Aids has always been associated with political and emotional instability. The potential for transmission of the virus by blood or gender, coupled with its first appearance among marginalized and criminalized populations, created a potent mixture of primal terror and horrific prejudice.
It can sometimes be difficult to remember how powerfully misinformation, fear and outright hostility shaped knowledge and experience of AIDS in the first decade or so of the pandemic. During this period, a positive HIV test meant a terminal diagnosis, and medical knowledge about transmission and treatment was still murky.
In Australia, the 1980s saw a subtle transition from epidemiological concentrations among gay men, sex workers and intravenous drug users to moralizing approval and discrimination. Some parliamentarians and church leaders in Australia have even proposed forcibly imprisoning anyone who tests positive for HIV.
In Africa today, shame and morality are combined differently. More than half the world's population living with HIV and AIDS lives in southern and central Africa, where prevalence among adults in some countries is more than 10%. Here transmission occurs predominantly heterosexually, and it is the gap between assumptions of monogamy and the gendered realities of sexual practice that poses the greatest public health challenge. Thus, the rate of transmission is increasing most alarmingly among the most sexually vulnerable groups of the population, namely young women.
Public health experts around the world knew it would be difficult to overcome the powerful forces of shame, stigma and fear that shaped the response to AIDS. That's why World Public Information Officers Health The organization coined World AIDS Day on December 1, 1988. They hoped it would become a powerful weapon in the fight against AIDS and misinformation.
Within queer communities, World AIDS Day has also always served a memorial and politicizing purpose. As early as 1988, just six years after the first diagnosis in Australia of what was initially described as “grid” (a gay-associated immune disorder), various types of memorial practices began to develop, intended to make sense of mounting losses in queer terms, as well as to act as a pressure point in shaping health policy.
That same year in Sydney, World AIDS Day emerged as a moment when those most affected by existential threats could reckon with the memories, history, present and future of the pandemic in a way that made sense to them.
This afternoon, activists, representatives of affected communities, government leaders, bureaucrats, health workers and carers came together to showcase Australia's AIDS quilt for the first time. During the proceedings, the Rev. Jim Dykes read one by one the names of the lives memorialized on the panels.
The fact that the AIDS blanket was sometimes ironically referred to as the “breeze of death” reminds us that a strange sense of irony remained a crucial aspect of the AIDS experience, even if those jokes sometimes bordered on comfort.
Later that evening, a large group of people gathered in Martin Place for a rally that was at once an activist demand for government funding, a sign of gratitude to the army of volunteer carers and workers, and a memorial to the lives already lost. The following weekend, several social events and club nights raised money for carer organizations, including a party for the care workers themselves, many of whom were already showing signs of carer fatigue.
The evening's rally would grow into an event that would attract around 10,000 people to the Domain in the coming years. Reading the names of the victims became the emotional core of the process. Community leaders remember how they forced themselves to read those names into the microphone and were left with a deep sense of beauty and warmth from the effect.
That this recitation took up more and more time in the 1990s was a brutal reminder of how the AIDS tidal wave was ravaging gay communities. Gay men in the mid-1990s described the loss of partners and friends with such concentration that it felt as if their entire social and intimate world had disappeared. One man I recently interviewed described how he was walking down a street in Darlinghurst in 1996 and realized that in every house he passed, he knew someone who had died.
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In Australia, the worst of the AIDS crisis was brought under control, first thanks to the incredible success of safe sex and needle exchange campaigns, and then, in 1996, because the advent of “combination therapy” turned HIV/AIDS from a terminal stage into a chronic diagnosis.
While comparable national contexts such as the US and UK experienced rising rates of HIV and AIDS diagnosis as early as the 1990s, Australia peaked in 1988, followed by a sharp decline.
The only possible explanation for this is the remarkable success of safe sex campaigns, which were initiated and developed by activists and supported, sometimes quietly, by state and Commonwealth governments who were convinced that moralizing about sex would not prevent transmission.
Researchers now describe the “Australian response” to AIDS as a historical phenomenon and a public health model to be followed. His success was remarkable.
There is much to celebrate in the history of our national model, not least because it is a shining example of how a public health disaster can be managed and mitigated when public policy and funding are based on community knowledge and experience.
However, there is also a heartbreaking historical irony in this Australian story.
Success meant that, historically and epidemiologically, HIV/AIDS remained extremely concentrated. In the late 1990s, between 80% and 90% of all reported HIV/AIDS diagnoses in Australia were among men who had sex with men.
The fact that most gay men in Australia began wearing condoms by the mid-1980s meant that all Australians were protected from the worst of the pandemic. The government did not need to isolate gays: their own sexual practices ensured that the effects of HIV/AIDS would remain under control.
We have now learned to describe HIV/AIDS as a pandemic due to its global spread. But the influence of this circulation was uneven. The HIV/AIDS pandemic has perhaps always been experienced and unfolded as a series of interconnected “epidemics” shaped by national and local conditions.
The consequences of HIV/AIDS have been and will be determined by the actions of the people who experience it and the choices of those who have the power and ability to do something about it.
