Transcript SamFriedman - Sociologists AIDS Network

What We’ve Done, Where We’re Going: The
History & Future of HIV/AIDS and its
Sociology
Sam Friedman
I would like to acknowledge
• NIDA projects:
– R01 DA DA019383-01A1 Staying Safe: Long-term IDUs who
have avoided HIV & HCV
– P30 DA11041 (Center for Drug Use and HIV Research;
Sherry Deren PI)
– R01 DA13336 (Community Vulnerability and Response to
IDU-Related HIV project)
– R01 DA13128 (Networks, norms & HIV risk among youth)
– R01 DA006723 Social Factors and HIV Risk
– R01 DA03574 (Risk Factors for AIDS among Intravenous
Drug Users ; DC Des Jarlais, PI)
• Hundreds of participants in these studies
• Colleagues and participants who have died of
HIV/AIDS and hepatitis C
• Many collaborators and co-authors
What we have done
• Early prevention work by sociologists with drug users
included Wayne Wiebel’s indigenous leader outreach
model; my work on organizing drug users against
HIV/AIDS; and San Francisco CHOW. ALL of these have
guided a lot of subsequent work in various countries
• MUCH sociological work has focused on supra-individual
levels of analysis and structural interventions
(Blankenship; Rhodes)—though I am not sure this was
fully represented earlier today.
• Work on risk networks and how HIV is transmitted. Martina
Morris, Alan Neaigus, and I have been deeply involved.
• Comparative studies of MSAs in the CVAR project; and
Ricky Bluthentahl and his colleagues have compared SEP
programs, behaviors and infection in a number of
California localities.
• Other important work has been done by many
sociologists in this room and elsewhere. Some
of these sociologists work in difficult
circumstances without public or professional
recognition.
• This relative lack of recognition is in part due to
the overwhelmingly individualistic/medical
focus of the AIDS research field.
HIV risk is a conditional probability
The probability is socially structured
+, on HAART
-
HIV Negative
Unknown, but GC+ and HSV-2+
NI Heroin or Cocaine; blue=other) by Link Type (sex=yellow line, IDU=red, sex and IDU=blue)
Friedman, Samuel R; Bolyard, Melissa; Khan, Maria; Maslow, Carey; Sandoval, Milagros; Mateu-Gelabert, Pedro; Krauss, Beatrice; Aral, Sevgi O. (2008). Group Sex Events and HIV/STI Risk in an Urban Network. J Acq Immun
Syn.49(4):440-446
Big Events research: Why do some transitions
lead to HIV epidemics and others not?
Diagram published in: Friedman, Samuel R; Rossi, Diana; Braine, Naomi. (2009). Theorizing “Big Events” as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks.
International Journal on Drug Policy 20:283-291
Sex and drug networks and behaviors may include Quasi-anonymous
risk nodes like group sex events or shooting galleries
Responses to what sociologists
have done
• Policy remains relentlessly behaviorally and medically
focused.
• In the first 6 of the NIDA NADR outreach projects, supraindividual projects (Wiebel, San Francisco CHOWs, my
organizing) led the way. But the behavioralists won the
internal battles in NIDA, and by the second and third waves
of grants later in the year, the behavioral-counseling
individual randomized control model won out.
• Similar patterns have happened at NIMH and CDC.
• And increasingly the focus in Washington, Atlanta and
internationally is on “bio-behavioral intervention” like
testing, microbicides, circumcision and vaccines—with
social and even behavioral sciences useful mainly as
adjuncts to them.
What is to be done? Thoughts on research topics (1)
• Studies of dialectics of policy formation
• Comparative longitudinal studies of epidemics and of
responses:
– a Community Vulnerability and Response study of MSM epidemics
in US cities
– Comparative studies of Big Events
• Most research on gender and HIV has been too social
psychological, dyadic, behavioral or interpretive. Too little
has looked at issues like how the strength of feminist
movements and/or the relative exploitation of men and
women affect local or national epidemics and responses.
• How do community structures, processes, policies, and
human agency affect the prevalence of kinds of “risk
environments” (Tim Rhodes) like group sex and injection
events, what people do in them, and how participants can
protect themselves.
What is to be done? Thoughts on research topics (2)
• Studies of socially-created categories of high-risk
people or events that are missed by surveillance
categories defined by behavioral epidemiology:
– Non-injecting drug users are likely a very large percent
of “heterosexual transmission cases”
– Many of the rest are women who have sex with women
and also with MSM or male IDUs or NIDUs.
• Race, racism and HIV: “Disparities research” has
not taken advantage of the rich knowledge
developed by sociology. See the next slide from
Friedman, Cooper & Osborne (2009, AJPH) as but
one example of how sociology might broaden
research on the epidemic among African
Americans.
Relationships among racialized social structures and processes and HIV-relevant cultural
themes, subcultures, networks and behaviors among African Americans
Friedman, S.R.; Cooper, H.L.F.; Osborne, A. (2009). Structural and social contexts of HIV risk among African-Americans. American Journal of Public Health. 99: 1002-1008, 10.2105/AJPH.2008.140327
What kind of sociology?
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Material reality is obviously important.
So are subjective ideas and social-physical practice.
Marxism seems well-suited for such analyses and action
Looming issues it points to now include the politics of hard
times:
– Making do in spite of cutbacks
– Fighting back successfully against cutbacks
– “Divide & Rule” strategies by capitalists, their media
and the State—and their implications for increasing
stigmatization and repression, and revivals of racism,
sexism and attacks on workers.
– Social movements of hard times—and new forms and
organizations of struggle
– And how and when drug users, gay men, women, and
people in Africa, East Europe, Asia and Latin America
can combine their struggles with these upcoming social
movements
Final thoughts
• Why has sociology been so weak in the politics of
HIV/AIDS? I would start with the general failure of the Left
in the 80s and since, which was based on and contributed
to weak movements
• This was reflected in the individualist focus of “scientific
thought” and of most HIV prevention and even care.
• In sociology, this led to a focus on risk behaviors, on forms
of symbolic interactionism disassociated from its “natural”
relation to Marxism, and on post-modernist and cultural
turns.
• These turned sociology away from a dialectical focus on
the interaction of social processes, the virus, and the
epidemic--and weakened community responses.
• This may have been less true for IDU studies and action,
but has been strong there too.
• My work has been cited by some as a model. Please be
aware that it is based on a Marxist dialectics of the real.