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Aids has always been laden with political and emotional volatilities. The possibility of blood- or sex-based transmission combined with its first emergence among marginalised and criminalised populations created a potent mix of primal terror and terrifying prejudice.
It can sometimes be difficult to remember just how potently misinformation, fear and outright hostility framed the knowledge and experience of Aids in the first decade or so of the pandemic. In this period, a positive result on an HIV test was a terminal diagnosis and medical knowledge about transmission and treatment was still cloudy.
In Australia in the 1980s it was an easy slide from epidemiological concentration among gay men, sex workers and IV drug users to moralising approbation and discrimination. Some parliamentarians and church leaders in Australia even suggested the forced imprisonment of anyone who tested positive for HIV.
Today in Africa shame and morality combine in a different way. More than half the global population of those living with HIV and Aids are found in southern and central Africa, where prevalence among adults in some countries is more than 10%. Here, transmission is primarily heterosexual, and it is the gap between assumptions of monogamy and the gendered realities of sexual practice that pose the biggest public health challenge. It is the most sexually vulnerable, then, in whom rates of transmission are growing most troublingly – namely among younger women.
Public health experts across the world knew it would be difficult to overcome the potent forces of shame, stigma and fear that textured the response to Aids. That is why public information officers at the World Health Organization invented World Aids Day on 1 December in 1988. They hoped it would become a powerful weapon in the fight against Aids and misinformation.
Within queer communities, World Aids Day has always served a memorialising and politicising purpose as well. Already in 1988, only six years after Australia’s first diagnosis of what had initially been described as “Grid” (gay-related immune disorder), various kinds of memorial practices were evolving to make sense of increasing loss on queer terms as well as act as a pressure point to shape health policy.
In Sydney that year, World Aids Day was transformed into a moment when those most affected by the existential threats could reckon with the memories, histories, present and future of the pandemic in ways that made sense to them.
In the afternoon, activists, affected communities, government leaders, bureaucrats, health workers and carers came together to display the Australian Aids quilt for the first time. During the proceedings, the Rev Jim Dykes read the names, one by one, of the lives commemorated on its panels.
That the Aids quilt was sometimes wryly described as the “doona of death” reminds us that a queer sense of irony remained a crucial dimension in lived experience of Aids, even if those jokes sometimes strained at the edges of comfort.
Later that evening, a larger gathering came together in Martin Place for a rally that was simultaneously an activist demand for government funding, a marker of thanks to an army of volunteer carers and workers, and a memorial to lives already lost. The following weekend, a smattering of social functions and club nights raised money for carer organisations, including at a party for the care workers themselves, many of whom were already exhibiting signs of carer fatigue.
The evening rally would evolve in the coming years into an event that brought together close to 10,000 people in the Domain. Reciting the names of those who had died became the emotional anchor of the proceedings. Community leaders remember both steeling themselves to read those names into the microphone and being left with a profound sense of the beauty and warmth of its effects.
That this recitation took longer and longer as the 1990s unfolded was a brutal reminder that the tidal wave of Aids was decimating queer communities. Gay men in the mid-1990s described losing partners and friends in such concentration that their entire social and intimate world seemed to disappear. One man I interviewed recently described walking down a street in Darlinghurst in 1996 and realising that in every house he walked past, he knew someone who had died.
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In Australia the worst of the Aids crisis was brought under control, first by the incredible success of safe-sex campaigns and the provision of needle exchanges and then, in 1996, because the emergence of “combination therapies” transformed HIV/Aids from a terminal to a chronic diagnosis.
While comparable national contexts such as the US and Britain faced rising rates of HIV and Aids diagnosis well into the 1990s, the peak in Australia occurred in 1988 followed by a sharp decline.
The only possible explanation for this is the remarkable success of safe-sex campaigns that were spearheaded and designed by activists and supported by state and commonwealth governments, sometimes quietly, that were convinced by the case that moralising about sex would not prevent transmission.
Researchers now describe the “Australian response” to Aids as both a historical phenomenon and a public health model to be followed. Its success was remarkable.
There is a lot to celebrate in the history of our national model, not least because it is such a powerful example of how a public health catastrophe can be managed and ameliorated when government policy and funding is informed by community knowledge and expertise.
There is also, however, a heartbreaking historical irony in this Australian story.
The success meant that, in historical and epidemiological terms, HIV/Aids remained remarkably concentrated. In the late 1990s, between 80% and 90% of all recorded HIV/Aids diagnoses in Australia were among men who had sex with men.
That most gay men started wearing condoms by the mid-1980s in Australia meant that all Australians were protected from the worst possibilities of the pandemic. The government did not need to quarantine gay men: their own sexual practices ensured that the consequences of HIV/Aids would remain contained.
We have now learned to describe HIV/Aids as a pandemic because of its global circulation. But the impacts of this circulation have been uneven. The HIV/Aids pandemic has, perhaps, always been experienced and unfolded as a set of interconnected “epidemics” shaped by national and local conditions.
The consequences of HIV/Aids have been and will continue to be made by the agency of humans who confronted it, as well as the choices of those in positions of authority and capacity to do something about it.
