Chronicity, crisis, and the ‘end of AIDS’

ABSTRACT

In biomedical, public health, and popular discourses, the ‘end of AIDS’ has emerged as a predominant way to understand the future of HIV research and prevention. This approach is predicated on structuring and responding to HIV in ways that underscore its presumed lifelong nature. In this article, I examine the phenomenon of HIV chronicity that undergirds the ‘end of AIDS’ discourse. In particular, I explore how the logic of HIV chronicity, induced by technological advances in treatment and global financial and political investments, intensifies long-term uncertainty and prolonged crisis. Focusing on over 10 years of anthropological and public health research in the United States, I argue that HIV chronicity, and subsequently, the ‘end of AIDS’ discourse, obscure the on-going HIV crisis in particular global communities, especially among marginalised and ageing populations who live in under-resourced areas. By tracing the ‘end of AIDS’ discourse in my field sites and in other global locations, I describe how HIV chronicity signals a continuing global crisis and persistent social precarity rather than a ‘break’ with a hopeless past or a promising future free from AIDS.

KEYWORDS:

• United States
• chronicity
• ageing
• health inequity
• HIV/AIDS

Acknowledgements

I would like to express my deepest gratitude and appreciation to those who shared their stories, experiences, and expectations with me; my research collaborators including Typhanye Dyer, Amelia Jamison, and Karen Kroeger without whom much of this work would not be possible; Matthew Thomann for providing generous feedback on previous draft versions of this paper; and the anonymous reviewers for their constructive feedback, which led to considerable improvements in this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

ORCID

Thurka Sangaramoorthy http://orcid.org/0000-0002-8467-5907

Notes

1. Haitians made up 4.4% of Miami’s population (Bureau of Census, 2010) in 2012 but represented 11% of the total reported cases of those living with HIV through 2012. Many have stressed that even these numbers are gross undercounts due to unstable patterns of housing, family networks, high mobility, distrust of government and health officials, immigration status, and other factors (Stepick & Stepick, 1990; Marcelin & Marcelin, 2001).

2. North Carolina, for example, experienced a rapid increase in its Latino population, from 1.7 percent in 1990 to 7 percent of the total population in 2008, a growth of more than 400 percent (Bureau of the Census, 2009). Much of the migration of Latinos to the U.S. Southeast—considered ‘new immigrant gateways,’ regions previously not regarded as major destinations for immigrants—has been driven by employment opportunities in construction and agriculture. As a result, the demographic makeup in these areas of the South differs from that of more established Latino communities across the country, with Latinos more likely to be young, male, unmarried, foreign-born, and recent arrivals. Public health experts have argued that these young male migrants lack the social and sexual networks found in established communities and may be at high risk for HIV and STIs (Painter, 2008).

Additional information

Funding

The work presented in this manuscript was supported by a seed grant from the University of Maryland NSF-ADVANCE Project (PIs: Sangaramoorthy & Dyer). It was also supported through the National Institute on Aging (1R01AG023636-01A2, PI: Becker); the National Institute on Minority Health and Health Disparities Loan Repayment Program (PI: Sangaramoorthy); and the Association for Prevention Teaching and Research Sexually Transmitted Diseases Prevention Fellowship and the US Department of Energy (DOE), Oak Ridge Institute for Science and Education Fellowship for work conducted while at the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. The findings and conclusions of this manuscript do not represent the official views or policies of these funding agencies.