HIV AIDS HI 176 Lecture Week 11 Dr Howard

HIV/AIDS HI 176: Lecture Week 11 Dr. Howard Chiang

Historical Chronology - Human immunodeficiency virus (HIV) – HIV-1 & HIV-2 - 1960 s and 1970 s: ‘silent’ decades - SIVcpz (simian immunodeficiency virus) – apes - 1981 -2: ‘gay’ disease - reported clusters of (1) Kaposi’s sarcoma and (2) Pneumocystis carinii pneumonia (PCP) - 1982: acquired immune deficiency syndrome (AIDS) - 1983 -9: growing public awareness - azidothymidine (AZT): first anti-HIV drug - December 1, 1988 – the first World AIDS Day - 1990 s - main cause of death in 25 -44 age group in USA - 4 th biggest global cause of death in 1999

Princess Diana gave Jonathan Grimshaw, director of a new AIDS centre in London and HIV positive, a firm handshake (1989) https: //www. youtube. com/watch? v=ATn-8 Nvowgk

AIDS Activism and Testimonials - Getting people living with HIV to testify publicly about being HIV positive is difficult, because HIV and discrimination went hand-in-hand (HIV was identified with specific social groups) – a stigmatizing force - Activist movement: community-based prevention and care approaches + more government attention - AIDS exceptionalism: the response to the epidemic must differ from other public health interventions - AIDS movement – broad based; myriad constituents; the first social movement to accomplish the mass conversion of disease ‘victims’ into activist-experts - built on the foundation of the gay and lesbian movement and borrowed from its strengths!

AIDS Activism and Testimonials - AIDS movement: - ‘cultural capital’ (Bourdieu) - played a part in treatment breakthroughs through the forceful lobbying of the pharmaceuticals industry, putting pressure on regulatory authorities to fasttrack the licensing of drugs (‘to get drugs into bodies’), and mobilizing patients to participate in clinical trials - Medicalization: the increasing impetus, beginning in the 1960 s and 1970 s, for many aspects of life to be framed in biomedical terms as ‘diseases’ requiring intervention (e. g. , depression, addiction, etc. ) - social environment: ambivalence about biomedicine

AIDS Activism and Testimonials - ACT-UP: AIDS Coalition to Unleash Power - http: //www. actupny. org - the model of self-organizing in the gay community - from New York to the rest of the world? - ‘Coming out’ – logical extension of the experience with the epidemic in North America and Europe - ‘testimonials’ – closest to the ‘realities’ of HIV - Paris World AIDS Summit in November 1994, where the Greater Involvement of People with AIDS (GIPA) initiative was ratified by countries attending - Vinh-kim Nguyen’s ‘confessional technologies’ - techniques deployed to get people talking - self as substrate – confession, truth, good life

The China-UK Project A. Historical Background: Changing Paradigms of Health Care - 1997, Limu township, Liangshan, Sichuan, Southwest China: China’s first case of HIV infection by drug injection – Nuosu (Yi), an ethnic minority - Sponsored by the Department for International Development, an official British aid agency, in cooperation with the Chinese government - Why did this well-intended and well-funded AIDS intervention project fail to improve local health conditions? - ‘failed’ state intervention

The China-UK Project A. Historical Background - Bringing biomedicine to Liangshan was both a necessity and a pragmatic strategy for the People’s Liberation Army - Cultural Revolution (1966 -76): Mao Zedong’s national health care programs led to a mass mobilization of China’s health personnel and resources - the state forced medical personnel to relocate from cities to the countryside, where they served as health workers, paramedics, or other types of workers, a policy that was associated with the training of over a million so-called barefoot decades - Deng’s era – redistribution of professionals

The China-UK Project A. Historical Background - Last 2 -3 decades: the disparity between rural and urban areas, the overall malfunction of the health care delivery system, and the ineffectiveness of the health care apparatus for epidemic control B. Case Study 1: Needle Exchange Program - Needle exchange – Amsterdam in 1984; New York - Limu: one week’s planning in April 2005 - First wave opposition – family members of drug users - Second opposition – whose responsibility for deaths? - traditional Nuosu judicial concerns

The China-UK Project C. Case Study 2: The Antiretroviral Treatment Program -The Project’s last undertaking in Limu -2 patients based on CD 4 cell counts (an essential part of the human immune system) - woman migrated to Chengdu - man – arrested for heroin possession -These problems are traceable to interwoven structural problems rooted in China’s health care -The prioritizing of private interests over public health may explain the lack of interagency coordination + inadequate local footing of the top-down policy planning and implementation in the Limu programs

http: //www. cdc. gov/hiv/pdf/Pr. EPguidelines 2014. pdf