For example, historians note that “prostitutes” were specifically singled out as the source of venereal disease in the period between 1900 and 1930, when national attention was first focused on the issue of venereal disease. In the early decades of this century, immigrant and native-born working-class white women were targeted by physicians and public health experts attempting to control outbreaks of syphilis. Historians of medicine have failed to mention that African American women were targeted as well. And few explore the meaning of the term “prostitute,” particularly with regard to black women. Since slavery, as historians of African American history have shown, the label is often used against all African American women irrespective of class, education, and most importantly behavior. Racial theories that ascribed to African American women an inherent immorality were buttressed by physicians and social reformers when the incidence of venereal disease among African American women began to rise in the twentieth century.
While the source and use of statistics on the incidence of venereal disease in the African American community was hotly debated, most observers agreed that the incidence was high in these communities throughout the country. One source notes that syphilis rates among African American women were as much as fifteen times those of white women, particularly for women in their childbearing years. Deaths from gonorrhea were also high.25 Statistics collected by physicians at the Syphilis Division of the Medical Clinic of the Johns Hopkins Hospital in Baltimore show that African American women had the highest rates of syphilis from 1916 until 1928. And while rates among black males and white males and females began to decrease after 1925, the rate among African American women seemed to be rising.26
No study that I know of goes beyond merely reporting that African American women were the most common sufferers of venereal disease to explore the meanings and uses that were made of this disparity by physicians, public health experts, and other social reformers in the past. I would argue that the historical record must be rewritten to illustrate how race influenced practices designed to control venereal disease, if we are to understand how the legacy of such practices affects current efforts to control AIDS.
Historians note that many repressive tactics were invoked by public health experts attempting to control venereal disease before World War II. Yet little is known as to how imposition of quarantines, detention, and internment were shaped by the racial and ethnic composition of the groups of women labelled prostitutes when the very possibility of infection could be used as a sufficient cause for incarceration. What was happening to African American women when physicians were simultaneously claiming that. “... ninety-five percent of the negro race are likely to contract syphilis or other venereal disease including those of the educated classes,” and “. . . the worn-out prostitute of today may be the woman you employ as your maid tomorrow?”27 African American physicians, sociologists, educators, and club women vigorously protested the view that the presence of venereal disease gave credence to the racist assertion that all African American women were inherently immoral.28 They pointed to socioeconomic factors and the exploitation of young black women in the cities by unscrupulous white and black men as important factors. In urban areas the increased visibility of African American women became a source of anxiety for whites. The interwar years were times of intense racial strife and severe economic crisis for African American women, who by the hundreds stood in unemployment lines on the streets of many cities.29 How and in what context were public health experts in their concern about venereal disease, supplying a new scientific justification to the existing process of policing so-called dangerous working women of color and white women?
Sexually transmitted diseases are highly stigmatized in this culture. How do we examine the impact of the stigma associated with these diseases on women’s lives? In article after article in this period, white physicians echo the themes: that all African American people had syphilis; and that the immorality of African American women could be measured by the numbers of illegitimate infants and the numbers of those born with congenital syphilis. Black women as source, cause, and victims of venereal disease had to contend with both the stigma and the severe effect of venereal disease on their reproductive health. In 1924, a study by the Association for Improving the Condition of the Poor in New York City found:Negro women suffering from syphilis but receiving neither adequate prenatal instruction nor medical treatment lost an average of fifty-four percent of their babies through miscarriage, still-birth, or death during the first two years . . . twenty-nine percent of surviving children of syphilitic mothers were diagnosed as syphilitic.30
As it is with AIDS today, commentary on the impact of syphilis as experienced by African American women is absent from this literature. In addition, physicians’ views of African American women were further diminished because they often failed to return to clinics for the expensive treatment of their disease during and after pregnancy, giving further “evidence” of their irresponsibility. Few of the white physicians and nurses who staffed these clinics showed any awareness that their attitudes and behavior toward African American women bore any relation to failure of these women to return for treatment.
The discovery that syphilis had a serious impact on maternal health and fetal death received a good deal of attention in the 1920s. Physicians at Johns Hopkins Hospital, who conducted a three-year study of the significance of syphilis in prenatal development and the causation of fetal death, argued increasingly for the need for complete medical control of pregnant women suffering from the disease. Their reports consistently articulate different methods of control for white women of the “intelligent classes,” described more as “innocent” victims, versus all black women, who are cited as “ignorant,” “unmoral,” and “unmanageable.”31 Social workers enlisted to encourage follow-up care for women with syphilis also reported that native-born white women took an intelligent interest in learning the facts about syphilis and accepted that they should not have more children, while black women and immigrant women were censured for their refusal to submit to the control of medical and welfare authorities.32 Given such facts, we might ask how the stigma associated with venereal disease affected the kind of support given to efforts to provide infant and maternal care for African American women as the rates of sexually transmitted diseases and infant mortality rates fell among middle-class white women.33
The incidence of venereal disease among African American women and the practices they were subjected to served as powerful ideological weapons to control the sexual and reproductive behavior of white women. African American women were punished because they suffered from disease associated with immoral behavior and for their so-called refusal to submit to medical authority. When physicians came to the defense of women who had a venereal disease, it was to a sentimental, objectified ideal, one that arguably bore little resemblance to most white women and hardly applied to African American women.34 Programs for middle-class white women were designed to reduce the stigma associated with having syphilis and seeking treatment. African American women’s options for treatment were limited by economic resources and the necessity of exposing themselves to censure by white professionals on an issue inextricably related to sex, in a context where their privacy and dignity could not be and never had been preserved. It is not surprising that programs that successfully treated African American women were largely staffed by African American physicians and nurses.35
From 1945 to 1964, syphilis rates among all groups fell in the United States. In 1945, syphilis rates among nonwhites were thirteen times higher than among whites. By 1964, they were still ten times higher than for whites. Total expenditures for venereal disease control fell steadily throughout that same period of time.
CONCLUSION
I believe that the invisibility and objectification of African American women in the AIDS epidemic is tied to the historical treatment of African American women with respect to sexually transmitted disease. The Tuskegee syphilis experiment is just one example
of the legacy of danger and death that sexually transmitted diseases represent for African American communities. For a black woman to expose that she had a sexually transmitted disease was, for much of this century, to render herself multiply stigmatized, bringing up older images of immorality and uncontrolled sexuality that neither class nor educational privilege could protect her from. It possibly meant that pregnancy carried more risks; it often precipitated long-term health problems and even early death. That physicians and public health experts have long accepted higher rates of sexually transmitted diseases among African American women is a sign that somehow this had quietly become a norm. That overt racial comments from white health care providers on the cause of this higher incidence of sexually transmitted disease and the attendant problems for fetal and maternal health are less evident today than in the 1920s is not necessarily a sign that attitudes have changed or that the stigma associated with these diseases has diminished.
Current public health efforts must address the long term stigma that African American women continue to experience with respect to sexually transmitted diseases. As the uninterrupted disparity in the incidence of these diseases within this community over the last fifty years indicates, those efforts have largely failed. Bringing to the fore the historical treatment and experience of African American women, their children, and their partners with respect to sexually transmitted diseases in the past is a necessary step.
In addition, most of all, what is needed is a viable black feminist movement. African American feminists need to intervene in the public and scientific debates about AIDS, making plain the impact that medical and public health policy will have on African American women. An analysis of gender is desperately needed to frame the discussion of sexual relations in the black community. Sexism lies behind the disempowerment and lack of control that African American women experience in the face of AIDS. African American women are multiply stigmatized in the AIDS epidemic —only a multifaceted African American feminist analysis attentive to issues of race, sex, gender, and power can adequately expose the impact of AIDS on our communities and formulate just policies to save women’s lives.
ENDNOTES
1 Testimony of Margaret Rivera, Report of the Public Hearing, “AIDS: Its Impact on Women, Children and Families.” (New York State Division for Women, 12 June 1987), 21.
2 Victoria A. Cargill and Mark Smith, “HIV Disease and the African American Community,” New England Journal of Medicine, 1990.
3 Tedd V. Ellerbrock et al., “Epidemiology of Women With AIDS in the United States, 1981 Through 1990; A Comparison With Heterosexual Men With AIDS,” Journal of the American Medical Association 265, no. 22 (12 June 1991): 2971.
4 Ibid.
5 IV drug users were constructed as male in the mass media before the spectacle of “crack babies.” Moreover, drug treatment models and facilities continue to favor male clients while the despair of women’s addiction to crack disappears quickly behind our image of them as monsters for “delivering drugs” to their babies.
6 By using the term “attention,” it is not my intent in this essay to disparage or belittle the heroic efforts of the many health care workers, activists, and others who have labored to bring the plight of African American women and other women with AIDS to light. By using the term “attention,” I only mean to address the fact that the deaths of African American women with AIDS have not garnered the kind of front-page headlines or other prominent popular media attention given to other people with AIDS, as will be discussed more fully later in the essay.
7 Jane Gross, “Bleak Lives, Women Carrying AIDS,” New York Times, 27 August 1987.
8 N. S. Padian, “Heterosexual Transmission of Acquired Immunodeficiency Syndrome: International Perspectives and National Projections,” Review of Infectious Diseases 9 (1987): 947—960.
9 Gross, “Bleak Lives.”
10 “Tale of Revenge Stirs AIDS Furor: Woman Claims She’s Trying to Infect Men, Prompting a Surge of Concern,” New York Times, 1 October 1991.
11 Ibid.
12 Ibid.
13 Ibid.
14 Shaharazad Ali, The Blackman’s Guide to Understanding the Blackwoman (1990). This is a very controversial and widely discussed book in the black community, which points to the tensions in heterosexual relationships
15 Ellerbrock, “Epidemiology,” 2973.
16 Ernest Drucker, “Epidemic in the War Zone: AIDS and Community Survival in New York City,” International Journal of Health Services 20, no. 4 (1990): 605. Drucker notes that fewer than ten percent of the estimated 150 to 250 thousand people infected with HIV in New York City know their HIV status.
17 Ellerbrock, “Epidemiology,” 2974.
18 Drucker, “Epidemic,” 609.
19 Drucker, “Epidemic,” 613.
20 “AIDS: Its Impact on Women, Children and Families,” 51.
21 “Searching for Women: A Literature Review on Women and HIV in the United States” (Working Group at the College of Public and Community Service, University of Massachusetts, Boston, and the Multicultural AIDS Coalition, April 1991), 54.
22 Robert A. Hahn et al., “Race and the Prevalence of Syphilis Seroreactivity in the United States Population: A National Sero-Epidemiologic Study,” American Journal of Public Health 79, no. 4 (1989): 469.
23 Ibid., 469.
24 Ronald Bayer, “AIDS and the Future of Reproductive Freedom,” in A Disease of Society: Cultural and Institutional Responses to AIDS, ed. D. Nelkin, D. Willis, and S. Parris (Cambridge: Cambridge University Press, 1991), 202.
25 Charles S. Johnson, “Public Opinion and the Negro,” Opportunity: A Journal of Negro Life 1, no. 7 (1923): 127.
26 Thomas B. Turner, “The Race and Sex Distribution of the Lesions of Syphilis in 10,000 Cases,” Bulletin of the Johns Hopkins Hospital 46, no. 2, 159—185.
27 Thomas Murrell, “Syphilis and the American Negro: A Medico-Sociologic Study,” Journal of the American Medical Association 54 (1910): 846—849.
28 Johnson, “Public Opinion,” 204.
29 Paula Giddings, When and Where I Enter: The Impact of Black Women on Race and Sex in America (New York: Bantam Books, 1984), 146.
30 John C. Gebhart, “Syphilis as a Prenatal Problem,” Journal of Social Hygiene 10, no. 4 (April 1924): 208—217.
31 J. W. Williams, “The Significance of Syphilis in Prenatal Care and in the Causation of Fetal Death,” Bulletin of the Johns Hopkins Hospital 31, no. 351 (May 1920): 141—145.
32 Mable Mildred Galt, “The Medical-Social Aspects of Pre-Natal Work as Related to Syphilis: A Study of the South Medical Clinic of the Massachusetts General Hospital, Boston, MA” (Ph.D. diss. Smith College School of Social Work, 1923).
33 See Molly Ladd Taylor, “Women’s Health and Public Policy,” in Women, Health & Medicine in America, ed. Rima Apple (New York: Garland Publishing, Co. 1990), 403.
34 Allan Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (New York: Oxford University Press, 1987), 17.
35 Gebhart, “Syphilis.”
CHAPTER SIX
Reading the Academy
To be black and female in the academy has its own particular frustra-
tion because it was never intended for us to be here. We are in spaces
that have been appropriated for us. But I consider every course I
teach a course in black feminism. Whether I am teaching William
Faulkner or Henry James, by speaking out on my position as a black
woman, the course becomes a black feminism course.
——NELLIE MCKAY
INTRODUCTION
African American women have been passionate about education and consummate institution builders for over a century both here and elsewhere. Despite racist and sexist treatment in a variety of institutional contexts, they have continued to struggle for equal access, fair treatment, and images of themselves within the academy. Their contemporary battles include transforming higher educ
ation to make it more responsive to the needs of black women, establishing black women’s studies, and revamping both black studies and women’s studies because of their insensitivity to gender on the one hand and race on the other. Since many contemporary black feminists find themselves within the academy, much of their discourse has been ignored or maligned because of its seeming irrelevance to the lives of black people.
A major challenge for feminists as we approach the twenty-first century is generating theory that is useful in liberating the black community from a host of ills. The continued development of our intellects, devalued by the larger community and frequently unappreciated or ignored within our own communities, is critical for both self-understanding and the survival of the group.
Words of Fire Page 59
