#16: Racism, HIV, and the monkey that no one f$@#ed
COMMUNITY REVIEWER: Dwayne Steward MPH
SOURCES
Instead of including exhaustive citations through the following show notes and transcript, we have listed the sources below (acknowledging that this heavily pulls from Jacques Pepin’s “The Origins of AIDS”. If you would like to know a specific citation or a source for one of the following statements, please reach out to us over email, we’d love to help!
The Origins of AIDS by Jacques Pepin (2nd Ed. 2021)
To Make the Wounded Whole, The African American Struggle Against HIV/AIDS by Dan Royles (2020)
The Boundaries of Blackness by Cathy Cohen (1999)
AIDS and Accusations by Paul Farmer (1992)
Impure Science by Steven Epstein (1996)
Let the Record Show by Sarah Schulman (2020)
Endgame, a documentary on Frontline (aired 2007)
“Origins of HIV and the AIDS Pandemic” by Paul Sharp and Beatric Hahn (2011)
SHOW NOTES
“If you end racial inequity today, you can end the HIV epidemic tomorrow”
A full episode on just history is a way to think deeply about how racism functions to create healthcare disparities,
This historical discussion builds the tools to identify and ultimately dismantle those forces of racism that continue to function today.
There is no community voice on this episode. We didn't want to ask someone to do the emotional labor of reliving all of these charged historical events when we're capable of doing the academic work to understand them from a historical perspective.
No one had sex with a monkey.
How HIV began: the wrong story
Both early theories of HIV’s origins and the scientific tale that slowly unfolded often played on racist tropes about Africa and Blacks in America.
The racist tropes of hypersexualized black individuals alongside the racist tropes of exoticizing of Africa combined early on in the HIV epidemic to influence understandings of where HIV came from.
How HIV began: the right story
Genetic science and decades of research has concluded that HIV was initially a virus in chimpanzees (which if you really care are no, not monkeys) that “spilled over” into humans
How? Through blood mixing during hunting (the so-called “cut hunter” hypothesis)
Why did HIV-1, group M (a genetic designation) become 99% of the world epidemic?
Right place, right time
Where: modern-day Democratic Republic of the Congo and Republic of the Congo.
What: a immunization campaign (taken on by the colonial Belgian government occupying this land) against “sleeping sickness”, or trypanosomiasis, thousands of folks received over thirty six (!) different shots as part of their immunizations
Wait, a vaccine did this?
Well, a vaccine campaign using shared needles, which allowed for blood-blood transmission of HIV, amplifying the HIV virus from one or two “cut hunters” into thousands of folks.
NOTE: the standard of care today is to never reuse a needle, but that was not the case then.
Once HIV was amplified through blood-borne transmission through reused needles, the epidemic could then be sustained and further spread through sex and sex work, but this was a smaller contribution to the epidemic
Unpacking the racism
In the book To Make the Wounded Whole, Dan Royal summarizes that: “theories about the origin of AIDS, resurrected racist ideas of black hypersexuality and barbarism historically used to marginalize people of color in the US.”
One way to tell the story is that extractive colonial labor practices created a non-endemic social and biological ecosystem where a virus was given the conditions to amplify itself to a sustained-pandemic level.
Misunderstandings of local sex work practices (“Free Women” vs. high-volume post-colonial urbanization prostitution) furthered racist tropes of hypersexualized Black people
Haiti’s controversial role in HIV history
The geopolitical backdrop
Haiti a former French colony, sees a new dictator in the early 60s who targets the educated class as part of his populist politics.
Meanwhile, the Belgian colonial administrative state has left central Africa and a series of ongoing upheavals continue to destabilize the region.
The result: migration
About 4,500 Haitians move back and forth as part of the UNESCO intervention in Central Africa this time.
It is likely that some of those travelers were infected with HIV and ultimately returned to Haiti with the virus
Then what?
The best evidence supports the theory, proven in other historical settings, that HIV acquired in central HIV was then amplified through blood exposure - now blood donation centers common in Haiti during this time.
Blood transfusion is 90% effective at transmitting HIV. At this time, the universal precautions in place that mandate blood testing for HIV and sterility standards for machines were not in place. Although unproven in Haiti, three other HIV outbreaks have been traced to blood donation centers with similar sterility practices.
As with central Africa, once blood-borne transmission had amplified HIV to a certain level, then sex could continue to maintain and grow the epidemic.
Why is this controversial?
We [your hosts] believe that the population of Haiti is a bystander to this. Basically, that there's not a specific culture or subculture within Haiti that is “to blame” for the HIV epidemic. However, that wasn't the prevailing opinion in the 1980s when all of this was unfolding.
The medical press blamed Haitian folk culture through racist and xenophobic tropes about voodoo, at times even using the phrase “zombie-like rituals” (quoting some prominent medical literature from the era)
The CDC labels Haitians as a group a “risk” designation, creating a stigma that dovetailed with racism and xenophobia.
Into the US.
Haiti had an established gay tourist industry up until the 60s.
The leading theory is that someone engaged with sex work had acquired HIV from a blood donation center or through sexual contact
Some of the advertisements for gay travel to Haiti are, you guessed it, really racist. The brochures traffic in ideas of hypersexual and “primitive” narratives around sex workers in Haiti.
This movement of tourists, many of whom were seeking sex, is likely the final step of HIV’s movement into the US.
Lastly:
This episode aims to re-conceptualize and reframe historical understandings of HIV’s emergence
Not as whose behaviors did what to whom
Rather, how extractive colonialism, migration patterns, economic marginalization, and social marginalization can all combine to push people to fringe economic and sexual opportunities.
In our hopes to work towards dismantling racist narratives and systems, we want to name both the current and historical forces of racism in the way that they've influenced our understanding and the impact of the AIDS epidemic.
Don’t forget to listen to part two!
TRANSCRIPT
[QHP THEME MUSIC STARTS]
Richard: Welcome to Queer Health Pod. QHP is a podcast about queer health topics for sexual and gender minorities.
Sam: My name is Sam. I'm a primary care physician, and I use he/him pronouns.
Gaby: My name is Gaby, I'm also a primary care physician and my pronouns are she/ her.
Richard: And my name is Richard, I use he him pronouns, and I'm a primary care physician, and I'm the director of LGBTQ clinical services at Bellevue Hospital in New York City.
Gaby: You're listening to QHP Season 2 – the history of HIV part 1.
[QHP THEME MUSIC ENDS]
Sam: Okay, so, a QHP first. What's with the cold opening, and where's our community voice?
Gaby: This is the first of a two part episode series. Both episodes are going to focus on how racism shaped the HIV epidemic. Today's episode is part one and it's going to center on how HIV came to be in humans and then traces the emergence of HIV throughout the United States. The underlying thread is that we'll be highlighting some of the early misinformation and harmful stereotypes that live as lore within this history of HIV.
Richard: These include harmful myths of how HIV came to exist in humans, how the so called high risk groups came about, and how racism and homophobia worked together to worsen the HIV epidemic.
Gaby: On the next episode, which is part two, we'll talk about how racism continues to impact the modern HIV epidemic.
Richard: And given the different focus, we're taking a different approach for each of these episodes. This episode is going to be predominantly historical, tracing the different political and social forces that informed how, where, and why HIV popped onto our radar. And then, we'll ground all of this within the lived experiences in the second episode.
Gaby: This framing is a big reason why you haven't heard a community voice speak on this episode. We don't have one.
Richard: We didn't want to ask someone to do the emotional labor of reliving all of these charged historical events when we're capable of doing the academic work to understand them from a historical perspective, and then we'll bring in folks to give their perspective specifically after. that.
Sam: Our sources for this capital H history, so to speak, include a handful of non- fiction books, but we lean heavily on Jacques Pepin's book, The Origin of AIDS. We also want to acknowledge that the way histories of HIV are often written can be analyzed in its own right. But, for the goal of today's episode in naming racism's impact on HIV, we will stick to the capital H historical consensus.
Richard: Which brings me to my next point, wanting to acknowledge that our positionality here is three white people hosting this episode. In researching this episode, we leaned on resources written by people of color, and you can check our show notes for that, but even in that context, we may have blind spots or missed things.
Gaby: And as you're checking our references, you may be wondering to yourself, why look backwards? Why are we doing a history episode?
Sam: One of the first things our community editor told us when we started work on this episode was the idea that if you end racial inequity today, you can end the HIV epidemic tomorrow. So yes, a full episode on just history is a way for us to nerd out, but it's also a way to think deeply about how racism functions to create healthcare disparities, and this historical discussion is also a way to give ourselves the tools to identify and ultimately dismantle those forces of racism that continue to function today. And if you think that sort of stuff matters and people should hear more about it, we agree.
Gaby: So subscribe on Spotify or Apple if you can. And if you can't pause this episode and text the link to one friend who you think might want to or need to hear it.
[TRANSITION MUSIC]
Sam: the first time you heard about h i v, what was your understanding of where it emerged from
Richard: The first time I heard about HIV, I was in a play in London sitting in the bleachers. There were these opera glasses and my father smacked these opera glasses out of my hand. I was like nine years old because no one knew how you got HIV and was sure if you could get it from tears or not. So I wasn't allowed to use these opera glasses.
Gaby: That's crazy.
Sam: And, very gay in its own way,
Richard: Super gay.
Gaby: I honestly think the first time that I was taught about HIV, I was taught about patient zero, who was a gay flight attendant, right?
Richard: Yeah, that was the main narrative about a gay man being, like, the vector and there was this whole Patient Zero story about some promiscuous flight attendant wantonly spreading the disease without regard for the health of others.
Sam: So you're both referencing the narrative about a patient zero that was popularized by Randy Schultz's history of HIV and AIDS and the band Played On. In this narrative, there's basically a slutty flight attendant who's beautiful, knows he's sick, but continues to have sex with everyone, and he's really the villain of Randy Schultz's historical telling of the story. This historical slut shaming has been debunked. But, we won't go into that today. I did want to ask you if you'd heard how HIV became a human disease.
Richard: I guess it was kind of implied that it had crossed over through sex with monkeys. The African connection was also made, but like, was never made explicit in my remembrance.
Gaby: When you say African Connection, can you explain what you mean by that?
Richard: That it was sex with monkeys in Africa. That actually was very specific about the connection. There were a lot of assumptions that it had come from Black people, although not clear exactly where. And it was this super strong narrative that I was not aware enough to question when I was a preteen dealing with my sexuality. And in retrospect, I can't imagine how I let that narrative... exist for as long as I did, but the truth is I was so scared that it was being pinned on gay people and dealing with my own gay identity that I didn't think to question those narratives.
Gaby: Suffice it to say, having sex with a monkey is not how HIV got into human populations, and there is a lot of racism built into that narrative that we're gonna unpack later.
Sam: To your point though, everyone in the U. S. is being told that it's a sexual disease, primarily, and then they're also hearing that the disease is being found in Africa, and that may be where it originated in human populations. So, racism allows people to connect those dots, ultimately with people thinking that maybe it's sex with a monkey, which is both absurd and racist. But I want to go back to what you said about monkeys, or technically chimpanzees, which gets us to the concept of spillover.
Richard: Spillover, like the expired condoms you threw away at the end of college?
Sam: Gaby, why don't you take a shot at this.
Gaby: Okay, so spillover is when your fashion sense starts to merge with your girlfriend's and then you start to share all your khaki pants. No, it feels off base. It doesn't really have anything to do with HIV, so I think I must be wrong.
Richard: Those are just called high waters.
Sam: While I chat GPT highwaters and you chat GPT spillover, I'll give you an answer that's a little more on point. What I'm referring to when I say spillover is the biological phenomenon where a virus or another pathogen in an animal population changes in some genetic way, so then it can infect human populations. And the reason this is so important is because HIV's spillover event is when it got into human populations. And as Richard alluded to already, the science and conversations around understanding where HIV spilled over from into human populations has been a controversial and racially fraught discussion in both scientific and popular press since the emergence HIV in the 80s.
Gaby: So do we have examples of other viruses that have spilled over?
Sam: Does RuPaul have a franchise? Okay. Please welcome to the stage. There are a few Marburg, LASA Virus, Ebola, Hendra, avian Flu in the nineties, Nips, West Nile, sars, swine Flu in 2009. And yes, COVID.
Richard: Fauci Drag Race All Star: Spillover Edition.
Gaby: So we know that spillover happens, but for me there's a question that remains. When did HIV spill over into humans? And, well actually here's a second question, why did it spill over? And to answer that, we turn to genetic science. And please do not zonk out yet if that phrase genetic science makes you drool out of boredom or something like that because I promise you I am one of the most unenthusiastic biology students who has ever become a doctor. And I am sitting here, recording this, telling you that the details are, for once, actually kind of important.
Sam: When the HIV virus gets into human cells, It starts to copy itself. But in this process of copying itself, it does not do an exact mirror image. It mutates
Gaby: . Meaning that some of its genetic material changes and looks different
Sam: We know that the rate at which these mutations come about when it's copying itself are pretty predictable. So what we can do is use those number of mutations between different viruses to figure out how much time has passed.
Gaby: So it's, it's almost like the mutations give us a breadcrumb trail of sorts. If we look at the genomes of two different HIV viruses, we can actually count the number of mutations between them to figure out how much time has passed and how far apart chronologically they actually are. It's kind of like a genetic version of carbon dating.
Sam: Correct. Another way to phrase it. You can sort of get a time and triangulate if you have two or three viruses to compare genetically.
Richard: So how did this play out with HIV?
Sam: The first clinical test for HIV is approved in 1985, but at this time we also know the genetic code of HIV. What scientists can do is to start looking for HIV in blood samples both from that time and also historical blood samples, meaning ones that were frozen either a few years or many years before. For various reasons, this hunt starts in Central Africa. So, a mix of Congolese and European researchers start testing blood around Central Africa, concentrating on areas where there's a high rate of AIDS in human populations. There's two blood samples taken from the modern day cities of Brazzaville and Kinshasa. And when those two were compared genetically, they were different by about 12%, which, once you run it through the mutational stopwatch algorithm, you can figure out that those two HIV viruses would have had a common genetic ancestor around 1908 or 1921.
Gaby: So you're basically saying that using, like, genetics math, which I will never pretend to understand, we know that HIV crossed over from another species into humans in that range of 1910s to 1920s. So what was going on then in the 1910s and 20s in Central Africa that caused all of this?
Sam: The first part of the answer to that question is called the cut hunter hypothesis. Remember that HIV is spread very efficiently through blood. The idea is that a hunter, while hunting or chopping up What was hunted, in this case a chimpanzee, would have been exposed to a virus in the chimpanzee's blood that was able to take hold in human cells.
Gaby: So that's the so-called cut hunter.
Sam: correct. It's worth noting that there probably wasn't a single cut hunter. There's different strains of H I V and each is thought to have its origins from a separate spillover event based on the genetic math that we can do. But when we talk about the HIV epidemic today, what we're really referring to is HIV one, as opposed to HIV two, which is much more geographically limited. And we're really referring to HIV group M specifically. That group M makes up 99% of the world's HIV circulating strains. And again, all of these one versus two and different groups are different genetic designations.
Gaby: This is actually kind of crazy. What about HIV 1m allowed it to become 99 percent of the world's HIV strain?
Sam: The answer to that question is really the story of HIV's spread from a chimpanzee population that was hunted into a global pandemic. In one word, the answer is colonialism, specifically by the Belgians, who had colonized much of what is today the Democratic Republic of the Congo, and just to the west, the Republic of the Congo. as part of their colonization of this area, the Belgians brought a massive campaign of vaccinations against local tropical diseases.
Richard: And just to be clear, there is a world in which this can sound magnanimous, like there was this big effort being made to benefit a local community, but let's remember that this is about keeping labor practices optimized. Productivity will suffer if workers are sick.
Gaby: In other words, colonialism.
Sam: One of the vaccination campaigns was against the sometimes lethal disease known as trypanosomiasis, or sleeping sickness. Patients who were treated by this one specific team in modern day Cameroon received an average of around 36 intramuscular injections.
Gaby: Which is actually an astronomical number. Just for context, the four COVID vaccines that I've received over the few years of the pandemic is a lot for most adults.
Sam: Right. And it's not just number of injections during this campaign, it's also how they were administered. Picture, basically a line of people where the doctors are going from one patient to another, using the same needle in rapid succession.
Gaby: And outside of blood transfusions, which we'll come back to later in this episode when we talk about Haiti, shared non sterile needles are one of the most efficient ways to transmit HIV through blood.
Sam: In a blood transfusion where the donor has HIV in the blood, there's a 90% chance that the recipient will also become infected with HIV. For sharing needles, where something is injected, there's about a 0. 67% of HIV being transmitted. And while that seems small, it is an odds of 1 in 150 more or less. Think about thousands of people getting many many shots and then it becomes an epidemic level number just from that small 0. 67
Richard: We should be clear that now, in any country that's using the standard of medical care, every needle is single use and there is no longer concern. However, this is one reason the HIV epidemic continues to be rooted in populations that share needles for injection drug use, for example.
Sam: So this immunization campaign is the perfect storm of conditions to amplify a few folks who have acquired HIV from hunting and now amplify it so there's a much larger level of the virus throughout the population.
Gaby: That's, that's really shitty.
Sam: This hypothesis for HIV has been proven for other bloodborne illnesses such as Hepatitis C and HTLV one, which in the 1930s and 1940s were also found to have been spread among people who were targets of these immunization campaigns.
Gaby: So to bring it all back, we're basically saying that H I V spilled over into humans in many places around the same time. But there is one big spillover event that we care about, which is the one for HIV -1 M, which is the dominant strain that we see today. And the reason group M kind of blew up is because it was in the right time at the right place.
Sam: So the historical story goes that one or two cut hunters make their way down to the modern day cities of Kinshasa and Brazzaville, which were then rapidly urbanizing hubs of the colonial industry that the Belgians were colonialing, so to speak, in that area. This immunization campaign becomes the perfect storm of conditions to take those one or two folks living with HIV from hunting and rapidly amplify it in a very dense urban population.
Gaby: So, can we attribute this exclusively to the colonial vaccination efforts, or were there other forces at play that helped HIV group M spread?
Sam: I'll give you three options. Sex, drugs, or rock and roll.
Gaby: Rock and roll.
Richard: Sex. It's always sex.
Sam: Yes, it is sex, not rock and roll. After the implication of HIV through vaccination campaigns it predominantly becomes a sexually transmitted disease within Central Africa. Prior to Belgian colonialism, there was a type of sex work called, quote, free women, which was a French colonial translation of the word. This was not high volume prostitution, so to speak, but sexual hospitality, where there's two or three regular male patrons, and the sex work includes domestic duties like cooking and washing clothes. As part of the impact of Belgian colonialization, there's a huge urban population boom in these city centers. And, part of that result, there's a rise in high volume sex work. And the reason we're making this distinction is because, one, there's a racist history of erasing the different types of sex works in their economic context. And two, because the type of sex work that predated this high volume urbanized sex work, epidemiologically was not enough to amplify or probably even sustain an HIV epidemic. But after the amplification of the HIV virus through vaccination campaigns, this high volume sex work, Epidemiologically, we know is enough to sustain and grow the populations of folks living with HIV.
Gaby: So to use Sam's historical knowledge to answer my own question, it really is the immunization campaigns that caused HIV's rapid spread from a few cut hunters. Sex is a later contributor to the pandemic, but without the shared needle vaccine situation, its contributions are negligible.
Sam: We should pause here to name the very notable function of racism historically and continually today, which is to hypersexualize Black people. At the time all this information is coming out, historians and scientists are putting narratives out there that there's an epidemic of a lethal disease with an uncertain cause and origins, and it's impacting Black communities at higher rates. But then, institutions are saying sex in Africa is what's causing this and where this came from. We want to point out that these were not sanitized and apolitical narratives. And that's really something that's so important to name, the way that science as an institution often gets to say because of its mission and because of its methods it can't be racist. These stories are coming out and they're perpetuating this concept that there was a group of people who biologically originated this virus, because of their different sexual habits, or worse sexual habits, or more immoral sexual habits. And that's really one of the dangerous forms that white supremacy within science can take, is saying, "well, because we're objective, because we're systematic, we're not, you know, we're not biased in any way." Whereas in reality, the really systematic thing here is systematic racism.
Richard: And that's it, right? Colonialism, capitalism, puritanism, and white supremacy, like, all in the same story. It just truly brings it all together.
Gaby: Ooh, good bell hooks reference.
Richard: It's clear how the context of racism and rampant health inequities in America in the 1980s, this story could be so weaponized against the folks suffering the most with HIV.
Sam: Right. To talk about sex and sex in Africa very much hit on the nerve of racism at the time, by people both in the US and abroad who are suffering from HIV and AIDS. In Dan Royal's book, To Make the Wounded Whole, he states the following: "theories about the origin of AIDS, resurrected racist ideas of Black hypersexuality and barbarism historically used to marginalize people of color in the US."
Richard: There are so many points to be made here, but one of them is that people who were suffering more from HIV were being blamed for having the disease and then being blamed for causing the disease. If you were someone who had HIV or AIDS, there was this fear and stigma around you for being the person who had the disease instead of the healthcare system reaching out and trying to identify the social factors that were influencing your ability to get treatment for it and bringing you into care, which we're still struggling to catch up with in all the ways that are still problematic.
Gaby: But though individuals are being blamed and stigmatized, you could take a different narrative. You could flip this on its head and say it's not the individual's fault, it's the colonial force's fault for disrupting the balance of an established social and economic ecosystem. Many spillover events happened in that time period. But without the megaphone of amplification that was colonial labor practices, we didn't really have the ability to fuel the fire into a full epidemic
Sam: So in some ways the story is simple. Hunting causes exposure to a chimpanzee virus which takes hold in a few humans. Those humans are subject to extensive colonial vaccination campaigns, amplifying a bloodborne illness. And then once amplified at a certain level, high volume sex work that's taken hold in a new colonial economy can then continue to be spread.
Richard: But within that, the quote, simple story, there are many ways that racism was at play. In how scientists looked into HIV and asked their questions and also announced their findings, and in the many ways these scientists ignored the impact of their work on the populations that, at the same time, were disproportionately impacted by HIV and AIDS.
Gaby: For those of you who used that music break to see if our merchandise store has Richard's Gay Opera Glasses, We're sorry that we a. don't have a merchandise store and b. specifically don't have opera glasses stocked. Anyway, back to our scheduled programming. We left our story in Central Africa where HIV is being amplified and sustained.
Richard: But how does it get to the United States?
Sam: History and science have arrived at Haiti as the historical stepping stone between the Central African epidemic and the North American epidemic, using the same science that we discussed in the first part of this episode.
Gaby: Meaning: genetics, mutations, and genetic math.
Sam: In 1957, Francois Duvalier comes to power, and history quickly labels him a dictator. Across the Atlantic at the same time in the late 50s and 60s, the departure of the Belgian colonial administrative state has left a power vacuum and caused multiple upheavals in what is now the modern day states of the Democratic Republic of Congo and the Republic of the Congo. Because of their shared colonial history, French is a common language, so from about 1963-64, Haitians were the second largest contingent after Belgium, among the UN folks who were teaching in the Congo area at that time. So while there's a new dictatorship at home, the UN is now also looking for an educated professional class to work for the UN in Central Africa. And this migration back and forth is a leading theory of how the HIV 1 virus that was then in Central Africa got to Haiti.
Gaby: Are there any more specifics as to exactly what happened?
Sam: Unfortunately, no, there is not specific proof that this is the story that played out. It was, and remains, easy to poke holes in this theory, despite the absence of another, more probable way that HIV got out of Central Africa and to North America. But, it is thought that of the roughly 4, 500 Haitian professionals who moved back and forth from Central Africa to Haiti during the 1960s, only one or a few of them would've had to have moved back with the H I V virus,
Gaby: So we know that there were people traveling back and forth between an HIV hotspot in Africa and Haiti, but There weren't massive vaccination efforts in Haiti, so how did those HIV positive travelers amplify into a full HIV epidemic in Haiti?
Sam: The answer to that question is blood donation or plasmapheresis centers. And while this part is unproven in the Haitian context of history, it has been proven that blood donation centers in China, Mexico, and India have all been identified as the sources of rapid transmission of HIV1. And that happens because the equipment being used is not properly sterilized between patients.
Richard: It's worth noting that because of HIV we have universal precautions in place that actually, mandate testing of blood and so blood products are much safer than they were at this time. At the time we did not know what to anticipate.
Gaby: So in Haiti's case, it's blood donation that is the predominant amplifying force. My follow up question is, Like in Central Africa, was there a secondary transmission route, like sex?
Sam: So sex is also part of the answer, and notably, we want to talk about the gay tourist industry and how that's one of the leading theories of how the virus left Haiti and got specifically into US North American gay male communities. You can find these old Spartacus gay travel brochures that in very racist terms, advertise like why a gay white man from the US would wanna come to Haiti. And they use sort of these explicit ideas of hypersexual and sort of quote, primitive narratives around people in Haiti.
Richard: It's also worth noting that now we're talking about multiple marginalized communities and the way that gay white men were oppressing marginalized people in Haiti. And if we look at a country like Haiti that's incredibly under resourced, that's under dictatorial rule, where people are desperate for any kind of economy, and then we think about how we oppress gay men to the point where they're not allowed to be out and they're self hating and can use their resources to find what they're looking for. Whether that's some kind of sexual liberation or validation and in other places. So of course we're going to take people who are the most marginalized and can't find what they need in the United States, and we're going to send them elsewhere. And we're going to use the fetishizing language of why it should be appealing instead of using more sort of affirming language around how to have a suburban life with your gay partner, right? Like, we just keep taking people who are disadvantaged and running this game about pointing everyone towards each other for blame instead of looking at the people in power and how the lack of resources really allow these narratives to take off. If there were equity in the United States and people could express their sexuality in ways that were healthy and meaningful, we probably wouldn't have needed that kind of industry. And so this narrative can pit gay white men from the United States against people in Haiti, where both groups were responding to significant marginalization.
Sam: The whole point that's the most interesting to me is that like there needs to be a narrative and there needs to be a group of people with a behavior that you can tie to a subculture for these things to get, you know, blamed on someone and someone has to take the blame instead of everyone just being a bystander.
Richard: And we're functioning under the assumption that the population of Haiti is a bystander to this. Basically, that there's not a specific culture or subculture within Haiti that is quote unquote to blame for the HIV epidemic. However, that wasn't the case in the 80s.
Gaby: In March of 1983, the CDC introduces four groups known to be suffering from HIV and AIDS at higher rates. And these groups get the nickname collectively of the 4 H club because each group started with an H. They stand for homosexuals, Haitians, hemophiliacs, or people who often have need for blood transfusions, and then the last one is heroin users, or people who might share needles. Each of these groups experiences stigma in their own distinct way. For Haitian people, there was a significant amount of overt racism in the way in which their suffering from AIDS was being discussed early on by the CDC as well as the lay press.
Sam: Much of Paul Farmer's book about this really fleshes this out. And one of his main examples is an article in JAMA, which is the Journal of the American Medical Association, one of the sort of most prestigious medical journals. And this article is titled quote "Night of the Living Dead". This article basically puts forth voodoo and quote, "zombie-like rituals" is a potential source of a virus causing AIDS. And there's tons of other scientific literature that basically blames Haitian folk culture through this like warped lens of racism and xenophobia and says to sort of like, this culture with these behaviors has caused this problem.
Gaby: Just to be abundantly clear, voodoo was obviously not how HIV spread. But the genetic studies that would tell the true story would only come years later, well after the 80s.
Richard: It's incredibly important to note that there were people at the time, particularly people who held less power, who were calling this out in real time. The president of the Haitian Medical Association criticized the CDC for putting forth scientific and racist attitudes in discussing the role of Haitians as a group in the larger HIV epidemic.
Gaby: And this is why, after two years of lobbying, the CDC removes Haitian as a risk group designation for HIV and AIDS. There were lingering effects. Haitian people would continue to be limited from giving blood. And that ban, as well as the resulting stigma, was later the subject of significant street protesting and demonstration in New York in the 1990s, all of which eventually led to the formation of an advisory panel by the FDA. And to Richard's point, this is super emblematic of the way that the community of Haitian people was organizing against AIDS related stigma in real time throughout the entire development or unfolding of the epidemic.
Richard: One thing that's missing from this conversation is that these narratives need to be thought of also from a restorative justice lens. The harm that was done by pinning these narratives on places like Haiti, continue to exist as narratives in the United States today, and we haven't thought about how are we going to go back and undo the harm that is still done to Haitians in the United States today by these narratives that still exist in many places.
Gaby: Absolutely, and that's a really, really important point. It's gonna be one that we get a bit more into in our second episode, where we're gonna be discussing the landscape of modern day HIV inequity, which I guess kind of brings me to my next point, which is, should we do a quick recap and wrap this up?
Richard: To summarize, blood mixing between primates and cut hunters led to the infection of humans with HIV. Colonialist worker vaccine initiatives with improper needle hygiene led to dissemination within a community. Homophobia in the U. S. led to gay tourism that spread the virus to the U. S. And ultimately, the time spent blaming marginalized groups to protect cisgender, heterosexual white Americans has led to deeply entrenched and harmful stories that make HIV deeply difficult to treat even today.
Sam: While today's episode might've brought out some historical high points and the way genetic science has been used to resolve historical controversies, the main thing we wanna leave you with is understanding the ways in which the telling of HIV's history continues to be filled with racist narratives. These narratives matter because like we said at the beginning, ending racial inequity today can end the HIV epidemic tomorrow. In our hopes to work towards restorative justice, like Richard was talking about and dismantling racist narratives and systems, we wanna be able to name both the current and historical forces of racism in the way that they've influenced our understanding and the impact of the AIDS epidemic.
Gaby: Today is not about knowing like which genetic test puts which HIV strain at which year, even though we spent some time talking about that. It's about pointing out that if we reconceptualize our understanding of HIV's history, if we think about how forces like extractive colonialism, migration patterns, dictatorial rule, economic and social marginalization, how all of these things impacted the spread of the virus. Then I think, for me at least, things crystallize a bit. It becomes more and more apparent that the people who suffered the most from this epidemic in real time were bystanders, caught at the center of a historical crosshairs.
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Gaby: QHP is a power-sharing project that puts community stories and conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: For books and research reference, please see our online show notes at www.queerhealthpod.com. But we also would like to acknowledge the many resources that went into this.
Richard: Such as the input of our fabulous community reviewer, Dwayne Steward.
Gaby: If you think that the stories and historical narratives that we told in this episode are important, please help others find this information by leaving a review on your podcast platform of choice or by subscribing on Spotify or Apple.
Richard: Our handle is @QueerHealthPod on Twitter and Instagram. You can also email us at QueerHealthPod@gmail..com
Sam: Thank you to Lonnie Ginsburg who composed the theme music heard throughout this episode. Opinions on this podcast are own and do not represent the opinions of any of our affiliated institutions, even though we are physicians. Don't use this podcast alone as medical advice. Instead, consult with your own healthcare provider.
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Richard: Why can I not say the word colonialist this morning? Coloni – what did you do to die today at a minute or two till two? A thing distinctly hard to say yet harder still to do. So they'll be ta ta two at twenty till two A rat ta ta ta ta ta ta ta ta two And the dragon will come when he hears the drum At a minute or two till two today At a minute or two till two. I do have a theater background, you know.