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An introduction to the issue of hivaids in todays society in the united states

  1. Persons and societies do not merely feel the impact of an event; they remake their lives and institutions to accommodate, negate, or preserve its effects.
  2. These longer term responses would be interesting to follow, and we hope that researchers will attempt to do so.
  3. It judged that systematic study would be beneficial in predicting the course of the epidemic's path through U. Most visible, perhaps, has been the conflict over access to new drugs and a ''fair price" for new therapeutic agents.

Medically, it is the appearance of a serious, often fatal, disease in numbers far greater than normal. Socially, it is an event that disrupts the life of a community and causes uncertainty, fear, blame, and flight.

The etymology of the word itself suggests the broader, social meaning: The medical meaning of the epidemic has been revealed in the sobering numbers reported in epidemiologic studies. Behind the epidemiologic reports and the statistical estimates lies the social disruption of the epidemic: The National Academies Press.

And behind the individual lives are the manifold ways in which a variety of institutions and practices have been affected by the epidemic. Two an introduction to the issue of hivaids in todays society in the united states the committee's reports, AIDS: In the course of preparing those reports, the committee noted that many of the social consequences an introduction to the issue of hivaids in todays society in the united states the epidemic were not being studied in any systematic way.

It judged that systematic study would be beneficial in predicting the course of the epidemic's path through U. Thus, in 1989 the committee established the Panel on Monitoring the Social Impact of the AIDS Epidemic, with the general mandate to study the social impact of the epidemic and to recommend how it could be monitored in order to contribute to the formulation of policies that might effectively deal with it.

In the course of its work, the panel, with the agreement of the parent committee and the several federal agencies that were sponsoring its work, modified this mandate and deleted the plan to recommend systems for monitoring. This report is an unusual undertaking for the National Research Council. Its objective is to form a picture of the effects of the AIDS epidemic on selected social and cultural institutions in the United States and to describe how those institutions have responded to the impact of the epidemic.

No attempt has been made to write a comprehensive history—there are not yet adequate studies of the epidemic upon which to base such an effort. Instead we have been selective in looking at those institutions for which sufficient information is available to describe impact and response. These descriptions cannot be considered complete and authoritative; but we do believe they suggest a pattern that should be of concern to the country and command the attention of policy makers attempting to deal with the epidemic over the next decade.

Each case has many dimensions—personal, professional, and institutional—through the many social organizations that touch Page 3 Share Cite Suggested Citation: Each set of interactions creates an impact, and the diverse impacts have generated equally diverse responses by individuals, groups, and communities.

The panel set out to study these impacts, and it immediately confronted the problem of defining the terms of reference. Reaching deeper into the language, however, impact has a more powerful meaning—collision.

In this use of the word, an impact is an effect that radically changes the previous state of affairs or even destroys it. After much discussion, the panel adopted a definition of impact that fits somewhere between these two meanings. We adopted this hybrid meaning not only because it more accurately describes the impact of AIDS on contemporary America—social institutions have not been destroyed—but because we quickly realized that social impact does not merely destroy; it evokes a reaction or a response.

It is more organic than physical. Persons and societies do not merely feel the impact of an event; they remake their lives and institutions to accommodate, negate, or preserve its effects.

The task of this panel was to go beyond, to the extent possible to limited human vision, the impression of the extraordinary impacts of AIDS on individual lives and on social institutions. We have tried to sort out those that will endure in such a way as to force, or to invite, Americans to take them into account in the next decade.

This epidemic is not ordinary in one quite specific way: This epidemic is not, like many historical epidemics, an invasion of morbidity and mortality that rapidly sweeps through a population. It comes and will stay for years, not only in the population, but in the individual people infected, and its presence will often be known to them and to others long before they suffer the disabling, lethal effects.

Similarly, rough estimates can be made of the numbers of people who will begin to experience those disabling, lethal effects years from now. Thus, Americans must think about this epidemic for many years into the future. The institutions we studied appear to have absorbed the impact of AIDS and accommodated to it in a very limited way. However, even a response that is partial and apparently transitory may mark the beginning of more fundamental change.

Several of the institutions we studied may follow this trajectory of limited initial response, followed some years later by very Page 4 Share Cite Suggested Citation: These longer term responses would be interesting to follow, and we hope that researchers will attempt to do so. However, the panel did not attempt to suggest a methodology for longer term monitoring: After extensive deliberation, the panel determined that it had sufficient information and understanding to describe social impact and response for six institutions broadly defined: The six institutions chosen are very different in structure, degree of centralization, and other dimensions.

Such differences affect the level of generalization appropriate to each area.

  1. However, the panel did not attempt to suggest a methodology for longer term monitoring.
  2. Originally, three case studies were envisioned. Its objective is to form a picture of the effects of the AIDS epidemic on selected social and cultural institutions in the United States and to describe how those institutions have responded to the impact of the epidemic.
  3. Quarantine, mass mandatory testing, and contact tracing all had notable disadvantages in dealing with a disease with a long latency period, that was spread chiefly through sexual activity or intravenous drug use, and that largely affected already stigmatized groups. Many of the prominent, even dramatic impacts of past epidemics, however, have so melded into the social fabric that people are often astonished to hear of them today, and some, interesting though they be, seem of little relevance to the current problem.

In the course of our work we also began to see another kind of impact and response—on public policies not necessarily connected to institutions. Originally, three case studies were envisioned: New York, Miami, and Sacramento. We were able to complete only New York—a city that could never be described as typical, but one that does vividly illustrate the impact and response to AIDS among major social institutions.

It is also rather common to find such references expressed in quite strong terms. For example, Milbank Quarterly's two-volume study, A Disease of society: AIDS is no "ordinary" epidemic. More than a devastating disease, it is freighted with profound social and cultural meaning. More than a passing tragedy, it will have long-term, broad-ranging effects on personal relationships, Page 5 Share Cite Suggested Citation: AIDS is clearly affecting mortality—though in some communities more than others.

It is also costly in terms of the resources—both people and money—required for research and medical care. But the effects of the epidemic extend far beyond their medical and economic costs to shape the very ways we organize our individual and collective lives. It is not clear what an "ordinary" epidemic would be. No epidemic seems ordinary to those who experience it.

The AIDS epidemic has invoked comparison with many epidemics of the past. Most commonly, the bubonic plague the Black Death that devastated Europe in the fourteenth century is recalled: Additional tends of millions had died in Asia during the preceding decade [McNeil, 1976]. This epidemic had unquestionable impacts. Historians attribute to it, at least in part, the emergence of nation states, the rise of mercantile economies, and the religious movements that led to the Reformation Campbell, 1931; McNeil 1976; Tuchman, 1978.

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As Anna Campbell 1931 noted, the Black Death "changed the minds of men" bringing new ways of understanding God, the meaning of death, the place of tradition, and the role of authority in religious and social life. Changes in the collective mind of a society might be the most profound of all impacts, for the new ideas generated by a major social tragedy can propel institutional change and outlast immediate changes to affect lives far in the future. AIDS has been compared with other epidemics, too: AIDS has its analogies to each of these epidemics—number of deaths, methods of prevention, stigmatization of sufferers and presumed carriers, and responses of authorities—all can be compared in general or in detail.

The comparisons are often illuminating, but sometimes misleading Fee and Fox, 1988. It can be said with some assurance, however, that none of the historical epidemics was "ordinary. They have, in this respect, had an impact on history or, as Campbell wrote 1931"on the minds of men. These established public health practices have had to be reconsidered in the current epidemic. Many of the prominent, even dramatic impacts of past epidemics, however, have so melded into the social fabric that people are often astonished to hear of them today, and some, interesting though they be, seem of little relevance to the current problem.

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For example, to attribute the existence of Protestant Christianity to the effects of the Black Death on religious ideas and sentiments has little influence on the ways in which people today think about religion or about epidemics.

Similarly, to attribute the existence of Canada as an independent nation to the fact that British troops had been vaccinated against smallpox before the Battle of Quebec, but American troops were decimated by the disease, is certainly to point to an effect of epidemic and, indeed, an impact. Yet that impact has been of little relevance to subsequent citizens and governments, except that "some Canadians to this day worship smallpox as the deliverer from United States citizenship" Foege, 1988: Many features of epidemics are no longer remembered and have left little imprint on the societies that they ravished for a time.

Indeed, one of the greatest of epidemics, the influenza of 1918-1920, has been called by its historian "the forgotten epidemic" Crosby, 1989. Worldwide, perhaps 30 million people died; in the United States, 675,000 people died, most of whom were not the usual victims of influenza the very old, infants, and childrenbut men and women in their 20s and 30s.

This terrible scourge might have had a great impact, but it passed and left almost no mark on the social institutions and practices of the time. Many people were mourned, but life quickly returned to normal. Even the absence of impact has a lesson for this study: It is not entirely clear how confidently one should accept the words of Milbank editors Nelkin, Willis, and Parris 1991: More than a passing tragedy, it [AIDS] will have long-term, broad-ranging effects on personal relationships, social institutions, and cultural configurations … AIDS will reshape many aspects of society, its norms and values, its interpersonal relationships and its cultural representations … the future will be different from both the past and the present.

Our report suggests that, in some respects, the AIDS epidemic may be more like the influenza of 1918 than the bubonic plague of 1348: Page 7 Share Cite Suggested Citation: Although it had by the end of 1991 infected perhaps 1 million people, brought devastating sickness to 206,392, and death to 133,233, it had not significantly altered the structures or directions of the social institutions that we studied. Many of an introduction to the issue of hivaids in todays society in the united states responses have been ad hoc and may be reversed when pressures subside.

Others may be more lasting, but only because they reinforced or accelerated changes already latent or budding within the institutions. It is the panel's opinion that the limited responsiveness of institutions can in part be explained because the absolute numbers of the epidemic, relative to the U. However, we believe that another major reason for this limited response is the concentration of the epidemic in socially marginalized groups.

Many observers have recently commented that, instead of spreading out to the broad American population, as was once feared, HIV is concentrating in pools of persons who are also caught in the "synergism of plagues" see Wallace, 1988: We believe that the patterns shown there are repeated throughout the country: This epidemiological direction reveals the disconcerting implications of our major conclusion.

The institutions that we studied are particularly weak at those points at which the epidemic is likely to be most destructive. For example, the health care system, which responded to the appearance of a new disease with some alacrity, is weakest organizationally and economically in those places where the affected populations are concentrated.

The problems of caring for those who are infected are magnified by the particular configuration of the U. Thus, our most general conclusion about the epidemic is that its impact has hit institutions hardest where they are weakest: Predictions of the imminent collapse of the health care system due to the epidemic, for example, now look shrill, but, conversely, hopes that the epidemic would force the country toward more rational and equitable reform of the system now also seem unrealistic.

Among the more permanent, however, two are particularly noteworthy. First, the institutions of public health, of health care delivery, and of scientific research have become more responsive to cooperation and collaboration with "outsiders. Many of these changes are positive and will contribute to the efficiency and efficacy of the institutions. Similarly, volunteer organizations stimulated by the challenge of the epidemic have discovered ways not only of supplying help where extant institutions were lacking, they have also influenced the policies and practices of those institutions.