Introduction AIDS/HIV(Human Immunodeficiency Virus) was first seen in Africa in the 1930s, but foundits way to the USA in the 1980s and was seen to be prevalent in gaypopulations. Originally, AIDS was called GRID or Gay-Related Immune Deficiencyby The New York Times and was alsocalled the “gay cancer” til 1985, when people realized that this disease wasnot only restricted to gay people.1Individuals like gay people were usually discriminated during the 80s and eventoday, and are marginalized to situations where they have a higher risk ofcontracting AIDS; therefore, causing them to become even more discriminated dueto their disease. Myths and misinformation about AIDS also increased stigmasurrounding 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 conductwill take place in the 1980s, when stigmatization of AIDS was at its peak. Asdiscussed by Richard Lewontin in his lecture “Biology as Ideology,” science isa social institution and people use science to prosper and continue socialstructures 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 isevidence of institutional discrimination of homosexual individuals in a medicalcontext. We will show how social biases of medical professionals concerningHIV/AIDS showing how not only the general public’s knowledge of these diseasesare built on stereotypes and social constructs, but also the medicalinstitution itself.
This will be done through having a group of generalphysicians to participate in an experiment that will analyze the biases ofdoctors towards homosexuals and AIDS. Historical context HIVis believed to have originated in Kinshasa, in the Democratic Republic of Congoaround 1920 when HIV crossed species from chimpanzees to humans. Up until the1980s, we didn’t know much about AIDS and it was largely undocumented, so thereisn’t much data on AIDS before that time. While sporadic cases of AIDS were documented prior to 1970, available datasuggests 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 300,000people could have already been infected. Human experiments Thefirst HIV case in the US is believed to be Robert Rayford, a 15-year-old blackteenager named Robert Rayford admitted himself to City Hospital in St.
Louis,Missouri in 1968 with multiple symptoms. Tests discovered a severe chlamydiainfection which had, unusually, spread throughout his body. Rayford declined arectal examination request from hospital personnel and was described asuncommunicative and withdrawn. The doctors suspected homosexuality/bisexualityand a history of receptive anal intercourse. Eventually, he was moved toBarnes-Jewish Hospital.In late 1968 Rayford’s condition seemed to have stabilized, but by March 1969his symptoms reappeared and had worsened. He had increased difficultybreathing, and his white blood cell count had plummeted. The doctors found thathis immune system was dysfunctional.
He developed a fever and died of pneumoniaon May 15, 1969.In1984, HIV was first discovered and was spreading rapidly in the gay malecommunities of New York City and Los Angeles. Dr. Marlys Witte, one of theRayford’s doctors, thawed and tested preserved tissue samples from Rayford’sautopsy, which tested negative. Three years later, in June 1987, Witte decidedto test the tissue samples again using Western blot, which found thatantibodies against all nine detectable HIV proteins were present in Rayford’sblood. A second test found identical results. However, these remained somecontroversy regarding whether the results of the test were accurate or if thesamples had been contaminated.2Inthe 1990s, there were drug trials conducted as part of a research by NationalInstitute of Health, involving hundreds of foster children.
These studies werein neglect of federal laws that offered foster children protection. Foster careagencies wanted new, unapproved treatments for HIV infected kids and hence theywere made a part of drug trials, thus exposing these vulnerable children to therisks of medical research and drugs that were known to have serious sideeffects in adults. Several children suffered severe side effects and some drugsended up making their condition worse.
One study found a disturbingly higherdeath rate in children who took higher doses of a drug.3 Stereotypes and Stigma Fromthe twentieth century, and continuing to this day, certain people have beenstereotyped and discriminated against in relation to AIDS. This includeshomosexuals, African Americans, poor people etc.Anexample of this is the stigmatization and harassment of the Haitian people inthe 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-existingfears, prejudices and social inequalities pertaining to poverty, gender, race,sex and sexuality, and so on, hence reinforcing these ideas.This stigma resultsin social exclusion, violence, labeling and denial of resources and servicesmeant for the consumption of all.
Research shows people presume stigma to bethere even when they haven’t directly experienced it, which actually ends upbeing more psychologically damaging and problematic. (Scambler & Hopkins,1986; Bharat, 1999; UNAIDS, 2001).Atthe beginning of HIV epidemic, gay men suffered abuse as they were blamed forthe transmission of HIV. Homophobic reporting by the media further exacerbatedthis. Headlines such as “Alert over ‘gay plague'”4, and”‘Gay plague’5may lead to blood ban on homosexuals” demonised the LGBT community. Human rights HIVinfected people and AIDS patients faced various forms of discrimination andhuman 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 namesreporting, partner notification, and confidentiality. These issues are, to thisday, far from resolved. As a matter of fact, they might have gotten worse, asold issues appear in new places or present themselves in new or different ways.For example, many employers refuse to hire HIV-infected individuals. In manyinstances, HIV-infected individuals are excluded from workplace healthinsurance schemes, which impacts their health and hence their ability to work.There are also new issues, with tremendous human rights implications, that havebeen raised for HIV-infected people, such as the large and growing disparitiesand inequities regarding access to antiretroviral therapies and other forms ofcare.
Moreover,America restricted entry for AIDS patients. Under legislation enacted by theUnited States Congress in 1993, patients found importing anti-HIV medicationinto the country were arrested and placed on flights back to their country oforigin.6 Literature Review Astudy conducted in 2008 among college students showed that the public has asimilar bias against homosexuals and HIV patients, as opposed to heterosexualsand patients with other diseases.7Anarticle published in the New York Times in 1982 was titled ‘NEW HOMOSEXUALDISORDER WORRIES HEALTH OFFICIALS’. Even though it is mentioned in the articleitself that heterosexuals were also affected by this disease, the headlineitself shows the attitude of people in that time towards homosexuals and AIDS patients.Dr. Lawrence D. Mass, a NewYork City physician, said that ”gay people whose life style consists ofanonymous sexual encounters are going to have to do some serious rethinking.
”8Another article from 2006 talks about howAIDS was referred to in the 1980s as ‘gay cancer’. Even after the actualreasons 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 hugestigma 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 racialminorities differently when it comes to prescribing pain management, especiallyconcerning opioids. The study shows that there is indication of bias when itcomes to treating patients based on their ethnicity, as some racial minoritiessuch as blacks are stereotypically more predisposed to drug addiction. Whitepeople are more likely to get opioid pain medication compared to blacks as aresult.
This shows how bias in a medical context can impact the type oftreatment a patient may receive as a result. Our study aims to see if medicalprofessional’s biases concerning a specific disease (AIDS) and a certaindemographic (gay people) impact the quality and type of health care theyrecieve. Methodology Theparticipants will be a sampled population of the United States who are medicaldoctors (more specifically general physicians who encountered AIDS but didn’ttreat it) in the 1980s. 500 doctors will be chosen in all, with 100 picked fromCalifornia, New York, Texas, Pennsylvania, and Illinois (5 of the mostpopulated states in the 1980s according to the 1980 US Census). Actors will behired and separated into four groups. Four actors from each group will be sentto these doctors’ offices with cameras to record their behaviors. All actorswill be white and male to remove any racial/gender bias from the equation.
Eachof these groups will be acting in four main methods: the first two groups willbe 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. Theonly difference between the two groups will be that one group will act in aneffeminate manner mimicking homosexual stereotypes.
The actors with no symptomsof HIV will be there for a general check up and the purpose of this will be tosee how the doctors’ general attitudes towards their patients are and if thereis any difference in attitude if the patient seems outwardly gay. The other twogroups will also have actors acting in the same manner as the other two, exceptthat they will show symptoms of having HIV. This will show any difference inattitudes towards individuals with AIDS vs.
without, and if being suspectedly”gay” adds to any discrimination. So to recap, the four groups are No HIV/NotHomosexual, No HIV/Homosexual, HIV/Not Homosexual, HIV/Homosexual. Theattitudes, behavior, and treatment of all four patients by the doctors will beexamined on the basis of discrimination towards gay patients, patients withsymptoms of HIV, and a combination of both. Thisexperiment shows how medical professionals are influenced by the society aroundthem and how lasting perceptions and biases can influence treatments andmanagement of patients. As mentioned previously, AIDS was originally given thename GRID (Gay-Related Immune Deficiency) and was referred as such by medicalprofessionals prior to its name change, with the word gay in the name used tofurther marginalize and stigmatize this minority group.
People also thoughtthat gay people were doing deeds against God and were therefore being punishedfor their sins, getting what they deserve. This frame of thought may have alsobeen carried to medical professionals, as first and foremost, doctors arehumans with inherent biases and opinions. Even while some attempt to suppressthese biases for the sake of professionalism, it still can come out. The waythis experiment is set up is to see if there is any such discrimination of gaypeople with or without HIV in the medical context. Doctors may diagnose someonewith more of an outwardly more “gay’ deposition with HIV more quickly comparedto someone who does not have any stereotypical homosexual attributes. They mayalso be more disciplining towards someone with HIV and seemingly gay,critiquing or asking questions about their lifestyle compared to those whodon’t seem gay but have HIV. Also, there may be evidence of mistakenlydiagnosing someone with HIV is they show gay attributes but have no symptoms ofthe disease.
These biases may negatively impact the quality of healthcare theseindividuals actually receive. We aim to discover that medical professionals aremore likely to diagnose individuals who show outwardly gay attributes with HIVfaster than ones who don’t, and a stigma towards gay people with no signs ofHIV being mistakenly assumed to have HIV. Conclusion Thisstudy is very important for the time period we are conducting it in, as thestigma associated with AIDS and homosexuality was further exacerbated by thefact that the Reagan administration ignored these cases and allowed thousandsto get affected as a result.9The US government acted as a institution of social legitimization, denying theseverity of HIV and perpetuating stereotypes associated with homosexuality andonly paid attention to the crisis when they saw that the “gay cancer” was notgay after all.
Medical science has numerous examples throughout history wheresociety 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 publichealth and to eradicating stigma and discrimination associated with thedisease.