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61 3 In order to understand the impact of cultural and social capital on the lives of Caridad and her cohorts, it is crucial to understand the city in which most of them lived. When I began planning my study in the mid-1990s, most of the women I worked with had just begun their journey as people living with HIV/AIDS. They moved within a national, regional, and municipal context that shaped what was possible. This chapter will offer a glimpse of the greater economic and political forces that shaped their worlds and framed their lives. It is far from comprehensive, because these stories could fill volumes. I have selected only what I deem to be critical, in the hopes that this will offer a greater context in which to understand Newark’s resourceful women. Snapshots of the HIV/AIDS epidemic across the nation and in four U.S. cities situate Newark’s stories in the national and regional scene of the period. Each city offers parallels and contrasts to Newark; each one is also home to a vibrant Puerto Rican community. City sketches are drawn from a variety of sources, including the results of the 1999 National Rapid Assessment, Response, and Evaluation (RARE) initiative. The RARE initiative was established in response to a 1998 request from the Congressional Black Caucus of the United States that the secretary of the U.S. Department of Health and Human Services declare a public health emergency in the black communities impacted by HIV/AIDS (Needle et al. 2003). While not meant to be definitive or comprehensive, these sketches do convey both the omnipresence of SAVA and the constantly shifting nature of HIV/AIDS epidemics. Women and HIV: The National Scene In 1981, the CDC noticed an alarming increase in cases of Kaposi’s sarcoma, a rare form of skin cancer (AIDS Education Global Information System n.d.). The New York Times ran an article announcing that doctors in New York and Unpacking Newark’s Epidemic California had diagnosed forty-one cases of the cancer, all appearing among homosexual men. Eight of the victims died less than twenty-four months after their diagnosis, and nine of these forty-one men developed severe defects in their immunological systems (Altman 1981). The cancer was not thought to be contagious, but public health experts believed that precipitating conditions, such as viruses or environmental factors, might exist. “The best evidence against contagion,” said one physician,” is that no cases have been reported to date outside the homosexual community or in women” (Altman 1981). Early that year, scientists began referring to the mysterious condition as GRID (gay-related immune deficiency) but it was soon renamed AIDS (acquired immunodeficiency syndrome) (Johnson and Ross; LSU Law Center 1993). By the following year, 285 cases were reported in seventeen U.S. cities and five European countries. The CDC had discovered that both sexual contact and infected blood transmitted the disease. However, the underlying immune deficiencies seen in these AIDS cases was still unknown (Johnson and Ross). In 1983, the CDC acknowledged that the female sex partners of men with AIDS were at risk of acquiring the virus (Kaiser Family Foundation Global HIV/AIDS Timeline). Nevertheless, HIV-positive women were largely overlooked until the mid-1980s. As late as 1991, it could still be said that to the extent women were considered at all, they were seen as carriers of the disease, not as people struggling to survive in their own right (LaGuardia 1991). By this time, the few studies that included women recruited sex workers and pregnant women to investigate transmission of the virus to male partners and fetuses (LaGuardia 1991, 21). But as early as 1986, some advocates and social scientists began to ask how HIV impacted women themselves. During the early 1980s, qualitative research emerged as a useful tool in the arsenal against AIDS (Singer et al. 2001). These studies were framed by the urgent need to understand social and cultural facilitators of transmission. Some examined local culture’s impact on drug use and sexual practices, which in turn affected women’s risks and perceptions of risk (Worth 1986; Amaro 1988; Lewis and Waters 1988; Mays and Cochran 1988). This work helped to establish a qualitative approach to the study of HIV-positive women that emphasized the development of successful prevention strategies (Osmond et al. 1992; Alonso and Koreck 1993; Farmer, Good, and Lindenbaum 1993; Lewis 1993; Romero, Arguelles, and Rivero 1993; Romero 1993; Clatts 1994; de Zalduando and...

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