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Wednesday, August 04, 2004

Dry Rot

In the most recent issue of Analog Science Fiction and Fact (As it happens, it's listed as the October 2004 issue. I can't explain this, save to say that it seems strangely appropriate to be receiving a science fiction magazine from the future) there is a rather thought-provoking article on the future of the AIDS crisis.

This article, titled We are Legend: The Social Consequences of the AIDS Crisis, by Laura M. Kelley, is a brief but interesting examination of the AIDS crisis from a social science standpoint. Now, obviously, many might think that the effects of this crisis are primarily medical or biological. Well, AIDS certainly is a biological agent, and its effects in the most immediate sense have been biological, however as any honest sociologist or psychologist will tell you, the biological and the sociological are not truly distinct. The recent push to add a section on Evolution and Social Behavior to the American Sociological Association is but one example of how this realization is shaping the discipline.

The simple truth is that the social organization of society can influence the evolution of biological systems. Such is the entire thesis of Jared Diamond's Guns, Germs, and Steel which argues that Europeans had immunities to deadly social diseases that Native Americans lacked because they were organized into denser, less sanitary, urban areas that provided a rich breeding ground for disease organisms. Similarly, the biological can easily shape the social, as has been the case with the plague that decimated the Byzantine Empire during the reign of Justinian and likely paved the way for this society's fall from power. Therefore, in a way that we do not normally consider, sociology and biology must be regarded as linked disciplines.

With this in mind, we must look beyond the medical aspects of a society that is coping with a devastating disease, and even struggle to look past the immediate social concerns of the plague, like "Who gets treatment and who doesn't." That these issues are important is beyond question, but that they are important to the exclusion of other concerns is a dangerous fallacy. Ms. Kelley draws our attention to an element that many do not wish to face: the future effects of this plague not just on the infected, but on civilization as a whole. Indeed, current estimates from the U.S. National Intelligence Council suggest that by the year 2020 130-million people will have died from AIDS, a figure that is slightly less than half of the population of the United States. More disturbing, estimates place the number of orphans created by the AIDS crisis at close to 20 million, with that figured expected to more than double by 2010.

Much as we might like to, we cannot turn away from this question and assume that medical science will rescue us from the consequences of pestilence. To date the only effective approach to arresting the spread of HIV has been behavior modification. The reduction or elimination of methods for transmission, such as unprotected sexual contact, have provided our only defense. I cannot stress this point enough, particularly to the sociologists in the crowd: the ONLY effective, reliable defense our species presently has against the AIDS virus falls within the domain of sociology. The biologists and medical doctors, on which we have long pinned our hopes, have thus far been impotent before this threat. The resistance of our society to this modern plague depends not on vaccines and drugs, or even on public sanitation. It depends upon programs that lead people to alter their behavior in ways that reduce transmission, and on a social context that supports such initiatives. Put simply: slowing the spread of AIDS depends on what we Sociologists study. Welcome to the war.

It is unfortunately the case that medical science may never gain the ability to fight this disease effectively. While 7 different vaccines to protect against AIDS are currently in various stages of development and testing, none are expected to be available before 2014, at the earliest. That's even assuming that a vaccine is possible at all. Even were one of these vaccines to work, most research has concentrated on protecting against the "B" strain of the virus prevalent in the developed world. With the majority of deaths occurring in the periphery where other strains of the disease are dominant, the chances of developing a functional vaccine in time to be useful are essentially nonexistent. Finally, even if the developed world is protected by a vaccine in the next ten years, the fact that other strains of the virus exists strongly suggests that reinfection with other types not affected by the vaccine is essentially inevitable. For the forseeable future the control of AIDS depends on the social, and not on the medical.

So what are the social dimensions of this plague? The significance of the rise in the death rate brought about by AIDS cannot be overstated. According to the U.S. Bureau of the Census, in Nigeria, where over 5% of the adult population is infected with AIDS, the crude death rate is believed to have more than doubled over what it would have been without AIDS. Simply put, we are facing an impending population crash in several areas of the world as larger numbers of adults who could be reproducing are, instead, perishing. Of those adults who are reproducing, a growing number of the offspring are infected with AIDS from birth, effectively removing them from the gene pool before they reach adulthood.

Certainly global population control is, and should be, an issue of concern for sociologists, however this plague is not the means through which to achieve it. This disease is eliminating not just individuals, but is wiping out entire segments of society. The damage to the social systems present can only be described as catastrophic. Without parents to care for and teach children, the next generation may well grow up in a manner reminiscent of The Lord of the Flies. With military organizations particularly hard hit in Africa, the apparatus necessary to maintain order is essentially crumbling from within. Whether you agree with the order or not, most would agree that almost any social order is preferrable to a state of anarchy. In a more immediately threatening sense, if arresting the spread of AIDS depends on organized behavior modification interventions, and the state's machinery is dissolving from within, the ability to implement any such programs is progressively weakening.

Leaving aside the threats to public peace, one must consider the economic impact of AIDS. Thus far the monetary costs of AIDS have been relatively slight on a national scale, reducing national GDP by "only" a point or two (Which, on further consideration, is a fairly staggering amount) but the eventual costs to all levels of society are more significant. For businesses and other organizations, such as the previously mentioned militaries, the loss of skilled personnel and the need to continuously replace them places an unending burden on functioning. A recent article published in the Harvard Business Review (AIDS Is Your Business Rosen S. et al. 2003) indicates that costs from AIDS have grown so significantly that some private organizations are now launching in-house AIDS prevention programs. At a household level the costs of caring for AIDS patients can be ruinous, especially for the poverty-stricken in peripheral nations. As adults and older children die, the odds that family-land will be sold increase. Further, the odds become better and better that such sales will leave land in the hands of western Agribusinesses, inaugurating a new era of trans-national tenant farming, or perhaps even Corporate neo-Feudalism. Finally, as the number of sick, infirm, and orphaned grows, the economic drains of caring for them will fall on a shrinking pool of healthy workers. The economic development of hard-hit areas can be expected to stall, and perhaps even backslide.

What is to be done? I honestly have no idea, save to say that however much we may not want to, it is necessary for sociology and sociologists to attend to the AIDS epidemic. This is not a public health area in which we can help, this is a public health area in which we are the ONLY ones who may be able to make the difference. The loss of life stemming from AIDS is rapidly compounding into the probable implosion of numerous societies. The economic and social consequences of such implosions for the world as a whole are significant. Our global society is suffering from a sort of dry rot: right now all we can see are the cracks, but the time is coming when the entire thing will crumble into dust. It's time for us to decide what to do about it.


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