The Behavioral Aspects of AIDS: An International Perspective
Peter G. Bourne Department of Psychiatry St. Georges Medical School, Grenada President, American Association for World Health
From the days when an infective agent was first suspected as being the causative factor in the sudden appearance of Kaposi's sarcoma and Pneumocystis carinii pneumonia, our thinking has been dominated by historical concepts based on our past experience with infectious epidemics. Smallpox, measles, and typhoid rushed to mind as comparable earlier examples of what we faced in dealing with the human immune deficiency virus. With the early conceptual thinking dominated by immunologists, virologists, and medical epidemiologists, the nature of the virus and the hunt for a vaccine that could be made universally available skewed the dialogue and became the central focus both for trying to understand the epidemic and in defining the shape of our response. Such thinking was also highly consistent with our cultural tendency to look for quick technological solutions to any problem confronting modern society. That the disease should have emerged first in this country among homosexuals caused speculation, no matter how irrational it may now seem, that this group might have some particular susceptibility to the virus rather than suggesting that we might be learning something fundamental about the behavioral ecology of the disease in a larger human context.
Now we are finally beginning to understand that the AIDS epidemic is not like bubonic plague spreading willy-nilly through the population as a whole. Rather, it is far better understood from the perspective of a behavioral model than an infectious disease model. It is also clear that, at least for the moment, a thorough understanding of such a behavioral paradigm offers the best basis for a strategy to control the epidemic. This becomes particularly clear if one looks at the disease on a global basis, examining both the demographic and the social patterns of who became involved as it has emerged in different countries.