close button

Sovereign Sun

The Effects of Culture on Responses to AIDS/HIV

Posted OnNovember 17, 2017 11:09

CategoriesPrimarySourceAnalysis

 


Introduction

The historic AIDS Quilt documents the raw reactions to AIDS/HIV of people from different cultural and national backgrounds. For example, in the panel of Patrick Gregory, the presence of a Greek background is quite evident. The panel includes characters from Ancient Greek mythology, such as Hermes and the Muses, a sixty-word story about a “young Olympian” written in Ancient Greek, and references to the island of Lesbos, Greece. In the first part of the paper, the main parts of the panel will be discussed, focusing on proving the presence of a Greek theme and the symbolism connecting the story and Patrick Gregory’s life. Following that section, certain cultural values of Greece will be explained and correlated to the responses represented by the panel –  proving that the relationship between culture and AIDS is a topic worth investigating – and the responses of Greece’s government and population. The next part of the paper will analyze the cultural values of Uganda and the effects they had on the stigmas, negative attitudes, and conservative policies surrounding AIDS/HIV. The fourth part of the paper will analyze the culture of Brazil and discuss how it might have influenced the nation’s policies on AIDS/HIV prevention program, which is regarded the most successful among all the developing countries. By realizing the effect that a nation’s culture can have on its reactions to the AIDS crisis, one can understand that there is no universal approach to fighting AIDS/HIV. There has been much disregard for this relationship at the international scene, leading to delayed responses by organizations such as the United Nations and excessive criticism from Western nations towards developing nations.


Block 1854: Patrick Gregory

Block 1854 of the AIDS Quilt appears similar to many of the other blocks; there is a plethora of colors, a variety of stylistic choices, and a lot of interesting graphics. Upon further inspection however, one can notice that the second from the left panel on the bottom, which is dedicated to Patrick Gregory, contains an unusual feature, two lengthy paragraphs of text. The second paragraph particularly draws attention to itself, since it is written in Ancient Greek. The paragraphs both tell the story of a “young Olympian leaping skyward” who is “struck down in mid-flight”. The man – also referred to as a “fallen athlete”, a “lost hero”, and an “artist” – is lifted by his relatives, the residents of Lesbos, and “Hermes’ kin”. They sing elegies and panegyrics, and then with the help of the Muses “prepare memorial banners to immortalize his name and deeds”.

Picture of the Patrick Gregory panel taken by John A. Taylor on 9/26/2017 at the NAMES Project Foundation HQ at Atlanta. 

The story and the corresponding imagery, which can be seen in the photograph of the panel above, appear to be a symbolism of Patrick Gregory’s life.  The Olympian mentioned in the story could represent Patrick Gregory. Since the character is described as young in both languages – “YOUNG” and “ΝΕΟΣ” – Gregory might have been in the prime of his youth, “leaping skywards” in a way, when he was diagnosed with HIV. The death of Gregory might be embodied as the act of being “struck down in mid-flight”, as he was flying and approaching the prime of his life. There are also hints that Gregory might have been an artist, since the hero is described as having “rainbow-colored paints flowing from his artists’ fingers” and the Muses, the inspirational goddesses for the arts in Ancient Greek mythology, assist in his memorial. The decision to specifically mention “rainbow-colored paints” and depict the flight of the hero with a rainbow in the imagery could be a allusion to Gregory’s homosexuality or simply his creative spirit.

A digital transcription of the English text found on the top part of the panel, presented in the original line formatting, is presented below.

YOUNG OLYMPIAN LEAPING SKYWARD, RAINBOW-COLORED PAINTS FLOWING FROM HIS ARTISTS’

FINGERS, IS STRUCK DOWN IN MID-FLIGHT. * RESIDENTS OF LESBOS, AND HERMES’ KIN,

IN PROCESSION WITH BLOOD RELATIVES, LIFT HIGH THE FALLEN ATHLETE, AND NEAR

HIS MORTAL BODY FROM THE FIELD, SINGING ELEGIES AND PANEGYRICS. * THEN,

ASSISTED BY THE MUSES, CLOSE FRIENDS OF THEIR LOST HERO, THEY PREPARE

MEMORIAL BANNERS TO IMMORTALIZE HIS NAME AND DEEDS.

The panels references to Greece extend further than the use of some mythological characters in a text. Patrick Gregory’s name, which is found in the bottom of the panel, is written in a large font mimicking the historic style of inscribed Ancient Greek characters, which focuses on representing letters with very few straight lines and sharp angles. The traditions mentioned in the text are not simply references to Ancient Greek mythology, they represent some real features of the honoring of heroes in Ancient and Modern Greek culture. The plot, which is the same in both languages, features errors in the Ancient Greek version: the mixing of the Latin counterpart of Greek characters, the misuse of Greek diacritics, and insignificant spelling errors. It is unclear if these mistakes were made because the person writing the translated text was not fluent in Greek or if they were being done on purpose, as part of an inside joke. However, regardless of the reason, it is obvious that the panel maker(s) put effort into making sure that the memory of Patrick Gregory was associated with Greece and Greek culture. Additionally, the inclusion of the “residents of Lesbos” in the commemorative ceremony indicates a connection between Patrick Gregory’s family and the Greek island, since Lesbos does not have a direct connection to any of the mythological characters mentioned. Therefore, the Greek roots of Patrick Gregory’s family might have subconsciously caused them to infuse certain aspects of Greek values and culture in the overall response represented by the panel.


Greece

Even though Greece experienced a spike in HIV cases during the peak of its economic crisis, its adult prevalence rate for HIV remains one of the lowest in the world. The importance of family unity and the general acceptance of homosexuals in the Greek culture have allowed people to be more comfortable seeking help and treatment. The government has introduced many syringe, needle, and condom distributions in order to decrease the injection-related HIV rate spikes.

Family unity is a critical component of Greek culture, and its effect is present in almost every aspect of life. Greek traditions often involve family, such as the formation of a bridal dowry from family heirlooms and goods, the archaic custom of delaying a man’s engagement until his sisters are married, and the rural custom of passing on a grandparent’s nickname to a grandchild. Greece is also famous for having mainly small family-owned businesses, despite the trend of globalization and dominance of multi-national companies. Greece has one of the largest numbers of SMEs (Small & Medium Enterprises) in the European Union, most of them being family businesses. In fact, a survey found that 80% of business owners in Greece considered their business as a “family business” (“Family Business Survey” 1). The findings of a study by the FAMBUS project showed that the “proportion of ownership held by family members” for family businesses was 90% (Vassiliadis 532).

In the panel, the influence of the Greek emphasis on family is quite evident in the response of Gregory’s family to AIDS. The family regards the death of Gregory as a loss (“fallen athlete”, “lost hero”) and a fall from grace, showing that they held him in high regard and were deeply saddened. It should be noted that the story only mentions “blood relatives”, which follows the Greek custom of not limiting the familial bond with only immediate family. According to a study examining the social support that HIV positive youth received, 71.7% of the 402 participants “reported that at least one family member knew their HIV status” (Lee 6). Since family is usually the first place one turns to in an unfortunate time, knowing that the family will support them is a incentive to disclose their status and seek treatment early. In other cultures, the lack of family support due to the shame associated with AIDS can cause delayed treatments and preventable deaths.

The panel is unclear on the purpose behind its use of the rainbow color scheme, since it could be associated with homosexuality or artistic creativity. However, “gay men and other men who have sex with men” are the highest at-risk group, which according to a UNAIDS report represent 68% of new HIV diagnoses in North America, 54% in Western Europe, and 48% in Central Europe (“Prevention Gap Report” 186). This makes it quite likely that the rainbows are symbolic of Gregory’s sexual orientation. The Greek culture’s stance on homosexuality is complicated; on one hand the nation has very liberal and progressive attitudes, but on the other hand the conservative Orthodox Church is a significant part of every Greek’s life. While still restructuring from the gruesome civil war Greece had experienced from 1946 to 1949, the Greek Parliament put the nation’s first official Penal Code into effect on January 1st, 1951. The Code only made homosexual sex illegal in cases of prostitution and seduction of “a person younger than seventeen years old” (Ελληνική Δημοκρατία [Hellenic Republic] 347). This can be interpreted as an official legalization of same-sex relationships, a policy that other Western countries, including the United States and most European countries, did not adopt until decades later. Other progressive policies such as anti-discrimination laws, open service, adoption by single LGBT individuals, and inclusive sex education have also been passed in Greece. Even though the government has consistently tried to propose even more LGBT right laws, there has been some resistance from the older generations of Greece which do not approve of same-sex marriage and joint adoption by LGBT couples due to historic religious values. On the other hand, the youth of Greece, which seems to be moving away from traditional and religious views, has more accepting outlook on homosexuality. In a study done on 186 social work students in Crete, 97.1% of the participants stated that no human should be punished for being a homosexual and only 7.4% and 8.9% responded that the had little or no acceptance of the gay men and lesbian women respectively (Papadaki 42-44). The more liberal environment of Greece allows homosexual people living with AIDS to be more comfortable with disclosing their status and seeking treatment, and enabled the Hellenic Center for Disease Control and Prevention, known as KEELPNO, to educate the public on homosexuality and safe-sex, which in 2015 reported a decrease in discrimination/stigmatization relating to AIDS and a 50% decrease of virus transmission through sexual contact.

Map from the European Centre for Disease Prevention and Control showing that Greece, like most E.U. countries, reports that men having sex with men is the major cause for HIV transmission. (“Reported HIV Transmission Modes in the EU/EEA 2016”)

In the midst of the crisis, Greece saw a surge in the number of new HIV cases during the 2011-2013 period, which according to KEELPNO was due to a spike in drug use in major cities. In response, the Center increased the efforts of its syringe exchange program and the distribution of informational material relating to HIV, resulting in a decrease of cases of HIV infection reported per 100,000 people from 7.2 in 2013 to 5.9 in 2014 (Chryssopoulos 1). Programs for syringe/needle exchange are often considered controversial, since they are seen by some as enabling drug addicts, but have been proved successful in Greece, which provided 268,157 syringes in 2015 (“Greece, Country Drug Report 2017” 18), and Brazil, which will be discussed later. It is important for a nation like Greece to have a progressive political environment in order for the government to create effective prevention policies concerning drug users.


Uganda

Sub-Saharan Africa, considered the origin of the HIV virus by most scientists, has always been the most affected region in the world  in the AIDS crisis. East and Southern Africa alone account for over 50% of total number of people living with HIV in the world, even though they hold only 6.2% of the world’s population (“AIDSinfo”). Even though AIDS has been an issue in Africa since 1920, there were no international or local efforts to deal with the public health crisis until the virus was rampant in the region and the developed countries in the world were beginning to be affected by it (Faria 56). The director general of the World Health Organization, Dr. Halfdan Mahler, “declared that not too much attention should be paid to AIDS” in 1985, but then made the “first declaration at a top global political level to demand worldwide mobilization against AIDS” in 1987 (Piot 8). According to Peter Piot, the founding executive director of the Joint United Nations Programme on HIV/AIDS called UNAIDS, people living with HIV in Africa “were largely without a voice until the 1990s”, and different UN agencies led “uncoordinated parallel actions on AIDS in developing countries without necessarily respecting national priorities” due to ideological clashes (Piot 8-9). Many African nations have drawn criticism from developed Western nations over their policies concerning AIDS, especially Uganda, which is seen by many as the flagship of the prevention systems many African governments have promoted. To understand this deep divide in the methods of HIV prevention, it is important to comprehend how the culture of Uganda has effected its people’s reaction and the government’s policies.

Uganda is a deeply religious nation. A government census done in 2002 found that 85.2% of the population was Christian, mainly Catholic or Anglican, and only 0.9% declared that they did not follow a religion, results that are consistent with past and current statistics (“2002 Uganda Population and Housing Census” 11). The strong connection Ugandans have to religion encourages them to maintain traditional values and attitudes on every-day life and politics. President Yoweri Museveni, who has been President of Uganda since 1986 and shown in the image bellow, promoted the “ABC” program; the letters stand for “Abstinence, Be faithful, use Condoms” (Miss HIV: Overcoming AIDS in Africa). This approach focuses on the traditional values that many Ugandans hold dear; the youth are expected to abstain from sexual relations until after marriage and always follow monogamous behavior. The Ugandan government considers the program successful, since the rate of adults infected with the HIV virus in the country was lowered from 15% to 6% in less than two decades (Miss HIV: Overcoming AIDS in Africa). Some critics however believe that the government is overestimating the decrease in HIV infections because the statistical data does not include enough measurements of the rural population, which according to the 2002 census represents the majority of the population (“2002 Uganda Population and Housing Census” 7).

President Yoweri Museveni delivering a speech at the 2008 HIV/AIDS Implementers’ Meeting in Kampala, Uganda (WALTER ASTRADA/AFP/Getty Images).

Many Western countries, which in comparison to Uganda are much less conservative and religious, have criticized the ABC program. The main concerns are that focusing on moral values rather than safe sex is not effective in the long run and that women are not protected in this prevention program. Unfortunately, the reliance on traditional views on marriage and sex also comes with an emphasis on patriarchy (Miss HIV: Overcoming AIDS in Africa). This power imbalance leads to situations where a woman can not refuse sexual contact upon a husband’s request, even if they are aware that their partner has contracted the virus from extramarital relationships or other means. Women are not only pressured by social and cultural obligations, but also by an economic dependence. In the bar graph below, the 2002 Uganda census shows the proportions of males and females by employment type. Even though 76.5% of males, shown in yellow bars, are paid employees or self employed, 63.1% of females are unpaid family workers (“2002 Uganda Population and Housing Census” 15). Since most females do not have economic independence, they might be too intimidated to disobey their husbands, meaning they can not impose abstinence, monogamy, or condom use. Many international organizations have declared the ABC approach as a violation of human rights and especially a hazard to women’s health.

Graph showing the proportions of males and females by employment type in Uganda (“2002 Uganda Population and Housing Census” 15).

The traditional and conservative values of Ugandans does not only affect the preventative policies, but also the people’s response to HIV disclosure. In many Sub-Saharan African nations, including Uganda, being HIV-positive is associated with tremendous stigma. Women are especially scared to disclose their status due to the humiliation they will face, even from their family members, since it is viewed as proof of sleeping around or being impure (Miss HIV: Overcoming AIDS in Africa). A 2015 study which aimed to assess how HIV-related stigma has changed during a period of increased availability of anti-retroviral therapy found that the percentage of respondents that endorsed “fears about disclosure” increased from 47% in 2006 to 61% in 2011 (Chan 6). Furthermore, a qualitative study in 2010 showed that most HIV-positive women in eastern Uganda were afraid to disclose their status due to “the intersection of gender norms, economic dependency, women’s roles as mothers and young age” (Rujumba 9). Fear of disclosure can have devastating effects, such as in the case of Gaelebale Thabang, who lost her sister in 1998 because she kept her status a secret even though treatment was available (Miss HIV: Overcoming AIDS in Africa). Many international organizations have been unsuccessful with their methods of HIV treatment in Africa, including the provision free anti-retrovirals, because of this stigmatized environment.


Brazil

Brazil was facing political turmoil when the AIDS crisis peaked in the country. The nation had just come out of a long military dictatorship, and the new democratic government decided to turn to very liberal and progressive policies. Left-leaning attitudes had become popular in Brazil after the military dictatorship, since much of the opposition consisted of Marxist and socialist groups. Starting in the 1990s, there is evidence of a growing liberal attitude as voters stopped supporting right-leaning groups and moved to centrist and left-leaning groups. In the 1989, the presidential election was won by the National Reconstruction Party, a Christian-conservative political party, but the 1994 and 1998 elections were won by the Brazilian Social Democracy Party, a centrist party, and the 2002, 2006, 2010, and 2014 elections were won by the Workers’ Party, a left-leaning socialist party (Álvarez-Rivera). This allowed the government to implement many progressive policies that had been delayed or rejected due to resistance from conservative groups.

One of the most important AIDS programs of Brazil is the universal provision of anti-retroviral treatment. In 1996 it became “the first low- or middle-income country to offer” free anti-retroviral drugs (Piot 14). However, as seen in the case of Uganda, such opportunities might not be very helpful if there is stigmatization associated with disclosure. Fortunately, according to Peter Piot, “AIDS appeared in a cultural context of openness about sexuality” (14). This is supported by a 2013 survey conducted in Brazil which found that “respondents displayed a higher acceptance of practices formerly considered to be deviant” and there was an “increasing flexibility of sexual norms” (Heilborn 42). Therefore, much of the “shame” associated with being HIV-positive, such as homosexual sex or having multiple partners, was not a factor in decisions involving disclosure and seeking treatment.

The openness about sexuality also allows the nation to appropriately deal with at-risk groups. The government has made extensive efforts to target the highest at-risk group, homosexual males, with its prevention policies. Originally, the HIV/AIDS prevention program had “avoided ‘singling out’ men who have sex with men out of fear that it could lead to more discrimination against them”, but in 2002 it launched a targeted prevention campaign which included awareness ads, informational pamphlets, and cooperation with non-governmental groups (“Brazil Launches First HIV/AIDS Prevention Campaign Aimed at Young Gay Men”). Television and movie theater ads, such as the campaign’s “centerpiece” ad in the embedded video below, featured gay men and presented slogans such as “Respecting differences is as important as using a condom” (“Brazil Launches First HIV/AIDS Prevention Campaign Aimed at Young Gay Men”). In 2007, a similar campaign was started targeting women. These efforts were followed by a “dramatic decline in HIV/AIDS cases among gay men, from 3,376 in 1996 to 647 in 2009, and among women, from 7,419 in 1996 to 2,034 in 2009” (Gómez). Attitudes that are accepting of homosexual behavior are not particularly common in other South America cultures. For example, in the neighboring nation of Columbia there were reports of mandatory HIV testing that the Revolutionary Armed Forces of Colombia, also know as FARC, imposed upon the residents of Vista Hermosa, which is illegal (“Guerillas Order HIV Testing for All Residents in Colombian Town”). After the results became known, three residents were banished, an action seen by many as a continuation of Columbia’s history of discriminating against gay men (“Colombian Guerillas Expel Three Town Residents Who Test Positive for HIV”).

Furthermore, progressive attitudes regarding sex have caused a controversially fierce promotion of safe sex by the Brazilian government. Former President Luiz Inacio Lula da Silva was a strong promoter of sex education in schools and argued that it was “the most effective method to prevent the spread of HIV and teenage pregnancy” (“Brazil Officials Say Condom Distribution Effective Part of HIV Prevention Campaign; Church Officials Criticize Policy”). Additionally, Brazil was one of the earliest nations to prioritize the use of condoms. The promotional campaigns were very successful, causing an increase in the percentage of the Brazilian population that “used condoms during their first sexual encounter” from 4% in 1986 to 48% in 1999, which was also aided by the 50% decrease in the cost of condoms (Levi 2375). These programs were criticized by many, especially the Roman Catholic Church, which represents the majority religion of the nation. In 2007, Cardinal Geraldo Majella Agnelo, president of the National Conference of Brazilian Bishops, said that the Church “cannot agree with the use of the condom” because it “encourages people to have inconsequential and irresponsible sex”, but the head of the health ministry’s HIV/AIDS program, Mariangela Simao, said that the “government cannot base its public health policies on moral and religious principles” (“Brazil Officials Say Condom Distribution Effective Part of HIV Prevention Campaign; Church Officials Criticize Policy”). Programs promoting safe sex among sex workers have also been created, a move considered controversial even among progressive countries. Prostitutes are given government-supplied condom and can learn about HIV transmission at state-funded workshops for prostitutes (Reel).

Much like Greece and other E.U. nations, Brazil has adopted a syringe/needle exchange policy. The program initially faced resistance from the judicial and law-enforcement sectors, but it has since proven to be extremely effective. The injecting drug users saw “a decrease in transmission of the virus of 7.6 percent in 1997 and 17.9 percent in 1998” (Sekles). As the nation becomes less conservative and more aware of the risks, the program grows and faces less opposition from regional governments.


Conclusion

From the analysis of the values of these three nations, it can be concluded that the culture of a nation will affect its population’s attitudes regarding AIDS/HIV and its government’s corresponding policies. More progressive and liberal nations, such as Greece and Brazil, have seen success in the battle against AIDS using programs focused on condom use, syringe/needle exchange, and openness regarding sexuality and sexual orientation. On the other hand, more conservative and traditional nations, such as Uganda, have reported very positive results with programs focused on abstinence and monogamy. Unfortunately, the international community seems to disregard the diverse cultures of the world when discussing global efforts to combat AIDS, causing political conflicts and clashing ideologies. There also seems to be a trend of Western nations excessively criticizing developing nations for not adopting the same prevention policies as them. Many international organizations have condemned the ABC program, mainly for justifiable reasons, but fail to recognize that certain conservative African countries, such as Uganda, interpret this as an attack on their traditional values and conservative culture. Criticism has even targeted progressive developing nations, such as Brasil. In 2006, the United States government informed Brazil that they would be “ineligible for a renewal of a $48 million AIDS prevention grant” due to their unorthodox and progressive programs for sex workers (Reel). This occurrence is particularly ironic since Brazil won the Bill & Melinda Gates Foundation award for the best model response in 2003 and recognized as having the most successful AIDS prevention and treatment programs in the developing world by the United Nations in 2004 (Gómez; Reel).

Disputes between nations only led to delayed responses and inefficient programs, a concept mentioned by Peter Piot in the third section of this paper. He also recognized that his techniques for convincing governments to introduce AIDS prevention policies needed to vary by country in order to be effective. According to him, since politics are more local rather than global, one needs to “analyze national policy development or advocacy in their historical and cultural contexts” (Piot 7). By understanding the effect cultures can have on responses and policies regarding AIDS/HIV, we can create a more understanding environment to have global discussions on tailoring prevention/treatment policies to each nations culture. This will allow us to create effective programs while also protecting human rights.


Works cited

The works are listed alphabetically, with Greek alphabet and number characters preceding Latin characters. Some of these works might require university accounts or academic database membership  to access.


 

0:00