From HIV to COVID19: Anthropology, urgency, and the politics of engagement

This article is part of the following series:

These comments were originally prepared for the “COVID-19 and Anthropology: Disease, Social Justice, and Well Being” Webinar hosted by the New York Academy of Sciences Anthropology Section on April 20, 2020.

What lessons learned from past epidemics (including HIV/AIDS) could we apply to COVID-19? What lessons are there to be learned from other countries’ responses to COVID-19? 

As a cultural and medical anthropologist and epidemiologist who studies the social and cultural contexts of infectious disease outbreaks, particularly HIV and other sexually transmitted diseases like syphilis, I’d like to share some thoughts on how we can apply lessons learned from ongoing epidemics to COVID-19. 

First, it’s important to note that HIV and COVID-19 are different not only in terms of their pathogenesis and epidemiological characteristics, but also how we respond to them through clinical, public health, and social measures. HIV is a global issue that still impacts millions of lives, and it evokes familiarity with the current crisis in terms of emotions it invokes like anxiety, anguish, and uncertainty, as well as social factors that impacted public and institutional responses. There are three key similarities between the ongoing HIV crisis and the current COVID-19 pandemic that I’d like to discuss in terms of lessons learned. 

A key similarity between the two has to do with fear and contagion. What seems very familiar is that the fear of the invisible virus reflects fear and blame of people who are seen as different or as foreign. In the early years of the HIV epidemic and even now, fear and discrimination towards those who are disproportionately impacted drove public and institutional responses. In the United States, people lost their jobs, children were kicked out of schools, public pools were drained, and dead bodies stacked up in hospitals because there weren’t enough beds or staff to treat those who fell ill. Those from Haiti and Africa were blamed for bringing the virus to Western countries, fueling existing Western racism and further cementing notions of black bodies as inherently diseased and feared.

These forms of violence, discrimination, neglect, racism and xenophobia are what we’re seeing now in response to the new coronavirus. As the disease progresses and becomes more concentrated in already marginalized communities, it’s important to remember how fear and deep rooted ideas about contagion can play a powerful role in propagating stigma and discrimination towards groups who are seen as unworthy and not as deserving as others. This isn’t simply about public perceptions, but also about institutionally-sanctioned neglect and structural racism, and how certain people are more likely to suffer as a result of ongoing and emerging policies and practices that intensify global inequality, poverty, and exclusion.

This brings me to my second point. Epidemics flow quickly towards pre-existing disparities along racial, class, and gendered lines. The impact of historical and continuing legacies of oppression and discrimination paved the way for HIV to disproportionately impact marginalized communities. Today, most individuals living with HIV don’t have access to prevention, care, and treatment. Women, sex workers, men who have sex with men (MSM), transgender persons, imprisoned people, those who engage in drug use, migrants, and refugees continue to face discrimination, stigma, and lack of access toinformation, testing, and treatment due to various policies and practices that uphold structural and social barriers.

We can expect COVID-19 to flow through similar structures. We are quickly learning that it is impacting marginalized communities much more and much longer, not just in terms of health effects but also in terms of severe social and economic impacts.

Finally, it’s important to note that we have seen the power of the state deployed at an unprecedented scale: travel bans, closures, social distancing, and quarantines. These are necessary and effective public health prevention responses.  

However, we’ve also witnessed unprecedented levels of government inaction like previous epidemics. In the United States, we are witnessing issues with lack of testing, lack of information, lack of protective gear, and health system overload. These are issues that derive from decades of underfunding our public health system by billions of dollars. Our public health financing structure is essentially broken. That’s led the US CDC and state and local health departments woefully unprepared to address public health emergencies such as COVID-19. 

In 2017, public health represented just 2.5% of all health spending in this country. Some of this shortfall has been covered by the Prevention and Public Health Fund established under the Affordable Care Act. But this fund has been consistently used to fund efforts not related to public health. In 2012, it was cut by $6 billion, in 2018, it was cut by $1.4 billion. These issues (along with others) deeply impact the ability of public health to actually prevent risk or to respond to health emergencies in a timely manner.

How can we move beyond doing the (albeit necessary) research to identify/confirm the perennial social determinants of health that contributed to the disparities in COVID-19 infection and mortality rates? How do we use our scholarship to address health disparities–and interlocking economic and political inequalities–in the US and globally? Can you point to models of scholarship or activism that could serve as inspiration for listeners?  

As anthropologists, we can apply these lessons learned to address health disparities in the United States and globally. I do think it’s important to understand, from multiple perspectives, that for many, COVID-19, like other conditions, is part of the broader context of inequity and suffering – an enduring crisis rather than a break from “normal.” 

Yet, I also want to emphasize that oftentimes, we tend to overlook our own misrecognition of the political framing of crisis. We tend to think of infectious disease outbreaks as discrete, extraordinary events. I think it’s equally important to engage in recognizing them as ordinary—in that what we are witnessing are spectacular instantiations of enduring injustice at multiple scales. As such, we need to not only trace and document issues related to the social context of COVID-19 health disparities, but also understand how such disparities are not an anomaly, but rather are systemic, productive, generative, and valuable to the operation of governing bodies and the management of populations. 

In other words, it’s important to understand how social inequities and health systems are co-constituted. There have been increasing public and academic discussions about the disproportionate health impacts of COVID-19 on populations who are already vulnerable. But very little of this discussion focuses on how certain social and cultural norms around health disparities, values about differences between certain bodies and social groups, and health and welfare structures were in existence long before COVID-19. Therefore, I think it’s important not only to focus on the health and social impacts of COVID-19 on certain communities, but also on how particular norms, values, structures, and institutions perpetuate these inequities, rendering them as natural or normal. I’d like to see more work on how notions of difference and disparities are made meaningful by discourses, practices, and structures that are supposed to protect us, and how they intersect with norms and values around efficiency, productivity, profit, and social control.

Further, I think scholarship and activism targeted at looking at these issues at the level of health systems, globalized political economies, and local governance is really important. Before, I discussed the role of public health financing on institutional responses to global crises. More work on health policy and funding to help us understand how such systems are highly dependent on major health threats of the moment, political shifts, and economic realities would be useful. Research focused on the culture of public health institutions is also critical. I think we are well-equipped to understand that local culture plays a role in managing epidemics, but more attention is needed to understand public health institutional culture and how that impacts local context and responses to health emergencies.

Finally, I think such crisis must also be understood in historical context — and in particular, in relation to empire-building and racial projects. Legacies of the trans-Atlantic slave trade, European (and US) colonialism of all forms, post-colonial development and aid, and civil unrest have contributed not only to patterns of the disease transmission, but also to failures of government and international actors to mount coordinated responses. This work can be incredibly helpful in thinking through the present moment as well as in reimagining a more just future.

What can anthropology contribute to building a better world during and after the COVID-19 pandemic? What sorts of rituals, memorials, or cultural practices have you observed that might help lead the way? What are your thoughts/prognosis for our health and wellbeing?

I definitely feel like this is a good time for anthropology to contribute in building a better world during and after the COVID-19 pandemic. Today’s anthropologists are making interesting contributions to human understanding and tackling civilization’s most pressing problems. Like other scholars, we have a lot of information the world needs to know, and there are increasing opportunities for us to add to national and global conversations that affect all of us. However, it is also important that we, as anthropologists, also don’t continually misrecognize enduring systemic failures as discrete time-framed crises for the sake of justifying disciplinary relevance.

As a scholar with specific subject matter expertise in anthropology and public health, and as an immigrant, a first generation college student, and a woman of color in the academy whose work and life are deeply intertwined, I’ve derived a lot of comfort and hope in bearing witness to the power of community coalitions while accompanying community leaders and advocates in mobilizing to take care of one another, to act, and to engage in necessary fights around issues that have long been in existence: universal and meaningful healthcare, abolition, housing rights, equal employment, gender equality, environmental justice, and rights of marginalized communities, displaced populations, migrants and immigrants. 

For instance, COVID-19, like other health and social crises, has exposed the need for universal health coverage and health financing in the US. We see that by examining other countries responses to COVID-19 like South Korea reveals how universal health coverage is an important foundation to cope with epidemic and health security crises. During the early years of HIV activism, there were similar debates about whether the fight was specific to the immediate saving of lives through research and treatment or whether the struggle was more about tackling all the various underlying disparities that allowed HIV to thrive. Since then, various leaders and groups in the United States have all called for universal health care, or Medicare for All, but in each case (at least it appears now), they and we have fallen short of the goal. The COVID-19 crisis creates another moment for us to change this, and I think it’s important for anthropologists to join in this ongoing fight. This is one of the major issues that are deeply personal to me, and that aligns directly with my scholarship.

I also work alongside community leaders, activists, and health and social providers in the field of HIV and immigration rights who have long refused to accept the status quo, and have instead, created their own forms of care. They’ve developed healthcare and support organizations, challenged and changed how treatment and services are delivered, and demanded that society and the government pay attention and respond. They see this as a necessary, just, moral, and legitimate response to the ongoing precarity characterized by economic scarcity, civic inequality, market-based health care, and exclusionary policies. To me, this also shows us how, in the face of such precarity, people also find means of relating to each other, connecting to each other, and taking care of each other. It shows us how people are reimagining precarity and uncertainty as relational, generating circuits of social connections and belonging through the care of others. It’s important to amplify these spaces and voices. This involves deep commitment and sustained action.

So what can we as anthropologists do to better engage with the broader public during these times? First, we must consider what critical “engagement” looks like: what, with whom, and why are we engaging? Anthropological intellectual activism requires us to move beyond the romanticization of ethnographic practices and to carefully consider the politics of translation and questions of value within our own work. Doing so allows us to better align ourselves with those most negatively impacted by unfair policies and actively participate in community and grassroots coalitions, local and national initiatives, and interdisciplinary collaborations within and beyond the academy to ensure that our scholarship is recognizable and useful to individuals and communities already engaged in the struggle for rights and resources to address their needs.

Thurka Sangaramoorthy is Associate Professor of Anthropology at the University of Maryland, College Park, and the author of Treating AIDS: Politics of Difference, Paradox of Prevention (Rutgers, 2014) and co-author of Rapid Ethnographic Assessments: A Practical Approach and Toolkit for Collaborative Community Research (Routledge, 2020).

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