to the newest intravenous therapeutic drug, he does have to take on questions about whether, because a company has an antibiotic to test, he wants to endure more toxic side effects or to have his life prolonged in light of his progressing blindness. Where economic access is less the question, the deeper dimensions of the health care system's exploitation of illness are more apparent.


CONCLUSION

For gay and bisexual PWAs in New York City, class has become a major organizer of the illness experience. Reflecting a general theme of provision of assistance only to those who are of desperately low income, governmental programs are geared primarily to the needy AIDS population. Voluntary nonprofit and community-based services and programs are available to all, but used less by the professional with AIDS who relies mainly on informal networks of family and friends for care and support. For the professional, family support engenders a heightened emphasis on privacy which reinforces the trend away from utilization of community-based care and toward involvement with private home care agency services. This trend is underwritten by the professional's access to extensive major medical insurance coverage which makes him a sought-after market for the burgeoning home health care industry.

Reliance on informal supports and private care dramatically distinguishes the professional's experience of AIDS from that of the less affluent. For the latter, the objective course of the illness is reportedly locked in struggles around housing, public assistance bureaucracies, and actual access to medical care support services. The professional with AIDS is confronted with a different set of problems. Once presented with options by virtue of resources or insurance coverage, the emotional and social costs of continuing to live with AIDS become more apparent.

Class variation in the experience of AIDS such as that described here can be missed in focusing upon the "risk group." If we wish to understand the reality of AIDS so as to provide a more humane context for treatment and care for all, we may benefit from attending to the dynamics of the illness in relation to more culturally germane groups such as class, family, or ethnic group.


NOTES

An earlier version of this chapter was presented at the Annual Meeting of the Northeastern Anthropological Association in Albany, N.Y., March 1988. I wish to thank the staff of New York University Medical Center's Department of Social Work for their information and support. I am also grateful to Shellee Colen and Richard Blot for their editorial help. This chapter is dedicated to the memory of Robert Golden.

1.
"In-kind" services are concrete, nonmonetary forms of aid (e.g., free housing, free food, or specific services) granted to individuals in need.
2.
The definition of social services as comprising only formal-level services is an essentially sociological definition which fails to address the ideological and behavioral

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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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