Map of life expectancy at birth from Global Education Project.

Wednesday, August 06, 2008

The IAS zeitgeist

Demonstrations aside, this conference has its particular culture and traditions, obviously built up over many years, but I don't know much about that since this is the first time I've attended. I've been involved in HIV/AIDS research and services in the U.S. for a long time One thing I noticed right away is that HIV-related conferences in the U.S. tend to be a lot, well gayer (NTTAWWT). There is plenty of gay representation here, to be sure, but my informal observation is that the majority of participants are actually women.

HIV disease was first noticed in the U.S., and it was formally called Gay Related Immunodeficiency Disorder, or GRID. It took a while for people to figure out that this disease actually existed elsewhere, particularly in Africa, where it had no particular association with homosexuality, and that anybody could get it. It is pretty sobering to realize that AIDS was killing people in Africa by the tens of thousands before anybody even noticed it, and that it had to start killing Americans to be officially discovered.

I said before that the conference is as much politics as science but I want to amend that remark. It's a false dichotomy. There's plenty of science here, this is where the cutting edge gets mainstreamed, and I'll tell you about that anon. The story of HIV disease is not exactly what we've been told. But the science drives the politics, and politics drives the kind of science we need to do.

What I mean by that is evident in the culture of this unique association. It is a scientific fact, demonstrated by difficult, complicated research under hard circumstances, that oppression, marginalization and stigma are principal causes of HIV infection and AIDS. Yes, biologically, anybody can get it; but your risk is dramatically increased if you are of low social status, forced to live in shame and hiding, poor, oppressed, and despised. It's easier to see that if you do get it, being poor and outcaste means you are much less likely to get adequate treatment, but it's the disease risk itself that's the key.

In the U.S. we are always talking about personal responsibility. But let's consider a woman in a conservative muslim society, such as Nigeria, where one of our speakers yesterday works. She enters an arranged marriage at 14, then her husband leaves her. She has no option but to become a sex worker. The Imams won't even recognize the existence of prostitution in their society, but insist that if they did discove it, the women would be killed. Of course they know it goes on but they can't really kill the women or the men wouldn't have anhy prostitutes to visit. The women can't insist that their customers use condoms because the customers can always go elsewhere and the women are desperately poor.

Think about men who have sex with men in societies around the world where we can't call them "gay" because that's an identity that doesn't even exist. They may be invisible, or they may occupy recognized but largely despised social roles. Think about migrant workers, forced to live apart from their families for months or years at a time. Drug addicts, prisoners, and women in societies where they are the property of their husbands -- these are people who cannot protect themselves against HIV unless they are given material and social resources and are allowed to step into the light.

This is both the science and the politics of AIDS. As an epidemiologist, you can't separate them. They're a single entity.

One of the most popular things to do here is to have yourself photographed with the giant anthropomorphized condoms. These amusing characters are the creation of Jose Saavedra, Director of the National AIDS Programme of Mexico. Dr. Saavedra has been notably successful among his international peers, and Mexico has a low rate of HIV. That's to the credit of the national government, as I said before, but Saavedra is definitely pushing the envelope here. Listening to an earlier speaker talk about the oppression that comes from not being allowed to marry, I remarked to my colleague, "Don't blame me, I'm from Massachusetts." (That was a famous bumper sticker that appeared after only Massachusetts gave its electoral votes to George McGovern over Richard Nixon.) Then when Dr. Saavedra spoke, he referred to his husband, and showed off his wedding ring, to thunderous applause. He and is partner had traveled to Massachusetts to get married. So I'm very proud of our state.

As Clinton said yesterday, gender equality is essential in this battle, and it's essential to the conquest of poverty and many of the other ills that afflict our kind. To be in a place where everybody from an Indian (i.e. Hindu) drag queen to gay activists from San Francisco to religious leaders from Indonesia to Nuns from Budapest and Doctors from Harvard to recovering addicts from Russia to former prostitutes to the former President of the United States are together and have equal stature is unique. This has got to be the only place it can happen.

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