Shaken Optimism about Modern Medicine

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Parsons believed, along with many scientists in the 1960s and 1970s, that modern medicine verged on conquering all major infectious diseases, at least for societies with effective systems of sanitation and public health. The appearance in the 1980s of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has shaken such optimism. It has now become clear that humankind faces a major pandemic that, despite modern science and technology, will take scores of millions of lives globally (WHO). Twenty years of research has failed to produce an effective vaccine. New antiretroviral medications are extending the life and health of many patients with HIV/AIDS, but not all patients are helped, and how long the others will benefit remains unclear (IAPAC). In the meantime, many patients do not receive the new treatments because they have not been diagnosed, are not willing to face the consequences of an HIV/AIDS diagnosis, lack access to care or means of paying for treatment, or do not trust medical institutions to help them (Klitzman).

The costs of the new medications for HIV/AIDS are prohibitively high for most of the populations in non-Western nations, and an active controversy in the early 2000s concerned ways of making them available at reduced cost in African, Asian, and Latin American societies. Until there is an effective vaccine or a less expensive cure, prevention programs must play a prominent role in overall HIV/ AIDS policy. In the United States, prevention programming still faces challenges in communicating effectively with sectors of the population most seriously at risk, in part because of political constraints on frank communication with adolescents and young adults regarding sexual practices and condom use and on laws affecting availability of sterile injection paraphernalia.

Western nations have had the public health resources to stabilize rates of HIV infections at low or moderate levels. According to World Health Organization (WHO) data from 2002, Thailand and Uganda had managed to reduce formerly high rates of infection. In a number of nations in sub-Saharan Africa, however, the continued rapid spread of HIV, as of2003 affecting more than 28.5 million people, in some countries over 30 percent of adults in their reproductive years, is radically changing demographic structures and life-cycle patterns. In Parsons's terms, a major feature of the epidemic is that it afflicts mainly youths, young adults, and people in early middle age. People who become diseased and die are losing their most productive years. Their deaths represent unfulfilled lives, with future achievements, relationships, and experiences all lost. The economic impact on whole regions and nations is becoming immense, as is the burden of caring for children whose parents have died. WHO reported in 2002 that India, China, Burma, Indonesia, and perhaps Russia also had rapidly growing epidemics and were at risk of experiencing similar effects on regional if not national bases.

In Western societies, where HIV infection is concentrated in homosexual men, injection drug users, and, increasingly, women sex partners of injection drug users and of men who have sex with men (CDC), its transmission has often involved stigmatized behavior. HIV, with the ugly image of a wasting, disfiguring, and dementing disease, has added vastly to the burdens of prior stigmas. Many people with HIV disease have experienced intense feelings of guilt, shame, and self-blame as an added dimension of their suffering (Klitzman). Moreover, many have experienced great loss. In social circles where HIV has become common, many individuals still in early adulthood have lost many friends and associates, an otherwise rare experience in modern societies, given the generally thorough control of death before old age. Many are burdened by the "survivors' guilt" typical of people who live through disasters that have claimed the lives of many others (Erikson). They often find that any attempt at a spirited resumption of everyday activities is complicated by feelings that their futures are hopeless or meaningless without the individuals who have been lost. People not infected but aware of being at risk of infection may feel that they will inevitably become diseased— even that they are already "dead," although still walking around. Efforts to change personal conduct in order to avoid exposure to HIV may be complicated by beliefs that it is impossible to stay well or that it would be better to accompany friends in heroic suffering and death (Weitz). In some

Western communities and in African and Asian nations, lassitude engendered by the HIV epidemic, through social loss, fear of death, and guilt, is causing immense social dislocation and will likely cause more in the future.

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