The Political Economy of AIDS

Merrill Singer

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351841115
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Features a collection of seven research-based articles on AIDS. This work seeks to cut through popular misunderstanding and conventional ideas about the spread and impact of AIDS by employing a political economic perspective in the analysis of the epidemic in diverse settings.

SECTION II

Gender, Ethnicity and Class in AIDS Risk in the Inner-City

CHAPTER 3

Articulating Personal Experience and Political Economy in the AIDS Epidemic: The Case of Carlos Torres

Merrill Singer

Carlos Torres (pseudonym), a twenty-eight-year-old Puerto Rican injection drug user, is struggling to overcome his drug habit, struggling to “get his life together,” struggling to be supportive to his wife who is in jail on drug charges and his children who are living with her parents in Puerto Rico, and, in addition to these daunting challenges, he is struggling to come to terms with the fact that he recently tested positive for exposure to the human immunodeficiency virus. Carlos is scared and confused and, like many people with HIV disease, desperate for understanding and for reprieve. Using narrative material from life history interviewing with Carlos as part of Project COPE¹ in Hartford, Connecticut, this chapter locates his troubled life and experience within the encompassing contexts of the working class Puerto Rican community in the United States, the street drug scene, the health crisis of the urban poor, and the encompassing American socioeconomic structure. The objective of this chapter is to explore the intersection of individual biography and political economy, the critical link that unites the innermost experiences of the individual with the widest kinds of social-historical phenomena.

Approaching the AIDS epidemic from this vantage is an extension of the insight of C. Wright Mills that “Neither the life of an individual nor the history of a society can be understood without understanding both” [1, p. 1]. Examining an individual case within the context of contemporary history and social structure, it is argued here, serves as one means of bridging the micro-macro dilemma that has emerged as a fundamental problem in the contemporary health social sciences [2, 3]. As DeWalt and Pelto emphasize, “articulating the linkages between microlevels and macrolevels” has become “among the most vexing issues in social science research” while at the same time being “a most promising area for current research and theory building” [4, p. 1]. The approach to micro-macro problem offered in this chapter provides a means of repersonalizing the subject matter and the content of the social science of health research by focusing on “the particular, the existential, the subjective content of … suffering” as both lived event and experience [5, p. 137], while, at the same time, not submerging the strong conditioning impact of class, gender, and ethnic relationships on human life and experience.

There is a great need for this kind of unified micro-macro focus in behavioral AIDS research, especially there is need for an approach that recognizes that not only is the personal political but that the political is personal as well. Unfortunately, too often in social science of AIDS research discourse remains frozen at the abstract and impersonal level. As HIV/AIDS spreads through a population and as the statistics begin piling up, there is a regrettable tendency to lose sight of the real people behind the mounting numbers. Unless AIDS strikes home and is diagnosed in a family member, friend, or acquaintance, it is possible to go on believing that AIDS is a distant shadow, one that does not befall “people like us.” Attitudes like this have been found even among people who engage in very high risk behavior, such as injection drug users. As Mayes comments with reference to difficulties she encountered after publishing a novel about a middle-class woman with AIDS:

The critics … were not interested in reading about the downfall of an attractive, successful professional, probably much like them. People who spread or had AIDS could not be viewed as like them [6, p. 84].

This kind of distancing allows the individual to avoid thinking about the people who die of AIDS or suffer with its painful symptoms. And it allows risk behavior to continue in the face of a lethal epidemic.

In response, one of the missions of what has come to be called the “AIDS community”—the set of people whose lives and behaviors have been significantly affected by the disease—has been to make sure they avoid burying the names, the distinctive life stories, and the poignant social memories of all of the individuals who die of AIDS. The Names Project, for example, created a giant AIDS quilt with hundreds of panels, each devoted to the unique memory of a single person who died of AIDS, for this precise purpose. Efforts like this are designed to keep a human face on the AIDS crisis, to never forget that AIDS kills people not numbers.

Farmer has suggested, “One way to avoid losing sight of the humanity of those with AIDS is to focus on the experience and insights of those who are afflicted” [7, p. 262]. Sufferer experience, an arena long neglected in the social science of health, increasingly has become a topic of research interest in recent years. But there are alternative ways of presenting and analyzing sufferer experience, including those that do not go far beyond the individual level. Scheper-Hughes, for example, has argued that in the AIDS epidemic the primary job of the social scientist is to be a “clerk of the records,” carefully recording but never interpreting or analyzing the lives of people with AIDS [8]. The objective is to become “a minor historian of the ordinary lives of people often presumed to have no history” [9, p. 419]. Sufferer experience, in this approach, is recorded in order to maintain an account of the human cost of AIDS [10].

By contrast, from the perspective presented in this chapter, sufferer experience is treated as a social product, one that is constructed and reconstructed in the action arena between socially constituted categories of meaning and the political-economic forces that shape the contexts of daily life. Recognizing the powerful role of such forces, however, does not imply that individuals are passive or lack the agency to initiate change, and it certainly does not mean that they are insignificant or faceless. Instead, it means that people respond to the material conditions they encounter in terms of the set of possibilities created by the existing configuration of social relations and social conditions. Within this framework it is possible to remain sensitive to the individual level of experience and necessary to do so if we are ever to create a more humane health care system and more humane lives for all people.

Thus, in attempting to understand Carlo’s reaction to and experience of AIDS, I begin with the difficult health and social conditions that have defined an important aspect of Puerto Rican life in the United States.

PUERTO RICANS, POVERTY, AND AIDS

Carlos’ life as a Puerto Rican man in the United States, as a drug injector, and as a sufferer of HIV disease is fully comprehensible only in terms of the wider context of these “personal” descriptors. By 1985, there were 2.6 million Puerto Ricans living in the United States, about one-third of the total Puerto Rican population [11]. Labor migrants, Puerto Ricans constitute an important section of the post-World War II new working class created to fill a demand for low-wage unskilled labor. In Wolf’s terms, the ingathering of this multinational work force on U.S. soil reflects “the general tendency of the capitalist mode to create a ‘disposable mass’ of laborers out of diverse populations, and to then throw that mass into the breach to meet the changing need of capital” [12, pp. 379–380].

Throughout its history, Wolf adds, the capitalist mode has exercised labor control through ethnic segmentation, allocating “different categories of workers to rungs on the scale of labor markets, relegating the stigmatized populations to the lower levels and insulating the higher echelons from competition from below” [12, p. 380]. Puerto Ricans are one group that consistently has been relegated to the bottom labor markets, and they are characterized by all of the expressions of social distress and suffering that goes along with occupying this rung in the U.S. social hierarchy. A review of the sociodemographic characteristics of U.S. Puerto Ricans reveals that they comprise one of the youngest and fastest growing ethnic subgroups in the country. Additionally, they are “more likely than non-Hispanics to drop out of school, be unemployed, and live in poverty” [13, p. 1]. As of 1987, only 53.8 percent of Puerto Ricans twenty-five years of age and older were high school graduates, compared to 63.4 percent of African Americans, and 77 percent of Whites [14]. Also in 1987, a time during which the national unemployment rate stood at 7 percent, the rate for Puerto Rican men was over 12 percent. While almost 10 percent of all non-Latino families in the United States live in poverty, among Puerto Ricans this figure stands at 38 percent [14]. Related to this is the fact that 30 percent or more of Latino twelve- to seventeen-year-olds live in single parent households, most of which are headed by women. Fifty-two percent of all Latino female-headed households live below the poverty line (compared to 27 percent of white female-headed households), while among Puerto Ricans this figure is 63 percent. Bean and Tienda conclude, “Puerto Ricans exhibit the least socioeconomic success of all of the groups, as well as many of the sorts of demographic behavior that are often associated with economic disadvantage” [15, p. 400]. In no small way, it is the personal misery and alienation produced by this disadvantage, combined with the insulting colonial status of Puerto Rico, that underlies a disproportionate level of involvement in injection drug use by Puerto Ricans. And it is this frequency of involvement with injected drugs that has fueled the AIDS epidemic among U.S Puerto Ricans, most of whom are concentrated in high infection areas of the Northeast [16].

Hartford, Connecticut, Carlos’ adopted home, exemplifies the contemporary situation for most Puerto Ricans living in the United States. While Puerto Rican migrants to the United States initially headed to New York City, and helped to create the largest concentration of Puerto Ricans away from the Island, by the 1980s the majority of U.S. Puerto Ricans lived outside of New York City. Increasingly, Puerto Rican migrants, most of whom are displaced workers who “could not be integrated into the capital-intensive industrializing economy of Puerto Rico” [17, p. 200] have moved to other U.S. cities, large and small, in an effort to find jobs and a decent place to live. As Backstrand and Schensul indicate,

Reflecting this national trend, Connecticut has experienced a 481 percent increase in the number of Puerto Rican residents since 1960s, 230 percent between 1970 and 1980…. Paralleling the state as a whole, Hartford’s Puerto Rican population has grown rapidly: 400–500 percent since the 1960s, and doubling between 1970 and 1980 [18, p. 10].

Between 1980 and 1990, there was another 58 percent increase in the Puerto Rican population of Hartford, producing a city population that is now approximately one-third Puerto Rican. The initial attractant to Hartford was the tobacco fields that lie north of the city, a place that is well suited to growing the outer layers of certain kinds of cigars. Not uncommonly these fields have been owned and operated by the same companies that produce tobacco and employ agricultural workers in Puerto Rico. However, the tobacco industry can absorb only a limited number of workers and many Puerto Ricans who migrated to the city to be with loved ones and find better paying jobs quickly turned from agricultural to industrial employment. Unfortunately, Puerto Ricans began moving to Hartford in large numbers just as the booming industrial era was coming to a close. Throughout the region metal, machinery, textile, weapons, and other factories were shutting down or moving South, laying off workers in waves as one field of production after the other fell victim to the changing needs of capital. While the city still retained its standing as an insurance and banking center, not many jobs were available in these industries for unskilled Puerto Rican workers with limited formal education.

With the collapse of its industrial base, the outmigration of skilled workers, and the substitution of unskilled workers from the South and the Caribbean, Hartford was transformed. Today, Hartford is the fourth poorest moderate-size city in the country. It has the fourth highest per capita crime rate in the nation, with drug-related activity accounting for 80 percent of all city crimes. Over 25 percent of households in the city have incomes below the poverty level and over 30 percent are on welfare. Fifty percent of high school students live in single-parent households under the pov...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• SECTION I: UNDERSTANDING EPIDEMICS IN POLITICAL ECONOMIC CONTEXT
• SECTION II: GENDER, ETHNICITY AND CLASS IN AIDS RISK IN THE INNER-CITY
• SECTION III: THE STRUGGLE FOR CARE AMONG PEOPLE WITH HIV/AIDS
• SECTION IV: AIDS IN THE THIRD WORLD
• Conclusion
• Contributors
• Name Index
• Topic Index