HIV/AIDS: 30 Years Later
On June 5, 1981, the CDC announced that a relatively rare form of pneumonia had been detected among a small group of young gay men in Los Angeles. The disease was later found to be linked to AIDS. In the three decades since then, millions more people have been infected with HIV. Today, 33 million worldwide are estimated to be living with HIV/AIDS.
From the moment the epidemic made its first, devastating appearance, the question of stigma has been a critical part of the story. It’s a key determinant in the spread of the disease, says SPH epidemiologist James Koopman. “Whether you’re talking about drug use and intravenous exchange or homosexuality, there’s been a big emphasis on stigma,” he says, adding that in all too many instances, the stigma associated with HIV/AIDS has led to the denial of people’s basic human rights. More features on:
- TB: the most common opportunistic infection for HIV and the leading cause of HIV-related deaths.
- HIV and unemployment: a vicious cycle.
- Shift: from a focus on prevention to a growing concern with the capacity of health systems.
VIDEO on progress and current concerns: SPH researcher Rachel Snow, adjunct lecturer Eve Mokotoff, and an HIV patient look back at the disease's first three decades and focus on the future priorities.
Tourism and HIV
Outside of sub-Saharan Africa, the Caribbean has the highest rates of HIV in the world. The Dominican Republic—where Mark Padilla, an assistant professor of health behavior and health education, conducts research on the confluence of tourism, sexuality, and health—has a one-percent HIV-prevalence rate. But among certain vulnerable populations, that rate is considerably higher. Padilla is at work on three studies aimed at clarifying what’s driving the spread of the HIV in the Dominican Republic and how policymakers can slow the epidemic:
In a study funded by the U.S. National Institutes of Health, Padilla is trying to untangle the complex relationship among tourism environments, alcohol consumption, and HIV risk. Through interviews with Dominicans who work in tourist enclaves, Padilla and his research team have found that the tourism industry in general promotes alcohol consumption (including binge drinking) among both tourists and locals who live and work in tourist environments. The reason? Businesses realize that sex and eroticism draw clients to consumption locations, even if those locations aren’t officially prostitution sites. “Client-tourists want to meet locals who are potentially available for sexual/erotic interactions,” Padilla says. To attract locals, businesses therefore distribute free alcohol-consumption coupons. This “synergy between the sex economy and the alcohol economy,” he adds, is a factor in the spread of HIV.
In order to reduce the spread of HIV among vulnerable populations, countries need policymakers who are committed to allowing HIV-prevention measures to be implemented in tourist environments. But this doesn’t always happen. Padilla and his research team are trying to find out why, and what, if anything, can be done to address the problem. They’ve talked to Dominican policymakers from an array of sectors—government, civil society, private tourism—and gotten mixed responses.
Some policymakers have mentioned the “fragility” of the tourism industry and the need to safeguard it by downplaying the threat of HIV. Others have said they believe HIV prevention is important, and they recognize its connection to tourism. Padilla and his team are disseminating their findings among policymakers, and the process is generating fruitful debate about how to tackle the problem.
Near the popular resort town of Punta Cana, on the southeastern coast of the Dominican Republic, there’s been a recent spike in HIV rates among transgendered people who reside in the area. Padilla and his colleagues are conducting an ethnographic study aimed at understanding the social and physical conditions that may be causing the spike. They’ve found that the transgendered community experiences extremely high rates of violence and abuse. “Many are kicked out of their homes and have no place to live,” Padilla says. “HIV is often an outcome of violence against these people.”
At first glance, it might seem that an expert in chronic disease–management interventions, survey analysis, and health-services research would have little to contribute to human rights work—but Michele Heisler has found the opposite to be true. A Robert Wood Johnson Clinical Scholar at UM and an associate professor of both health behavior and health education and internal medicine, Heisler has been collaborating on human rights investigations with the Massachusetts-based organization Physicians for Human Rights for over 15 years. Last year, Heisler realized a life-long dream when she joined the board of directors of PHR.
“If you have specific clinical and epidemiological skills, there’s a lot you can do in terms of documenting human rights violations,” she says.
Among the studies to which Heisler has contributed is a 2008 population-based study showing that opt-out HIV testing significantly reduced the stigma associated with HIV/AIDS in Botswana and Swaziland. (With opt-out testing, people are required to get HIV testing unless they choose not to.) In a separate study, Heisler documented discrimination against and poor treatment of people with HIV in Nigeria.
Heisler’s involvement with human rights work dates back to her days working for the Ford Foundation in Latin America and later as a medical student, when she began volunteering for PHR and other organizations. Among other projects, she has worked on a nationwide survey and training program for forensic physicians in Mexico, on a United Nations human rights truth commission in El Salvador, and on a study in Turkey examining both forensic documentation of detainee torture and abuse and violations of medical neutrality in the Kurdish Diyarbakir region. That study led directly to the UN’s Istanbul Protocol, which lays out principles for how forensic and other health professionals should document evidence of torture and abuse.
More recently Heisler and PHR have been working with an exiled Sudanese physician to document abuse in his country. They’re compiling data from hundreds of case files to provide to the International Criminal Court.
Although her human rights work constitutes a relatively small portion of her academic research, Heisler says it’s her “soul work. When you do this kind of work, you meet incredible people. If anything, it protects you against being depressed, because you’re just in awe of how resilient people are.