Culture and AIDS

Christopher C. Taylor

As AIDS continues to spread its way from one part of the world to another and from one sector of the U.S. population to another, it is becoming increasingly clear that societies are being forced to come to grips with two aspects of AIDS pathology, one which is directed toward AIDS the "disease" and another which is oriented toward AIDS the "illness. " This disease/illness distinction ( Kleinman, Eisenberg & Good, 1978: 251-52) differentiates between "disease," the biological and psychophysiological malfunctions occasioned by sickness,1 and "illness," the manner in which a specific sickness is experienced by the sufferer ( 1978: 251-52) and culturally labeled, explained, and valued ( Kleinman, 1980: 72). While biomedical practitioners generally concern themselves almost exclusively with the "disease" component of AIDS, it is apparent that for sufferers and society the "illness" component of AIDS is also important. AIDS as "illness" incorporates judgments about its meaning for sufferers and society, judgments that are culturally specific and receive expression through the medium of metaphor.

For example, we know that HIV suppresses the immune system, that in its later stages it invites "opportunistic infections," and that AIDS is almost always fatal; these are characteristics of the "disease," AIDS. However, many Americans fear and detest AIDS more for its perceived association with a "debauched" life-style, most notably, homosexuality and intravenous drug use, than for any direct health threat to themselves. The moral judgments leveled against gay men and IV drug users by certain segments of the American population have become part of AIDS as "illness," part of AIDS as a "social construct" (cf. Berger & Luckman, 1967). This construct, I maintain, has influenced the response that American health authorities have taken against AIDS as much as, if not more than, scientific thinking about the "disease" component of AIDS.

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