Finally, the imputing of personal responsibility for their condition to persons with AIDS may be just an especially dramatic example of a trend that began many decades ago in American medical culture. The publication of the Flexner Report in 1910 is generally viewed as a watershed event in the organization and ideology of American medicine. The establishment of scientific medicine with its focus on the individual both in treatment and in research "had the effect of making the individual responsible for his or her own health, and, in effect, of taking this responsibility away from society" ( Berliner 1975: 577). Contemporary concerns over the costs of health care have given rise to a modern version of prevention, one which emphasizes the deleterious effects of individual "lifestyles." John Knowles, the late president of the Rockefeller Foundation, made the point quite directly:

[C]ontrol of the present major health problems in the United States depends directly on modification of the individual's behavior and habit of living. . . . I believe the idea of a 'right' to health should be replaced by the idea of an individual moral obligation to preserve one's own health--a public duty if you will. The individual then has the "right" to expect help with information, accessible services of good quality, and minimal financial barriers. ( 1977:59,61)

This perspective is an ideological foundation for denying individuals who engage in risky behavior access to "good quality" health care services and even to health information. The advocates of individual responsibility seem uninterested in the complexities of individual motivation or the role of cultural conditioning in the shaping of behavior. They seem to assume a uniformly high degree of autonomous individual control over one's life circumstances, denying the relevance of gender, social class, or racial caste in determining the parameters of individual choice. The very term "life-style" has the connotation of free consumer choice, perhaps in keeping with an implicit emphasis on health as a marketplace commodity. If this ideological trend continues to gain credence in American culture, the sick role will become increasingly irrelevant and may be replaced with a very different configuration, something we might call the "at-risk" role. This change in the way Americans perceive and respond to illness will not be confined to persons with AIDS.


NOTES
1.
In terms of our interests, it is worth noting that the necessity to isolate the deviant implies the danger of contagion.
2.
Throughout this chapter the term "normal" is used in the social psychological sense of that which is culturally prescribed and expected. Thus, "normal" connotes both the dominant values of the society and the most frequent behavior. In no case is "normal" meant to connote "natural" or "universally good."
3.
Although in the strictest sense "monogamy" is a form of single-partner marriage,

-42-

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Culture and AIDS
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Chapter One - Introduction: Culture and Aids 1
  • Chapter Two - Aids in Cultural, Historic, and Epidemiologic Context 9
  • Notes 23
  • References 24
  • Chapter Three - the Sick Role, Stigma, and Pollution: the Case of Aids 29
  • Notes 42
  • References 43
  • Chapter Four - Assessing Viral, Parasitic, and Sociocultural Cofactors Affecting Hiv-1 Transmission in Rwanda 45
  • Note 51
  • References 51
  • Chapter Five - Aids and the Pathogenesis of Metaphor 55
  • Note 64
  • References 65
  • Chapter Six - Aids and Accusation: Haiti, Haitians, and the Geography of Blame 67
  • Notes 88
  • References 89
  • Chapter Seven - Prostitute Women and the Ideology of Work in London 93
  • Notes 108
  • References 109
  • Chapter Eight Minority Women and Aids: Culture, Race, and Gender 111
  • Notes 128
  • References 131
  • Chapter Nine Language and Aids 137
  • Notes 157
  • References 158
  • Chapter Ten Aids and Obituaries: the Perpetuation of Stigma in the Press 159
  • References 168
  • Chapter Eleven Sex, Politics, and Guilt: A Study of Homophobia and the Aids Phenomenon 169
  • Note 181
  • References 181
  • Chapter Twelve Increasing the Cost of Living: Class and Exploitation in the Delivery of Social Services to Persons with Aids 183
  • Notes 198
  • References 201
  • Chapter Thirteen Postscript: Anthropology and Aids 205
  • Note 208
  • References 208
  • Index 209
  • ABOUT THE EDITOR AND CONTRIBUTORS 215
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