AIDS BASIC THEMES DURING EPIDEMICS Jonathon Erlen

Define terms epidemic, pandemic, and endemic. Give beginning story of AIDS epidemic: 1981 cases at L.A. General Hospital-first called GRID-Robert Gallo made initial breakthrough in diagnosising this disease along with a French medical scientist-there were some earlier cases (1968 in St. Louis and late 1970’s prostitutes) United Nations figures recently released estimate 50 million AIDS cases world wide in 1999 and 16.4 million deaths since the start of this epidemic-there are no accurate world wide figures on HIV cases. 70% of the AIDS cases are in subSaharan African.

1. the same errors in handling epidemics are repeated over and over. 2. there is an ecological perspective to all epidemics=a combination of biological causes and social responses. 3. there are political issues raised by epidemics ie: the creation of government administrative units and government responsibilities during an epidemic ie: additional funding,quarantine measures and mass screening.

4. scapegoating specific groups in society ‑ using an epidemic as an excuse to attack socially unacceptable groups ie: Jews during the Plague, poor and immigrants during cholera (1832, 1849), prostitutes with the VD epidemic, homosexuals and IV drug users during AIDS.

5. individuals are blamed for bringing the epidemic on themselves (victim blaming) by bad behavior ie: laziness and drunkenness and poverty during cholera (1832, 1849), until after WWII cancer carried this type of social stigma, improper sexual behavior and drug abuse for AIDS; in these cases the epidemic was not seen as an equal opportunity disease ‑ you had to misbehave to get it so there was a strong social stigma attached to these epidemics.

6. existing health facilities were either unable or unwilling to care for those struck by the epidemic ie: creation of leprosariums to care for the lepers during the Middle Ages and sanatoriums for TB victims in late 19th and early 20th centuries, refusal to treat cholera victims in 1832 and 1849 in regular hospitals, concerns over overcrowding and the need to isolate patients on separate floors in AIDS epidemic.

7. physicians and other health professionals reactions to epidemics ie: many ran away and there was frustration with their inability to help the sick during an epidemic ‑ both lowered the doctors' public image and raised ethical concerns ie: plague and yellow fever (late 18th and 19th centuries) and need for AMA policy to force physicians to treat AIDS patients, Pitt Medical School policy on AIDS patients.

8. massive economic damage done to communities by epidemics and economic opposition to dealing with epidemics ie: quarantine during the plague and yellow fever outbreaks, 1918 influenza epidemic in Pittsburgh with the closing of bars and movies, who pays the costs for care of AIDS patients and research on this disease? 9. epidemics are blamed on outsiders bringing disease into a community ie: quarantine measures during the plague, yellow fever was called the "strangers' disease", influenza was called the "Spanish flu", Haitians and Africans blamed for AIDS.

10. public reactions to an epidemic center on ignorance of the cause of the disease and the nature of the epidemic leading to irrational fear bordering on panic ‑ the public looses confidence in traditional societal institutions ie: government, church, medicine ie: plague, cancer, AIDS. 11. the politically weaker an affected group is the harsher will be the public health measures used against them during an epidemic ie: poor and immigrants treated differently than middle and upper class victims or the "innocent victims.”

12. society has always found it difficult to confront the lifestyle issues which are seen as leading up the epidemic ie: poverty during the cholera and TB epidemics, social isolation of minority groups (plague in Chinatown 1900 ‑ 01), homosexuality and IV drug abuse during AIDS epidemic ‑ human nature has been to react to an epidemic with fear + blame + denial.

13. during an epidemic the individual's rights are abridged or ignored for what is considered the public's good ie: property is seized and destroyed, people are quarantined (imprisoned) in their own homes or in pest houses, mass screening are initiated. 14. public education about the causes and nature of an epidemic does not stem the tide of fear and repression toward certain groups in society and often raises public fears based on misinformation ie: 1916 polio epidemic in N.Y.C., AIDS.

15. public health policies during an epidemic are strongly supported by the majority of the public and used to buttress already existing social divisions and prejudices. 16. in mass epidemics quarantine has not been effective but public fear and ignorance has raised this issue time and again: cholera (1832 and 1849), TB, AIDS.

17. AIDS now is being viewed using the chronic disease model rather than as an epidemic-impact of this change? 18. AIDS is not the “new plague”-it is not an equal opportunity disease like the plague and other major past epidemics. 19. There is little hope in the short run for a “magic bullett” cure for AIDS because of the rapid mutation rate of this retro-virus.

20. AIDS has changed the nature of the medical school population-no longer can students enter medicine without concern that their work will place them in danger period doctors not concerned about health risks but AIDS changed this reality so some potential applicants decided not to go to medical school and chose other career paths.