The impulse to punish the sick has a long history in public health — a history shot through with calls to coerce and quarantine the sick. Those efforts have repeatedly disproportionately impacted the poor, racial minorities, sex workers, and other stigmatized communities — sometimes by design, but more often as a matter of practice. […]
As the HIV epidemic crystallized, it did so alongside the New Right’s calls for Americans to take personal responsibility for their lives by putting an end to New Deal welfare programs. Conservatives in federal and state legislatures worked in concert to gut welfare programs while declaring a war on crime that prompted a rise in incarceration rates unprecedented in human history. [Beckett & Western 2001] Funding to higher education was drastically cut while the number of prisons exploded, leading modern activists to demand “schools, not prisons.” [Meiners & Winn 2010] For Black men especially, sociologists have demonstrated that incarceration has become a normal and even probable life event. [Pettit & Western 2004]
Evangelical conservatives capitalized on [the] association [between HIV and stigmatized communities], issuing damning proclamations that the “gay plague” would cross over and infect middle-class American families. The cover of the July 1983 issue of Jerry Falwell’s Moral Majority Report perfectly encapsulates the stigmatizing narrative invented by conservatives. Featuring a photo of a White, middle-class family with two children whose faces are covered with medical surgical masks, the headline read: “Homosexual Diseases Threaten American Families.”
[T]his punitive view of the epidemic resonates with public health’s message that risky individual health behaviors cause disease and need to be prevented. The logical leap from arguing that we need to prevent individual health behaviors that cause disease to blaming individuals for engaging health behaviors labeled “risky” was not so great. Medical historian Allan Brandt observed in 1997 that
AIDS has been placed strongly within the paradigm of responsibility. If one “merely” avoids the risk behaviors associated with transmission of the virus — unprotected sexual intercourse and sharing needles for intravenous drug use — one can avoid AIDS. Therefore, infection is a clear — and usually terminal — marker of individual risk taking, of engaging in behaviors typically held to be deviant or criminal. According to this view, those who are infected are responsible for their plight. AIDS is caused by a moral failure of the individual. [Brandt & Rozin 1997]
In ushering in a new era of risk avoidance in which the responsibility for one’s health was placed on each individual’s shoulders, public health inadvertently contributed to a context in which blame and punishment seem apt disease control strategies.
Although Patient Zero was a fictional character invented by a journalist, his story fueled calls for public health to institute coercive and punitive measures in response to AIDS. These demands for control resembled many of the historical cases reviewed in this chapter in that they typically singled out especially marginalized people for control: in the case of Patient Zero, an immigrant gay man; in other cases reviewed in this chapter, the poor, racial minorities, sex workers, and even alcoholics. When public health institutions discriminatorily target specific groups of people for coercive measures that are not applied to other groups, their efforts reinforce the view that certain social groups are to blame for the spread of disease. Their implicit offense is not their risky behaviors but their social difference. In this way, the history of punitive disease control is at times indistinguishable from America’s troubled history of social marginalization.
We cannot know what would have happened if more cases of Ebola had been brought to American shores, or what will happen when the next infectious disease becomes epidemic in the United States. As this book reveals, however, disease and punishment are more closely linked than even before in modern history.
— Trevor Hoppe, Punishing Disease: HIV and the Criminalization of Sickness (2017), Ch. 1. Bold mine.
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