AID has always been full of political and emotional instabilities. The possibility of blood- or gender-based transmission combined with its first emergence among marginalized and criminal populations created a potent mixture of initial terror and terrible prejudice.
It can sometimes be difficult to remember how misinformation, fear, and outright hostility shaped the knowledge and experience of AIDS in the first decade of the epidemic. In this period, a positive result on an HIV test was a final diagnosis and medical knowledge about transmission and treatment was still unclear.
It was an easy slide from epidemiological concentration to moral approval and discrimination among gay men, sex workers and IV drug users in Australia in the 1980s. Some MPs and church leaders in Australia suggested forced imprisonment of anyone testing positive for HIV.
Shame and morality meet in a different way in Africa today. More than half of the global population living with HIV and AIDS is found in Southern and Central Africa, where prevalence among adults exceeds 10% in some countries. Here, transmission is predominantly heterosexual, and it is the gap between perceptions of monogamy and the gendered realities of sexual behavior that poses the greatest public health challenge. Again, it is the most sexually vulnerable, with rates of transmission increasing most worryingly – namely among young women.
Public health experts around the world knew it would be difficult to overcome the powerful forces of shame, stigma, and fear that have plagued the AIDS response. That’s why public information officers at the World Health Organization invented World AIDS Day on December 1, 1988. They hoped it would become a powerful weapon in the fight against AIDS and misinformation.
Within gay communities, World AIDS Day has always served a commemorative as well as political purpose. Already in 1988, only six years after the first diagnosis in Australia of what was initially described as “the grid” (gay-related immunodeficiency disorder), a variety of memorial practices were developing to understand the growing harm on queer terms, as well as to act as a pressure point to shape health policy.
That year in Sydney, World AIDS Day was transformed into a moment when those most affected by existential threats could engage with the memories, history, present and future of the epidemic in ways that made sense to them.
In the afternoon, activists, affected communities, government leaders, bureaucrats, health workers and carers came together to display the Australian AIDS Quilt for the first time. During the proceedings, the Rev. Jim Dykes read one by one the names of the lives commemorated on its panel.
The AIDS quilt was sometimes described as “the angel of death”, reminding us that the strange sense of irony remains an important dimension in the lived experience of AIDS, even if those jokes sometimes strain at the edges of comfort.
Later that evening, a large gathering gathered for a rally at Martin Place that was simultaneously an activist demand for government funding, a symbol of thanks to an army of volunteer caregivers and workers, and a memorial to the lives already lost. Over the following weekend, several social functions and club nights raised funds for carer organisations, including a party for the care workers themselves, many of whom were already displaying signs of carer fatigue.
The evening rally would grow over the coming years into an event that would bring together around 10,000 people across the domain. Remembrance of the names of those who had died became the emotional basis of the proceedings. Community leaders remember having to brace themselves to read those names into the microphone and feeling deeply the beauty and warmth of its effects.
As the 1990s unfolded, this text took up more time, a brutal reminder that the tidal wave of AIDS was destroying queer communities. Gay men in the mid-1990s described losing partners and friends so concentratedly that their entire social and intimate worlds disappeared. One man I interviewed recently described how he was walking down a street in Darlinghurst in 1996 and realized that every house he passed knew someone who had died.
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The worst of the AIDS crisis in Australia was brought under control, first by the incredible success of safe-sex campaigns and the provision of needle exchange and then, in 1996, because the emergence of “combination therapy” transformed HIV/AIDS from a terminal to a chronic diagnosis.
While comparable national contexts such as the US and UK faced rising rates of HIV and AIDS diagnoses in the 1990s, Australia’s reached a peak in 1988 and a sharp decline thereafter.
The only possible explanation for this is the remarkable success of safe-sex campaigns that were driven and designed by activists and supported, sometimes tacitly, by state and Commonwealth governments, who were convinced by the case that morality about sex could not prevent transmission.
Researchers now describe the “Australian response” to AIDS as both a historical event and a public health model to be followed. Its success was remarkable.
There is much to celebrate in the history of our national model, not only because it is a powerful example of how a public health disaster can be managed and improved when government policy and funding are informed by community knowledge and expertise.
However, there is also a heartbreaking historical irony in this Australian story.
The success meant that, historically and epidemiologically, HIV/AIDS remained remarkably concentrated. In the late 1990s, between 80% and 90% of all recorded HIV/AIDS diagnoses in Australia were in men who had sex with men.
By the mid-1980s most gay men in Australia had begun wearing condoms, which meant that all Australians were protected from the worst possibilities of the epidemic. The government did not need to isolate gay men: their own sexual practices ensured that the consequences of HIV/AIDS would remain controlled.
We have now learned to describe HIV/AIDS as an epidemic because of its global spread. But the impact of this circulation has been uneven. The HIV/AIDS pandemic has, perhaps, always been experienced and unfolded as a set of interconnected “epidemics” shaped by national and local circumstances.
The consequences of HIV/AIDS have been and continue to be caused by the agency of the humans who suffered it, as well as the choices of those in positions of authority and capacity to do something about it.
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