A Timeline of Challenges and Progress in Addressing HIV/AIDS

In the 1980s and 1990s, fear, paranoia, and confusion over the enigmatic and epidemic HIV virus marked American culture. HIV, which stands for human immunodeficiency virus, weakens the human immune system and can easily spread through bodily fluids. It is often transmitted through needles and unprotected sex. HIV is especially noteworthy and dangerous because it can lead to a condition known as AIDS, or acquired immunodeficiency syndrome. People with AIDS have great difficulty fighting off infections due to the damage on their immune systems, and easily develop deadly illnesses such as tuberculosis and lymphoma. In 1987, President Reagan referred to AIDS as “public health enemy #1,” and throughout the late ‘80s and ‘90s many popular TV shows and films, such as Miami Vice and Philadelphia, took up issues of AIDS in their storylines. Rap duo Salt-N-Pepa released a song called “Let’s Talk About AIDS” in 1990, directly confronting prevention and misconceptions of AIDS. Perhaps most notably, several figures prominently in the public eye, such as NBA star Magic Johnson, came forward as HIV-positive.

Since the 1990s, however, AIDS and HIV have largely faded away from public attention in the United States, as if the virus itself had similarly vanished. While today it would seem a stretch to view a show like Rent as particularly topical, as HIV/AIDS rarely make headlines these days, it is dangerous and irresponsible to consider HIV a problem of the past. The breakthrough and widespread adoption of antiretroviral treatment has lowered the reach and deadliness of many AIDS cases in the U.S., yet thousands of Americans still die from AIDS-related causes each year, succumbing to infections or cancers that arise from the body’s debilitated immune system. Many do not have access to affordable healthcare, do not have reliable transportation to keep up with appointments, or feel too ashamed to pursue treatment after decades of stigma against the disease. In the South, where about half of new HIV diagnoses occur in the U.S., impoverished African-American communities are particularly plagued by low levels of healthcare accessibility. This phenomenon is detrimental, as U.S. infection rates for African Americans sit at eight times that of whites.

The contemporary situation is even more alarming in the Global South. Only one-third of those living with HIV in poor and moderate-income countries are on antiretroviral medication, allowing the virus to continue spreading at an astonishing rate, with no clear deceleration in sight. Indeed, 97 percent of people worldwide who have HIV live in these countries. AIDS treatment is also extremely expensive, and several African countries— including Ethiopia, Kenya, and Zimbabwe— spend 30 to 60 percent of their total health ministry budget on HIV and AIDS. In short, the countries most affected by HIV (primarily due to the low rate of condom use) are least able to pay for its treatment and prevention, and do not benefit from a massive pop culture push for awareness and advocacy.

Many of the cultural and social consequences of the initial AIDS crisis in the U.S. remain relevant and are still felt today. The crisis certainly ignited rampant homophobia both in the U.S. and internationally, as bigots and reactionaries abused gay and bisexual men, ousting them as those responsible for the epidemic. Several contemporary studies have shown that gay men around the world still feel a lasting sense of self-stigma, which leads to unhealthy behavior related to HIV. For instance, MSMGF, a global health organization dedicated to men who have sex with men and HIV, concluded in a 2014 study that men who perceived more stigma and discrimination for their sexuality were less likely to seek out and take advantage of HIV services, such as testing and prevention programs. The opposite held true for men with higher levels of engagement and identification with the LGBT community. Smaller-scale studies in China and Tijuana, Mexico yielded similar results, indicating that conceptions of masculinity and homophobia often led to depression and self-stigma for men who have sex with men, deterring them from the question of HIV altogether. Conversely, the shock of the epidemic opened up a discourse for many issues, including medical privacy, the concept of patient activism, and sex education. Both in the public sphere and in private, people began talking about these issues for the first time, either because they previously held a taboo status or had simply yet to be conceptualized. With unavoidable issues and confusion regarding sexually transmitted diseases, homosexuality, and medical ethics facing the world, these conversations had to take place.

AIDS may no longer hold its epidemic status in the U.S. or garner as much media attention as it once did. Nevertheless, the lack of an HIV vaccine, the incredibly low rate of the viral suppression in the Global South, and the mere continued existence of what was once “public health enemy #1” in the contemporary world demonstrate the importance of looking forward as well as backward in our reflection on HIV. Because the fight against AIDS and HIV is far from over, the continued push for the accelerated development and widespread availability of treatment is indispensable.

Max Lichtenstein ‘20 studies in the College of Arts & Sciences and is a staff writer for WUPR. He can be reached at max.lichtenstein@wustl.edu.