Seth Kalichman, Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy
Seth Kalichman (University of Connecticut) contributes a groundbreaking analysis of the way some have denied the realities of AIDS. AIDS denial appears in different forms from different segments of the population. However, Kalichman’s most impressive accomplishment is to have globally understood the denial discourse. By doing so, he joins with other major scholars like Cindy Patton, Inventing AIDS, and Jacob Levenson, The Secret Epidemic: The Story of AIDS and Black America, in offering a political sociology of postmodern fragmentation, dislocation, and perils of struggles with life and death in the time of AIDS. The big lesson in this context is that decisions made in one geographic region and at a given time has consequences around the globe. Decisions affect others even when the global west makes decisions; they affect the developing global south.
Denying AIDS includes six chapters. Chapter 1 develops the persistence of the denial of science problem. In brief, there has been scientific history demonstrating that the Human Immunodeficiency Virus (HIV) is the cause of AIDS. In addition, science shows that exchange of bodily fluids transmits the virus. Moreover, social and behavioral sciences have determined HIV more likely transmits under conditions where the virus is prevalent, and where anal and vaginal sex and sharing hypodermic needles are prevalent. In spite of this, many commentators about AIDS claim that HIV is not the cause of AIDS and that the transmitting conditions are not determinative. For example, some have suggested that lifestyle and poor environmental conditions cause the body’s inability to resist disease. Others add to such claims by suggesting that a class of individuals have an economic incentive for demanding the HIV-as-cause narrative since those social strata gain profits from the AIDS services industry.
The annual number of registered deaths in South Africa rose by 87%, again this was during a time when poverty rates were declining. Among those aged 25–49 years, the rise in deaths was 169%. Although more people may have died simply because population growth was also occurring, population growth is not a plausible explanation for the greatest increase in deaths occurring among young people. In 1997, 25–49 year olds accounted for 30% of all deaths, whereas in 2005 42% of all deaths occurred in this age group. These population based statistics clearly support the corresponding HIV prevalence statistics and reflect HIV as the obvious cause of AIDS. (pp. 126–127)
Chapters 3–5 take a closer look at denialism in science, journalism, and politics. Chapter 6 presents Kalichaman’s prescription for combating denialism. He recommends that we all become dissidents rather than denialists. For him, “a dissident means listening to all sides and weighing the evidence” (p. 160). This recommendation may prove to be naïve. Kalichman understands this since in this chapter and his epilogue he admits denialism will not go away.
According to the 2000 census, blacks make up approximately 13% of the US population. However, in 2005, blacks accounted for 18,121 (49%) of the estimated 37,331 new HIV/AIDS diagnoses in the United States in the 33 states with long-term, confidential name-based HIV reporting. Of all black men living with HIV/AIDS, the primary transmission category was sexual contact with other men, followed by injection drug use and high-risk heterosexual contact. Of all black women living with HIV/AIDS, the primary transmission category was high-risk heterosexual contact, followed by injection drug use. Of the estimated 141 infants perinatally infected with HIV, 91 (65%) were black (CDC, HIV/AIDS Reporting System, unpublished data, December 2006). Of the estimated 18,849 people under the age of 25 whose diagnosis of HIV/AIDS was made during 2001–2004 in the 33 states with HIV reporting, 11,554 (61%) were black. (Centers for Disease Control and Prevention. Revised August 2008)
In addition, one CDC study reported that among young African American men who have sex with men, 46% are HIV infected (Centers for Disease Control and Prevention 2005). The evidence is clear that most of the incidence among African American males is in men who have sex with men. Among African American women, the most incidence is in those with injection drug use and abuse and heterosexual sexual partners. Nevertheless, the interesting thing is that the trend line for African American infection is on the increase and the trend line for Euro American infection is on the decrease.
Why then have so many decided to focus on infections in the developing world, the global south, while interest in U.S. infections decline? One answer to this question is that Kalichman’s analysis of HIV-related denials only scratches the surface. For example, there are two longstanding HIV-related denials. One is the denial of substantive differences among racial and ethnic groups that create different conditions for infections and require different prevention intervention strategies. Another is the denial that structural power over the governance of HIV/AIDS services industry could change; strategies to share HIV intervention prevention decision-making power with communities of color could easily find implementation.
The CDC has done a great deal of work on health disparities vis-à-vis HIV. For example, it diffused scientific based interventions. Among some of the leading interventions is SISTA (Sisters Informing Sisters about Topics on AIDS). The aim is to inform African American women about social-skills and it uses peer facilitators among highest risk groups to reduce their risky sexual behaviors. Another is Many Men, Many Voices (3MV), an STD/HIV prevention intervention for gay men of color. POL (Popular Opinion Leader), identifies, enlists, and trains key opinion leaders to encourage safer sexual norms and behaviors within their social networks. Most of these interventions are translations of ones that white gay males used when their populations were in crisis. While all of the scientific based interventions have shown experimental effectiveness, the overall incidence and prevalence continues to escalate among African Americans. In addition, practices associated with dominant group authorization of credentials before professionals join the conversation and influence decisions might preclude creative thought necessary for researchers to conceive of more prevention that is effective. Such exclusionary practices and denials would affect the spread of HIV among African Americans and Levenson chronicled some of this history in The Secret Epidemic (2004).
HIV researchers could make greater effort to diversify their institutes, centers, cores, and programs. Once they accomplish diversification, they could treat their minority colleagues with respect and deference. To do so, it would be necessary for them to seek diversity in thought among the minority colleagues. For example, they could seek scholars that hold terminal degrees in social and behavioral sciences who are also men who have sex with men and are HIV positive. These men likely know the terrain where HIV transmission happens among African Americans. Such scholars could bring a great deal to the table when it comes to denials. For example, they might caution scholars not to engage in name-calling. Moreover, they might stress the importance of avoiding condescending talk, particularly when they are members of a group that conquered the minority group where the spread is significant. Finally, they would likely ask research questions that members of exogenous communities and cultures might not typically consider.
Kalichman’s book is a major accomplishment. He points us in the direction where our work must go next. We must do as he recommends, confront our denials knowing that we will never conquer them. However, we are capable of implementing harm reduction structures that require our work is evidence-based knowledge. As far as AIDS is concerned, HIV causes it and under certain conditions, it spreads more than it does under other conditions.