Understanding Aids: Historical Interpretations and the Limits of Biomedical Individualism
American Journal of Public Health. 1993 Oct; 83(10): 1477-1486.
The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a "gay plague," by analogy with the sudden, devasting epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques of both paradigms, it is possible to discern the emergence of an alternative paradigm of AIDS as a collective chronic infectious disease and persistent pandemic. Each of these constructions of AIDS incorporates distinct views of the etiology, prevention, pathology, and treatment of disease; each tacitly promotes different conceptions of the proper allocation of individual and social responsibility for AIDS. This paper focuses on individualistic vs collective, and biomedical vs social and historical, understandings of disease. It analyzes the uses of individualism as methodology and as ideology, criticizes some basic assumptions of the biomedical model, and discusses alternative strategies for scientific research, health policy, and disease prevention.
Aids; Aids Serodiagnosis; Alternative Therapies; Analogy; Attitudes; Autonomy; Acquired Immunodeficiency Syndrome; Biomedical Research; Blood; Blood Donation; Chronically Ill; Disease; Drug Abuse; Discrimination; Health; Health Care; Health Care Delivery; Health Personnel; Historical Aspects; HIV Seropositivity; Homosexuals; Illness; Medicine; Metaphor; Physicians; Political Activity; Preventive Medicine; Public Health; Public Policy; Research; Self Induced Illness; Social Discrimination; Social Problems; Socioeconomic Factors; Sociology; Sociology of Medicine; Stigmatization;
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