The soil was the South Bronx in the 1960s and 1970s, one of the poorest communities in the United States. With buildings leveled by arson and systematic neglect, its population crammed into debilitated and overcrowded housing without access to basic public safety and public health services, the inescapable poverty of the New York borough provided fertile ground for an epidemic. The seed -- the first seed -- was HIV, which spread easily through populations of people who injected drugs. An escalating war on drugs, an epidemic of incarceration and policies that served as barriers to healthcare served as the wind, that spread the seed across populations in the South Bronx. By the '90s, that soil, seed and wind had begun to efficiently spread an epidemic of drug-resistant tuberculosis, planted on the same fertile ground.
It was a saga repeated 8,000 miles away in South Africa in the decades that followed where the inequities and lasting impacts of Apartheid provided the soil for HIV and then extensively drug-resistant tuberculosis in the remote and poverty entrenched district of Tugela Ferry. There policies based on denial, discrimination and stigma, along with a mining industry that moved populations, separated families and crowded workers together in suffocating spaces fueled the spread of those epidemics.
The stories were told and linked by Dr. Gerald Friedland of Yale University's School of Medicine, in the N'Galy-Mann lecture on the opening night of this conference. They tell a story of a disease that goes beyond a plot line of host and pathogen, he said, with a common theme of human rights and social justice.
They also were stories offering both hope and lessons.
"AIDS is a great teacher," he said.
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