Several years ago, during one of the first seminars on AIDS in Nigeria, a group of health policy experts met to discuss the implications of this new and troubling pandemic. Following a long discussion about whether there was indeed cause for concern and what needed to be done, particularly in terms of prevention, a woman stood up to ask how she could get her husband, whom she knew had other sexual partners, to use a condom. Her question shocked or embarrassed everyone in the room. What happened? Everyone fell silent. No one was ready to pursue the question or provide...

The popular conception and typical media image of the person with AIDS (PWA) or HIV disease is male—either a gay man or a male injection drug user. Media portrayals of women and AIDS early in the epidemic tended to ignore women entirely or depict them as vectors of transmission¹ or as the victims of bisexual male partners.² Only the latter depiction considered women at risk of illness and death, and its emphasis on bisexual men made the risk seem most threatening to middle-class, primarily white women.³

In fact, the risk to women has been substantial and is rapidly increasing,...

African Americans appear to be the most disproportionately affected of all ethnic groups by the AIDS epidemic.¹ They are 12 percent of the total U.S. population, but comprise 30 percent of all reported AIDS cases.² Of every 5 black adult AIDS cases, 1 is a woman, compared to 1 in every 19white cases and 1 in every 7 Latino cases. The cumulative incidence of AIDS (number of cases per 1 million persons 13 and over) was more than 11 times higher for black women than white women between 1983and 1988.³ Moreover, AIDS is the leading cause of death in black...

“Crises and disasters have always held a special fascination for social scientists, at least in part because they expose the fundamental assumptions, institutional arrangements, social linkages, and cleavages that are normally implicit in the social order.”¹ The AIDS epidemic is no exception. The biological and medical imperatives associated with HIV have been effectively translated into a moral panic.² This panic has in turn uncovered significant social processes and arrangements related to sexuality, gender, and social control.

Not surprisingly, the AIDS epidemic has brought with it repetitive calls that “somebody do something.” Historically, epidemics typically evoke demands for some form of...

Conceptualizations of “prostitution” and “the prostitute”¹ are likely to affect the way societies respond to prostitution in the context of AIDS. This paper discusses two distinct societal responses: the traditional STD-control model and a newer, community-based organizing model which comes directly from the work of prostitutes. Both responses are born in and affect discourses on prostitution, sexuality, and disease. The paper examines how the discourse is changing as a result of prostitutes’ active involvement in the struggle to prevent the spread of this tragic disease. My thinking in this paper is the result of 17 years research and activism in...

Beginning in the early 1970s, major advances were made in the treatment of hemophilia. Before that time, men with hemophilia¹ who suffered from unpredictable bleeding episodes were regular visitors to clinics and emergency rooms, where they required immediate medical attention and blood transfusions. The consequences of their bleeding were cumulative, often resulting in joint deformity and a subsequent need for bracing, physical rehabilitation, and joint repair surgery. Lowered life expectancy and a range of psychosocial problems also resulted. For those who triumphed over the disease’s worse effects, a sense of invulnerability (“I can beat anything”) something emerged. For others came...

Disease is a matter of cultural definition¹—like beauty, it is in the eye of the beholder.² Opinions about causes and risks as well as preventive behavior are based in the social world. The social meanings attributed to AIDS and its consequences are in part responsible for several groups’ marked tendency to deny its presence in their midst. AIDS was first publicized as being related to membership in certain “risk groups” (such as gay white males and, later, Haitians) rather than involvement in certain “risk behaviors” (such as sharing infected needles or having penetrative sex without a condom). Consequently in...

Since the early 1980s, AIDS has been spoken about in many countries. It became a household word in South Africa in the late eighties. And today an average ten-year-old who has been exposed to some form of health education knows about AIDS.

Most people still talk about AIDS as a remote threat that is somehow unlikely to harm them. Still others are quite concerned about, even afraid of, what might happen to them and their families should they get AIDS. Listen to the voices of a group of women discussing the effects of AIDS on their lives: You are asking...

In successful intervention programs to reach women at high risk for HIV infection, trust is the most essential component: in outreach work trust is established when women from the community Identify with the outreach worker and claim her as “one of their own.” The paraprofessional outreach workers come from the communities they now work in, so they are culturally sensitive and have personal knowledge of high-risk sex and drug behavior. This chapter explores strategies that were found to be effective in a Los Angeles-based program.

In 1987, the National Institute on Drug Abuse funded a three-year, multisite study of women...

To explain how and why I started WORLD,¹ you need to understand what it was like before.

In June of 1990 my best friend (whose sister had AIDS) told me she’d made an appointment to get tested. I decided, what the hell, I’d take the test too. I told myself she needed the support.

Her test came back negative. Mine was positive. I didn’t really expect it—I’d been in a monogamous relationship with Daniel for five years , and I definitely wasn’t prepared for it. When the counselor told me my test had come back positive, life number one...

I joined the prostitutes’ rights organization COYOTE in San Francisco back in 1982 because I was being prosecuted in a case that I thought was stupid, racist, sexist, and biased. I had heard of Margo St. James before; she was the only person I had ever heard talk positively about prostitution. In 1978, I was working with a group of eight women. We were busted for prostitution and conspiracy. The prostitution charges we could deal with, but conspiracy is a felony. We spent a year in court. It cost the taxpayers over a million dollars, and in the end they...

These are examples of personal ads running in lesbian newspapers around the country. I found them in lesbian papers published in San Francisco, Los Angeles, New York, Illinois, and Michigan. These magazines ran the gamut from lesbian-separatist newspapers to sex-positive lesbian magazines likeOn Our Backs.And while they contain many descriptions that are awful, each contains one identical and terrifying disqualifier: no HIV-positive lesbians wanted here.

I spend an incredible amount of my time as the director of a lesbian AIDS project disagreeing with other lesbians who are still repeating the dyke mantra, “Real lesbians don’t get AIDS,” while...

Everything has a beginning. AIDS has a beginning. AIDS and men. AIDS and women. AIDS and injection drug users IDUs). AIDS and prevention has a beginning. AIDS and outreach has a beginning. Scores of epidemiologists, medical historians, anthropologists, journalists, social scientists, and other armies of commentators will author their versions of the beginning. This is one such comment on the history and the beginning of AIDS prevention for women IDUs. It is not epidemiological. It is not social science, and it will not pretend to be objective. It is simply one woman’s localized view of how the powerful forces of...

The future impact of AIDS will be felt most sharply in the Third World. In Africa, where inadequate health and social infrastructures have been further weakened by prolonged economic crisis and structural adjustment policies, AIDS prevention is a crucial development issue.¹ It is imperative to understand the social causes of this epidemic of what is, in the main, a sexually transmitted disease and to employ effective methods to limit its spread. The latter include education for personal and social empowerment, and policies and resources to make sustainable development more than a slogan.² Research to aid effective AIDS prevention has become...

Understanding lesbian involvement in the AIDS epidemic requires analysis beyond the question of ethical choice. Participation in any social movement, including the response to AIDS, IS highly determined both by internal movement factors such as recruitment and mobilization techniques.¹ and by external factors such as potential recruits’ shared values, sympathy for political goals, and existing organizational memberships. Thus, the values, social location, and occupation of a lesbian significantly affect the possibilities of her involvement in AIDS work. To understand their complex relationship to AIDS, we need to know the dominant networks, cultures, and institutions of North American lesbians when AIDS...

We bring to the writing of this chapter the premise that nursing and nurses are an integral and indispensable part of the health care delivery system, in particular of the HIV / AIDS care system. Critical issues facing nurses in this epidemic are the political challenges in maintaining quality of care, access to health care, and treatment and safety for providers.

We are not academicians nor are we researchers. We are two nurses, each with 10 years of experience in the HIV epidemic. We have noted the resounding absence of nurses’ voices in chronicling the epidemic, yet we know that...

Advocates waging struggles to provide preventive, diagnostic, and clinical care services for HIV-infected women encounter a health care system ill equipped to meet even the barest needs of much of the population. Structural elements seriously hamper the efforts of advocates, clinicians, and researchers to provide a majority of people with acceptable levels of care. The basis of the system is the market. Based on the premise that health care is a commodity, the distribution, development, financing, and delivery of services respond to market forces rather than to people’s needs.

The HIV epidemic began to affect women as the failures of...

The reproductive decisions and behaviors of pregnant women have come under intense and unrelentings scrutiny during the past several years.¹ Discussions of maternal-fetal conflict, fetal rights, trafficking drugs to a minor in utero, and fetal neglect have become commonplace. At the same time, considerable attention has been focused on the criminalization of pregnancy through the punitive sentencing of women convicted of substance use while pregnant or at the time of delivery. It is not surprising, then, that the medical, social, political, and economic concerns raised by the reproductive choice of pregnant HIV-infected women have served to intensity this scrutiny, catapulting...

In the course of its 10 years of existence, the perception of AIDS as an illness confined to minority groups has changed to a recognition of it as a risk for the entire population, regardless of sex or nationality. Women, who in industrialized countries were hardly infected at first, have suffered increasing incidence of the disease during the latter half of the 1980s. In many geographical areas, the men-te-women infected ratio is already 1:1, as in Africa, or 1:2, as in the Caribbean.¹

The increasing number of female AIDS patients is connected to the growing importance of heterosexual transmission relative...