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Article

Sub-Saharan Africa has the world largest proportion of adults and children living with AIDS. To mitigate the multiple consequences of the epidemic, novel forms of governance arose as international organizations usurped the roles traditionally played by states; new funding streams emerged that led to asymmetries in biomedical resource allocation; and diverse partnerships among international agencies, nation-states, and local and international nongovernmental organizations emerged. Global health actors attempted to define AIDS policy and programming as an apolitical biomedical intervention. However, political dynamics were evident in the negotiations between international donors and African state bureaucracies in setting AIDS policy agendas and the contestations between African and international social movements and global health agencies over AIDS treatment drug prices and access to treatment interventions across the continent. During the first two decades of the African AIDS epidemic (1980–2005) the dominant approach to AIDS disease mitigation was the focus on AIDS prevention, and across sub-Saharan Africa standardized prevention interventions were introduced. These interventions were founded upon limited evidence and ultimately these programs failed to stem rates of new HIV infections. Social movements comprising coalitions of local and international activists and scientists brought extensive pressure on global health institutions and nation-states to reform their approach to AIDS and introduce antiretroviral therapy. Yet the path toward universal provision of antiretroviral treatment has been slow and politically contentious. By the second decade of the 21st century, antiretroviral therapy interventions together with AIDS prevention became the dominant policy approach. The introduction of these initiatives led to a significant decline in AIDS-related mortality and slowed rates of transmission. However, health disparities in treatment access remain, highlighting ongoing shortcomings in the political strategies of global health agencies and the public health bureaucracies of African states.

Article

In the past 50 years, lesbian, gay, bisexual, transgender, and intersex (LGBTI) activism in Australia has grown from small, localized organizations to national campaigns calling on all Australians to affirm LGBTI people’s equality. While the issues and activist strategies have evolved over the past 50 years, there have been two persistent patterns: most organizations and activism have been state based and have drawn on international influences, especially from the United Kingdom and United States. In the 1970s the organizations CAMP (Campaign Against Moral Persecution) and Gay Liberation presented competing visions of LGBTI equality, but both recognized the importance of visibility in order to change societal attitudes and influence law reform. Campaigns to decriminalize male homosexuality began in the 1970s and continued across the states through the 1980s and even into the 1990s in Tasmania. After law reform, activists shifted their advocacy to other areas including anti-discrimination laws, relationship recognition, and eventually marriage equality. HIV/AIDS was another important cause that generated grassroots activism within LGBTI communities. State AIDS councils worked in partnership with the federal government, and Australia had one of the world’s best public health responses to the epidemic. Pop culture, international media, and visibility at events such as the Sydney Gay and Lesbian Mardi Gras gradually shifted public opinions in favor of LGB equality by the 2000s. Transgender and intersex rights and acceptance were slower to enter the public agenda, but by the 2010s, those two groups had attained a level of visibility and were breaking down preconceived stereotypes and challenging prejudice. Indeed, politicians lagged behind public opinion on marriage equality, delaying and obfuscating the issue as the major political parties grappled with internal divisions. In 2017 the Commonwealth government held a postal survey asking Australian voters whether or not they supported same-sex marriage. This was an unprecedented exercise in Australian polity that was divisive, but LGBTI activists succeeded in their campaign and secured an overwhelming victory. The postal survey’s outcome also set the stage for new political fights around LGBTI people’s rights: so-called religious freedom, transgender birth certificates and support for LGBTI young people.

Article

Barry L. Tadlock and Christopher Glick

A study of the LGBT movement within Canada, the United States, Mexico, and Australia reveals the movement’s youth and vitality. Only since the mid-1900s has there been what one might identify as an organized social movement within any of these four countries. A key similarity across the social movements in these four countries has been the formation of associated interest groups. These groups have transformed the LGBT movement. Scholarly research regarding the movement and its attendant interest groups reveals decades of growth and development. These changes over the years allow scholars to investigate topics such as how the LGBT movement compares to other social movements, how various sexual and gender minority communities have been incorporated into the larger movement, and how movement groups have utilized various strategies in pursuit of movement goals. In the United States, the gay rights movement was one of a few distinct movements included within a larger new social movement. These various movements shared the fact they were organized around a goal of identity expression. (The extent to which a gay rights movement morphed into a broader LGBT movement is also an important part of the U.S. story.) In Canada, the modern movement for LGBT individuals exemplified a gradual process rising out of the post–World War era; it was attached to a rise in Quebecois nationalism and the growth of First Nations peoples’ rights movements. Conversely, Australia has seen a slower progression than Canada or the United States, in part because Australia has had a relatively inactive set of social rights movements over the same period. (There is evidence that Australian social rights movements came to consciousness more from a global than a domestic narrative.) Finally, with respect to Mexico, one might assume that LGBT successes there have lagged behind those in the United States because of a more vibrant social movement community in the United States and also because Mexicans are assumed by some to be more religious than residents of the United States. However, there is evidence that the LGBT movement has had greater electoral and policy successes in Mexico. This could in part be due to a history in Mexico of LGBT activists identifying with other revolutionary agents who sought broad structural changes in that country.

Article

The role of the symbolic child figure has shifted substantially within discourses of LGBT politics and activism in the United States since World War II. From the 1950s well into the 1980s, the putatively heterosexual child was portrayed as the potential victim of homosexuality—victimized by influence, predation, and infection. By the early 21st century, the child had become a figure who was often represented as benefiting from LGBT civil rights—either as the child of lesbian or gay parents whose union was strengthened by the acquisition of civil benefits and protections or as a young gay or trans person struggling to accept a non-normative identity. This cultural shift both reflected and helped generate specific governmental and institutional policies—from the sexual psychopath laws of the 1950s, to the emergence of school-based Gay-Straight Alliances in the 1990s, to the central role of the child in debates over same-sex marriage in the 2000s.

Article

HIV/AIDS in Europe highlights the centrality of politics at local, state, and international levels to the successes and failures in fighting transnational, global threats. Though several European states have led the international struggle against HIV/AIDS and have made great strides in treatment and prevention, others host the fastest-growing epidemics in the world. Even in states with long histories of treatment, specific subpopulations, including many LGBTQ communities, face growing epidemics. This variation matches trends in public policy, the actions of political leaders, and social structures of inequity and marginalization toward affected populations. Where leaders stigmatize people living with HIV (PLHIV) and associated groups, the virus spreads as punitive policies place everyone at increased risk of infection. Thus, this epidemic links the health of the general public to the health of the most marginalized communities. Mounting evidence shows that a human rights approach to HIV/AIDS prevention involving universal treatment of all vulnerable communities is essential to combating the spread of the virus. This approach has taken hold in much of Europe, and many European states have worked together as a political force to shape a global human rights HIV/AIDS treatment and prevention regime. Despite this leadership, challenges remain across the region. In some Eastern European states, tragic epidemics are spreading beyond vulnerable populations and rates of transmission continue to rise. The Russian case in particular shows how a punitive state response paired with the stigmatization of PLHIV can lead to a health crisis for the entire country. While scholars have shed light upon the strategies of political legitimization likely driving the scapegoating and stigmatization of PLHIV and related groups, there is an immediate need for greater research in transnational social mobilization to pressure for policies that combat these backward political steps. As financial austerity and defiant illiberalism spread across Europe, key values of universal treatment and inclusion have come into the crosshairs along with the European project more generally. Researchers and policymakers must therefore be vigilant as continued progress in the region is anything but certain. With biomedical advances and the advent of the “age of treatment,” widespread alleviation from the suffering of HIV/AIDS is a real possibility. Realizing this potential will, however, require addressing widespread political, social, and economic challenges. This in turn calls for continued interdisciplinary, intersectional research and advocacy.

Article

AIDS is a new disease that was first recorded in 1981. In the 1980s and early 1990s, there were concerns that it would decimate populations; prevention was slow to take hold, and there was no cure. By the mid-1990s it was clear, in the developed world, that it would be mostly contained to specific populations. Effective but expensive treatment was unveiled in 1996. However, in Africa there were fears of a continent-wide epidemic. AIDS emerged in central Africa (HIV1) and west Africa (HIV2) and spread from there. In the 1990s it reached southern Africa, the current epicenter. It has become evident that AIDS has not meant the collapse of economies and nations or the hollowing out of populations. Treatment options mean people can live normally provided they adhere to the drug regime, but they are costly. The worst epidemic is in the southern cone of Africa. Here it continues to have political consequences, although causality is hard to ascribe. Unique features of the disease are that the modes of transmission include its geographic location and the excessive involvement of donors in the response; the lack of African ownership makes it a global political problem. At the moment the lives of millions of Africans depend on the generosity of the West, and that future is uncertain. AIDS is a greater challenge to southern and eastern African states than anywhere in Africa and indeed the world. The international engagement particularly in the provision of treatment means the disease has global political ramifications.

Article

In general, the German Democratic Republic (GDR) did not treat its gay and lesbian citizens very favorably. Although the legal situation was more liberal than in the Federal Republic (West Germany) and other Western European countries, most homosexual East Germans lived in a state of invisibility at best, or suffered direct homophobia at worst, often at the hands of the government. In the mid-1980s, the public and government stance toward homosexuality liberalized slightly, leading to small improvements in the lives of gay East Germans. However, gay East Germans never experienced many of the same freedoms or opportunities that their West German, other Western European, or American counterparts enjoyed. Gay East Germans occupied a difficult position within the socialist ideology of the GDR. In theory, each East German was equal, enjoying universal rights and opportunities, and living free from discrimination. At the same time, however, the smallest building block of the society was the heterosexual, reproductive, married couple: a model into which same-sex desiring people could not fit. This doctrine of supposed equality probably contributed to the fact that homosexuality was decriminalized earlier in the GDR than in the Federal Republic, but it was also used by the SED (Sozialistische Einheitspartei Deutschlands: the ruling, dictatorial party) as an excuse not to engage further with the specific needs of gay citizens until the mid-1980s. The GDR saw some limited gay activism in the 1970s in the form of the Homosexuelle Interessengemeinschaft Berlin (HIB); however, the group’s activities never really extended outside of East Berlin and did not lead to significant political or social change. More impactful activism occurred in the 1980s under the aegis of the Protestant Church as the only organization in the GDR that operated largely outside of state control. The SED eventually yielded to some of the demands of gay activists—by sanctioning publications and meeting spaces, for example—but did so primarily to draw gay activists out of the protection of Church structures and in order to be able to monitor and control them more easily. There are few East German literary or artistic works that engage with homosexuality, although a number of relevant literary works were published in the 1980s. These contributed to a fledgling discourse around homosexuality, shifting the issue from a taboo topic to one more acceptable for discussion in the public sphere. However, when East German audiences viewed Heiner Carow’s Coming Out in 1989—the first and only East German feature film to depict homosexual relationships—many claimed that it was their first exposure to homosexuality. And, since the GDR ceased to exist as a state fairly abruptly in 1990, one will never know how the trajectory of gay rights activism may have continued.

Article

The fight to effectively treat and stop the spread of the human immunodeficiency virus (HIV) has made meaningful progress both in the United States and globally. But within the United States that progress has been uneven across various demographic groups and geographic areas, and has plateaued. While scientific advances have led to the development of medicine capable of both treating and preventing HIV, law and policy dictate who will have ready access to these medicines and other prevention techniques, and who will not. Law and policy also play a crucial role in determining whether HIV will be stigmatized, discouraging people from being tested and treated, or will be identified for what it is—a preventable and treatable disease. To make further progress against HIV, the United States must address healthcare disparities, end the criminalization of HIV, and devote additional resources toward combatting HIV stigma and discrimination.

Article

Hijras are described as eunuchs and hermaphrodites, and they are a subgroup within the transgender community in South Asia. They go beyond Western descriptions of LGBT persons and are better understood as a complex interplay of gender, sexuality, traditions, and kinship. Hijras face social stigma and legal discrimination due to their nonconformance with the gender and sexual norms of hetrosexuality dominant in India’s society. They negotiate their identity through religion and mythology, whereby they undergo rituals of castration and emasculation, by virtue of which they play a significant role in ceremonies and festivals. Previously, legal frameworks like the anti-sodomy law of Section 377 of the Indian Penal Code (IPC) and the lack of a gender category for the transgender in official government documents resulted in discrimination and marginalization of the Hijra community. They faced harassment and violence from the police, medical establishment, and other individuals, and they experienced systemic exclusion from vital social services like employment and healthcare. Legal reform in India, such as the Supreme Court’s recognizing the transgender community as a “third gender” in 2015 and the decriminalization of sodomy in 2018, have been positive steps to improve the status of Hijras. However, inconsistencies in the definition of transgender persons and ambiguity in operationalizing the self-identification process remain, posing a challenge to effective policy implementation. Sociocultural norms of Hindutva and homophobic ideology are still prevalent, resulting in little improvement in the marginalized status of Hijras and the transgender community in India.

Article

Eastern Europe and Central Asia (EECA) is the only region in the world where annual HIV infection rates continue to grow. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2019 approximately 1.4 million people in the region were living with HIV. The main factors that have contributed to the spread of the epidemic over the past two decades include injecting drug use, the stigmatization and marginalization of vulnerable groups, the increasing spread of HIV into the general population, and the lack of evidence-based prevention and treatment programs necessary for controlling the epidemic. Limited access to life-saving antiretroviral treatment has intensified the impact of the epidemic in EECA and increased mortality rates among people living with HIV (PLWH). In the post-Soviet space, Russia is experiencing by far the biggest HIV/AIDS epidemic. This can be attributed largely to the government’s failure to introduce evidence-based prevention measures for vulnerable groups, e.g., harm reduction programs, which are recommended by international health organizations. Other countries in the region have been more pragmatic in their approach and introduced harm reductions programs on a broader scale. In Ukraine, the efforts to combat HIV, which led to an initial stabilization of the epidemic in 2012, have been endangered by the military conflict in the eastern part of the country and subsequent internal displacement, which has increased HIV vulnerability. In comparison with Russia and Ukraine, the countries of the South Caucasus and Central Asia are less affected by HIV. However, labor migration to Russia constitutes a persistent risk factor for HIV transmission from higher-prevalence Russia to lower-prevalence South Caucasus and Central Asia. Although initially the HIV/AIDS epidemic has been mainly driven by injecting drug use, it is also clearly linked to lesbian, gay, bisexual, and transgender (LGBT) politics and policies in EECA. Because of widespread stigmatization and marginalization, the spread of HIV within LGBT communities remains underreported and is barely visible in official HIV statistics. This makes it difficult for prevention programs to reach out to vulnerable groups. In all countries in the region, prevention efforts among LGBT communities remain inadequate and largely depend on local civil society organizations (CSOs), which lack the capacities to provide nationwide information campaigns and other prevention programs for the LGBT community. In addition, the work of CSOs that advocate for HIV prevention among LGBT groups is further undermined by repressive laws, e.g., the 2013 “gay propaganda law” in Russia, which has increased the stigmatization of LGBT people and has made prevention outreach more difficult. Research has contributed to our understanding of HIV vulnerability and its impact in EECA. Further research is needed, however, into the social and political factors that explain the persistent failure of regional decision-makers to adequately address the growing HIV epidemic.

Article

From the earliest days of its recognition in the United States, the condition that came to be known as acquired immunodeficiency syndrome (AIDS) has been associated with the gay community. In fact, when the U.S. Centers for Disease Control and Prevention (CDC) first made written notice of the syndrome in 1981, the acronym GRID (gay-related immune disease) was commonly, although not officially, used to describe it. In the five years that followed, the causal agent, human immunodeficiency virus (HIV), was discovered, specific demographic groups were identified as at heightened risk of infection, and transmission routes—including sexual activity, intravenous drug use, and transfusion of blood and blood products—were determined. Identification of HIV with the gay community as a major risk group had important ramifications for prevention and treatment policy, as the community mobilized a rights-based approach that advocated harm reduction over abstinence and access and affordability of treatment over the interests of the private market. These concepts carried into later debates as the world recognized the global severity of HIV and grappled for the first time ever with a goal of universal treatment access in the world’s poorest countries where the pandemic is most severe. Identification of HIV with values, conceptual structures, leadership, and mobilization drawn from the gay community also had ramifications on the social and political contexts of AIDS treatment and prevention globally, as governments and cultures that had ignored or demonized their gay populations have increased their interactions with them as “risk groups” and as political actors. Despite the remarkable inroads made into accessibility of treatment, the world remains without a vaccine, a cure, or the political will to fully implement universal treatment access, which means that eradication of the global pandemic remains elusive.