Tag Archives: Kaiser Family Foundation

“Cc…: CCC,” part 15

[Kendall Thomas, in continuation from “Cc…:  CCC, part 14]

My point here is that the landscape of “international AIDS” in the U.S. is, first and foremost, a psychic space whose field of action is the interiorized projection (Rorty’s “sentimental education”) that allows Americans to “feel” that they are part of the global culture of concern about the HIV pandemic.  Needless to say, the heightened sensitivity of the American public to the imagined pain of those who are living with (and dying from) AIDS in other parts of the world has yet to take the form of a collective public demand that the U.S. government increase its support for international treatment and prevention efforts.  (Tellingly, the Kaiser Foundation survey I mentioned earlier found that nearly half of those polled doubted that more money would result in any meaningful progress in the struggle against AIDS in Africa.)  If anything, the “international turn” in the U.S. domestic discourse on HIV/AIDS has served as an alibi for not addressing the intranational scandal of HIV infection and illness on our own shores.  Consider the following state of affairs.  The U.S. continues to record about 40,000 new infections each year.  Roughly one-half to two-thirds of the 800,000 to 900,000 Americans with HIV/AIDS do not receive regular medical care.  Up to one third of Americans do not know that they are infected.  African Americans, who represent 12% of the U.S. population, make up 47% of new AIDS cases.  African American women account for nearly two thirds of the new AIDS cases among women in the U.S.  Some 56% of the African Americans living with HIV are not on combination drug therapy.  They are 1.5 times more likely not to get preventive treatment for PCP.  Although they represent only 15% of the total U.S. population under the age of 13, African Americans make up 62% of the nation’s pediatric AIDS cases.  Half the new AIDS cases among young people between the ages of 13 and 19 are among African Americans.  AIDS continues to be the leading cause of death for African Americans between the ages of 25 and 44.  A recent study of young men who have sex with men suggests that in parts of the U.S., one in three gay African Americans are infected with HIV, a rate fully comparable to that of the hardest hit African countries.

Does this mean that AIDS analysis and activism in the U.S. should turn inward and cut itself off from the rest of the world?  Not at all.  I am not urging a narcissistic return to the isolationism that has characterized too much of the history of the U.S. response to HIV/AIDS.  I am saying that in engaging with the question of where to act now, we in the U.S. have a responsibility to continually think the global around the axis of the domestic.  We have a responsibility, too, to develop and defend a radical vision of solidarity across the mental borders that AIDS sentimentalism has drawn between the international pandemic and the intranational epidemic.  In my view, the measure of those of us who live in the U.S. must be taken by our willingness to fight AIDS as fiercely at home as we do abroad.


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“Cc…: CCC,” part 14

I’ve been thinking about the original question Deb posed about how we might read and respond to the “concluding imperative” of Piot’s preface to the UNAIDS report:  Now act!”  Ensuing discussions have raised other questions that are nested in Piot’s injunction (I’m thinking in particular of Gregg’s intervention, which, as Deb notes, takes up the issues of “What,” “Who,” and “When”).  I keep returning, though, to a question (or rather a set of questions) that, to my mind, is at least as urgent as the questions of agency and temporality on which Piot’s imperative invites reflection.  That question is simply this:  “Where?”  Where is the space or field or geography of the action(s) “we” are enjoined to take?

The document in which Piot’s injunction appears is called the Report on the global HIV/AIDS pandemic.  The nominative anachronism of this title is worth remarking, since it takes us back to an earlier time in the history of the naming practices that have enveloped the life of the virus (which, as Cindy Patton has recently reminded us, includes the pre-history before “The Name” of the virus itself).  We all remember the moment in the 1990s when we began to speak of the “HIV/AIDS epidemic” as the “pandemic,” in order to register the emerging consciousness that this was a cluster of epidemics that covered, or would soon come to cover, the entire world.  In the U.S. context, this new nomination has over time had the important and salutary effect of opening the national consciousness about HIV/AIDS.  My sense is that U.S. based global AIDS activists have been able to use the language of an international HIV pandemic to expand the domestic discursive space accorded to HIV.  The recognition that “we are not the world” has enlarged the national conversation about AIDS on issues from U.S. government spending abroad to the drug pricing policies of the transnational pharmaceutical corporations.

This shift in the U.S. public imagination has increasingly made it impossible not to think about HIV/AIDS in international terms.  Surely that is a good thing.  However, it would probably be a mistake to read too much into the broadened public perception of the AIDS crisis in the U.S.  For example, a recent survey by the Kaiser Family Foundation found that a majority of Americans are able to correctly identify Africa as the region of the world with the largest population of people living with HIV/AIDS.  However, only a minority of those surveyed believed that the U.S. government should be more involved than it has been in responding to AIDS in Africa.  To paraphrase Richard Rorty, the “globalization” of the U.S. public’s perception of AIDS has meant little more than an increased interest in “hearing sad and sentimental stories.”  During the first two decades, the “face” of AIDS in the American mind was the headshot of the “ravaged” Rock Hudson or the “courageous” Ryan White; by the third, that “face” belongs to the “frail” South African Nkosi Johnson.  In many ways, the image of the “international AIDS pandemic” in the collective U.S. consciousness serves  much the same purpose as that of “international human rights”:  it is a tool (to borrow again from Rorty) for “manipulating sentiments, [for] sentimental education.”

[Kendall Thomas’ e-mail continues in the following post]

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