Gay Plague Research Articles

A counter-story to the rags-to-riches narrative: A Finnish male model wearing hobo style during the deep depression in the age of AIDS

As a former male model whose modelling career lasted 25 years (1988–2013) and as a researcher, I am interested in the production of meanings and knowledge related to representations of masculinity. As a gay former male model who was classified as ‘other’ but represented the normative ideal and passed for straight in fashion shows and photographs, I look back on images of myself differently and against the grain. I analyse three of my fashion photographs – taken for the Finnish tabloid City in 1993, when AIDS was considered the ‘gay plague’, but never published – in terms of critical studies of masculinities, gay and sexuality studies, and queer theory. I speculate and examine gestures, facial expressions and poses in the photographs that were still intolerable and prevented their publication 30 years ago. The publication of my photographs now is concrete proof that masculine gestured performances are becoming more inclusive and diverse.

Building a Timeline for LGBTQ+ Global Cinemas (1910–2019): Movie Production Trends from a Collaborative Internet Cinema Database

Building a Timeline for LGBTQ+ Global Cinemas (1910–2019): Movie Production Trends from a Collaborative Internet Cinema Database

An interdisciplinary view of AIDS in the 1980s: On stage, Journalism and Health

This article presents acquired immunodeficiency syndrome (AIDS, in Portuguese, or AIDS), when it appeared in the 1980s from an interdisciplinary perspective: on the one hand, signs, symptoms, diagnostic methods and treatment are addressed and are part of the biomedical model that participates in the interpretation of this disease; on the other, the representations of the disease in journalistic articles published in the newspaper O Globo, one of the most important in Brazil. Health and Journalism help to build ideas and understand concepts, prejudices and stigmas that relapse dwell and still fall on the disease that became known as the gay plague, one of several denominations attributed to AIDS when it arose. It is discussed whether it is possible to understand the health-disease process from a plural perspective, which goes beyond the limits of medicine. For this, we analyze texts from the newspaper O Globo, which deal with the HIV/AIDS binomial, paying special attention to the language and lexicography used in the elaboration of them, and taking into account the medical view about the disease in the 1980s. The work allows us to conclude that it is possible and necessary to face the health-disease process using not only biological phenomena, but using social, economic, political and environmental aspects, in front of various disciplinary fields.

The Media and HIV/AIDS Education Campaigns: Corporate Responsibility, Aesthetics and Power

Chandran (2014) argues that the use of media in HIV and AIDS education has been on a scale unprecedented in health education, and social media in particular has played a key role in producing the universal awareness of HIV and AIDS. Theoretical perspectives on the media in HIV/AIDS education vary considerably. Early critical accounts stress that the mass media played a role in the distortion of scientific and medical findings concerning HIV and AIDS, privileging certain types of information over others, such as emphasising AIDS in the early years as a ‘gay plague’, gave precedence to biomedical constructions of HIV/AIDS. Many feminist, queer and AIDS activist accounts move beyond these discussions of media distortion and moral panic of HIV/AIDS by considering the distinctive ways in which discourses actively operate in the construction of gender, sexuality and epidemic. For the most part, however, these analyses maintain a focus on national HIV/AIDS education campaigns and their mediation by public policy.

Making HIV Testing a Routine: Facing the Truth 

Wrath of God syndrome, Gay-related Immuno- deficiency Syndrome, Gay Cancer, Gay Plague—these are the names AIDS had in the 1980s. False myths made uninfected people afraid to interact with affected individuals. A political cartoon of these times bitterly made fun of the prevailing attitude towards the disease, “It affects homosexual men, drug users, Haitians and hemophiliacs...Thank goodness it hasn’t spread to human beings yet (Black, 1985)."

Sexual health: the Cinderella of reproductive health services

Twenty-five years ago, articles in this Journal highlighted the lack of resources allocated for family planning services in Britain and also major concerns regarding policies on induced abortion, sexuality and...

Introduction: Queering the Issue

‘Is the rectum a grave?’ Leo Bersani’s question was a foundational one for the field of Queer Theory as it developed in the United States in the late 1980s and early 90s in the context of what was dubbed ‘the gay plague’ by a hostile press. Queer Theory was ‘born’, in the work of Eve Sedgwick most particularly, from this epidemic of death. It was an epidemic that confirmed, as Bersani’s defiant question articulates, the phobic association between queerness and annihilation. In No Future: Queer Theory and the Death Drive (2005), Lee Edelman likewise emphasizes the association between queerness and negation in a system governed by ‘reproductive futurism’. Thus, the queer ‘figures, outside and beyond its political symptoms, the place of the social order’s death drive: a place, to be sure, of abjection expressed in the stigma, sometimes fatal, that follows from reading that figure literally’. Both Bersani and Edelman exhort, in their differently inflected ways, a queer embrace of this emplacement to expose and rupture a heteronormative system that must posit the queer as death to maintain its own exclusionary force. ‘Passage’ is the title of the artwork on the cover of this special issue of the Irish University Review, ‘Queering the Issue’. By Galway-based artist Cathal Kelly, the image is of a rectum, figure of queer jouissance that is also a figuration of annihilation within what Joseph Valente calls ‘hetero-semiotics’. Imaged queerly ‘athwart’, the ‘inside’ of the organ is exposed to our view, signalling an opening up that undoes the multiple stigmatizing ‘closures’ associated with the queer. The ‘homo-centric’ work of Bersani and Edelman, as Fintan Walsh describes it, values the spectacle of the anus because of its signification of unproductive, unredemptive sexuality. As Bersani observes, ‘where the rectum is the grave in which the masculine ideal (an ideal shared – differently – by men and women) of proud subjectivity is buried, then it should be celebrated for its very potential for death’. While acknowledging the value of what has become known as the ‘anti-social thesis’ in Queer Theory, I choose to read Kelly’s work otherwise: as an opening out to the other that oscillates between the

Men who have sex with men: stigma and discrimination

The first cases of AIDS were identified in gay men in the USA, and the disease was originally termed gay-related immune deficiency (GRID). Mobilisation of attention and resources was slow, partly because of the association between AIDS and male homosexuality and corresponding reluctance on the part of government officials to acknowledge the importance of the epidemic. 25 years later, the same reluctance is evident in many parts of the world, and again, scarcity in attention and resources is affecting responses to HIV transmission in homosexual men. 1 Beyrer C Baral SD van Griensven F et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012; (published online July 20.)http://dx.doi.org/10.1016/S0140-6736(12)60821-6 Google Scholar The complex relation between homosexuality and HIV continues to mark the epidemic, even in countries where most infections are unrelated to homosexual contact. 2 Dowsett G The ‘gay plague’ revisited. in: Herdt GH Moral panics, sex panics. New York University Press, New York2009: 130-156 Google Scholar That most societies regard homosexuality with a mixture of disdain and disgust has therefore been, and remains, a major factor in the development of the epidemic. 3 Parker R Aggleton P HIV and AIDS-related stigma and discrimination. Soc Sci Med. 2003; 57: 13-24 Crossref PubMed Scopus (1648) Google Scholar The cultural challenge of HIV/AIDSAs the HIV epidemic enters its fourth decade, HIV transmission in several parts of the world shows no sign of abating—for example, in sub-Saharan Africa an estimated 1·9 million people became newly infected in 2010.1 Certain affected populations in the epidemic are more marginalised than others, notably gay men and other men who have sex with men. A biologically heightened vulnerability to HIV and the limited uptake and use of barrier methods, especially among younger cohorts of men who have sex with men, fuelled by stigma and in some parts of the world criminalisation, makes addressing the issue of HIV/AIDS in men who have sex with men complex, as this Lancet Series shows. Full-Text PDF

Introduction: Early and Modern Biospheres, Politics, and the Rhetorics of Plague

I know positively . . . that each of us has plague within him; no one, no one on earth is free from it.- Camus, The Plague (229)The plague of age is upon us, rasps an anonymous phone caller to shock-jock radio talk show host, Logan Burnhardt, early in recent film Dead Air (2009), just as a deadly pathogen has been unleashed by terrorists in major urban centers across U.S. In chaos that ensues, Burnhardt and his coworkers at station KCBP, ostensibly in Los Angeles, witness events familiar in cinematic subgenre now often called biohorror: infected victims suffer, approach death or actually die, and then transform into zombielike crazies or maniacs that attack their fellow citizens with a compulsive frenzy that spreads virus further and produces widespread public upheaval. American Cities Under Siege, reads one television news CNN -styled headline, as number of victims careens into thousands.For all its morbid bravura, however, what distinguishes Dead Air is not its portrayal of rabid pandemic, which borrows heavily from earlier films such as 28 Days Later (2002), or striking similarity of its narrative scenario to that in Pontypool (2008);1 instead, it is way Dead Air makes theme of plague explicit on two registers. First, it confirms sense that viewers of biohorror movies, especially those involving zombies, may have had for some time-that stories they tell have revived logic of plague devastation, as Stephanie Boluk and Wylie Lenz argue in this issue. Only a few months after release of Dead Air, in fact, Ruben Fleischer's Zombieland (2009) reconfirmed zombie-plague connection when, early in story, character named Columbus remarks that zombies are the plague of twenty-first century. Second, and more broadly, Dead Air and successors like Zombieland help identify a development during past three decades in which scientific, cultural, and political representations of biological catastrophe, especially in U.S. and Europe, have renewed and refurbished notion of plague, while often doing so in oblique or implicit fashion.In these terms, it is striking to recall Michel Foucault's comment in 1976 that the biological risks confronting [human] species are perhaps greater, and certainly more serious, than before birth of microbiology (History 143). Nearly thirty-five years later, that sense of biological risk appears all more palpable, since more recent threat of diseases such as AIDS (once called gay plague), Ebola, avian influenza, mad cow disease, and most recently, H1N1 flu has profoundly changed our perception that phenomenon of plague has merely been a thing of past-whether as specific pneumonic, septicemic, or bubonic versions caused by Yersinia pestis, or other similarly devastating diseases ranging from cholera to yellow fever to Spanish flu. When Foucault wrote those words in The History of Sexuality, possibility of nuclear destruction would probably have seemed most critical menace to human survival, as it had in previous decades. While that prospect continues to loom, however, biogenetic equivalent has lately been more predominant possibility contemplated in scientific reports, media, and popular culture. The difference between George Romero's landmark modernization of zombie myth in Night of Living Dead (1968) and more recent treatments in past decade such as Danny Boyle's 28 Days Later offers a case in point: while Romero's corpses were vitalized by an unspecified form of radiation (often identified as nuclear) and seemed able to remain alive indefinitely, Boyle's zombies are created by biological pathogens that take their course by ultimately destroying zombies themselves. As part of that paradigm shift, in past ten years number of fictional movies and television programs devoted to theme of deadly epidemics has grown exponentially, including Shawn of Dead (2004), Re- Genesis (2004-08), Pathogen (2006), The Plague (2006), 28 Weeks Later (2007), Blindness (2008), Doomsday (2008), Quarantine (2008), The Happening (2008), Fringe (2008-10), and The Crazies (2010), to name only a few. …

Homosexuality in India

Homosexuality can be described as the orientation and inclination of a person to have sexual relations with a person of his or her own sex. The clustering of Acquired immune deficiency syndrome (AIDS) cases among male homosexuals in the initial phase of the HIV epidemic in the USA and a few other Western countries led to a misleading notion that the disease afflicted only reckless male homosexuals and it was often referred to as the 'gay plague' or 'gay cancer', 'gay' being the current vogue word for homosexuals. Very little is known about the practice of homosexuality in contemporary India. According to Ashok Row-Kavi, a self-acclaimed homosexual activist, the number of exclusively or predominantly homosexual men in India may be over 50 million. A vast majority of them are married and living with their wives. A culturally identifiable group known by the Urdu term hijra lives in most parts of India and are known to depend, at least partly, for their livelihood on working as male prostitutes. Most hijras are castrated males and dress as females. In addition to a large section of the hijra community, there are many full-time or part-time male prostitutes in India. Some of them live in red-light areas of metropolitan cities; many seek male clients by offering massage services in parks, beaches, hotels, and houses. Male prostitution is increasingly visible in India. In Delhi there are as many as twenty agencies offering handsome masseurs in the classifieds of the newspapers (Hindustan Times).

Offending the other: Deconstructing narratives of deviance and pathology

Narratives of homophobia and the repathologization of gay men now emerge and coalesce in often unconsidered ways. Within this paper, we present a deconstructive analysis of a recent paper published within the British Journal of Social Psychology (Crossley, 2004) and highlight how a narrative of repathology emerges through the selective appropriation of particular textual sources. By employing pathological constructions of sexual conduct between men; focusing upon singular homogenized constructions of gay men and simplistic constructions of health promotion and through a process of reconstructing HIV as a gay plague and it is possible to embroider a moral tale which constitutes a further deviant 'othering' of gay men. We contend that by employing (functional) discourses of 'unconscious motivation', together with a constellation of disclaimers, caveats and tokenistic pluralization, it becomes possible for psychologists to engage in homophobic knowledge production whilst maintaining an identity as a (dis)interested professional. Our analysis raises issues pertinent to all social psychologists engaged in 'suspicious' research on 'the other'. To this end, we expand our critique by employing ideas from Ricoeur's hermeneutic phenomenology to provide more general discussion of ethical and constructive ways of engaging in textual analyses of persons outside one's own tradition.

Tribute - Remembering Ruben Sher

No abstract available.

E-confession as a Disciplinary Technology and the AIDS Subject

In 1984, I first heard about the homosexual disease . The following days passed in shame and fear; shame for my homosexual impulses and fear for the fatal illness which would punish me for them. Only fourteen-years-old, sexually aware but innocent, and my interpretation of AIDS was a mixture of a death-sentence, a discipline mechanism and a divine punishment. Being a teenage homosexual in the moral panic period (1982-1985), where AIDS was mediated as the gay plague as God s or nature s judgment on moral decay meant that the feelings of moral and social guilt would be a part of your maturation experience (Weeks, Jeffrey, 1989, 4-5). Although my interpretation of AIDS throughout the years changed, my pubic notions of the plague became an inseparable part of my sexuality and my encounters with the AIDS subjects and objects. About two years ago, while searching on the internet for recent HIV statistics and data I found a site named avert.org, where carriers and patients publish their personal stories. AVERT is an international HIV and AIDS socialwelfare organization, located in the UK, that claims to have three aims: first, to educate the people globally, second, to fight the stigma and discrimination surrounding the disease , and finally, to raise money for medical research and treatment (AVERT.ORG, 2002, http://www.avert.org/about.htm). Intrigued by these digital forms of confession, I clicked on the Personal Stories section and began reading the electronic letters. There, I found this article s topic. Keywords: Homosexuality, AIDS, Discipline, Punishment

The de-gaying and re-gaying of AIDS: contested homophobias in lesbian and gay awareness training

From the first recognition of AIDS as a disease, it was publicly conceptualized as a ‘gay plague’. In response, health education and diversity training sought to counter this association claiming that AIDS is an ‘equal opportunity’ virus - that it can affect anyone. In this article, we analyse talk about HIV/AIDS within a data corpus of 13 tape-recorded lesbian and gay awareness training sessions. Counter to the way in which interactions are described in the lesbian and gay awareness training literature, we found that it was trainees, rather than trainers, who pursued discussions about HIV/AIDS, and who did so in order to claim the ‘de-gaying’ of AIDS, which they treated as representing a ‘non-prejudiced’ position. By contrast, and in response to trainees’ insistence on de-gaying AIDS, trainers were ‘re-gaying’ AIDS. Our analysis highlights that in these sessions - designed explicitly to counter homophobic attitudes - apparently ‘factual’ claims and counter-claims about infection rates and risk groups are underpinned by essentially contested definitions of what constitutes a ‘homophobic’ attitude. We conclude by pointing to the value of detailed analysis of talk-in-interaction for understanding professional practices, and suggest strategies for improving the pedagogic value of training.

Looking Back to Look Forward

In reading Richard Sowell’s editorial in a recent issue of JANAC (May/June 2004), I was moved to sit down at my computer and put my thoughts and feelings in what could be called an extremely condensed version of my experiences working with persons with HIV/ AIDS over the past two decades. Dr. Sowell’s passionate words in favor of a comprehensive global approach to HIV/AIDS care for all world citizens sparked my personal memories to the appearance of HIV/AIDS in the United States, when it was thought to be a disease reserved for a select group of people within our national borders. My work in HIV/AIDS goes back to Los Angeles, California, in January 1982, where as a fairly green oncology RN, I was introduced to the first known GRID (the nomenclature for what we now know as Acquired Immune Deficiency Syndrome was then known as Gay-Related Immune Deficiency) patient brought to my hospital. Prior to this period, the media and public called it “gay cancer,” due to the Kaposi’s sarcoma lesions that were noted in many of the presenting patients. The disease we now know as AIDS was soon revised from “gay cancer” to GRID, although publicly it was also called the “gay plague.” Early on in the reporting of this illness, the disease was presenting only in gay males. It was later in 1982 that the AIDS designation was coined by the Centers for Disease Control and Prevention (CDC), as the disease process was found in people other than those in the gay community, such as heterosexual men and women, hemophiliacs, and those using intravenous drugs. It was to be yet another year before the codiscovery of HIV (Human Immunodeficiency Syndrome), the causal agent of the disease state, by Luc Montagnier, MD, of the Pasteur Institute in France and Robert Gallo, MD, of the National Institutes of Health in the United States. Back at my unit in early 1982, the stated reason for the patient’s admission to the oncology floor was simple: The patient showed signs of immunosuppression, just as the chemotherapy-treated oncology patient would. It seemed logical to those in charge of patient care to place the patient on the oncology floor. Total isolation was ordered for the patient, and because there were two negative-pressure rooms on the oncology floor, we were tapped. The nurse manager immediately asked nurses to “volunteer” to work with the new patient, as there was a great deal of fear among the staff regarding the communicability of this new disease. The stories many of you remember, or those of you who are too young have heard of and/or read about, describing the irrational fears of many health care professionals and the general public at the time are unfortunately, in many cases, quite true. It was promised to the staff that did volunteer that a hospital psychologist would hold regular group meetings to allow us to vent our concerns, fears, and feelings if we chose to take care of the GRID patients. This was a time long before laws such as the Americans With Disabilities Act, which was signed by President George H. W. Bush in 1990. Staff members, including nurses, doctors, nursing attendants, and all other ancillary staff were not compelled to care for this particular category of patient; thus, necessary care could, and sometimes did, fall by the wayside if a willing and/or compassionate staff member was not available. There were indeed staff members (including nurses) who dressed-up in so-called “moon suits” to give even the simplest of care to the GRID/AIDS patient, such as taking a paper dinner tray in to the room. It was as if the care provider was literally taking a space walk, anticipating contact with a species from another planet. I witnessed instances of family members of nurses coming to the hospital floor and

HIV Update

In 1981, six women in the United States were observed to have similar symptoms of immune deficiency as five previously healthy gay men (Guinan and Hardy, 1987Guinan M. Hardy A. Epidemiology of AIDS in women in the United States: 1981 through 1986.Journal of the American Medical Association. 1987; 257: 2039-2042Crossref Scopus (184) Google Scholar). However, it was the occurrence of this constellation of symptoms in the gay men that prompted the first official report of acquired immunodeficiency syndrome (AIDS). Before the syndrome was called AIDS, it was termed Gay Related Immune Deficiency (GRID) and in the lay press, the “gay plague” (Shilts, 1988Shilts R. And the band played on: Politics, people, and the AIDS epidemic. Penguin Books, New York1988Google Scholar, p. 121).The experience of women with HIV/AIDS went largely unreported in the early years of the epidemic. Assumptions were made early on that this was a disease of gay men and injection drug users, and the natural history of the disease in women was thought to mirror that of men. When reports of gynecologic manifestations in women began to appear, guidelines for management of the disease in women followed (Modlin and Saah, 1991Modlin J. Saah A. Public health and clinical aspects of HIV infection and disease in women and children in the United States.in: Faden R. Geller G. Powers M. AIDS, women, and the next generation. Oxford University Press, New York1991Google Scholar). It took some years, however, before the Centers for Disease Control and Prevention amended its definition of AIDS to include specific gynecologic symptoms. Early research focused largely on issues related to perinatal transmission, and critics have suggested that interest in women and HIV has largely focused on women as infected vessels carrying fetuses and as vectors of disease to their sexual partners. It was not until 1993 that a pilot study was begun to trace the natural history of HIV infection in women, and in late 1994, funding for additional research was made available through the Women’s Interagency HIV Study (Katz, 2000Katz A. HIV screening in pregnancy. University of Manitoba, Winnipeg, Canada2000Google Scholar). Since then, research has flourished, with entire journals devoted to various aspects of the disease trajectory, and thousands of manuscripts are published each year describing new studies and new knowledge. In this Clinical Issues series, we look at HIV in women across the life span. Ann Williams addresses the gynecologic health of women infected with HIV. Dianne Morrison-Beedy and colleagues report on a study of HIV risk behavior in adolescent girls, a high-risk group for both HIV infection and unplanned pregnancy. Anne Katz presents an overview of nursing care for pregnant women with HIV infection, and this is complemented by an article by Elizabeth Damato and Marisha Meleski addressing the care of newborns exposed to HIV during pregnancy and birth. Finally, Debra Jackson and her colleagues in South Africa explore current issues in infant feeding related to HIV infection. These articles present a snapshot of current knowledge. Research in epidemiologic and clinical studies is ongoing, broad, and fast moving. Clinical practice guidelines change often, and remaining up to date in the areas of knowledge and research utilization remains a challenge. But we cannot be overwhelmed, because this epidemic will continue to challenge us as care providers, educators, family members, and friends of those infected. Whether we work in large urban centers or small rural communities, whether we practice at the bedside or in the community, we have all faced the complex nursing and social needs of women who are infected with HIV and their children. This epidemic shows no signs of slowing down or going away. As nurses we will continue to respond to the needs of our patients and their families, our students and colleagues, and the public at large. This Clinical Issues series is one small piece of the nursing response to the most significant health care issue of our time.

Probabilities and health risks: a qualitative approach

Health risks, defined in terms of the probability that an individual will suffer a particular type of adverse health event within a given time period, can be understood as referencing either natural entities or complex patterns of belief which incorporate the observer's values and knowledge, the position adopted in the present paper. The subjectivity inherent in judgements about adversity and time frames can be easily recognised, but social scientists have tended to accept uncritically the objectivity of probability. Most commonly in health risk analysis, the term probability refers to rates established by induction, and so requires the definition of a numerator and denominator. Depending upon their specification, many probabilities may be reasonably postulated for the same event, and individuals may change their risks by deciding to seek or avoid information. These apparent absurdities can be understood if probability is conceptualised as the projection of expectation onto the external world. Probabilities based on induction from observed frequencies provide glimpses of the future at the price of acceptance of the simplifying heuristic that statistics derived from aggregate groups can be validly attributed to individuals within them. The paper illustrates four implications of this conceptualisation of probability with qualitative data from a variety of sources, particularly a study of genetic counselling for pregnant women in a U.K. hospital. Firstly, the official selection of a specific probability heuristic reflects organisational constraints and values as well as predictive optimisation. Secondly, professionals and service users must work to maintain the facticity of an established heuristic in the face of alternatives. Thirdly, individuals, both lay and professional, manage probabilistic information in ways which support their strategic objectives. Fourthly, predictively sub-optimum schema, for example the idea of AIDS as a gay plague, may be selected because they match prevailing social value systems.

The politics of AIDS: Introduction

From its first designation as a gay plague, HIV/AIDS has been a heavily politicized disease, a disease that has fractured official standard operating procedures in science, medicine, public health and governance. In many ways, AIDS helped to expose a battleground of contested interests while emerging as an arena for both the re-assertion of ‘traditional’ (i.e. dominant) values as well as rebellion against the traditional politics of exclusion and privilege. Yet the politics of AIDS has remained an understudied domain. This set of papers seeks to overcome this neglect by exploring underlying political dimensions of the AIDS pandemic, especially in the way the pandemic has been constructed by epidemiology, biomedicine, and medical anthropology. Authored by a group of medical anthropologists and an anthropologically oriented political scientist, the papers provide a jarring glimpse at the profound influence of society on health and disease.

Understanding AIDS: historical interpretations and the limits of biomedical individualism.

The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a "gay plague," by analogy with the sudden, devastating epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques of both paradigms, it is possible to discern the emergence of an alternative paradigm of AIDS as a collective chronic infectious disease and persistent pandemic. Each of these constructions of AIDS incorporates distinct views of the etiology, prevention, pathology, and treatment of disease; each tacitly promotes different conceptions of the proper allocation of individual and social responsibility for AIDS. This paper focuses on individualistic vs collective, and biomedical vs social and historical, understandings of disease. It analyzes the use of individualism as methodology and as ideology, criticizes some basic assumptions of the biomedical model, and discusses alternative strategies for scientific research, health policy, and disease prevention.

Thinking and rethinking AIDS: implications for health policy.

In the United States, we see three main phases in the construction of the history of AIDS, with each having very different implications for health and social policy. In the first, AIDS was conceived of as an epidemic disease, a "gay plague," by analogy to the sudden, devastating epidemics of the past. In the second, it was normalized as a chronic disease, similar in many ways to diseases such as cancer. In the third, the authors propose a new historical model of a slow-moving, long-lasting pandemic, a chronic infectious ailment manifested through myriad specific HIV-related diseases. The new paradigm of AIDS incorporates the positive aspects of both earlier conceptions. It emphasizes, like the plague model, the etiology, transmission, and prevention of disease but rejects its assumption of a time-limited crisis. It takes from the chronic disease model an appropriate time frame and concern with the clinical management of protracted illness but insists on the primacy of prevention. The authors criticize both infectious and chronic disease models for their individualistic conceptions of disease and their narrow strategies for disease prevention. They further argue that the traditional distinction between, and approaches to, infectious and chronic diseases need to be rethought for other diseases as well as for AIDS.