Brazilian cardinal Claudio Hummes once said, “We know that social exclusion is closely tied to the new economic world order, globalized, with free and open markets, which isn’t bringing prosperity or social justice to all.” The degenerative effects of this social exclusion even extend to public health. How else could it be that we are 30 years into the fight against HIV/AIDS, and we are still excluding select populations from meaningful engagement? Community based organizations and their supporters often have lofty intentions, but in the Western world, they are frequently beholden to funders, and funders may just as easily be altruistic, as they may be opinionated, and those opinions often extend to which social groups are “worthy” of attention, and consequent the beneficiaries of program funding, or even a voice in the debate.
I have attended numerous sessions at the International AIDS Conference 2012 where the topic of discussion has been about engaging “special populations”, not just as survey respondents, but as human beings. Social exclusion, that is, the identification of another social group as an “other” is a natural human tendency, as that is often how we develop our own self-concept, and sometimes has value as a tool for personal growth, but when applied in the community is pernicious in terms of resultant ostracization and stigma. It is hypocritical for a “human services” field to have such a dehumanizing element. But how do we move beyond our basic human tendency to form in-groups and out-groups? At the Hispanic Research Forum, I exhorted attendees to advocate for funding programs that address individuals as whole persons and holistic approaches that recognize that people are more than the sum of their demographic categories. Cliché as it may sound, people need to be treated as complex human beings, with varied motivations, abilities, skills, circumstances, and backgrounds, not simply as vectors for disease or epidemiological classes. This certainly requires us to understand those who we serve in greater depth – psychologically, historically, economically, socially, and culturally. I sometimes despair that with 30 years of combatting HIV/AIDS, we still find it difficult to wrap our head around the notion of community engagement. Clearly, there is a disconnect between our desire to eradicate this disease and our desire for simplicity. Nothing about HIV/AIDS is simple, from the disease itself, to the at-risk populations.
The United States denied numerous visa requests for conference attendees who were also active substance abusers or sex workers, preventing us from gathering information that help us understanding a high risk population in depth, giving them a voice, and understanding them as people, rather than categories. Similarly, data on the transgender population is thin on the ground, and ultimately we do not have a clear picture of the social impact HIV/AIDS has had on the transgendered. Exclusion based on broad categorization not only jeopardizes public health, but it is unscientific, and in all its essentials, anti-human. As the front line of a wide range of disenfranchised, suffering, and forgotten communities, we need to get our act together and resist the growing tendency to see demographic categories, and instead see people. You never know when your own category might be thus excluded. Fight for justice for all, and we are all raised up. As John Donne’s famous poem No Man is an Island says, “Each man’s death diminishes me, for I am involved in mankind.”
Written by Dr. Miriam Vega