The soil was the South Bronx in the 1960s and 1970s, one of the poorest communities in the United States. With buildings leveled by arson and systematic neglect, its population crammed into debilitated and overcrowded housing without access to basic public safety and public health services, the inescapable poverty of the New York borough provided fertile ground for an epidemic. The seed — the first seed — was HIV, which spread easily through populations of people who injected drugs. An escalating war on drugs, an epidemic of incarceration and policies that served as barriers to healthcare served as the wind, that spread the seed across populations in the South Bronx. By the 90s, that soil, seed and wind had begun to efficiently spread an epidemic of drug-resistant tuberculosis, planted on the same fertile ground.
It was a saga repeated 8,000 miles away in South Africa in the decades that followed where the inequities and lasting impacts of Apartheid provided the soil for HIV and then extensively drug-resistant tuberculosis in the remote and poverty entrenched district of Tugela Ferry. There policies based on denial, discrimination and stigma, along with a mining industry that moved populations, separated families and crowded workers together in suffocating spaces fueled the spread of those epidemics.
The stories were told and linked by Dr. Gerald Friedland of Yale University’s School of Medicine, in the N’Galy-Mann lecture on the opening night of this conference. They tell a story of a disease that goes beyond a plot line of host and pathogen, he said, with a common theme of human rights and social justice.
They also were stories offering both hope and lessons.
“AIDS is a great teacher,” he said.
He told how recognizing the epidemics and the factors that fueled them, caring for individuals “with humanism and competence,” and for communities with mobile health units were among the interventions that slowly, but effectively stemmed the tide of the epidemics in the Bronx, and how the introduction of infection control and home-based care used community strengths to stem the toll of disease in the Msinga subdistrict of Tugela Ferry.
While Msinga was the poorest community in South Africa, and the South Bronx among the poorest in the United States, interventions based in the rights of residents in those communities to public health and public services were effective.
And they offered a chance to avert future public health disaster, but only if the role of human rights and social justice are recognized in the process, he said.
“Sudden and unexplained epidemics of HIV and tuberculosis are not sudden, and can be explained,” Friedland concluded. “And they can be successfully confronted and turned back.”