The AIDS Epidemic and Sociological Enquiry
by Bronwen Lichtenstein, University of Alabama-Birmingham
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The AIDS epidemic captured the public imagination in an unprecedented way when it emerged in the U.S. in early 1980’s. Widespread concern was fanned by iconographic images of a “gay plague” and the cataclysmic spread of disease among “innocent populations”(assumed to be heterosexuals). These images of a new, deadly epidemic yielded a substantial body of literature on the biomedical, epidemiologic, and social aspects of HIV/AIDS. Sociologists have been active contributors to this literature, at the forefront of advancing academic understandings of the social dimensions of HIV/AIDS. Their work shaped governmental, state, and community responses to the epidemic, including in such agencies as the National Institutes for Health and the Centers for Disease Control and Prevention (CDC).
Despite an admirable record in public health policy and activism, there is the question about how well the sociology of HIV/AIDS has fared within our discipline. It has been suggested informally that sociologists seeking to publish on HIV/AIDS may have fared better in interdisciplinary forums than in sociology itself. The sociological contribution to the interdisciplinary literature on HIV/AIDS has, in fact, been praised as: “rapid, sophisticated and productive” (Sociology of Health and Illness, 1990: 247). However, for sociologists seeking a home for AIDS-related articles there is no specialist journal on AIDS in sociology, nor even one that addresses the social dimensions of epidemic diseases. A few health-related journals do exist in U.S. sociology (for example, the Journal of Health and Social Behavior), but AIDS-related manuscripts must vie for publishing space with all of the others that fall under the rubric of medical sociology or the sociology of health. It is important to know how much publishing on HIV/AIDS exists in mainstream forums within sociology itself.
The data presented below outline the trends in publishing and presenting on HIV/AIDS in mainstream sociology journals and at ASA national meetings.1 The ten journals presented in Figure One were selected on the basis of their reputation and readership in the discipline. The list is certainly not exhaustive, but it does offer an insight into the publishing history on HIV/AIDS in U.S. sociology. As shown in this figure, the AIDS epidemic does not appear to have captured the sociological imagination of the journals in any meaningful way.
Figure 1 shows that journals, such as the American Journal of Sociology, American Sociological Review, and Social Forces, published no articles on HIV/AIDS during the review period, and others such as Symbolic Interaction, Social Perspectives, and Qualitative Sociology published very few.
Even the health-related Journal of Health and Social Behavior published only 16 articles during the 14-year period of review. The British-based Sociology of Health and Illness fared better, with a total of 20 articles. Although not depicted in Figure 1, another British-based journal, Social Science and Medicine, had published 206 articles within the same period. However, Social Science and Medicine is an interdisciplinary publication, and its record on HIV/AIDS only serves to highlight the relative absence of articles on HIV/AIDS in the sociology journals. Whether this absence is due to lack of submissions or editorial disinterest is unclear. My inquiry to journal staff was unfruitful, with incomplete databases and editorial policy making this type of information unavailable for research purposes.
The ASA national meetings are also an important venue for sociological work on HIV/AIDS. Figure 2 offers an insight into the trends in AIDS-related work at these meetings. The total number of presentations in all sessions is shown in light shading over a 15-year period from 1986 to 2000. The darker shading at the top of each column represents the proportion of AIDS-related papers for each year. Few AIDS-related papers were presented at national meetings before 1986.
There are two trends of interest to sociologists in Figure 2. First, the number of papers on AIDS-related topics (for example, AIDS and drug use, AIDS care, HIV prevention, community activism) modestly increased from 1986 to 1994, and then began to decline. The percentage of contributions on HIV/AIDS stands at 5.5 percent of the total, after peaking at 10.7 percent in 1989. In contrast, the number of presentations in all categories has increased more than twofold over the review period.
When combined, the trends show more definitively the steady rise in all categories of presentations at ASA national meetings and the declining number of presentations for HIV/AIDS. This decline may be for disciplinary reasons, such as fewer submissions on HIV/AIDS, or it could be influenced by broader trends, such as the prevailing belief that HIV/AIDS is “treatable” or “curable,” and therefore of less concern to the general public. The comparison data of ASA presentations and sociology journals in Figure 3 show more definitively that interest in HIV/AIDS is waning, particularly in the reviewed journals.
These comparison data reveal parallel trends, such as increasing attention to HIV/AIDS during the late 1980s and early 1990s, then a modest decline during the late 1990s. Overall, there are more articles and paper presentations now than at the beginning of the review period, especially at ASA meetings. However, the recent decline in published work has occurred at a time when it may be more important than ever to present HIV/AIDS as a sociological issue. The structural dimensions of the epidemic are becoming more apparent, even as HIV/AIDS is being presented in media and popular discourse as a chronic social problem like crime, prostitution, or illicit drug use. The stigma, blame, and marginalization that are associated with HIV/AIDS are socially constructed phenomena that afflict people with AIDS and those who are at risk of HIV transmission. Increasingly, the AIDS epidemic is disproportionately afflicting minorities in the U.S., and the sociological perspective is important for social policy initiatives affecting this sector of the population.
The dearth of AIDS-related articles in the reviewed journals suggests that AIDS has never truly been perceived to be a sociological issue, and thus, sociologists writing about HIV/AIDS may feel compelled to publish in the interdisciplinary literature. The data presented here strongly suggest that sociology journals are not the best venue for work on HIV/AIDS. Unfortunately for the sociologists seeking to publish AIDS-related work outside the discipline, there are signs that HIV/AIDS may be losing ground in the interdisciplinary literature as well (Bloor, 1995).2
This review presents a challenge for the new millennium. The HIV/AIDS epidemic is not waning, but it should not be perceived to be an intractable problem beyond the realm of sociological analysis or intervention. Sociologists should therefore not be reactively bound by popular conceptualizations about AIDS as “intractable,” “chronic,” or “hopeless,” which makes the impact of HIV/AIDS easier to discount or dismiss. Instead, we, as sociologists, should be creating an independent epistemology of AIDS to explicate the macro-structural factors that shape the epidemiologic patterns of HIV/AIDS, and we should also seek to reframe popular discourse on HIV/AIDS to reflect sociological conceptualizations. This course of action would seem crucial if claims by sociologists about the social construction of disease and its representations are to be heeded. The sociology journals, in particular, could advance this agenda by actively fostering a scholarly interest in writing and publishing on HIV/AIDS. It may also be time for a new journal that addresses the sociology of HIV/AIDS and other emerging diseases with an epidemiologic locus in what is often referred to as “social context.”
For more information, contact: Bronwen Lichtenstein, PhD, Assistant Research Professor, Department of Sociology, 237 Ullman West,University of Alabama -Birmingham, 1212 University Boulevard, Birmingham, AL 35294-3350; e-mail firstname.lastname@example.org.
1The methods and data gathered for this analysis are available upon request from the author.
2Bloor, Michael. 1995. The Sociology of AIDS Transmission. London: Sage.