Water seeks its own level; so too do injustice, marginality, and ill health.
It is no coincidence that Acquired Immune Deficiency Syndrome (AIDS) disproportionately affects gay men, African Americans, injection drug users (IDUs), and others whose access to civic entitlements-and human dignity-has been undermined. Although we often talk about the risk of acquiring HIV (the human immunodeficiency virus, which causes AIDS) in terms of vulnerability, we must be mindful that although certain behaviors are more likely to facilitate HIV transmission (anal or vaginal intercourse without a condom and sharing drug-injecting apparatus for adults; during childbirth and through breastfeeding for infants), these sorts of risk occur in the context of people's lives. Such "risk taking" is more likely to occur in those communities that are marginalized: socially, economically, and in terms of wellness.
The dominant discourses about HIV/AIDS are medical. There are rich, important bodies of literature about public health (epidemiology and health services administration), basic science (virology, physiology, and pathology), and pharmacotherapy (drug treatments). Public health has to a large extent situated behavioral analyses in specific "at-risk" communities: most often gay men, IDUs, sex workers, and the sexual partners of IDUs. From a public health perspective, focusing on specific categories of "risk takers" makes sense: the traditional goal of public health is to contain disease to prevent its affecting society at large. Regardless, basic science has allowed education and prevention campaigns to focus on the detailed specifics of transmission and infection, enabling much more precise (and therefore effective) educational campaigns to be launched. Similarly, this knowledge has been integral to the development of pharmacotherapeutics to slow the progression of AIDS and treat AIDS-related opportunistic infections. Without the contributions of medicine, effective educational campaigns (in terms of HIV prevention or living with HIV) would be impossible to develop.
However, for all the important medical findings, profound limitations remain. The reasons why people engage in risky behaviors, and the meanings they ascribe to such behaviors, don't fit very well in the medical paradigm. Instead, such behaviors are often presented as burdensome to the rest of society-even when the motivation behind the behaviors is positive and affirming, or despite society's bearing an often substantial burden of responsibility for creating the conditions that lead to the "risky" behavior in question.
This notion of risky behavior operates differently in specific communities. Gay men, while remaining socially and politically marginal, have also had access to economic and human capital-powerful tools that quite literally saved many lives when the public health sector deemed "gay cancer"