and female conjugal infidelity were the primary reasons for the spread of AIDS, he maintained, and should be strictly discouraged. It did not seem to occur to him that men frequent female prostitutes, nor that more often Rwandan men are unfaithful to their wives than vice versa. My point is not so much that the commentator was wrong in laying the blame for AIDS upon women, as much as that he was relying upon an old cultural attitude concerning the nature of female sexuality to explain a new problem. Despite the newness of the "disease" of AIDS, the "illness" of AIDS has been, in part, culturally prefabricated. Hence, as in the poster described earlier in this chapter, an infected woman is chasing a reluctant man.


CONCLUSION

Societies around the world with a high HIV seroprevalence have tended to construct illness metaphors about the sickness in very specific ways. These metaphors often strike more at emotionality than at rationality, but they can be understood by looking closely at the society's history and culture. Illness metaphors draw social and moral boundaries between the imagined states of civility and disorder. They describe both the disruptive forces societies fear from outside their borders, as well as the subversive forces societies fear from within. Furthermore, these illness metaphors influence the course of action that social systems take to combat disease, for whether a society responds attentively or with indifference to a disease depends in large part upon its perception of the status of those who suffer from it. In some instances these metaphors become part of the problem, part of the pathogenic process associated with disease. Responsible health policy thus entails curing society of its "illnesses," as well as of its "diseases."

While it seems useful to denounce the process of constructing potentially harmful illness metaphors as Sontag ( 1977) has done, it is also naive. The process of attributing social and moral values to the largely fortuitous occurrence of contracting disease is probably an inevitable corollary to social existence. Instead, an attempt must be made to understand the specific cultural logic that underlies these metaphors. Even if metaphoric elaboration cannot be avoided with certain sicknesses, we should remember that metaphors can be changed, and that hopefully, we can discourage the tendency to blame our diseases on scapegoats. While no effort should be spared in attempting to understand AIDS as a "disease," we also need to comprehend AIDS as an "illness," and this means attempting to understand society and culture.


NOTE
1.
The term "sickness" will be used throughout this chapter whenever it is unnecessary to rigorously distinguish between "disease" and "illness."

-64-

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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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