How HIV/AIDS warns us

Trigger warning: HIV/AIDS, heterosexism, cissexism, anti-Black racism

Once again, it’s World AIDS Day. Just like last year, there’s no google doodle, which helps dampen the discussion around HIV/AIDS as an on-going problem. It probably didn’t help stir up conversation around the issue that rather recently the disease has already been in the news – either because of price gouging on immunodeficiency drugs or new research into a possible HIV vaccine.

That vaccine – which pushes the limits of common definitions of a vaccine because of HIV’s unique viral structures – actually demonstrates what can happen when public interests are privatized. While to some extent publicly funded (too much to the taste of some), research into ways to combat HIV/AIDS has long sought either this type of vaccine or similar solutions designed around preventing the spread of HIV. What medical options exist for the millions already infected worldwide – who are disproportionately LGBT and Black – is kind of ominously given less focus.

Zambia
A public sign reading “Know your HIV status” in Simonga, Zambia, from here.

This isn’t a new dynamic either. From its inception, the HIV/AIDS crisis was greeted with solutions aimed at containment. From the early debates over abstinence versus protected sex, to the recent sexual revolution heralded by PrEP and PEP, that’s been where most public attention, professional research, and money has gone. A vaccine is just another chapter in that history.

There’s some understandable reasons for the emphasis on preventing infection, admittedly. In the early years of the epidemic, HIV was really baffling, and so medically treating it was basically guesswork. Preventing infections was the easiest and best way to save lives, and to a large extent remains so. Even now, when living with HIV has become less difficult and dangerous, having options for both HIV positive and HIV negative people to choose between in order to reduce risk of infection has its benefits. People can use methods that work best for them – what’s wrong with that?

The logic there is subtly consumerist, of course. The funds – public and private – that have gone into developing different ways of addressing HIV look in the long run more like business research and development. The Martin Shkreli controversy should once again remind us that the medical items designed and tested with those resources, are increasingly lining the pockets of a private medical industry.

Like any business, they’ve assessed their potential clients – and they saw little money to be made in a tighter focus on the marginalized populations with the highest infection rates. Prevention has a broader set of potentially customers, a section of whom have more disposable income than the average person in sub-Saharan Africa or transgender woman in the industrialized world.

The social costs of that commercial outlook have been staggering.

hiv aids subsaharan africa
(From here.)

Since I mentioned this in light of the more market-driven solutions being touted on climate change, I will admit, those are two radically different issues. The flaws inherent in a response to global warming that values certain populations over others will look different than the preference for prevention over treatment in HIV/AIDS research. That said, who’s to say that isn’t already happening?

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