HIV/AIDS through Different Sociological Lenses
Amidst recent innovations and progress in medicine, HIV (human immunodeficiency virus) /AIDS (acquired immunodeficiency syndrome) remains a salient health issue in the world affecting around 37.7 million individuals (UNAIDS, 2021). When the first case of HIV/AIDS emerged in the 1980s, the lack of scientific knowledge and research resulted to a high mortality rate amongst positive individuals (Fauci and Lane, 2020; Whiteside, 2016). Nonetheless, modern medical science has allowed people living with HIV to deter the development of AIDS and live relatively normal healthy lives up to an average of 70 years (Burton, 2019). Aside from being a medical problem, HIV/AIDS is also a social issue that necessitates sociological inquiry (Patterson and Wolf, 2010). By applying functionalism, conflict perspective, and symbolic-interactionism, the understanding of HIV/AIDS as a social phenomenon can be further elaborated.
I. Functionalism
Some sociologists liken society to a living organism with different interacting organs. This sociological framework, known as functionalism, perceives society as a complex system of interrelated parts that work together in order to maintain equilibrium and solidarity (Cockerham, 2015). In health sociology, Parsons (1951) underscored the importance of maintaining good health and the promotion of effective health care in order for society to perform its normal functions.
Similarly, functionalism can be utilized to understand HIV/AIDS as a disease that threatens the stability and functions of society. Individuals who are afflicted by this illness have to relinquish their obligations from their community and they also pose a risk to infecting other healthy individuals. Thus, Parsons conceived of the sick role as a mechanism of social control that has a specific function in the treatment of illness. Although Parson’s ideas are not entirely applicable for chronic illnesses such as HIV/AIDS, Parsonian functionalism can be further extended to accommodate them (Varul, 2010).
The sick role is a set of expectations that endows the individual the right to retreat from normal life (e.g. work and leisure) until they recover from illness. For an individual to be considered legitimately sick they must: (1) have not caused their own problem to evoke sympathy, (2) want to get well, and (3) their illness must be confirmed by physicians to follow treatment (Schipke, 2019). However, for long-term illnesses like HIV/AIDS, these criteria are not perfectly met. Nonetheless, they are still considered legitimately sick by society and must be treated to control the disease from affecting other segments of the population.
Firstly, a shift in medical perspectives has framed the condition of HIV/AIDS as a consequence of external social factors rather than a personal fault (Giami and Perrey, 2012). Initially, people who were HIV positive were blamed for moral reasons such as promiscuity and homosexuality that incited less sympathy. However, research has proven that there are numerous factors that can affect transmission such as accidents with infected needles and parent-to-child transmission during pregnancy. Due to these developments, HIV/AIDS can evoke more sympathy for its legitimization as a disease. Next, HIV positive individuals undergo a process of normalization (Varul, 2010). Although they cannot fully recover from their illness, they are expected to perform social roles such as work or school as long as it does not affect their health and they continue their medical treatment. They occupy a role of duality that renders them sick but at the same time capable individuals to a certain degree (Crossley, 1998). For example, the new technology of antiretroviral therapy makes the transmission of the virus to non-infected individuals less likely. Thus, HIV positive individuals can reclaim their normal sexual lives that they have initially withdrawn from during the early stages of their illness when the possibility of transmission was still high.
II. Conflict Perspective
Another perspective in health sociology highlights how power relationships determine different health outcomes. The conflict perspective posits that inequality in the quality of health and access to healthcare significantly shapes the distribution of health resources (Yumnam and Dasgupta, 2017). Moreover, inequalities in terms of gender, race, sex, ethnicity, etc. are also reproduced in the healthcare system. Hence, people who come from disadvantaged social backgrounds are more likely to become ill and if they do, they would receive inadequate healthcare (Kapilashrami and Hankivsky, 2018).
Just like any other disease, HIV/AIDS is unequally distributed in different groups of society. It also echoes the structural inequalities that are historically embedded in the healthcare system. According to Watkins-Hayes (2014), the HIV/AIDS epidemic is characterized by inequalities that are fuelled by racial, gender, class, ethnic, and sexual inequities. These inequalities profoundly contribute to the likehood of exposure of the individual to the virus; the oppressive realities that they may experience; and the medical, scientific, and political response that they receive for their illness.
A pertinent example to illustrate the inequalities of HIV/AIDS in terms of social background is the prevalence of the disease among gay men. According to the CDC (2021), gay men are at a higher risk of acquiring HIV because receptive anal sex compared to other modes of intercourse (e.g. vaginal and oral) is more conducive to viral transmission. Simultaneously, gay men also suffer homophobia, discrimination, and stigmas that can make them suffer from mental illness and influence how they seek or obtain quality healthcare. According to Wolitski and Fenton (2011), since gay men are likely to suffer anxiety and depression, they are more likely to engage in risky behavior such as having unsafe and unprotected sex that exposes them to HIV. Furthermore, stigma and homophobia can deter gay men from seeking medical care due to feelings of shame and embarrassment for their sexuality (Pampalia et al., 2021). In conclusion, the different intersections of sex, gender, and mental illness clearly illustrate the inequalities of HIV/AIDS in certain groups in society.
III. Symbolic-Interactionism
The preceding perspectives emphasized the stability or conflict present in the sociology of health and illness. On the other hand, symbolic-interactionism places precedence on how health and illness are socially constructed. This involves the processes on how people create social meaning and identities during interaction with people who are ill and how these situations are defined in the presence of sick individuals (Cockerham, 2016).
In the case of HIV/AIDS, people living with HIV/AIDS (PLWHA) have socially constructed identities that affect the perception of one’s self in relation to other groups and individuals. The labelling theory, closely associated with symbolic-interactionism, explicates the experience of PLWHAs. It is concerned with how the majority negatively labels individuals who do not conform to cultural norms and standards (Pantelic et al., 2019). Similar to this line of thought, being sick with HIV/AIDS represents a deviation from the norm of being healthy. Hence, once a person infected with HIV/AIDS is labelled, they occupy a new self-identity that has different implications to broader society (Khalifa et al, 2017).
A relevant example to the symbolic-interactionist aspect of HIV/AIDS is the concept of stigma. For PLWHAs, the label of being positive with HIV does not only mean that they are infected with the virus. It also affects how people perceive them and ultimately how they perceive themselves. According to Fam et al. (2021), stigma in PLWHAs ascribes negative social and personal characteristics once they are labelled. Firstly, stigma shapes the attitudes, ideas, and behavior of other people towards PLWHAs. A prevalent negative image that people hold towards PLWHAs is that their condition is a consequence of immorality and sexual deviance that renders them unclean, impure, or immoral. These preconceived beliefs may lead to acts of discrimination and harassment towards PLWHAs (Mahajan et al, 2008). On the other hand, stigma can also affect the self perception of the PLWHAs. According to (Brown et al., 2003), their negative social identities can drastically affect their sense of self-worth and self-esteem. PLWHAs may internalize the negative scripts that society attaches to them. Consequently, they may hold negative self-images of themselves that may cause psychological harm such as depression and anxiety (Holzemer et al., 2007). In conclusion, the social construction of meaning and identities associated with HIV/AIDS significantly impact the lives of PLWHAs and how broader society treats them.
This paper was written in partial fulfillment of Sociology 197 (Special Topics in Sociology) course at the University of the Philippines — Visayas.
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