ABSTRACT
For 20 years, a standard critique of US government responses to the HIV pandemic has been that it revealed a puritan distaste for sex, shown in the reluctance to support measures, such as condom promotion and support for gay and sex worker groups, which were a staple of the response in at least some other western countries. Many liked to point to the divergence between the US response and that of, say, Switzerland, the Netherlands and Australia as evidence of a significant cultural difference, rather as, several decades later, it became fashionable to juxtapose US and European values. The idea that ‘America is from Mars, Europe from Venus’, which was the name of an academic conference in Berkeley in 2006, became the popularised version of Robert Kagan’s (2003) more fundamental claim for growing divergence across the Atlantic. Kagan does not write of matters sexual, but he might well have used issues such as gay marriage and sex education to demonstrate his claims for a growing cultural gap. The role of the USA in helping define, frame and finance the global response to HIV and AIDS far outweighs that of any other country, and the religious right has undoubtedly had a considerable influence on this response. At the same time, other forces have been prominent in supporting rather different responses, such as strong support for emerging gay groups and programmes directed at male to male sex. While it is easy to point to the sex-negative aspects of official US policy, this too easily ignores the larger cultural, social and political impact of very different influences from within the USA. More important, it becomes an alibi for other governments that show equal distaste for recognising the sexual transmission of HIV, but who largely escape scrutiny because so much hostility is focused on the USA. From its discovery, through the illnesses of young gay men on the two coasts in 1981, the USA has been central to global developments around the new epidemic, which in many places was originally conceptualised as an ‘American’ disease, such that in Japan and the Philippines gay bars and saunas originally banned westerners as if they carried contamination with them. An American disease perhaps? – but also
one associated with globalisation, both in its spread and the responses to the epidemic. HIV was carried across military, trade and tourist routes, and even if the theory that a certain Quebecois air steward was Patient Zero, and somehow the source, an imaginary Adam, of all other infections, is fanciful (Shilts 1987), it took the multitudinous movements of the late twentieth century to ensure HIV quickly reached almost all parts of the world. Whatever the aetiology of the disease it spread quickly, the virus transmitted through sexual intercourse, shared needles and contaminated blood. We sometimes forget that one of the most seriously affected groups were people with haemophilia, many of whom died from HIV in blood that had been donated as a public service by men who were quite unaware of any danger. The impact of the USA is reflected in both the dominance of biomedical science and the encouragement of political activism. The USA funds and carries out the majority of international biomedical research, and despite the early battle over whether the French discovered HIV ahead of the Americans, US-based researchers have dominated the field (Epstein 1996). Programmes against HIV/AIDS have become the means to spread certain discourses and identities, especially those connected with sex, so that western concepts such as ‘men who have sex with men’ and ‘sex workers’ have become part of the universal language of AIDS. It is important to remember that it was gay organisations across the world, beginning with the Gay Men’s Health Crisis in New York City, that pioneered what would become the most effective mobilisation for prevention, namely peer-based education and information that accepted rather than prohibited a wide range of sexual behaviours and sought to give people the means to reduce the risk of HIV transmission, not change their desires (Altman 1985; Patton 1985). AIDS is an excellent example of the globalisation of US-based epistemologies: even the dissident views of President Mbeki were fuelled by the US scientist, Peter Duesberg. The international language of the epidemic is largely North American, and its symbols – the red ribbon; the Memorial Quilt; the idea of the involvement of People with AIDS – have grown out of the US domestic response. Indeed, HIV demonstrates Connell’s (2006) argument that the discourses of globalisation are disproportionately those of the North Atlantic. US influence is exerted through a range of institutions, including foundations, universities, pharmaceutical companies, church groups and development organisations, which are often working at apparent cross purposes. Yet in some ways their collective efforts involve an inevitable Americanisation, recalling Joseph Nye’s term ‘coercive democratisation’ (Nye 2006). US influence on the global pandemic is symbolised by treatment activism inspired by ACT UP, by programmes of monogamy and abstinence, often linked to evangelical Christianity, and by celebrities from Elizabeth Taylor and Richard Gere to Bill Clinton and Bill Gates. One might note the irony that, despite so many signs of US leadership, the major international conferences on AIDS have not been held in that country for 18 years because of the ban, shared with only a few other countries, on admitting people with HIV. This does not mean, of course, that the USA is absent from such meetings. At a planning meeting for the regional AIDS conference held in Sri Lanka in 2006 the names suggested by the local committee for plenary speakers were almost invariably those of people working in the USA; at a similar meeting in Mexico City two years later there were arguments in the programme committee about how far concerns around the US agenda should drive the global debate.
