African Kaposi’s Sarcoma in the Light of Global AIDS: Antiblackness and Viral Visibility

Abstract

Drawing on the theoretical frameworks of antiblackness and intersectionality and the concept of viral visibility, this essay attends to the considerable archive of research about endemic Kaposi’s sarcoma (KS) in sub-Saharan Africa accrued during the mid-20th century. This body of data was inexplicably overlooked in Western research into KS during the first decade of the AIDS epidemic, during which period European and Mediterranean KS cases were most often cited as precedents despite the volume of African data available. This paper returns to the research on KS conducted in Africa during the colonial and postcolonial period to consider visibility, racial erasure, and discourses of global epidemiology, suggesting that the dynamics of medical research on HIV/AIDS have proceeded according to a tacit paradigm of antiblackness manifest in multiple exclusions of Africa from global health agendas—most recently the exclusion of the region from antiretroviral (ARV) drug therapy during the first decades of the treatment’s availability. During that decade KS all but disappeared among people with access to ARV therapy while KS became even more prevalent in sub-Saharan Africa, escalating along with HIV.

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Notes

  1. 1.

    For a critique of therapeutic optimism in the West and in the context of promoting pre-exposure prophylaxis in Africa, see Patton and Kim (2012).

  2. 2.

    The term “signature condition” appears throughout the history of writing on AIDS/HIV. For an example of its use to describe KS, see “People Dying From a Disease They Didn’t Have: The CDC Revises the Case Definition of AIDS, January 1, 1993” (Body Positive 2001).

  3. 3.

    We do not have space to describe in detail the complex, changing, and contradictory classification of KS after 1981. On this matter, see the thorough analysis provided in Preda (2005).

  4. 4.

    On the issue of the appearance of KS in gay men in the 1980s U.S. context, see Altman (1981) and Fannin (1982). On KSHV research and discovery, see Chang et al. (1994) and Altman (1994).

  5. 5.

    A substantial scholarly literature is devoted to the interpretation of visualization as a means of knowing and experiencing health and illness. See, for example, Cartwright (1995, 2013), Ostherr (2005, 2013), and Serlin (2010).

  6. 6.

    One system for classifying KS identifies subtypes as classic, endemic or African, immunosuppression- or transplant-associated, and epidemic or AIDS-associated (Wahman et al. 1991; Antman and Chang 2000; Tschachler 2011).

  7. 7.

    On disruptive negativity, see Michelle Boulous Walker (2002) interpretation of Julia Kristeva’s use of Sigmund Freud’s concept of negation. Walker emphasizes that negation, understood as a semiotic process, is linked to expulsion and rejection and is always embodied. For Kristeva, Walker explains, “negativity (or rejection) is a somatic process which is both heterogeneous to and constitutive of the symbolic” (Walker 2002, 106). The semiotic inhabits language, and is always articulated through the body (Walker 2002). See also Edelman (2004) on disruptive queer negativity.

  8. 8.

    Mosam et al. state: “[T]he incidence of Kaposi’s sarcoma has increased exponentially with the HIV/AIDS pandemic with a shift in trend demonstrating a dramatic increase in females and occurrence in younger individuals. Kaposi’s sarcoma specific therapy is underutilized due to poor access to highly active antiretroviral therapy and financial constraints in SSA [sub-Saharan Africa]” (Mosam, Aboobaker, and Shaik 2010, 119).

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Correspondence to Pawan Singh.

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Singh, P., Cartwright, L. & Visperas, C. African Kaposi’s Sarcoma in the Light of Global AIDS: Antiblackness and Viral Visibility. Bioethical Inquiry 11, 467–478 (2014). https://doi.org/10.1007/s11673-014-9577-5

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Keywords

  • Kaposi’s sarcoma
  • HIV
  • Africa
  • Viral visibility
  • Viral intersectionality
  • Antiblackness