2025 Theses Doctoral

Between Science and the State: Xenophobic Anti-Blackness in the CDC’s Early AIDS Science

Adetiba, Elizabeth

Forty-three years and 43 million deaths after its initial discovery, the HIV/AIDS epidemic continues to claim lives and perpetuate disproportionate suffering. Although the impact of the virus extends to almost every global region, no continent has seen more AIDS-related devastation than sub-Saharan Africa, followed by the Caribbean. Despite significant progress in combatting the epidemic, there exists no viable vaccine, and AIDS remains a leading cause of death in Africa and the Caribbean. Since the earliest days of the epidemic, AIDS has been explicitly racialized as a Black disease. This raises the question of how global health institutions have framed and responded to the social epidemiology of the disease.

Moreover, it suggests the intriguing, and disturbing, possibility that the racialization of AIDS, rather than an effect of racial disparities in the incidence of the disease, has helped to cause them.This dissertation analyzes the scientific knowledge produced about HIV/AIDS in relation to affected Black populations across the globe. I focus on the racist narratives produced during the first decade of the epidemic (1981-1991). Expanding on the theoretical work of Cathy Cohen, Steven Epstein, Paul Farmer, Alexandre White, and other social scientists who investigate the relationship between institutions of public health and sociopolitical marginalization and domination, I demonstrate how the politics of blame and anti-Blackness influence the knowledge production process, and structure various public health policies and interventions to exacerbate what W.E.B. DuBois termed “the [global] color line.”

The empirical field for this work is presented in the form of a case study focused on one of the most influential institutions of AIDS science: the Centers for Disease Control and Prevention (CDC). The data for this study is comprised of extensive archival research from both the CDC’s Mortality and Morbidity Weekly Reports (MMWR) and subject files from the National Archives, in addition to 50 oral history interviews from Emory University’s Global Health Chronicles archive, and seven in-depth, semi-structured interviews that I conducted with former and current CDC officials. The time frame for this study encompasses the entirety of the epidemic’s course, beginning with its initial discovery in 1981, to the present day. Because this study is centered on the knowledge produced by the CDC, the geographic focus is largely concentrated on the United States and Global North. However, the analysis—particularly in the later chapters—extends to sub-Saharan Africa and the Caribbean.

The findings of this study reveal: 1) as the leading institution of knowledge production during the early years of AIDS, the CDC strategically utilized historically-familiar tropes of Black sexual deviance to explain away trends and patterns in disease transmission that scientists did not yet understand 2) the urge to impart blame during a time of public health crisis yielded important public health mis-categorizations and distinctions (originally concerning Haitians, then expanded to West and Central Africans) that perpetuated xenophobic anti-Blackness and 3) the scientific racialization of AIDS extended beyond the first decade of the epidemic into the era of epidemic intervention and disease treatment via HAART; the research produced by the CDC was amplified globally as a result of international partnerships with U.S. allied-countries and the World Health Organization.

The structure of this dissertation proceeds as follows: Chapter 1 provides an overview of relevant literature as well as the theoretical contribution of this study. Chapter 2 presents the empirical data and methodology at the center of this study. Chapter 3, the first empirical chapter, explores the ways in which anti-Haitian and anti-African (and thus anti-Black) bias was cultivated within the CDC’s AIDS-related epidemiological reports. This chapter depicts how racist claims and narratives were integrated into the burgeoning science of the epidemic despite pushback from some academics and activists.

Chapter 4 links the CDC’s public health claims on Haitians and Africans to major changes in immigration policy, and explores how CDC officials today have come to make sense of the science they produced in the first decade of the epidemic, and the resulting policy impact. In this chapter, I engage a unique archive of oral history interviews conducted by and with former CDC officials in the HIV/AIDS division, in addition to my own in-depth interviews with some of these officials. The fifth and final empirical chapter of this study focuses on the CDC as a global actor, and the ways in which its international initiatives and the interventions that characterize them are rooted in the same anti-Black stigma featured in the agency’s early AIDS science.

Overall, I show that the CDC’s “dual-advantage” in two separate fields – the field of government and the field of biomedical science – helps to explain why and how the science of HIV/AIDS was racialized from its inception. Its position as a powerful political actor means that it sometimes de-prioritizes the upholding of scientific principles in order to align itself with the broader aims of the state. This may be particularly true in contexts of medical uncertainty when the agency faces pressure to respond to crisis and yet does not have clear scientific knowledge through which to orient its activity. In the context of the early AIDS epidemic, the CDC strategically deployed culturally-specific and historically familiar narratives of xenophobic anti-Blackness within the science it produced as a response to pressures it faced to fill the gaps of AIDS knowledge.