One of the things we have seen over the course of the semester is that government policies with respect to AIDS are not exactly what we might expect them to be if interventions were rationally planned and carried out to minimize suffering and to protect the population.

Realistically, government programs are shaped and guided by politics, so to understand how programs related to AIDS, or indeed programs of any kind, work we have to understand how politics work.

In the Aronowitz reading, we hear about one of the most visible and influential political groups related to AIDS, ACT-UP, a group based in New York that has been very aggressive about confronting politicians and engaging in disruptive protests. Aronowitz not only describes their activities but asks why it is that they are so influential. Realistically, we might not expect them to be influential because they are not made up of very many people and many of the people active around AIDS do not seem to support them or their activities.

Aronowitz suggests that ACT-UP is an example of a radical political group, and he says that today is a time when radical groups can be especially effective. This is in contrast to an approach to politics that he calls "liberal".

Aronowitz means by liberal something different than what the news media usually describe as liberal---their meaning involves a commitment to extensive government programs and a philosophy that government ought to provide a safety net and take care of the basic needs of the population.

Aronowitz's meaning of liberalism has more to do with the expectations we have about how decisions get made in government, and therefore how citizen action does and should affect the political process.
Liberal politics takes the position that government ought to be guided by voters and the wishes of voters.
Voters often are represented by associations that lobby, participate, and provide information to government and to citizens.
Politicians are expected to pay attention to these groups because they represent voters and can turn out people on election day to vote for or against a politician.
Because politicians are confronted by many groups whose demands clash with each other, we cannot tell exactly how politicians will vote or act on a given issue; but liberals believe that the way politicians make decisions is fundamentally based on the way the perceive and balance the many interest groups and associations that make demands on them. Liberals believe that politicians respond to the public and to voters.

Aronowitz's discussion is based on a recognition that in today's political enviornment, small influential groups and effective minorities have a disproportionate effect on governmental decisions. We see this in the organization of health care services where it seems that big business interests influence and shape government policy. But government is not just guided and directed by big business. Certain noisy, effective public groups like ACT-UP also have great influence. Somehow our system of government responds to intense or powerful small interests more than to larger but less focused public groups and interests.

It is useful to have stepped back and recognized that we have some general expectations about how government works, and we see that decision-making does not work as we might have expected. We might not understand why this is on purely theoretical terms. We can understand what happened better if we look more specifically at the history of AIDS policy.

The politics of AIDS was shaped in the early 1980s as the new disease began showing up in San Francisco, LA, and New York. Although no one knew what the disease was or what caused it, there were enough cases and the outcomes were so bad that one might have expected a big public health response and a great deal of public concern---look at the response to anthrax, West Nile Virus, or Legionnaires disease where in each case the number of people who have died number in the tens. Even as the number of those killed by AIDS climbed beyond 1000 there was little governmental or public response.

The understanding of this from the early 1980s was that the nonresponse was due to the fact that this was perceived as a gay disease or one that affected intravenous drug abusers. President Reagan was explicitly unsympathetic to gays or to AIDS as a problem that affected this population group. Others in the population also were unsympathetic, or they were outrightly hostile. From the beginning, then, we saw that the response to this medical problem was not rational in the sense of being aimed at providing care to those who were sick or protecting the population from infection. The slow governmental response, in comparison to the fast response in the gay community described in class by Messer, was thought to have killed thousands of people who could have been educated to act in safer ways.

From the beginning, then, the understanding among gays was that the government would not do research, spend money on public health, or provide care if it was left to the normal processes of decision-making. It was assumed that government was hostile to AIDS and that the community of people sympathetic to AIDS had to make themselves visible and politically effective.

In the early years, this was done partly by self-help organization within the gay community and partly as entertainers and other famous people joined in the formation of and fundraising for new charities that provided funding for AIDS action.

Where these groups were a basis of social movements in the early 1980s, through the late 1980s their message was being accepted and government was increasingly allocating money for research and services. Often the groups that started out as critical protest groups were given grants to be the organizations that would administer services. As they became conduits for government funding, these formerly critical groups gradually became part of or supporters of government because they were the designers and implementers of the programs. We call this process cooptation: a situation where formerly critical groups are brought into the governance process and led to be supporters of the way government makes decisions and runs programs.

From the standpoint of those who thought government and mainstream society always would resist providing adequate funding for AIDS, this cooptation was dangerous and a source of concern. They felt that government gave funding and services in the first place only because there were effective, confrontational politics. Once the political movements have been killed through the process of cooptation, government would be free to gradually cut back on funding and also to gradually encumber programs with regulations that would work against the interests of those with AIDS. Therefore, it was important to political critics to continue protesting and to develop effective political organizations that were separate from the groups that were providing services. This was the role adopted by ACT-UP.

ACT-UP has been very much influenced by the civil rights and anti-war movements of the 1960s wherein activists engaged in civil disobedience and were prepared to be arrested to make their point. ACT-UP also recognizes in ingeneous ways that political and other public action depends on a certain acceptance and decorum in order to function. Being disruptive and confrontational in creative ways, ACT-UP was able to be politically effective with a small number of people.

What we learn from this organization is that effective politics are in important ways based on symbolic actions. This style of politics runs against the grain of the dominant, conservative, political style of America today. However, ACT-UP shows that such a group can be extremely effective, and often more effective than large, representative, rationally operated social and political movements.

Politics in this style has become an important means of advancing many idealistic movements like the environmental movement and sometimes this is the only way that governments can be confronted and made to respond to broad social concerns---like preservation of the rain forest.

The concern, however, is that liberalism in the political sense is dead. If this is the case, to whom are these groups accountable? And how does the mass of the population have its interests represented?