Early impacts of race and class on African American health

My History thesis focused on the Conservative Right’s reaction to the AIDS epidemic in 1980s America and how it impacted students at the University of North Carolina-Chapel Hill.  I found a great deal of reluctance to provide education to Americans due to the 1981 emergence of the virus in the homosexual male community and the transmission amongst IV drug users.  While HIV/AIDS did initially affect groups that were often condemned by the Moral Majority and Conservative Republicans, it quickly became a public health issue that impacted all Americans.  Misinformation concerning the transmission of the virus persisted well into the late 1980s, due to the government’s resistance to provide the American public with the facts.  Surgeon General C. Everett Koop was appointed in 1982 and wanted his first order of business to be education of the American public regarding the transmission of HIV.  Americans in the early to mid-1980s believed the virus could be transmitted through casual contact; kissing, food preparation, insect bites, hand holding, airborne pathogens.  There are four ways in which HIV can transmitted; sexual intercourse, needle sharing, mother to fetus/breastfeeding, and blood transfusions.  This information was not made public until the U.S. government released an official statement in September of 1986 and then Koop released his report in October of the same year.  President Reagan did not publicly address the epidemic until 1987, and according to Koop, Reagan was hesitant to provide education to the public because it would alienate him from his highly conservative supporters.  Withholding life-saving information because leaders disagree on American morality is a deep rooted issue often influenced by race, class and gender. 

            Unfortunately the AIDS epidemic is not the first time the United States failed to protect its citizens from preventable health risks and care for those already in poor health.  Historically, minorities suffered poor health care that further isolated them from the upper class white men in power.  Before researching the specifics of racism present in the AIDS epidemic, I plan on providing some insight into the ways in which the health of black Americans was dealt with following the abolition of slavery.  Starting with the tuberculosis outbreak, then moving on to the Tuskegee Syphilis Study, I intend to show the inequalities of United States health care.


Tuberculosis Outbreak

            The Tuberculosis outbreak in the late 1800s and early 1900s presented itself as an issue of race and class rather than a universal public health concern.  Tera W. Hunter, author of To ‘Joy my Freedom, presents an excellent narrative of the tuberculosis outbreak and its impact on black women and their families.  Hunter claims there were three major events in the late nineteenth century that shaped society; slavery was abolished in 1865, the germ theory was validated, and tubercle bacillus was discovered in 1882.  Some Southern, white doctors claimed these newly freed blacks, now not being cared for by planation owners, were not able to tend to look after themselves.  Whites used their own hesitations of black leisure time to frame the TB outbreak, “L.C. Allen highlighted the propensity of urban blacks to stay up late at night and ‘frolic’ in the streets.  Their attendance at picnics, dance halls, and theaters deprived them of the rest and sleep needed to revitalize their energy in order to engage in gainful work and seduced them into ‘licentious debaucheries of the most disgusting character’” (Hunter 191).  Doctors also claimed that TB was not present in the African race before 1865, a very false allegation.  Tuberculosis indeed infected African slaves; it was simply labeled differently, called “Negro Consumption”, “Negro Poisoning,” and “ Struma Africana.”  Black physician, Rebecca Cole questions the diagnosis of TB in black patients, believing it was an easy out for white doctors unsympathetic to black ailments, 

“Hosts of the poor are attended by young, inexperienced white physicians.  They have inherited the traits of their elders, and let a black patient cough, they immediately have visions of tuberculosis.  Let him die, and though in the case there may be good reason for a difference of opinion, he writes, tuberculosis, and heaves a great sigh of relief that one more source of contagion is removed” (Hunter 193).  

The fear of a “black disease” infecting the white population works nicely to frame the larger anxiety of blacks becoming a part of American society and “Africanizing” the land of WASPs.


            After tuberculosis was labeled a black disease, white upper class Americans took no time in blaming “the help” for rapidly spreading the bacteria.  At the heart of the scandal were black washerwomen, although they were not at fault.  Hunter describes the public health movement to enact sanitation standards for washerwomen, something that was rooted in racism.  These white officials believed that those with African blood were inherently dirty and in possession of bad blood.  Dr. George Brown was at the head of the sanitation movement and displayed his uneducated theories regarding race and disease, “He related instances of ‘how immoral servants handle and fondle your children during the day and frequent the lowest dives at night’” (Hunter 210).  Brown campaigned to regulate washerwomen and led to the labeling of TB as a “Negro servants’ disease,” but his actions had a bigger impact than simply control of cleanliness.  Due to the move of blacks from live-in to day laborers, whites became concerned that without their supervision blacks were disregarding their own health. The outbreak of tuberculosis and its spread being blamed on blacks sets the stage for continued misinformation regarding health care in the African American community.


Tuskegee Syphilis Study (1932-1972)

            Starting in 1932, the United States Public Health Service began studying black men in Macon County infected with syphilis. The study can be broken into three phases, none more moral than the next and all in direct violation of post WWII Nuremberg Trial results declaring testing on humans unethical.  The first phase sought 400 men, over the age of 25, who had been infected for five years or more to be studied for six to eight months.  These men were not told they had syphilis nor did they receive proper medical treatment, they continued to suffer from the deadly venereal disease.  The outcome of the disease could be as severe as death, but often included attacks on the cardiovascular and neurological systems leading to mental illness, blindness and deafness, as well as bloody ulcers near the joints.  Doctors decided a few months was not long enough and instead decided to study these men for 5-10 years, leading to phase two of the study. A control group of uninfected men was established and researchers began conducting autopsies on both infected and healthy men.  This continued into the 1960s when ethical questions began to arise in the third phase of the study, brought up by Public Health Service employee, Peter Buxtun.  He wrote a letter to the Public Health Service officials in 1968, receiving no response,

“I am impelled to ask: 1) was this study initiated to obtain physical examinations and autopsy reports on the syphilitic damage which these men were being allowed to endure? 2) Have any of these men been fully treated? 3) Have any of these men been told the nature of this study? 4) Is this study still underway? In other words are untreated syphilitics still being followed for autopsy? (Gray 76)”

The lawyer representing the men of Tuskegee calls Buxton a helpful “whistleblower” and believes without him the study would have gone on for years. It was not until 1972 that the case was made public in the early 1990s that the names of victims were released.

            The Tuskegee Study employed a black nurse, Eunice Rivers, who is interviewed for a 1953 Public Health Records follow-up on the long-term research study.  The interviewer reports,

Image“One cannot work with a group of people over a long period of time without becoming attached to them…The ties are stronger than simply a patient and nurse.  There is feeling of complete confidence in what the nurse advises…Realizing that they do depend upon her and giver her their trust, she has to keep an open mind                             and must be careful always not to criticize, but to help in the most ethical way to see that they get the best care” (Rivers).

This passage seems odd, considering the nature of the study.  How can Rivers consider any care she gave to these men ethical when she was aware of their deadly disease? 

            Syphilis is sexually transmitted and without proper care these men would have unknowingly infected their sexual partners. Doctors validated their ethics by claiming the men were in the latent or non-transmittable stages, thus protecting their partners and offspring from the deadly disease; this is false.  Records blacked out the names of wives but 62 records remain that show only 28 of the 62 women received treatment for syphilis. These women may have undergone treatment and been cured, but if they continued to have sex with their infected partners they would still be at risk for transmission. Syphilis can also be transmitted to fetuses by the mothers and often leads to birth defects such as, deafness, blindness, and other mental handicaps (Reverby 129-132).  The withholding of medical care to over 400 black men profoundly impacted an entire community and was absolutely preventable. The fact that these men were all African American and the study was conducted by white doctors suggests that Jim Crow America was a hostile place for blacks to inhabit.

President Clinton’s apology for the unethical treatment of the men of the Tuskegee Syphilis Study



Eunice Rivers et al., “Twenty Years of Followup Experience in a Long-Range Medical Study,” Public Health Reports 68 (April 1953): 391-395

Gray, Fred D. The Tuskegee Syphilis Study: The Real Story and Beyond. Montgomery, Alabama: Black Belt Press, 1998.

Hunter, Tera W. To’ Joy my Freedom: Southern Black Women’s Lives and Labors after the Civil War. Cambridge, Massachusetts: Harvard University Press. 1997.

Reverby, Susan M. Examining Tuskegee: The Infamous Syphilis Study and its Legacy. Chapel Hill: The University of North Carolina Press, 2009. 


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