Archives
Social construction of HIV/AIDS: Theory and policy implications
Michael Polgar
Abstract
This paper considers five different social constructions of HIV and AIDS. In a
medical model, science describes HIV scientifically and in the body, in terms of
a compromised immune system, opportunistic infections, treatment and care.
An epidemic model identifies risk behaviours and transmission routes,
informing health education and disease prevention. Organizational
conceptions of AIDS developed by large interests, particularly hospitals,
according to economic, administrative, and health concerns. Social
constructions of AIDS as plague or punishment against society are advanced
by moralists who equate HIV with taboo social and sexual behaviour, Political
constructions of AIDS, highlight public health in the face of obstacles to
treatment and the delivery of services to people living with HIV. Political and
moral constructs are at odds over AIDS as a form of social stigma, magnifying
many forms of prejudice and discrimination. Each construct is supported by
an institutional authority, framing the problems and responses to HIV and
AIDS, the dominant metaphors and symbols, and the most pressing questions
and uncertainties.
References
Aggleton, P, P Davies, G. Hart, AIDS: Foundations for the Future, Taylor and Francis,
London, 1995
Aggleton, P, AIDS: facing the second decade London, Falmer Press, 1993.
Aiken, L and H Smith (1993) "Effects of Specialization on the Status and Autonomy of
Nurses: Results from a Natural Experiment in Hospital AIDS Care," Paper presented at
the ASA in Miami, August.
American Nurses Association (ANA) (1991), Position Statement on Personnel Policies
and HIV in the Workplace, Washington DC.
Barbour, R. "A Telling Tale: AIDS Workers and Confidentiality," in Aggleton, P, P
Davies, G. Hart, AIDS: Foundations for the Future, Taylor and Francis, London, 1995.
Bayer, R (1991) "AIDS, Public Health, and Civil Liberties" in F. Reamer, ed., AIDS and
Ethics, New York, Columbia U. Press.
Becker, M, J Joseph (1988), "AIDS and Behavioural Change to Reduce Risk: A Review,"
American Journal of Public Health 78 (4), 394-410.
Bennett, P and J Wrubel (1989) The Primacy of Caring, Melno Park CA, Addison-
Wesley.
Bloor, M. The Sociology of HIV Transmission, New York, Sage, 1995.
Bosk, C and J Frader (1991) "AIDS and its Impact on Medical Work: The Culture and
Politics of the Shop Floor," in D Nelkin, D Willis and S Parris, eds A Disease of Society:
Cultural Responses to AIDS, Cambridge, Cambridge University Press, 150-171.
Brandt, A (1987) No Magic Bullet: A Social History of Venereal Disease in the United
States Since 1880, expanded edition, New York, Oxford U Press.
Cameron, M (1993) Living with AIDS: Experiencing Ethical Problems, London, Sage.
Centers for Disease Control and Prevention (CDC) (1995), HIV/AIDS Surveillance
Report 6 (2), Atlanta, CDC; 7 (1).
Colomobotos, J, P Messeri, M Burgunder, et al. (1994) "Physicians, Nurses and AIDS:
Findings From a National Study," Research Report, No. 1. AHCPR Pub. No 94-0043.
Rockville MD, AHCPR.
Douglas, M, (1990) "Risk as a Forensic Resource," Milbank Quarterly 4, 1-16.
Dowsett, G, M Davis, and B Connell, "Gay Men, HIV/AIDS, and Social Research: An
Antipodean Perspective," in Aggleton, P, P Davies, and G Hart eds, AIDS: Rights, Risk
and Reason, London, Falmer Press, 1992.
Emmanuel E, (1988) "Do Physicians Have an Obligation to Treat Patients with AIDS?"
New England Journal of Medicine 315 (25), June 23, 1686-1690.
Epstein, S, "The Construction of Lay Expertise: AIDS Activism and the Forging of
Credibility in the Reform of Clinical Trials," Science, Technology and Human Values
20 (4), Autumn 1995, 408-437.
Fee, E and D Fox (1988) AIDS: The Burdens of History, Berkeley, UC Press.
Fee, E and N Krieger (1993) "Understanding AIDS: Historical Interpretations and the
Limits of Biomedical Individualism," American Journal of Public Health 83 (10), 1477-
1486.
Feldman, T, R Bell, J Stephenson et al. (1990) "Attitudes of Medical School Faculty and
Students Toward AIDS," Academic Medicine 65 (7), 464-66.
Ficarrotto, T, M Grade, and L Zegans (1991) "Occupational and Personal Risk Estimates
for HIV Contagion Among Incoming Graduate Nursing Students," Journal of the
Association of Nurses in AIDS Care 2 (1), 5-11.
Ficarrotto, T, M Grade, N Bilwise, et al. (1990) "Predictors of Medical and Nursing
Students' Levels of HIV/AIDS Knowledge and their Resistance to Working with AIDS
Patients," Academic Medicine 65, 470-471.
Fisher, M (1994) Sleep with the Angels, Publishers Group West, Moyer Bell.
Fox, R (1980) "The Evolution of Medical Uncertainty," Milbank Quarterly 58 (1),1-49.
Fox, R (1979) "Training for Uncertainty," in R. Fox, Essays in Medical Sociology:
Journeys into the Field, New York, John Wiley and Sons, 19-50.
Fox, R, L Aiken, and C Messikomer (1991) "The Culture of Caring: AIDS and the
Nursing Profession," in Dorothy Nelkin, David Willis and Scott Parris, eds. A Disease of
Society: Cultural Responses to AIDS, Cambridge, Cambridge University Press, 226-256.
Freeman, E. (1993) "AIDS-Designated Units of Scatter Beds: Which is Better?
Point/Counterpoint," Journal of the Association of Nurses in AIDS Care 4 (1), 64-66.
Fulton, R and G Owen, "AIDS: A Sociological Review," in R Fulton and R Bendiksen
eds, Death and Identity, Philadelphia, Charles Press, 1994, 382-405.
Gee, G. (1989) "Nurse Attitudes and AIDS," in D Rogers and E Ginzburg ed., Public
and Professional Attitudes Towards AIDS Patients, Boulder, Westview.
Gemson, D, J Colombotos, J Ellison, et al. (1989) "AIDS Prevention: Knowledge,
Attitudes and Practices of Primary Care Physicians," Archives of Internal Medicine 151
(June 1991), 1102-1108.
Gerbert, B, (1988) "Changing Dentists' Knowledge, Attitudes, and Behaviour Relating
to AIDS: A Controlled Educational Intervention," Journal of the American Dental
Association, 116 (7), 8511-854.
Gerbert, B, B McGuire (1991) "The Impact of Who You Know and Where You Live on
Opinions about AIDS and Health Care," Social Science and Medicine 32 (6), 677-681.
Goss, D and D. Adam-Smith, Organizing AIDS, London, Taylor and Francis, 1995.
Gusfield, J (1981) The Culture of Public Problems, Chicago, U. Chicago Press.
Hayward, R, and M Shapiro (1991) "A National Study of AIDS and Residency Training:
Experiences, Concerns, and Consequences," Annals of Internal Medicine 114 (1), Jan.
23-32.
Herek, G and J Catitanio (1994 ) "Conspiracies, Contagion, and Compassion: Trust and
Public Reactions to AIDS," AIDS Education and Prevention, 6 (4).
Herek, G (1990) "Illness, Stigma, and AIDS," in P Costa and G VandenBos eds,.
Psychological Aspects of Serious Illness, Washington, APA, 105-149.
Hersh, E, G Cromwell, K Ferentz et al. (1993) "HIV in Maryland: Experiences and
Attitudes of Family Physicians," Medical Care 29 (10), 1051-1056.
Hilgartner S, and C Bosk (1988) "The Rise and Fall of Social Problems: A Public Arena
Model," American Journal of Sociology 94 (1), 53-78.
Jager, H, ed (1988) AIDS Phobia: Disease Pattern and Possible Treatments, New York,
John Wiley and Sons.
Jemmott, J, J Freleicher and L Jemmott (1992) "Perceived Risk of Infection and Attitudes
Toward Risk Groups: Determinants of Nurses' Behavioural Intentions Regarding AIDS,"
Research in Nursing and Health 15, 295-301.
Kaplan, H, R Johnson, C Baily, et al. (1987) "The Sociological Study of AIDS: A Critical
Review of the Literature and Suggested Research Agenda," Journal of Health and Social
Behaviour, 28 (June), 140-157.
Kelly, J, S. St Lawrence, S. Smith, et al. (1987) "Medical Students' Attitudes Toward
AIDS and Homosexual Patients," Journal of Medical Education 62. 549-556.
King, M, (1994) AIDS, HIV and Mental Health, Cambridge, Cambridge U. Press.
Knorr-Cetina, K (1983) Science Observed: Perspectives on the Social Study of Science,
London, Sage Publications.
Konoff, E and O Ewers (1990) "Care of AIDS patients as a source of Stress to Nursing
Staff," AIDS Education and Prevention, 2 (4), 338-48.
Lang, N (1990) "Sex, Politics and Guild: A Study of Homophobia and the AIDS
Phenomenon," in D. Feldmean ed., Culture and AIDS, NY, Praeger.
Leblanc, A (1993) "Examining HIV-Related Knowledge Among Adults in the US,"
Journal of Health and Social Behaviour 34 (March), 23-36.
Levine, M (1992) "The Implications of Constructionist Theory for Social Research on
the AIDS Epidemic Among Gay Men," , in The Time of AIDS, G Herdt and S
Lindenbaum eds. Sage. 185-198.
Lewis, C and J Coffee (1991) "Public Health Nurses and AIDS," Nursing Outlook 39 (3),
132-135.
Link, N, et al. (1988) "Concerns of the Medical and Pediatric House Officers About
Acquiring AIDS from their Patients," American Journal of Public Health 78, 455-59.
McCaig, L, A Hardy and D Winn (1991 ) "Knowledge about AIDS and HIV in the US
Adult Population: Influence of the Local Incidence of AIDS, AJPH 81 (12).
McGarrahan, P (1994) Transcending AIDS: Nurses and HIV Patients in New York City,
Philadelphia, U Pennsylvania Press.
McGuirk, K and T Miles (1992) "Establishing a Dedicated AIDS Unit," Journal of
Nursing Administration 17 (6), 25-30.
Monette, P (1994) The Last Watch of the Night, New York, Harcourt Brace.
Nelkin, D, D Willis and S Parris, eds (1992) A Disease of Society: Cultural Responses to
AIDS, Cambridge, Cambridge University Press.
Patton, C (1985) Sex and Germs, South End Press, Cambridge MA.
Peabody, B (1986) The Screaming Room, Oak Tree Publications.
Perrow, C, M Guillemin, (1990) The AIDS Disaster, New Haven, Yale U Press.
Petrow, S (1990) Dancing Against the Darkness, New York, Lexington Books.
Polgar, M (1995) Nurses and AIDS Care: Occupational Risk Perception and the Social
Construction of HIV, Philadelphia, Ph.D. Dissertation.
Prohaska, T, G. Albrecht, J Levy, et al. (1990) "Determinants of Self-Perceived Risk for
AIDS," Journal of Health and Social Behaviour 31, 384-394, December.
Quam, M (1990) "The Sick Role, Stigma, and Pollution: The Case of AIDS," in D
Feldman, Culture and AIDS,, New York, Prager, 30-44.
Ratzan, Scott (1993) AIDS: Effective Health Communication for the 90s, Taylor and
Francis, Washington.
Richardson, JL, et al. (1987) "Physicians' Attitudes and Experiences Regarding the Care
of Patients with AIDS and related Disorders (ARC)," Medical Care 25, 675-86.
Rizzo, J, W Marder, and R Willke (1990) "Physician Contact with and Attitudes Toward
HIV-Seropositive Patients: Results form a National Survey," Medical Care 28 (3), 251-
260.
Rogers, D and E Ginzberg (1989) Public and Professional Attitudes Towards AIDS
Patients, Boulder CO, Westview Press.
Rosenberg, C (1988) "Disease and Social Order in America," in E Fee and D Fox, AIDS:
The Burdens of History, Berkely, U California Press.
Rushing, W. (1995) The AIDS Epidemic: Social Dimensions of an Infectious Disease,
Boulder, Westview.
Santana, S. et al, (1991) "HIV in Cuba," International Journal of Health Services 21 (3),
511-537.
Schneider, B (1992) "AIDS and Class, Gender and Race Relations," in J Huber and B
Schneider, The Social Context of AIDS, Newbury Park, Sage, 19-45.
Shapiro, M (1992) "Residents' Experience in, and Attitudes Toward, the Care of Persons
with AIDS in Canada, France, and the United States," Journal of the American Medical
Association 268 (4), 510-515.
Shilts, Randy (1987), And the Band Played On, New York, St. Martin's Press.
Shulman and Mantell (1988 ) "The AIDS Crisis: A US Health Care Perspective," Social
Science and Medicine 24 (10).
Smith, J. (1996), AIDS and Society, New York, Prentice Hall.
Sontag, S. (1989) AIDS and its Metaphors, New York, Farrarr, Straus and Giroux.
Stine, G. (1995) AIDS Update 1994-1995, Englewood Cliffs NJ, Prentice Hall.
Sweat, M and M Levin, "HIV/AIDS Knowledge Among the US Population," AIDS
Education and Prevention 7 (4), 355-372, 1995.
Thomas, S and S Quinn (1991) "The Tuskeegee Syphillis Study 1932-1972:
implications for HIV education and AIDS Risk," AJPH 81 (11).
Treichler, P (1992) "AIDS, HIV, and the Cultural Construction of Reality," in The Time
of AIDS, G Herdtand S Lindenbaum eds Sage, 65-100.
van Servellen, S and B Leake (1993) "Burn-out in Hospital Nurses: A Comparison of
AIDS, Oncology, General Medical and Intensive Care Nurses," Journal of Professional
Nursing 9 (3), 169-177.
Watney, S (1989 ) "Taking Liberties," In Taking Liberties, London, Serpent's Tail.
Weitz, R (1989) "Uncertainty and the Lives of Persons with AIDS," Journal of Health
and Social Behaviour 30 (September), 270-281.
Weitz, R (1991) Life with AIDS, New Brunswick, Rutgers Press.
World Health Organization (1995) Report of the Global Programme on AIDS, Geneva.
Yedida, M, J Barr, and C Berry (1993) "Physicians' Attitudes Towards AIDS at Different
Career Stages: A Comparison of Internists and Surgeons," Journal of Health and Social
Behaviour 34, 272-84.
Zuger, A (1991) "AIDS and the Obligations of Health Care Professionals," in F Reamer
ed., AIDS and Ethics, New York, Columbia University Press, 215-239.
eContent Home