‘Expendable Populations’
By Gary Kinsman, excerpted from the Radical Noise article “SOME NOTES ON LEARNING FROM AIDS ACTIVISM FOR OUR RESPONSES TO THE CORONAVIRUS (COVID-19) PANDEMIC”
Edited for length
While living though the current Coronavirus/COVID-19 crisis I am struck by the connections between the AIDS crisis (which is also not over) and this health crisis. At the same time there are also major differences between these two different health crises including mode of transmission, impact on people’s bodies and health and to some extent who is most affected. I was actively involved in AIDS organizing and activism in the 1980s and 1990s and have also been involved in documenting some of these histories. In this initial sketch I try to draw out some of what can be learned from the history of AIDS organizing and activism for the current pandemic. I know this is partial and limited. Please feel free to add to it or critique it. It is intended to get discussion going.
Referring to AIDS organizing and activism I refer firstly (but not only) to the treatment based (but always much broader) direct action informed activism associated with various AIDS Coalition to Unleash Power (ACT UP) groups that existed across the USA, in ‘Canada,’ and around the globe (some of which still exist) or groups like AIDS ACTION NOW! (AAN!) based in Toronto. These groups with the themes of “Silence=Death, Action=Life” focused on fighting to get access for people living with AIDS/HIV to treatments to fight the infections that were actually killing people. They put the needs of people most affected by AIDS at the centre of the social response. I am also referring to the first wave of the setting up of community based groups in the early 1980s (and later) that supported people living with AIDS/HIV, developed education and fought against discrimination when governments were leaving people to die. These forms of activism extended and saved people’s lives.
Like all health emergencies the AIDS crisis was/is a condensation of many social relations – including sexuality, race, gender, class, poverty, underdevelopment, colonialism and neocolonialism, ability, drug use, sex work, the power of pharmaceutical corporations, the character of the medical profession, problems with public health and so much more. It is always important to ask which ‘public’ is being defended and whose ‘health’ is being protected? For the AIDS crisis to be fully addressed all of these relations had to be engaged with.
‘Expendable populations’ and fighting discrimination and stigmatization
In the early years of the AIDS crisis there was little official and state response since it was seen as only affecting ‘expendable populations’ — gay men/men who have sex with men, drug users, Haitians and other people of colour (including the racist construction of ‘African AIDS’) and sex workers. These were the groups identified as the “high risk groups” and this term was lifted out of epidemiological discourse to organize social discrimination and stigmatization against these groups. These people were thought by moral conservative governments as ‘expendable’ and therefore years of social and health care response were lost in the fight against AIDS. Instead the ‘general population’ (coded as white, middle class and heterosexual) was defended against the ‘vectors’ and ‘reservoirs’ of infection. Early AIDS organizing fought against this by refocusing on the risk activities that anyone could engage in and by affirming the importance of the lives and needs of people living with AIDS/HIV and the communities most affected by AIDS. It also took up the concerns of those who were being ignored in the social response to AIDS, including the needs of women and people of colour. AIDS activists argued for the needs of those most directly affected to be at the centre of the social response and not only the needs of the non-infected.
In the current pandemic there has been the social organization of discrimination, racism, and stigmatization against people from Asian countries. In a slightly more localized fashion this has also been mobilized against people from Iran — in the middle eastern context in particular. This early focus on the pandemic as only affecting ‘other’ people (and only viewing these ‘other’ people as the ‘threat’) led to weeks of delay in developing a response in many state and official circles.
But there are also ways in which those most vulnerable to the coronavirus — older people and those living with compromised or weakened immune systems – including people with cancer, HIV infection, diabetes, heart conditions, and forms of disability — are seen as also being ‘expendable.’ The elderly were viewed as ‘non-productive’ (in relation to capitalist production), or by some as a ‘drain’ on social resources — in contrast to Indigenous traditions where elders are seen as having wisdom and are treated with great respect– and those with immune-compromised bodies, including those with cancer and HIV, often those living with disabilities were also viewed by these people as ‘expendable.’
With the articulation of ‘washing your hands” as part of the preventative measures this means that all those who cannot access clean water (like many on First Nation reserves in ‘Canada’) also become ‘expendable.’ With the official advice of ‘social distance’ and ‘social isolation’ as the way to prevent transmission this also makes all those who do not have the material basis to do this becoming ‘expendable.’ It is now clear to me that the term ‘social distancing’ participates in dissolving the social and since we need to maintain and build the social in the context of this pandemic we need to use terms like spatial or physical distancing instead. Those who cannot participate in these distancing and isolation practices include the poor and homeless (who are often racialized), and those in institutions (including nursing homes) and prisons, as well as those who cannot miss waged work when they are sick given the massive growth of precarious labour and the lack of paid sick days and social support given the ripping apart of the social wage by neoliberal capital. The class and racialized dimensions of this become very clear. Finally the closing of borders serves to place the lives of refugees, migrants and those without status in very difficult situations. These are mostly people of colour.
All these approaches prioritize the lives of those least at ‘risk’ of death from the coronavirus — the younger, the ‘healthy,’ the non-disabled, those with healthy immune systems, and the wealthy over everyone else. It is their health that was being protected. They became the ‘public’ to be defended from those who could potentially die from COVID-19. Calls for attention to the specific needs of Indigenous nations and communities, homeless people in the shelter systems, the need for all workers to have paid sick leave and relief from evictions and mortgages and to be able to refuse unsafe work, the need for adequate social supports, and for the needs of refugees and migrant workers to be addressed are ways to actively cut across this. This must be taken up as central to social responses to the pandemic.