Introduction on AIDS before that time. While sporadic

 

Introduction

 

AIDS/HIV
(Human Immunodeficiency Virus) was first seen in Africa in the 1930s, but found
its way to the USA in the 1980s and was seen to be prevalent in gay
populations. Originally, AIDS was called GRID or Gay-Related Immune Deficiency
by The New York Times and was also
called the “gay cancer” til 1985, when people realized that this disease was
not only restricted to gay people.1
Individuals like gay people were usually discriminated during the 80s and even
today, and are marginalized to situations where they have a higher risk of
contracting AIDS; therefore, causing them to become even more discriminated due
to their disease. Myths and misinformation about AIDS also increased stigma
surrounding the disease and caused polarization, creating a “them” vs “us”
mentality against homosexuals with AIDS. (https://www.avert.org/professionals/hiv-social-issues/stigma-discrimination) The experiment we will conduct
will take place in the 1980s, when stigmatization of AIDS was at its peak. As
discussed by Richard Lewontin in his lecture “Biology as Ideology,” science is
a social institution and people use science to prosper and continue social
structures already set up, making these ideologies seem natural and legitimate.
This study will attempt to show that the way how AIDS was treated in the 80s is
evidence of institutional discrimination of homosexual individuals in a medical
context. We will show how social biases of medical professionals concerning
HIV/AIDS showing how not only the general public’s knowledge of these diseases
are built on stereotypes and social constructs, but also the medical
institution itself. This will be done through having a group of general
physicians to participate in an experiment that will analyze the biases of
doctors towards homosexuals and AIDS.

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Historical context

 

HIV
is believed to have originated in Kinshasa, in the Democratic Republic of Congo
around 1920 when HIV crossed species from chimpanzees to humans. Up until the
1980s, we didn’t know much about AIDS and it was largely undocumented, so there
isn’t much data on AIDS before that time.
While sporadic cases of AIDS were documented prior to 1970, available data
suggests that the current epidemic started in the mid- to late 1970s. By 1980,
HIV may have already spread to five continents (North America, South America,
Europe, Africa and Australia). In this period, between 100,000 and 300,000
people could have already been infected.

 

Human experiments

 

The
first HIV case in the US is believed to be Robert Rayford, a 15-year-old black
teenager named Robert Rayford admitted himself to City Hospital in St. Louis,
Missouri in 1968 with multiple symptoms. Tests discovered a severe chlamydia
infection which had, unusually, spread throughout his body. Rayford declined a
rectal examination request from hospital personnel and was described as
uncommunicative and withdrawn. The doctors suspected homosexuality/bisexuality
and a history of receptive anal intercourse. Eventually, he was moved to
Barnes-Jewish Hospital.
In late 1968 Rayford’s condition seemed to have stabilized, but by March 1969
his symptoms reappeared and had worsened. He had increased difficulty
breathing, and his white blood cell count had plummeted. The doctors found that
his immune system was dysfunctional. He developed a fever and died of pneumonia
on May 15, 1969.

In
1984, HIV was first discovered and was spreading rapidly in the gay male
communities of New York City and Los Angeles. Dr. Marlys Witte, one of the
Rayford’s doctors, thawed and tested preserved tissue samples from Rayford’s
autopsy, which tested negative. Three years later, in June 1987, Witte decided
to test the tissue samples again using Western blot, which found that
antibodies against all nine detectable HIV proteins were present in Rayford’s
blood. A second test found identical results. However, these remained some
controversy regarding whether the results of the test were accurate or if the
samples had been contaminated.2

In
the 1990s, there were drug trials conducted as part of a research by National
Institute of Health, involving hundreds of foster children. These studies were
in neglect of federal laws that offered foster children protection. Foster care
agencies wanted new, unapproved treatments for HIV infected kids and hence they
were made a part of drug trials, thus exposing these vulnerable children to the
risks of medical research and drugs that were known to have serious side
effects in adults. Several children suffered severe side effects and some drugs
ended up making their condition worse. One study found a disturbingly higher
death rate in children who took higher doses of a drug.3

 

 

 

 

 

 

Stereotypes and Stigma

 

From
the twentieth century, and continuing to this day, certain people have been
stereotyped and discriminated against in relation to AIDS. This includes
homosexuals, African Americans, poor people etc.

An
example of this is the stigmatization and harassment of the Haitian people in
the early 1980s, who were accused of having brought AIDS into the USA (Farmer
& Kim, 1991). 
?AIDS related stigma and discrimination are usually based on pre-existing
fears, prejudices and social inequalities pertaining to poverty, gender, race,
sex and sexuality, and so on, hence reinforcing these ideas.This stigma results
in social exclusion, violence, labeling and denial of resources and services
meant for the consumption of all. Research shows people presume stigma to be
there even when they haven’t directly experienced it, which actually ends up
being more psychologically damaging and problematic. (Scambler & Hopkins,
1986; Bharat, 1999; UNAIDS, 2001).

At
the beginning of HIV epidemic, gay men suffered abuse as they were blamed for
the transmission of HIV. Homophobic reporting by the media further exacerbated
this. Headlines such as “Alert over ‘gay plague'”4, and
“‘Gay plague’5
may lead to blood ban on homosexuals” demonised the LGBT community.

 

Human rights

 

HIV
infected people and AIDS patients faced various forms of discrimination and
human rights violations in the 1980s. This included mandatory HIV testing,
travel restrictions, barriers to employment and housing, access to education,
medical care, and/or health insurance; and the many issues raised by names
reporting, partner notification, and confidentiality. These issues are, to this
day, far from resolved. As a matter of fact, they might have gotten worse, as
old issues appear in new places or present themselves in new or different ways.
For example, many employers refuse to hire HIV-infected individuals. In many
instances, HIV-infected individuals are excluded from workplace health
insurance schemes, which impacts their health and hence their ability to work.
There are also new issues, with tremendous human rights implications, that have
been raised for HIV-infected people, such as the large and growing disparities
and inequities regarding access to antiretroviral therapies and other forms of
care.

Moreover,
America restricted entry for AIDS patients. Under legislation enacted by the
United States Congress in 1993, patients found importing anti-HIV medication
into the country were arrested and placed on flights back to their country of
origin.6

 

 

 

Literature Review

 

A
study conducted in 2008 among college students showed that the public has a
similar bias against homosexuals and HIV patients, as opposed to heterosexuals
and patients with other diseases.7

An
article published in the New York Times in 1982 was titled ‘NEW HOMOSEXUAL
DISORDER WORRIES HEALTH OFFICIALS’. Even though it is mentioned in the article
itself that heterosexuals were also affected by this disease, the headline
itself shows the attitude of people in that time towards homosexuals and AIDS patients.
Dr. Lawrence D. Mass, a New
York City physician, said that ”gay people whose life style consists of
anonymous sexual encounters are going to have to do some serious rethinking.”8

Another article from 2006 talks about how
AIDS was referred to in the 1980s as ‘gay cancer’. Even after the actual
reasons for the disease were discovered and heterosexuals started getting it,
it was still, for a long time, referred to as gay cancer which created a huge
stigma which continues to this day.

In a research study (http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224)
conducted in the United States, it was found that doctors treat racial
minorities differently when it comes to prescribing pain management, especially
concerning opioids. The study shows that there is indication of bias when it
comes to treating patients based on their ethnicity, as some racial minorities
such as blacks are stereotypically more predisposed to drug addiction. White
people are more likely to get opioid pain medication compared to blacks as a
result. This shows how bias in a medical context can impact the type of
treatment a patient may receive as a result. Our study aims to see if medical
professional’s biases concerning a specific disease (AIDS) and a certain
demographic (gay people) impact the quality and type of health care they
recieve.

 

 

 

 

 

 

 

Methodology

 

The
participants will be a sampled population of the United States who are medical
doctors (more specifically general physicians who encountered AIDS but didn’t
treat it) in the 1980s. 500 doctors will be chosen in all, with 100 picked from
California, New York, Texas, Pennsylvania, and Illinois (5 of the most
populated states in the 1980s according to the 1980 US Census). Actors will be
hired and separated into four groups. Four actors from each group will be sent
to these doctors’ offices with cameras to record their behaviors. All actors
will be white and male to remove any racial/gender bias from the equation.

Each
of these groups will be acting in four main methods: the first two groups will
be a patient with no apparent symptoms of HIV which will serve as a control.
All characteristics and symptoms of the patients will be somewhat similar. The
only difference between the two groups will be that one group will act in an
effeminate manner mimicking homosexual stereotypes. The actors with no symptoms
of HIV will be there for a general check up and the purpose of this will be to
see how the doctors’ general attitudes towards their patients are and if there
is any difference in attitude if the patient seems outwardly gay. The other two
groups will also have actors acting in the same manner as the other two, except
that they will show symptoms of having HIV. This will show any difference in
attitudes towards individuals with AIDS vs. without, and if being suspectedly
“gay” adds to any discrimination. So to recap, the four groups are No HIV/Not
Homosexual, No HIV/Homosexual, HIV/Not Homosexual, HIV/Homosexual. The
attitudes, behavior, and treatment of all four patients by the doctors will be
examined on the basis of discrimination towards gay patients, patients with
symptoms of HIV, and a combination of both.

This
experiment shows how medical professionals are influenced by the society around
them and how lasting perceptions and biases can influence treatments and
management of patients. As mentioned previously, AIDS was originally given the
name GRID (Gay-Related Immune Deficiency) and was referred as such by medical
professionals prior to its name change, with the word gay in the name used to
further marginalize and stigmatize this minority group. People also thought
that gay people were doing deeds against God and were therefore being punished
for their sins, getting what they deserve. This frame of thought may have also
been carried to medical professionals, as first and foremost, doctors are
humans with inherent biases and opinions. Even while some attempt to suppress
these biases for the sake of professionalism, it still can come out. The way
this experiment is set up is to see if there is any such discrimination of gay
people with or without HIV in the medical context. Doctors may diagnose someone
with more of an outwardly more “gay’ deposition with HIV more quickly compared
to someone who does not have any stereotypical homosexual attributes. They may
also be more disciplining towards someone with HIV and seemingly gay,
critiquing or asking questions about their lifestyle compared to those who
don’t seem gay but have HIV. Also, there may be evidence of mistakenly
diagnosing someone with HIV is they show gay attributes but have no symptoms of
the disease. These biases may negatively impact the quality of healthcare these
individuals actually receive. We aim to discover that medical professionals are
more likely to diagnose individuals who show outwardly gay attributes with HIV
faster than ones who don’t, and a stigma towards gay people with no signs of
HIV being mistakenly assumed to have HIV.

 

Conclusion

 

This
study is very important for the time period we are conducting it in, as the
stigma associated with AIDS and homosexuality was further exacerbated by the
fact that the Reagan administration ignored these cases and allowed thousands
to get affected as a result.9
The US government acted as a institution of social legitimization, denying the
severity of HIV and perpetuating stereotypes associated with homosexuality and
only paid attention to the crisis when they saw that the “gay cancer” was not
gay after all. Medical science has numerous examples throughout history where
society has impacted its diagnosis and treatment, and HIV/AIDS is no exception.
Adopting a human rights approach to HIV/AIDS is in the best interests of public
health and to eradicating stigma and discrimination associated with the
disease.