The Peculiar Epidemic, Part I: Social Response to AIDS in Alameda County

The morbidity and mortality caused by epidemics threaten social functioning of complex societies. Societies mount a social response to epidemics in order to contain the potential damage from uncontrolled disease. Despite the threat posed by epidemics, social and contextual ‘vulnerabilities’ often impede efforts to contain epidemics. The AIDS epidemic provides an example of a ‘peculiar’ epidemic, in which threat to social welfare failed to provoke adequate social efforts at containment. In order to examine the miscarriage of epidemic response, we interviewed 31 AIDS providers in Alameda County, California, about the development of their AIDS-related services. According to the people interviewed, epidemic response in the County was marred by stigma associated with AIDS, lack of adequate funding, difficulties in building collaborative effort in a fragmented care system, and other political and social problems. In spite of these obstacles, social mobilization enabled directors of a wide variety of health care agencies to incorporate care and prevention into their services. The findings support the concept that ‘vulnerabilities’ can derail epidemic response, making widespread social mobilization an essential tool for epidemic control. The discussion centers on the implication of these findings for the theoretical understanding of social response to epidemics.