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73 Presentation SOCIETY, DRUG INJECTORS, AND AIDS SAMUEL R. FRIEDMAN, PIuD.1 BRUCE STEPHERSON, B.A.2 JOYCE WOODS, M.A.3 DON C Des JARLAIS, Ph.D.4 THOMAS P. WARD, BA.5 AT the 1991 AIDS Update Conference in San Francisco, Don Francis presented a plenary talk on prevention strategies entitled "The virus or the people, whose side are we on?"1 Similarly, in this paper, we highlight how social, economic, and political structures have contributed to the spread of human immunodeficiency virus (HIV) and hampered efforts to fight the epidemic . We also discuss the ways in which one of the most stigmatized groups of people in our society—drug injectors—have responded to the epidemic. It is easy for us, as the authors, to miss our step in a paper such as this over intentions. Americans are individualistic and moralistic, and thus judge social issues in terms of individual intentions and guilt. Hence, statements about social structures that impoverish or oppress people tend to be perceived as claims that the people who run dominant institutions want to be exploitative or oppressive. As a result, issues concerning socioeconomic structure get reduced to speculation about the personal guilt or innocence of the powerful. The other side of this individualistic interpretation is that those who are oppressed or exploited are seen as the causes of their own poverty or diseases. 1 Senior Principal Investigator, International Working Group on AIDS and IV Drug Use, Narcotic and Drug Research, Inc., 11 Beach Street, New York, NY10013. 2 Research Associate, International Working Group on AIDS and IV Drug Use, Narcotic and Drug Research, Inc., 11 Beach Street, New York, NY10013. 3 Project Director, International Working Group on AIDS and IV Drug Use, Narcotic and Drug Research, Inc., 11 Beach Street, New York, NY 10013. 4 Director of Research, Beth Israel Medical Center, Chemical Dependency Institute, First Avenue and 16th Street, New York, NY 10003. 5 Research Associate, Narcotic and Drug Research, Inc., 11 Beach Street, New York, NY 10013. Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 74 Society, Drug Injectors, and AIDS Instead of this moralistic approach, we want to analyze society in a less personally judgmental way. To a large extent, everyone in the system has reasons to act the way they do, and these actions usually seem "good" to them. Thus, the disasters that occur on a daily basis, and the ongoing miseries that afflict the lives of millions of persons, are the products of the actions of wellmeaning people who respond in defensible ways to the necessities and opportunities offered by our system. Having said this, it is time to characterize the system. We live in a society where racial and gender inequalities are integral elements of both social stratification and collective beliefs, and where the perceived and the latent needs of a business economy dominate priorities, agendas, and our daily lives. In this paper, we discuss how the nature of this society might be reflected in the AIDS epidemic, in drug injectors' lives, and in the ways people and institutions respond to the epidemic. As a final prefatory note, it is important to be clear that this model of the interaction of our society with AIDS and drugs is offered as a guide for future research, rather than as a finished piece of work. Very little research has studied the interactions of large-scale socioeconomic structure with either AIDS or drug use. Ten years into the AIDS epidemic, however, it is past time for us to begin raising these issues and highlighting some of their implications for research and social action. AIDS and the demographics of drug injectors Blacks and Latinos are more likely to get AIDS than are whites. Among men 15 years of age or older, blacks were 2.8 times as likely as whites to get AIDS as of January 18,1988, and Latinos 2.7 times as likely. Among women, the risk of getting AIDS was lower than for men, but the relative risks for black women and Latinas, compared to white women, were 13.2 and 8.1, respectively.2 To a large extent, these disparities...

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