What We’ve Done, Where We’re Going: The History & Future of HIV/AIDS and its Sociology

1. What We’ve Done, Where We’re Going: The History & Future of HIV/AIDS and its Sociology Sam Friedman

2. I would like to acknowledge • NIDA projects: • R01 DA DA019383-01A1 Staying Safe: Long-term IDUs who have avoided HIV & HCV • P30 DA11041 (Center for Drug Use and HIV Research; Sherry Deren PI) • R01 DA13336 (Community Vulnerability and Response to IDU-Related HIV project) • R01 DA13128 (Networks, norms & HIV risk among youth) • R01 DA006723 Social Factors and HIV Risk • R01 DA03574 (Risk Factors for AIDS among Intravenous Drug Users ; DC Des Jarlais, PI) • Hundreds of participants in these studies • Colleagues and participants who have died of HIV/AIDS and hepatitis C • Many collaborators and co-authors

3. What we have done • Early prevention work by sociologists with drug users included Wayne Wiebel’s indigenous leader outreach model; my work on organizing drug users against HIV/AIDS; and San Francisco CHOW. ALL of these have guided a lot of subsequent work in various countries • MUCH sociological work has focused on supra-individual levels of analysis and structural interventions (Blankenship; Rhodes)—though I am not sure this was fully represented earlier today. • Work on risk networks and how HIV is transmitted. Martina Morris, Alan Neaigus, and I have been deeply involved. • Comparative studies of MSAs in the CVAR project; and Ricky Bluthentahl and his colleagues have compared SEP programs, behaviors and infection in a number of California localities.

4. Other important work has been done by many sociologists in this room and elsewhere. Some of these sociologists work in difficult circumstances without public or professional recognition. • This relative lack of recognition is in part due to the overwhelmingly individualistic/medical focus of the AIDS research field.

5. HIV risk is a conditional probability The probability is socially structured +, on HAART - HIV Negative Unknown, but GC+ and HSV-2+

6. Attended Group Sex Party (Pluses) and Had Unsafe Sex at Group Sex Party (Circles) by Gender/Sexuality (MSM=up triangle, WSW=down triangle, other female=circle, other male=square) by Hardest Drug Use Ever (from dark red to light pink: IDU, Crack, NI Heroin or Cocaine; blue=other) by Link Type (sex=yellow line, IDU=red, sex and IDU=blue) Friedman, Samuel R; Bolyard, Melissa; Khan, Maria; Maslow, Carey; Sandoval, Milagros; Mateu-Gelabert, Pedro; Krauss, Beatrice; Aral, Sevgi O. (2008). Group Sex Events and HIV/STI Risk in an Urban Network. J Acq Immun Syn.49(4):440-446

7. Big Events research: Why do some transitions lead to HIV epidemics and others not? Diagram published in: Friedman, Samuel R; Rossi, Diana; Braine, Naomi. (2009). Theorizing “Big Events” as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks. International Journal on Drug Policy 20:283-291 Sex and drug networks and behaviors may include Quasi-anonymous risk nodes like group sex events or shooting galleries

8. Responses to what sociologists have done • Policy remains relentlessly behaviorally and medically focused. • In the first 6 of the NIDA NADR outreach projects, supra-individual projects (Wiebel, San Francisco CHOWs, my organizing) led the way. But the behavioralists won the internal battles in NIDA, and by the second and third waves of grants later in the year, the behavioral-counseling individual randomized control model won out. • Similar patterns have happened at NIMH and CDC. • And increasingly the focus in Washington, Atlanta and internationally is on “bio-behavioral intervention” like testing, microbicides, circumcision and vaccines—with social and even behavioral sciences useful mainly as adjuncts to them.

9. Studies of dialectics of policy formation Comparative longitudinal studies of epidemics and of responses: a Community Vulnerability and Response study of MSM epidemics in US cities Comparative studies of Big Events Most research on gender and HIV has been too social psychological, dyadic, behavioral or interpretive. Too little has looked at issues like how the strength of feminist movements and/or the relative exploitation of men and women affect local or national epidemics and responses. How do community structures, processes, policies, and human agency affect the prevalence of kinds of “risk environments” (Tim Rhodes) like group sex and injection events, what people do in them, and how participants can protect themselves. What is to be done? Thoughts on research topics (1)

10. What is to be done? Thoughts on research topics (2) • Studies of socially-created categories of high-risk people or events that are missed by surveillance categories defined by behavioral epidemiology: • Non-injecting drug users are likely a very large percent of “heterosexual transmission cases” • Many of the rest are women who have sex with women and also with MSM or male IDUs or NIDUs. • Race, racism and HIV: “Disparities research” has not taken advantage of the rich knowledge developed by sociology. See the next slide from Friedman, Cooper & Osborne (2009, AJPH) as but one example of how sociology might broaden research on the epidemic among African Americans.

11. Relationships among racialized social structures and processes and HIV-relevant cultural themes, subcultures, networks and behaviors among African AmericansFriedman, S.R.; Cooper, H.L.F.; Osborne, A. (2009). Structural and social contexts of HIV risk among African-Americans. American Journal of Public Health. 99: 1002-1008, 10.2105/AJPH.2008.140327

12. What kind of sociology? • Material reality is obviously important. • So are subjective ideas and social-physical practice. • Marxism seems well-suited for such analyses and action • Looming issues it points to now include the politics of hard times: • Making do in spite of cutbacks • Fighting back successfully against cutbacks • “Divide & Rule” strategies by capitalists, their media and the State—and their implications for increasing stigmatization and repression, and revivals of racism, sexism and attacks on workers. • Social movements of hard times—and new forms and organizations of struggle • And how and when drug users, gay men, women, and people in Africa, East Europe, Asia and Latin America can combine their struggles with these upcoming social movements

13. Final thoughts • Why has sociology been so weak in the politics of HIV/AIDS? I would start with the general failure of the Left in the 80s and since, which was based on and contributed to weak movements • This was reflected in the individualist focus of “scientific thought” and of most HIV prevention and even care. • In sociology, this led to a focus on risk behaviors, on forms of symbolic interactionism disassociated from its “natural” relation to Marxism, and on post-modernist and cultural turns. • These turned sociology away from a dialectical focus on the interaction of social processes, the virus, and the epidemic--and weakened community responses. • This may have been less true for IDU studies and action, but has been strong there too. • My work has been cited by some as a model. Please be aware that it is based on a Marxist dialectics of the real.