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HIV/AIDS

HIV/AIDS. HI 176: Lecture Week 13 Dr. Howard Chiang. Historical Chronology. Human immunodeficiency virus (HIV) – HIV-1 & HIV-2 1960s and 1970s: ‘silent’ decades - SIVcpz (simian immunodeficiency virus) – apes

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HIV/AIDS

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  1. HIV/AIDS HI 176: Lecture Week 13 Dr. Howard Chiang

  2. Historical Chronology • Human immunodeficiency virus (HIV) – HIV-1 & HIV-2 • 1960s and 1970s: ‘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 • 1990s- main cause of death in 25-44 age group in USA- 4th biggest global cause of death in 1999

  3. 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-8Nvowgk

  4. 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!

  5. 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 fast-track the licensing of drugs (‘to get drugs into bodies’), and mobilizing patients to participate in clinical trials • Medicalization: the increasing impetus, beginning in the 1960s and 1970s, 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

  6. 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

  7. The China-UK Project • 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

  8. The China-UK Project • 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

  9. The China-UK Project • 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 • 2 peer educators arrested by police

  10. 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

  11. http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf

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