Social Attitudes and Stigma
Though AIDS is an enormous public health problem, public perceptions of the epidemic have not always been accurate. Despite considerable evidence that AIDS is not easily communicated, widespread fears persist, reminiscent of the belief that syphilis could be transmitted by drinking cups, toilet seats, and doorknobs. Such late Victorian concerns are now cast in a contemporary light. In the fall of 1985 a New York Times /CBS poll found that 47 percent of Americans believed that AIDS could be transmitted via a shared drinking glass, while 28 percent believed that toilet seats could be the source of contamination.[13] Another survey found that 34 percent of those polled believed it unsafe to "associate" with an AIDS victim even when no physical contact was involved. The California Association of Realtors instructed its members to inform prospective buyers whether or not a house on the market had been owned by an AIDS patient.[14]
Because of the considerable fear the AIDS epidemic has engendered, and the fact that the disease has principally affected two already marginal social groups (gays and intravenous drug users), its victims have been further victimized by stigmatization and discrimination. AIDS pa-
tients have lost jobs, housing, and social support. At risk not just from a serious, terminal disease, AIDS sufferers also have to deal with a series of social perceptions and attitudes that encourage further discrimination and isolation. Even the medical profession has not been free from the fear of AIDS: Early in the epidemic some physicians refused to treat AIDS patients, despite assurances that the virus was not easily transmitted.[15]
The hysteria and stigma have even led to attempts to segregate victims. The first major skirmish in this battle arose over whether children with AIDS should be permitted to attend school. Ryan White, a thirteen-year-old AIDS victim, was banned from his Indiana school. This issue has attracted a vehement, ongoing debate, but most jurisdictions have permitted children with the disease to attend when they posed no risk to other students. In Queens, New York, angry parents kept their children home in two school districts because a child with AIDS was permitted to go to school. The boycott reflected a pervasive mistrust of scientific authority, as well as a lack of understanding about the nature of uncertainty in science. Could officials assure—absolutely—that the disease could not be passed in the classroom? Medical science, which deals in probabilities, could not offer the definitive guarantees that many demanded.[16]
Stigma goes beyond AIDS patients to anyone considered at risk of carrying the infection. Indeed, not only have AIDS patients been subject to discrimination, but the public response to the disease has also been accompanied by a rise in attacks on homosexuals. Fire officials have refused to resuscitate men they suspected might be homosexual, and police have worn gloves in apprehending suspects in some municipalities.[17]
Our understanding of AIDS and its meaning has been powerfully shaped by the media in what has been a complex process. AIDS has generated outstanding science writing as well as scurrilous reports bent on raising irrational fears and public hysteria. The death of movie idol Rock Hudson in October 1985 demonstrates the paradoxical relationship of AIDS and the media. Hudson's death became the occasion for recognizing that AIDS was a vast problem that merited more attention; his death put a human face on the epidemic for many Americans. It also became the occasion for speculation about Hudson's sexuality and for a prurient interest in the gay subculture. Hudson's plight was heavy with irony. This macho screen star, the press now speculated, had lived a secret life. AIDS brought a pale, thin, dying Hudson out of the closet, and President Ronald Reagan finally uttered the dangerous monosyllable, "AIDS."
But Hudson's death also led to heightened fears of hidden disease.
Who knew who was gay? Who knew who might have the disease? Hudson's death created alarm among Hollywood actors that they might contract the disease in the course of making movies and television shows. Some critics suggested that Hudson had acted irresponsibly by not informing his fellow cast members of the television serial "Dynasty" and by kissing his costar, Linda Evans, in one episode. In this respect, Hudson's death again raised concerns that AIDS victims and those who carry the virus could place others at risk. Shortly after Hudson's death, his estate was sued by a lover, who claimed that Hudson had never informed him he had AIDS.[18]
The fact that the two principal high-risk groups are already highly stigmatized in American society has had a powerful impact on responses to the epidemic. Some have seen the AIDS epidemic in a purely "moral" light: AIDS is a disease that occurs among those who violate the moral order. As one journalist concluded: "Suddenly a lot of people fear that they and their families might suddenly catch some mysterious, fatal illness which until now has been confined to society's social outcasts." AIDS, like other sexually transmitted diseases, has been viewed as a fateful link between social deviance and the morally correct. Such fears have been exacerbated by an expectant media. "No ONE IS SAFE FROM AIDS," announced Life magazine in bold red letters on its cover.[19] Implicit was the notion that "no one is safe" from gays and intravenous drug users. The disease had come to be equated with those who are at highest risk of suffering its terrible consequences.
Underlying the fears of transmission were deeper concerns about homosexuality. Just as "innocent syphilis" in the first decades of the twentieth century was thought to bring the "respectable middle class" in contact with a deviant ethnic, working-class "sexual underworld," now AIDS threatened heterosexuals with homosexual contamination. In this context, homosexuality—not a virus—causes AIDS. Therefore, homosexuality itself is feared as if it were a communicable, lethal disease. After a generation of work to strike homosexuality from the psychiatric diagnostic manuals, it had suddenly reappeared as an infectious, terminal disease.[20]
The AIDS epidemic thus offered new opportunities for expressions of moral opprobrium. Patrick Buchanan, conservative columnist and former Reagan speechwriter, explained, "The poor homosexuals—they have declared war upon Nature, and now Nature is exacting an awful retribution."[21] Criticizing government expenditures on research to produce a vaccine, Commentary editor Norman Podhoretz asked: "Are
they aware that in the name of compassion they are giving social sanction to what can only be described as brutish degradation?" Podhoretz's position—that gays get what they deserve, that to investigate treatments would merely encourage unhealthy behaviors—is a classic position in the history of sexually transmitted diseases. It also demonstrates a remarkably uninformed view of the epidemic, as well as a complete disregard for the public health.[22]
In a now classic work, Stigma : Notes on the Management of Spoiled Identity , sociologist Erving Goffman defined what he considered to be three types of stigma. The first is an abomination of the body; clearly AIDS could be so categorized. The second is a blemish of individual character; again victims of AIDS and other sexually transmitted diseases have traditionally been seen as lacking control, as immoral and promiscuous. And third, Goffman identified the tribal stigmas of race, nation, or religion. This, too, has been a recurring theme in considerations of venereal disease—the notion that particular groups were especially prone to infection. Perhaps the sexually transmitted diseases carry a particularly weighty stigma because they cut through each of these categories; an undesired difference , of a sexual nature, that sets its victims apart. Victims of AIDS thus suffer the biological consequences of a terrifying, fatal disease as well as a deep social stigma.[23]
Fear of disease and the homophobia it has generated have forced the gay-rights movement into defensive action in order to fight a rising tide of discrimination. In fact, the epidemic threatens to undo a generation of progress toward gay rights. Not only does AIDS threaten the lives of many members of the gay community, it has unleashed a considerable political and legal threat. In June 1986 the Justice Department issued a decision that held it permissible for employers to bar AIDS patients or those infected with the virus from work. The ruling held that federal law did not protect the civil rights of those who might be considered dangerous to others; moreover, the ruling left the evaluation of such "real or perceived" risks to the employer. The decision was issued despite government scientists' repeated statements, on the basis of considerable epidemiological and biological evidence, that the disease was not casually transmitted.[24]
Public health officials openly expressed their dismay with the ruling, which threatened to encourage the irrational fears of the disease that they had worked so diligently to alleviate. Calling the ruling a "license to hound AIDS victims," the New York Times wrote in an editorial that "no one should want to curb the powers of public health officials to control a disease as deadly as AIDS. But to throw AIDS victims out of their
jobs is a capitulation to unwarranted fear that protects no one."[25] As journalist Charles Krauthammer noted, the ruling undercut all anti-discrimination legislation: "The whole point of such laws is to say this: It may indeed cause you psychological distress to mix with others who you irrationally dislike or fear. Too bad. The state has decided that these particular prejudices are destructive and irrational. Therefore the state will prohibit you . . . from acting upon your groundless prejudices." As Krauthammer concluded, "It should not matter if people think you can get AIDS in the Xerox room. You can't. Ignorance is a cause of discrimination. It is not a justification for it."[26]
Such a ruling may not be upheld in court. But the courts have not supported recent attempts to provide basic civil liberties for homosexuals. Soon after the Justice Department ruling in 1986, the Supreme Court upheld, in a five to four decision, the constitutionality of a state's sodomy law in a case that was considered a major setback to the gay-rights movement.[27] This ruling, which conflicted with the court's recent affirmations of the right to privacy, can be fully understood only in the context of the AIDS epidemic. Nevertheless, in 1987 and 1988 the court ruled that people with infectious disease are protected by the statute prohibiting discrimination against the handicapped.