Raise Your Hand if You’re in the General Population

In a series of articles on the HIV/AIDS pandemic in Latin America published in the July 28 issue of Science magazine, one phrase in particular caught my eye: "The virus is also moving from high-risk groups to the general population." It wasn't the first time I'd read about this so-called "general population," but the more I think about it, the more uncomfortable I am with the concept. In epidemiological terms, I think I understand what it means: HIV/AIDS is now affecting populations other than sex workers, people who inject illegal drugs, and men who sleep with men--that is, the groups that traditionally become infected first when HIV/AIDS shows up in a particular country. In the other corner, we have the general population: mothers, housewives, heterosexual adolescents, celebrities, professionals, educated people, married couples, me, you, our families.

Now, I'm not an epidemiologist, but my hunch is that sex workers and people who inject illegal drugs and men who sleep with men aren't just having sex with each other. I would hazard a guess that they're also having sex with this so-called general population--and, last I checked, HIV was transmitted sexually. Furthermore, aren't sex workers and people who inject illegal drugs and men who have sex with men ALSO mothers, and housewives, and heterosexual adolescents, and celebrities, and professionals, and educated people, and married couples, and yes--sometimes even me, you, and our families too? Who gets to decide where the general population begins and ends?

In a series of articles on the HIV/AIDS pandemic in Latin America published in the July 28 issue of Science magazine, one phrase in particular caught my eye: "The virus is also moving from high-risk groups to the general population." It wasn't the first time I'd read about this so-called "general population," but the more I think about it, the more uncomfortable I am with the concept. In epidemiological terms, I think I understand what it means: HIV/AIDS is now affecting populations other than sex workers, people who inject illegal drugs, and men who sleep with men–that is, the groups that traditionally become infected first when HIV/AIDS shows up in a particular country. In the other corner, we have the general population: mothers, housewives, heterosexual adolescents, celebrities, professionals, educated people, married couples, me, you, our families.

Now, I'm not an epidemiologist, but my hunch is that sex workers and people who inject illegal drugs and men who sleep with men aren't just having sex with each other. I would hazard a guess that they're also having sex with this so-called general population–and, last I checked, HIV was transmitted sexually. Furthermore, aren't sex workers and people who inject illegal drugs and men who have sex with men ALSO mothers, and housewives, and heterosexual adolescents, and celebrities, and professionals, and educated people, and married couples, and yes–sometimes even me, you, and our families too? Who gets to decide where the general population begins and ends? And isn't the thing about HIV/AIDS that we're all vulnerable, because we're all sexual beings (except for the Bush administration, and the majority of the U.S. Congress, and the Vatican, of course, given their commitment to abstinence)? And every time we have sex, no matter how protected we feel, aren't we taking a risk?

Living in fear certainly isn't the answer to this dilemma–sex is part of being human and what worthwhile part of being human doesn't involve some kind of risk, whether it's physical, emotional, spiritual, or intellectual? And I don't mean to dismiss some very important, well-documented realities about HIV/AIDS–certain groups of people, by virtue of norms and circumstances and geography and history and experience and discrimination, are disproportionately vulnerable. But the point is, as long as we keep talking about HIV/AIDS in terms of the general population (us) versus "high-risk groups" (them), in terms of rich countries (us) versus poor countries (them), in terms of people who have control over their lives and their decisions (us), versus people who don't (them), the world–and I'm not just talking about the general population–is never going to come to an understanding about how to confront this pandemic that we're all living with, whether we're HIV-positive, HIV-negative, or–the category into which most of the world falls, and it's not just because testing isn't available widely enough–we really can't say for sure. As long as we keep othering, and intellectualizing, and declaring, and prescribing, without really coming to terms with our own behavior, our own decisions, our own inconsistencies, our own fears, and our own god-given tendency to do things that baffle us afterward, we're still going to be mystified every time we learn about someone who was in possession of all the facts, who was empowered to make his or her own decisions, and who still had unprotected sex. And that's a conundrum worth contemplating.

I am indebted to the Nigerian feminist Ngozi Iwere, whose analysis first inspired me to question the concept of the "general population." Read more about Ngozi here.