AIDS: The Making of a Chronic Disease - Softcover

Fee, Elizabeth; Fox, Daniel M.

Softcover

ISBN 10: 0520077784 ISBN 13: 9780520077782

Verlag: University of California Press, 1991

Inhaltsangabe

When AIDS was first recognized in 1981, most experts believed that it was a plague, a virulent unexpected disease. They thought AIDS, as a plague, would resemble the great epidemics of the past: it would be devastating but would soon subside, perhaps never to return. By the middle 1980s, however, it became increasingly clear that AIDS was a chronic infection, not a classic plague.

In this follow-up to AIDS: The Burdens of History, editors Elizabeth Fee and Daniel M. Fox present essays that describe how AIDS has come to be regarded as a chronic disease. Representing diverse fields and professions, the twenty-three contributors to this work use historical methods to analyze politics and public policy, human rights issues, and the changing populations with HIV infection. They examine the federal government's testing of drugs for cancer and HIV, and show how the policy makers' choice of a specific historical model (chronic disease versus plague) affected their decisions. A powerful photo essay reveals the strengths of women from various backgrounds and lifestyles who are coping with HIV. A sensitive account of the complex relationships of the gay community to AIDS is included. Finally, several contributors provide a sampling of international perspectives on the impact of AIDS in other nations.

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Über die Autorin bzw. den Autor

Elizabeth Fee is Associate Professor of Health Policy and Management at the School of Public Health at The Johns Hopkins University in Maryland. Daniel M. Fox is President of the Milbank Memorial Fund and Professor of Social Sciences in Medicine at the State University of New York, Stonybrook.

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Now, a decade after AIDS was first recognized, there is increasing evidence that analogies to the past can be misleading, as they usually are in the history of war or economics or anything else. In this essay we summarize and criticize the brief historiography of the epidemic and suggest research questions and methods that may lead to more valid and useful historical writing. We then introduce the essays in this volume, essays that lead us in the directions we have proposed as both necessary and useful. - from the Introduction.

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AIDS

The Making of a Chronic DiseaseBy Elizabeth Fee

University of California Press

Copyright © 1991 Elizabeth Fee
All right reserved.
ISBN: 9780520077782
Introduction: AIDS, Public Policy, and Historical Inquiry
Elizabeth Fee and Daniel M. Fox

Acquired Immune Deficiency Syndrome—AIDS—has stimulated more interest in history than any other disease of modern times. Since the epidemic was first identified in 1981, scientists, physicians, public officials, and journalists have frequently raised historical questions. Most often these questions have been about contemporary social and epidemiological history: Why did the disease emerge when and where it did? How has it spread among members of particular groups? Others have asked how societies have responded to epidemics in the past, and still others have questioned how the past will affect the future: What does the history of medical science and public health in this century suggest about our ability to control the epidemic and eventually to cure the disease?

These urgent historical questions are being asked at a time when the study of history often appears less relevant to public affairs than it did in the past. For more than a generation, men and women who rely primarily on historical methods have been losing influence as educators and as advisors to public officials. Practitioners of historical methods once dominated the social sciences. Historical inquiry was also essential for the study of epidemiology and public health. In recent decades, however, historical methods have become subordinate to experimentalism and model building in university curricula for the social sciences and public health and in the priorities of most of the organizations that sponsor research in the hope of ameliorating social problems. Some historians have helped create this situation by insisting on professional detachment, but, in fact, most people who use historical methods have had little choice but to do research for its own sake, whether their discipline is history itself, sociology, economics, political science, literary studies, or epidemiology. Historians, increasingly, have been writing for other historians, with little hope that they can help inform or shape the directions of public policy.

A full discussion of the complicated causes of the decline of history as a basic discipline of public policy is outside the scope of this volume. These causes include changes in priorities at all levels of education, a widely shared assumption in our culture that all problems will ultimately be solved by "hard" (quantitative, experimental) research, and, not least, a loss of interest in the relevance of their work among many scholars who use historical methods.

The diminished status of historical methods of analysis has not, of course, meant that history has disappeared from public discourse. Most people have continued to behave as if interpretations of the past are important to them. Generalizations about history abound in learned journals and in the press and public documents. This history is usually drawn from institutional memory (a euphemism for long-time employees); often it is oral tradition—particularly in the professions. Sometimes the generalizations are derived from a hurried reading of a few books or articles or from several telephone calls to historians.

Examples of this superficial use of history have been plentiful during the AIDS epidemic. Lack of serious attention to historical analysis leads to quick and crude generalizations. Here are a few problematic statements that have been made many times:

Basic research should receive more funds because in the past this has been the path to discovering the causes and cures for diseases.

There is a long historical record of public health workers protecting the confidentiality of the people they screen and test.

Authority has always prevailed over liberty during periods of social terror about infectious disease.

Medical progress for more than a century has made plain the fundamental biological origins of disease.

Some readers, even some historians, who read these statements quickly may wonder what is wrong with them. Each is only a partial account of evidence from the past and is therefore a dangerous basisfor action in the present. Each statement, moreover, caricatures the complex ways that our descriptions of the past shape our sense of possibilities in the present. Each is a simplistic statement; people who know the pertinent historical data would respond: "not quite."

The authors in this volume offer a more thorough reading of the history of infectious diseases. The chapters exemplify some of the ways that the rigorous application of historical methods can contribute to public understanding of the AIDS epidemic.

The phrase historical methods requires more precise definition. It is a way of thinking and acting on information to create a nuanced description of events in the past. The information is invariably primary data: the records left by contemporaries. These records are usually words and numbers (both published and unpublished), images and objects. What other historians have written about these records—secondary sources—are hypotheses about the past grounded in primary data. These hypotheses must repeatedly be tested against the data in which they are grounded and for their power to explain newly discovered primary sources.

Historians create nuanced descriptions for several purposes. Some seek to recreate the past as contemporaries would have experienced it. Others try to discern patterns in events over time, and thus interpret primary sources in ways that would have astonished contemporaries. Many historians want both to discover historical patterns and accurately to reflect the lived experience of the past. In addition, historians are always conscious of the culturally specific, and hence are wary of positing universal principles.

Historical methods change as frequently as other areas of scientific discourse. At any time, moreover, people who use historical methods disagree about major issues of theory and practice. The contributors to this volume hold various views on controversial historiographic issues, some of which are evident in their papers. Nevertheless, the authors share a number of historiographic principles, no matter what their original discipline. They share them with most people who use historical methods to study health affairs in our time. The three most important of these principles are (1) cautious adherence to "social constructionism," (2) profound skepticism about historicism, and (3) wariness about "presentism." We will describe each of these in more detail.

Social constructionists, to oversimplify, hold that historical reality is created by people; that is, it does not exist as a truth waiting to be discovered. Some social constructionists include the data of the biologicaland physical sciences in their analysis, arguing that the institutions and procedures of these disciplines are the result of complex social interactions. The human body, they argue, has no historical existence except in primary sources about how it has been perceived and described by members of different societies at different times. Other historians, though sympathetic to social constructionist interpretations of the history of disease and medical practice, reject the radical relativism that denies that knowledge in the biological sciences can be independent of its...

Details zur Ausgabe

• Verlag: University of California Press
• Erscheinungsdatum: 1991
• Sprache: Englisch
• ISBN 10: 0520077784
• ISBN 13: 9780520077782
• Einband: Taschenbuch
• Anzahl der Seiten: 440
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar