanding conflicting descriptions of the AIDS pandemic.

• Patton, Cindy. Inventing AIDS. New York: Routledge, 1990.

  Using the tools of the cultural studies of science, the author analyzes how the meaning of AIDS has been constructed and its consequences for intervention, care, and critical politics.

• Rowden, Rick. The Deadly Ideas of Neoliberalism. New York: Zed Books, 2009.

  A critical history of how neoliberal transformations in the structures of public health delivery, as designed by the major institutions of global finance, have undermined national-level and global responses to the AIDS pandemic.

• Stillwaggon, Eileen. AIDS and the Ecology of Poverty. New York: Oxford University Press, 2006.

  A global analysis of how impoverishment has created the conditions for the AIDS pandemic. In particular, the author argues that the physiological effects of poverty produce mass susceptibility to infection with HIV, explaining both its regional intensities and its global dispersion better than explanations focused on behaviors.