By Shudipta Shabnam Islam
The Acquired Immunodeficiency Syndrome (AIDS) is one of the most politicized diseases worldwide. Its politicization manifests through the particular geographies of the AIDS epidemic, positioning it in areas stricken by poverty (Farmer, 1999). The strong correlation of AIDS prevalence to poverty demands a deeper analysis so that the socio-economic factors which allow AIDS to function in its particular geographies can be understood. The comedy series South Park uses its characteristic play with satire to contextualise AIDS prevalence patterns and illustrates its strong link to capital. By using South Park as the unit of analysis, I will argue that HIV/AIDS is intimately and inseparably related to capital and forms of capital expansion and exploitation. The paper examines how capitalist motives have historically, politically and socially created the conditions necessary for the perpetuation of HIV/AIDS. Additionally, it asserts that these same conditions have also systemically forged hindrances to the access of capital, which in turn, exacerbates the epidemic. South Park’s view on AIDS represents both these realities, although in different forms of expression. The first half of this paper will position the argument within the conceptual framework of Adam Geary. This will be followed by an analysis of how capital has, throughout the course of history, drawn out the lines along which the epidemic follows. It is important to note that my analysis of the epidemic, reinforced through South Park’s portrayal of the disease, is situated only within the context of the United States.
From its very first onset into the United States, AIDS has been the subject of cultural, social and political blame of the ‘other’. Ken Horne, a resident of San Francisco suffering from aggressive Karposis’s Sarcoma(KS), was the first recognized case of AIDS in the United States by the Centre for Disease Control (CDC) in 1980 (Hughes, 1997). However, Gaëtan Dugas, a homosexual French-Canadian who had multiple sexual partners in New York during the 80s, is labelled the official ‘Patient Zero’ (McKay, 2014). The subsequent increase in KS amongst the homosexual community created the first instances of blaming the “other”, specifically Dugas, and the reconstruction of AIDS as a Gay Related Immunodeficiency Disease (GRID) (Altman 1986). When the retrovirus, Human Immunodeficiency Virus (HIV), was finally recognized as the cause of and mode of transmission for AIDS in 1981 by Robert Gallo, the blaming of the other manifested through the redeployment of HIV/AIDS infection to four socially constructed risk-groups for infections (also commonly regarded as the 4Hs) – homosexuality, haemophiliacs, heroin users and Haitians (Gallo, 2006). AIDS was not viewed in the American mind as a disease that pervaded all segments of society (Altman, 1986; Geary, 2014). The development of the fourth and final group, Haitians, was particularly important because it was one of the earliest cases of organized blame towards an ethnic group that occupied marginalized status in America. Although the incidence rate amongst Haitians was 250% less than other risk groups (Frank, Weiss, Compas, Bienstock, Weber et al. 1985), the prevalence of the disease within a visible minority immediately established a new scapegoat for the penetration of the virus to heterosexuals, women and children (Gilbert, Rambaut, Wlasluk, Spira, Pitchenik et al., 2007) This was exacerbated by pre-existing negative stereotypes about Haitians (Santana & Darcy, 2000).
More than three decades after its controversial emergence to the public scene, the HIV/AIDS epidemic continues to be present largely in marginalized populations. The AIDS epidemic in the United States proliferates in small parcels of impoverished ghettos in industrialized urban cities (Geary, 2014). According to a CDC sponsored study, the ability of HIV to proliferate in these areas of poverty is so great (a 2.1% infection rate) that it can be classified as a generalized epidemic (Centre for Disease Control). Within a generalized epidemic, “at-risk groups” such as males that have sex with males (MSM), sex-workers and injecting drug users are omitted from the sample (Geary, 2014). In comparison, the epidemic across the nation at large had a reported infection rate of 0.5% which classifies it as a concentrated epidemic (Centre for Disease Control). A concentrated epidemic includes the at-risk groups within its sample (Geary, 2014). Furthermore, the study revealed that HIV transmission and prevalence was inversely proportional to household income as well as other indices of socio-economic status such as education, access to healthcare and employment (Centre for Disease Control). The study effectively concluded that people from the lowest socio-economic status were the most likely to have and transmit HIV and were confined within the inner-city neighbourhoods. 80% of these neighbourhoods are largely inhabited by historically racialized bodies of colour (Geary, 2014). Of these people of colour, Blacks comprise at least 50% of most inner-city ghettos and up to as much as 80-90% in the larger ghettoes in Detroit and Chicago (Geary, 2014). These statistics create the necessary pre-conditions to shift the attention of AIDS public health responses and action away from the white, middle-class, social space and towards these racialized areas of poverty. In this case, the blaming of the ‘other’ manifests largely as behavioural pathologies of racialized individuals that live in areas of poverty (Farmer 1999; Geary, 2014). Experts continually assert that the poverty that raids the inner-city causes various pathological behaviours such as excessive alcohol consumption and higher rates of drug use; consequently, this can lead to unprotected, sexual promiscuity (Geary, 2014). A 2008 paper published in Lancet called for the “rigorous” change in behaviour as a means to successfully prevent HIV transmission (Coates, Richter & Caceres, 2008), without taking into account socio-economic factors. Behavioural prescriptions included delaying the onset of “first intercourse”, drug-harm programs and information, syringe disposals, reduction in the number of sexual partners and condom usage amongst many others (Coates, Richet & Caceres, 2008). However, CDC has shown that the rate of acquiring HIV for every 10,000 exposures to an infected individual was 0.5-50 during unprotected sexual intercourse (both anal and penile-vaginal) (Geary, 2014) (Table 1). The acquisition rate in injected drug users was 67 per 10,000 exposures of shared, infected needles (Geary, 2014) (Table 1).
Table 1 Estimated per-act risk for acquisition of HIV, by exposure route* (cited from Geary, 2014)
For behaviour alone to account for the generalized AIDS epidemic observed in the urban ghettos of America, the individual would have to have a 1000-100-fold increase in sexual intercourse and 100-fold increase in drug use than the ‘average’ person. In similar fashion to the Haitian case, the statistical reality of AIDS in the ghetto did not reinforce the imagined blame attributed to behavioural choices. Geary asserts that behaviourally-induced exposures do not equate to susceptibility (Geary, 2014). In the event that it did, the prevalence of AIDS across the entire nation would exhibit the same generalized epidemic pattern as observed in inner city neighbourhoods (Geary, 2014). Geary emphasizes the action of the immune system in being central to understanding why AIDS raid the impoverished, marginalized populations of the society (2014). The human body contains multiple layers of defence mechanisms that need to be breached before HIV can be transmitted to the human sera, let alone be present in high enough dosages to create an infection (Geary, 2014). Mechanical defence barriers need to be breached in order for HIV to penetrate the body; once penetrated, HIV must fight off the aggressive and coordinated attack mechanisms of white blood cells (Geary, 2014). For HIV to create the onset of symptoms that are characteristic of AIDS, the individual exposed to HIV must be immunocompromised to allow transmission in the first place (Geary, 2014). Geary’s framework deduces that racialization and impoverishment is tightly linked to the production of immunocompromised individuals, allowing AIDS to proliferate in the neighbourhoods that inhabit them.
The intersectionality between racialization and impoverishment, however, is not a new phenomenon. Economic motivation has historically fuelled the structures that perpetuated racialization and subsequent impoverishment, beginning with the Trans-Atlantic slave trade in the 1500-1800s (Marcum & Skarbek, 2014). During this period, approximately 2 million people from the African continent were forcibly relocated, through the Middle Passage, to the New World to work on plantations (Marcum & Skarbek, 2014). This was one of the first documented instances of the racialization of Black bodies through the systemic dehumanization and brutal subjugation which particularly characterized and legitimized slavery to the New World (Wilkins, Whiting, Watson, Russon & Moncrief, 2012). Although a subject of strong debate, Fogel & Engerman (1974as cited in Post, 2003) asserts that plantation slavery was a form of capitalist expansion – “planter capitalism”. The structures established by slavery produced a reservoir of ‘free’ organized labour that could be exploited to accrue maximum profits (Fogel & Engerman, 1974 as cited in Post, 2003). Although that may have held true initially, the years following the depression of the 1830s were met with stagnancy of economic profits in Southern United States where plantation slavery was most widespread (Post, 2003). The maintenance of slave labour and the inability of owners to reduce their labour force created the preconditions that led to a second expansion of capitalist production: the industrialisation of Northern United States (Post, 2003). Despite the abolition of slavery during the industrial era of the American Civil War, Blacks continued to be racialized through social isolation, violence and political exclusion from the predominantly white American community that had been established (Davis, 1990; Wilkins et al., 2012). The rise of neo-classical economic theory during the mid-20th century dominated both the social and political spaces of industrialising cities in the United States and caused a bolstering of capitalist industries post-World War II (Arango, 2000). The resulting influx of African-Americans to Los Angeles at this time produced a direct threat to the perceived employment and economic opportunities of the white middle-class inhabiting L.A. (Brown, Vigil & Taylor, 2012). Neo-classical ideology overlapped with racist sentiments towards African-Americans, resulting in a host of policies that systemically containerized them to neighbourhoods and segmented them to the lowest class of labour work (Brown, Vigil & Taylor, 2012; Jeffries & Stanback, 1984). Policies enforced strict curfews and restrictions on inhabiting areas outside the containerized spaces, the violations of which lead to incarceration (Brown, Vigil & Taylor, 2012; Davis, 1980). The political formation of white gangs utilized brutal violence and threats to ensure that no one in these ghettos were able to gain upward social mobility (Davis, 1990). The combined effort of economic expansion for capital motive, and the pervasiveness of political policies based on neo-liberal rationale, structurally repressed the economic growth of racialized communities through the ghettoization of American cities. Similarly, the subjugation of Mexicans prior and during the Mexican-U.S. War was a manifestation of Hispanic racialization. The establishment of the U.S. Mexican border resulted in the displacement of thousands of Mexicans on the U.S. side of the border, resulting in isolated communities of their own (Nevins, 2002).
Racialized populations marginalized into poverty are, by ‘virtue’ of their marginalization, immunocompromised populations who are more likely to be infected by HIV (Geary, 2014). The fight for capital and wealth accumulation throughout history has created bodies that have faced structural violence which limit their ability to be healthy in various capacities. One way that racialized bodies are generally more immunocompromised is through the perception of expected violence (Geary, 2014). Franz Fanon describes how racism and prejudice becomes mentally engrained in the human mind (1967). Fanon’s prescription of racial embodiment can explain why centuries of Black subjugation and brutal targeted violence increase the Black individual’s expectation of violence towards them (Fanon, 1967; Geary, 2014). Geary exemplifies this by correlating elevated hypertension levels to the chronic stress levels that result from this perceived unsafety felt by populations that have been historically ostracized (Geary, 2014). Studies have revealed that chronic stress creates inflammatory responses that inhibit modulation of the immune system, through the excessive release of the hormone cortisol (Reiche et al., 2014). The individual with a compromised immune system is thus constructed out of structural racism and ghettoization.
In stark contrast, the popular TV sitcom, South Park, is set in the suburban town of South Park in the state of Colorado, with predominantly white, middle class inhabitants (Frim, 2014). Although the position of South Park with regards to political reality has been highly contested, Frim asserts that the show uses satirical representations or misrepresentations of current socio-political issues to portray the foundational realities that shape these issues (2014). Many scholars, such as Becker, reject the notion that South Park represents the stances of one political ideology over others; however, they continue to assert that through parody and hyperbole, the show brings out, at the very least, the socio-political ignorance that plagues current issues (Frim, 2014). Within this conceptual framework, South Park’s representation of HIV/AIDS in the episode “Tonsil Trouble” (Episode 1, Season 12) can be understood as both a satirized distortion and a hyperbolized version of the reality of the epidemic. The distorted reality unfolds through the infection of Eric Cartman with HIV as a result of a blood transfusion during his tonsil removal operation. Cartman’s distress over being HIV positive is aggravated further when his friend, Kyle Broflovski, mocks him for becoming infected. As a revenge tactic, Cartman feeds his infected blood to a sleeping Brovslovski. The reality of HIV transmission is tremendously distorted. Although it is not impossible that HIV could infect the white, middle-class strata from suburban Colorado, under Geary’s analysis, the reality of HIV transmission is that it disproportionately targets the non-white poor that live in the impoverished slots of land in industrialized urban cities. Geary also exposes the effectively low rate of transmission which calls for a greater focus on disease to susceptibility as opposed to simple exposure. The reality of susceptibility is down-played through the over-simplification of HIV transmission in both characters. As white, middle-upper class residents of South Park, like most of South Park’s community, Cartman and Broflovski do not fall under these susceptible groups. The gross misrepresentation of factuality can be attributed to the typical South Park satire to which Frim refers (2014).
As the episode continues, Cartman and Broflovski seek out the celebrity and former basketball player Magic Johnson to find out how he managed to prolong his lifespan despite his AIDS diagnosis. Upon realizing that Johnson sleeps with an enormous quantity of cash, the boys discover that the cure to AIDS is money. This discovery was not only the highlight turning point of the episode, but also highly exaggerated. In the episode, bank notes were pulverized and treated to create a concentrated liquid form of money which founded the cure against HIV. The ultimate message sent out to the audiences was the need for capital or cash to solve a disease which has largely been isolated to underprivileged bodies. This hyperbolic representation of the cure represents the realities of the intimate relationship between HIV transmission and infection, AIDS onset and access to capital or money. Although the episode may, at first glance, appear to serves as comical relief, a deeper analysis of its plot reveals the socio-political histories of economic development that have systematically created the conditions of poverty in which HIV/AIDS was allowed to selectively flourish (Geary, 2014). Not only did historical means of capital acquisition systemically construct ghettos, but it also hindered the access to capital by ghettoized populations. Marcuse introduces the term “outcast ghettos” to describe the involuntary formation of communities that “have been excluded from the mainstream economy by the forces of macroeconomic development” (1997). This denial of access to capital manifests through unemployment and huge wage differentials between races. The 2010 census by the United States Census Bureau reported that the average annual incomes amongst non-Hispanic Whites was ~$55,000 in comparison to ~$32,000 and ~$37,000 in Blacks and Hispanics respectively. Furthermore, 27% of Black and Hispanics were unemployed compared to only 10% of non-Hispanic Whites. The racial inequality in employment rates and wages are attributed to the implicit and advertently racist policies which were reinforced under Ronald Reagan’s administration, largely influenced by the theories of economic-rationale (Jeffries & Stanback, 1984). Furthermore, the “feminization of poverty” has meant that female-headed families were significantly more likely to be unemployed (Jeffries & Stanback, 1984). The 2010 census also reported that Blacks were twice as more likely and Hispanics three times as more likely to not have health coverage in comparison to Whites. Those that do have health insurance, Wilkins et al. reports are more likely to be misdiagnosed (2012). Thus, capitalist macroeconomics has not only caused the construction of outcast ghettos, but has also forged barriers that prevent the upward economic mobility of their inhabitants. A positive-feedback loop is observed where the expansion of capitalist modes of economy constructed racialized, poverty and immunocompromised-stricken neighbourhoods that serve as hot-beds for HIV infections. These same conditions produce structural obstacles to earn capital which could be used to access healthcare.
Capitalist expansion has created the necessary environments for subjugating bodies of colour to justify regimes of oppression (Wilkins et al., 2012) as well as containerizing them to isolated communities. Through macroeconomic and capitalist expansion and industrialization, these racialized bodies have been segmented to the lowest earning jobs (Jeffries & Stanback, 1984). They are confined within the barriers of poverty forged through rapid, neo-liberal economic expansions which limit their access to capital either in monetary form or in the form of healthcare. In this regard, South Park successfully highlights the importance of the access to capital for the HIV epidemic. However, it does so without positioning or situating the disease in the complex framework to which it belongs.
 For the purpose of this research paper, I use the term capital somewhat loosely. The use of this term throughout the paper is exchangeable with money, wealth or accrual of economic profits.
 Karposi’s Sarcoma is a form of skin cancer that proliferates in HIV infected patients (Hughes, 1997). It is often used as an indicator for the onset of AIDS.
 There have been several cases of HIV/AIDS before 1980. However, Ken Horne is the first documented case. Cases earlier than 1980 were only discovered in later years through the study of preserved samples.
 These at-risk groups are redundant and no longer apply in the widespread discourse centred on HIV transmission
 Haitians were derogatorily termed as “voodoo” or “boat people” (Santana & Darcy, 2000).
 According to the UNAIDS definition, a generalized AIDS epidemic is characterized by one that has a disease transmission rate greater than 1% (Geary, 2014).
 Notable exceptions include the McCormick family, the Black family, Tuong Lu Kim and ‘Chef’
 The presence of Magic Johnson in this episode is ironic because he is a rich, Black, and presumably healthy (due to his athletic career) man. Magic Johnson’s access to capital may at first glance appear to be contradictory to my analysis. However, on closer inspection, it in fact reinforces Geary’s framework. Geary provides evidence that Black women at the same socio-economic status as white women still present more health problems (such as lower infant birth weights) (Geary, 2014). In fact, the richest Black women tend to have more health problems than the poorest white women (Geary, 2014). This strongly emphasizes that historical racial subjugation has rendered racialized bodies susceptible and immunocompromised. No matter how far up the socio-economic ladder they have climbed, they are still unable to escape the systemic, structural violence against them.
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Shudipta is a 4th year student, finishing up her undergraduate degrees in Health & Disease and Diaspora & Transnational Studies at the University of Toronto. She is originally from Bangladesh but has been born and raised in different nations throughout the world. Her interest in Diaspora and Transnational Studies stems from her own experiences of movement and negotiation with South Asian heritage. She is interested in pursuing the field of public health using a community-based, bottom-up approach. Her paper “Can I Buy My Way Out of AIDS?” places AIDS within historical and socio-economic context. AIDS itself is transnational, exhibiting specific patterns of geographies which tie into greater systems. While this paper explores Trans-Atlantic slave trade, racism, poverty and neo-liberalism, she would like to further her research on these themes and how they interact with the public health system.