Melding Art and Science to More Fully Explore Issues of Public Health

Abby Miller, Alexis C. Pheng, and David R. Wessner, Davidson College

The Value In Combining Art and Science

Over 60 years ago, C. P. Snow lamented the separation of the sciences and the humanities. As he argued in his influential book, The Two Cultures and the Scientific Revolution, scientists and artists talk past each other, assuming their disciplines to be separate and distinct (Snow, 1959) Despite his call to action, the sciences and the humanities too often remain separate on college campuses. Students may identify themselves as right-brained or left-brained; artists or scientists. Courses may present content in a siloed fashion. Even the layout of campuses may perpetuate this division, with classrooms, buildings, and libraries devoted to one discipline or the other existing in physically disparate spaces.

Yet, there is a true worth in melding art and science in the classroom. We and others have described the pedagogical value of interdisciplinary courses that allow students to use art to explore scientific topics (McDonald and Wessner, 2003; Fox and Wessner, 2015; Thurley, 2016; Segarra et al., 2018). In this essay, we further investigate how art can be incorporated into STEM classes by describing a particular interdisciplinary assignment, presenting work done by students to complete this assignment, and discussing the usefulness of this approach. The assignment was administered in an upper level undergraduate seminar course in which HIV/AIDS is used as a case study to explore issues of public health. While all three collaborated on writing this essay, the perspectives of the course instructor (Wessner) and two undergraduate students (Miller and Pheng), who completed and then reflect on their experiences with the assignment, are presented.

The Assignment

To promote student engagement with art, the curator of our institution’s art gallery approached instructors of three different courses and explored ways in which we could incorporate art in our classes. Although each instructor ultimately approached this challenge differently, all of us pursued the same general framework. Students in each class would visit the gallery and receive an introduction to the collection. Then, small groups of students would select a piece of art from the collection and explore how it related to the course content. Finally, some of the pieces selected by the students would be displayed in a small exhibition designed to show the larger College community how art could be incorporated into various classes.

For the instructor (Wessner), the goals of this assignment were several-fold. First, it would provide the students with an opportunity to explore the College’s art collection and learn more about this valuable resource. Second, it would allow members of the class to approach course material in an interdisciplinary fashion. Third, it would allow the students to explore independently a topic that was not covered previously during the semester. The students worked in pairs, with each pair selecting a piece of art that they thought resonated with the course content. I encouraged them to think broadly. As I noted in my instructions to the class, a painting from the 1800s that depicts the mistreatment of women certainly isn’t about HIV/AIDS. Instead, it could be used as an entrée to a discussion about HIV/AIDS and gender-based violence. After selecting their work of art, students were asked to write a 300-word curator’s statement that provided a brief description of the piece and the rationale for selecting it. Additionally, they were asked to write a longer, more academic essay that thoroughly explored the HIV/AIDS-related issue addressed by the art.

The Student Piece: How Art Parallels Current Public Health Issue

[DW] For this project, two students (Miller and Pheng) selected the art piece “The Unfortunate Man” produced by American photographer, Duane Michals (for an example of the photo, see this website: https://collection.cmoa.org/objects/ff87351e-9151-40c5-892e-d9bb071cce8d). The photo, shot in 1976, presents a grayscale photograph of a naked man arching himself in agony, while the accompanying text reads:

The unfortunate man could not touch the one he loved.
It had been declared illegal by the law.
Slowly his fingers became toes and his hands gradually became feet.
He began to wear shoes on his hands to disguise his pain.
It never occurred to him to break the law.

In their analysis of this piece, they explored the stigma still experienced by members of the LGBTQ+ community and how that stigma affects access to healthcare.

[AB, AP] As seen in the photograph, shoes cover the man’s extended hands, presenting a visual metaphor of his inability to “touch the one he loved.” The man is unable to pursue his partner of choice.

To us, this photograph presents a visual representation of the barriers imposed upon the LGBTQ+ community in the pursuit of basic human rights, such as health and happiness.

When viewing this work of art, we were reminded of previous class discussions about the stigma faced by members of the LGBTQ+ community and how this stigma can lead to poorer health outcomes among people living with HIV. To complete this assignment, we decided to explore the intersection of LGBTQ+ stigma, healthcare access, and HIV/AIDS more fully.

The constraints placed on the unfortunate man by societal standards reflect the considerable number of LGBTQ+ Americans who are restricted in their access to full benefits of the health-care system. Certain legal, economic and social factors continue to stand between LGBTQ+ Americans and treatment, and this phenomenon has detrimental secondary impacts on the spread of HIV/AIDS beyond just the LGBTQ+ community in America.

Due to the absence of federal legislation prohibiting healthcare inequity based on sexual orientation and gender identity, people of the LGBTQ+ community are often limited in recourse when they face legal obstacles. During the Trump administration, the US Department of Health and Human Services (HHS) renounced regulations that prohibit unfair practices against the LGBTQ+ community. In June of 2020, HHS released legislation that redefined “sex discrimination” as it pertains to exclusively male versus female, therefore reversing the Obama-era rule that protections can be based on not only birth-assigned sex, but gender identity as well (Simmons-Duffin, 2020).

Additionally, HHS enacted new regulations that essentially give health providers the ability to refuse providing certain key services to LGBTQ+ and other individuals based on their own religious or social preconceptions, such that healthcare workers are “free from coercion” on account of their “religious beliefs or moral convictions” (Moreau, par. 2, 2019). This virtually allows any individual or entity involved in a patient’s care, from the hospital’s board of directors to the receptionist that schedules appointments and procedures, to put their personal beliefs ahead of a patient’s health. State-level health research has shown that as a result of this practice-based discrimination, LGBTQ+ individuals, particularly lesbian and bisexual women and transgender people, are more likely to forego treatment for chronic conditions because of discomfort in healthcare spaces (Thoreson, 2018). This regulation averts health care organizations and providers from guaranteeing equal access of care. In practice, it allows healthcare providers not only to deny access to abortion and sterilization procedures, but also to deny treatment, therapy, and preventative care for patients seeking HIV/AIDS resources.

Despite alarming rates of infection within the nation, the provision of HIV services for the LGBTQ+ community is inadequate, as their specific needs are not prioritized by the government. In one study, researchers reported that only 78% of primary care providers would be comfortable treating LGBTQ+ patients, leaving the other 22% to perpetuate their own prejudice due to personal beliefs and cultural incompetency (Nowaskie and Sowinski, 2019). Brian Byamukama, founder of RUMI (Rural Movement Initiative) highlights the insecurity many LGBTQ+ people face in the health care system when he states that:

“Many LGBT people are too shy to go to health centres to get services as they face a lot of discrimination when they get there. There is an idea that you can contaminate people somehow… Once I went to get tested for HIV and I realised the doctor did not want to touch me. They separated me from the rest of the people in the clinic. That really brought my heart down” (“Homophobia and HIV,” par. 31, 2019).

Practices like this are prevalent and they decrease the accessibility and likelihood of HIV testing, which is both a means of obtaining personal treatment and a preventative measure against further spread of HIV/AIDS. When people stop receiving HIV tests and do not treat chronic conditions such as HIV, the net infection rate in the United States could steadily increase. Although healthcare providers may protect their freedom of conscience, discrimination based on religious beliefs ultimately contributes to the 14% of HIV positive people in the United States who do not know they are infected and are able to spread infection.

Another exacerbating factor of HIV viremia in the LGBTQ+ community is homelessness, which is often caused by familial rejection, inability to get a job based on sexual orientation or gender identification, and secondary mental health conditions caused by social stigma, such as depression and anxiety. Though there are no nationally representative datasets of the adult population experiencing homelessness in the US that include covariates of sexual orientation and gender identity, many analyses show that anywhere between 20-40% of the homeless youth population in the United States identifies as part of the LGBTQ+ community (Durso and Gates, 2012). LGBTQ+ youth are 120% more likely than those who identify as heterosexual or cisgender to face homelessness (Chapin Hall, 2017).

One article highlights a tight link between homelessness, HIV infection and low rates of viral suppression based on data released by the San Francisco Department of Public Health in 2017 (Land, 2018). It defines homelessness as “a main driver of new [HIV] transmission” (Land, par.11, 2018) and observes trends in homeless persons having higher viral loads on average when compared to people with housing, and also the likelihood of viral suppression relating to the degree of housing stability. Another study supports these findings, concluding homelessness as a predictor for incomplete HIV viral load suppression (Thakarar, 2016). The study focused on HIV-seropositive individuals enrolled in a health care program for homeless persons. Linkage to care is essential for HIV-seropositive persons to have access to cART and other supportive services. Combination antiretroviral therapy, or cART, refers to the combinations of drugs that decrease HIV viral loads to keep infections under control. Thakarar’s study (2016) emphasizes that housing plays a critical role in the bridge to healthcare and ultimately, HIV viral suppression. It demonstrated that a higher proportion of homeless individuals on cART had incomplete viral suppression compared to housed individuals on cART. Such results are consistent with prior research, which find that poor compliance with cART is associated with homelessness. The provision of stable housing can lower the costs of caring for homeless individuals, which in turn, decreases their financial burden and promotes continuum of HIV care. Moreover, high percentages of homeless individuals are infected due to increased exposure to injection drug use, lack of clean needles, and stifled access to HIV prevention methods, such as condoms, antiretroviral therapy, PEP, and PrEP. These co-factors contribute to the spread of HIV/AIDS in the homeless community – particularly in the homeless LGBTQ+ community – and are rooted in the perpetuation of anti-LGBTQ+ beliefs and exacerbate the national HIV/AIDS epidemic.

In addition to social and legal barriers to HIV/AIDS treatment, the economic disparities between LGBTQ+ individuals and the rest of the population have barred them, both directly and indirectly, from accessing treatment associated with HIV/ AIDS. A 2013 survey (Brown) undertaken by the Pew Research Center stated that 21% of LGBTQ+ respondents had reported the unfair treatment from employers in their pay and promotions. This practice in the workplace feeds economic disparities on a national scale, and various wage gap analysis has demonstrated that gay and bisexual men in the U.S. earn 10 to 32% less in comparison to their similarly qualified heterosexual counterparts (Rivas, 2015). Although tobacco, poor diet and exposure to toxic agents are often cited as some of the top killers in the United States, low socioeconomic status overwhelmingly underlies all of these variables and is directly linked to morbidity and mortality. The national trend in stifled economic status leaves the LGBTQ+ population at a deficit in their access to health care and increases the likelihood of their HIV/AIDS going untreated. In 2010, antiretroviral therapeutics cost an average of $9360 per year (Carter, 2010). Now, the total yearly cost of ARV drugs have more than doubled since that time, proving to be a severe monetary stressor for many adults in the LGBTQ+ community, a group that is reported to be more likely to experience food insecurity and participate in SNAP, formerly known as Food Stamps (Brown et al., 2016). Therefore, the LGBTQ+ community in the lowest socioeconomic bracket has both the lowest rate of HIV viral suppression and the highest chance of further transmission.

Stigma remains a significant barrier to treating the current infected population and preventing further spread. Aggressions toward LGBTQ+ people, on both the micro and macro scales, perpetuate secondary conditions under which HIV/AIDS thrives disproportionately. Legal and economic discrimination are perpetuated by underlying social stigma associated with sexual or gender “deviance,” and until concrete measures are taken to address these institutions, HIV/AIDS will continue to thrive under the oppressive conditions opposed against LGBTQ+ people in the United States. The impact of stigma associated with identifying as an LGBTQ+ person has been proven to have negative implications for overall health and well-being. Discrimination perpetuated in the healthcare field undermines diagnosis, treatment, and successful health outcomes for LGBTQ+ people, and acts as a persistent barrier for these individuals in accessing basic health care needs. This trend can be seen world-wide, but the evaluation of the LGBTQ+ community and their access to HIV/AIDS treatment specifically in the United States offers a critical commentary on the concrete social and legislative barriers formed as a secondary result of prejudice.

Conclusion

In this seminar, we explored the intersection of scientific discoveries and public health outcomes, using HIV/AIDS as a case study. This final project furthered that exploration by incorporating art as an additional means of investigating HIV/ AIDS. Naturally, many people compartmentalize art and science into their own mutually exclusive disciplines. However, we often find art used as a medium to advertise, raise awareness, or spark conversations about science and public health. This is especially true for HIV/AIDS. From the very beginning of the epidemic, artists like Keith Haring and the collective Gran Fury used their work as a form of activism and public health intervention, eventually leading to the emergence of a culture in response to the epidemic through collective arts.

Today, we also find scientists using art as a tool of translation, allowing their audience to interpret their findings in a more comprehensible and relatable manner. The Blood: Attract and Repel 2017 exhibition at the Science Gallery Melbourne, curated by scientists and artists alike, is a great example of an aggregation formed between art and science. Focusing on the notion of blood as a social taboo and form of self-identity, this exhibition highlights the underlying stigma associated with the biological fluid. A piece titled “Blood Objects,” created by German designer Basse Stittgen, consists of plastic products molded out of HIV+ blood. Made under intense heat, the blood-ridden objects are completely sterilized and are thus, incapable of infection. Despite their noninfectious status, some people are still uncomfortable holding the objects. Comprised of both the collection of objects and the reaction towards it, this art piece can be interpreted as a reflection of the underlying stigma against HIV+ people in spite of having treatments available rendering low transmission rates of the disease. Our final assignment for the seminar was curated in a similar fashion in an effort to explore how the HIV/AIDS epidemic specifically affected the LGBTQ+ community in the United States.

Throughout our class, we explored the history of HIV diagnosis and treatment in the United States and learned how the epidemic has disproportionately affected minorities and individuals with stigmatized identities. As the course instructor, I thought this final assignment provided students with a unique opportunity to explore the interdisciplinary nature of not only public health, but also a liberal arts education. They were able to investigate the art collection of our institution, think broadly about the meaning of artistic works, and dive deeper into a specific public health topic. The exercise, in my opinion, allowed them to develop a more nuanced and more compassionate view of the course material.

As students, we found this project to be a profound supplement to the course, as it allowed us to not only examine the inequities in disease proliferation within the LGBTQ+ population, but also examine the sensitivity and training that we need in the medical field going forward. High quality health care should not only take into consideration the patient’s disease state, but act as an interdisciplinary practice through factoring in personal backgrounds and identities. Both of us (Miller and Pheng) are aspiring physicians, and this project has been an invaluable investigation into the pervasive, underlying causes of disease in the United States. Over the past 10 years, medical schools have begun incorporating greater public health focuses on disease, and they have encouraged medical students to explore the impact of stigma in the healthcare field in the curricula. This change will hopefully create a physician base that is committed to treating patients regardless of their identities and provide a more equitable healthcare system for our diverse, 21st century population. By intentionally incorporating art into STEM courses, as we have done in this course, we may be able to achieve more fully this goal.

As the instructor, I appreciated the thoughtfulness and depth of understanding exhibited by all of the students who completed this assignment. Although each pair explored a different aspect of HIV/AIDS, they all expertly integrated knowledge from the course, outside information, and their interpretation of the art. The assignment allowed students to explore the central theme of the course in a new way. Hopefully, it also fostered in them a deeper appreciation of art and a sense of how the arts and STEM can be united.

Acknowledgements

We’d like to thank Lia Newman, Director and Curator of the Van Every/Smith Galleries at Davidson College, for encouraging our class to explore the art collections of the College and for graciously talking with us about how to interpret pieces of art. We’d also like to thank the other members of HHV 395 for completing their own versions of this assignment.

Works Cited

“Addiction Among The Homeless Population.” Edited by Amanda Lautieri, Sunrise House, American Addiction Centers, 9 Feb. 2021, www.sunrisehouse.com/addiction-demographics/homeless-population/.

Brown, Anna. “As Congress Considers Action Again, 21% of LGBT Adults Say They Faced Workplace Discrimination.” Pew Research Center, Pew Research Center, 30 May 2020, www.pewresearch.org/fact-tank/2013/11/04/as-congress-considers-action-again-21-of-lgbt-adults-say-they-faced-workplace-discrimination/.

Brown, Taylor N. T., Romero, Adam P., and Gates, Gary J. “Food Insecurity and SNAP Participation in the LGBT Community.” Williams Institute, July 2016, williamsinstitute.law.ucla.edu/publications/lgbt-food-insecurity-snap/.

Carter, Michael. “HIV Treatment Is Costly, Especially for the Sickest Patients.” Aidsmap.com, NAM, 27 Sept. 2010, www.aidsmap.com/news/sep-2010/hiv-treatment-costly-especially-sickest-patients#:~:text=Antiretroviral%20therapy%20 cost%20an%20average,with%20higher%20CD4%20cell%20counts.

Durso, Laura E., and Gary J. Gates. “Serving Our Youth: Findings from a National Survey of Services Providers Working with Lesbian, Gay, Bisexual and Transgender Youth Who Are Homeless or At Risk of Becoming Homeless.” EScholarship, University of California, UCLA: The Williams Institute, 12 July 2012, www.escholarship.org/uc/item/80×75033.

Fox, Ann M., and David R. Wessner. “What Happens When Literary Critics and Scientists Converse?: Teaching a Course on Representations of HIV/AIDS.” Pedagogy, vol. 15, no. 3, 2015. doi:10.1215/15314200-2917121.

“Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.” ClinicalInfo, Department of Health and Human Services, 18 Dec. 2019, www.clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/cost-considerations-and-antiretroviral-therapy.

“Homophobia and HIV.” Avert, Avert, 10 Oct. 2019, www.avert.org/professionals/hiv-social-issues/homophobia.

Land, Emily. “Homelessness Linked to HIV Infection and Low Rates of Viral Suppression.” San Francisco AIDS Foundation, San Francisco AIDS Foundation, 7 June 2019, www.sfaf.org/collections/beta/homelessness-linked-to-hiv-infection-and-low-rates-of-viral-suppression/.

McDonald, Anna G. and David R. Wessner, “The Visual Art of HIV/AIDS: An Interdisciplinary Approach to Teaching About HIV/AIDS.” Bioscene: Journal of College Biology Teaching 29, no. 1, 2003.

“Missed Opportunities: Youth Homelessness in America.” Voices of Youth Count, Chapin Hall at the University of Chicago , Nov. 2017, www.voicesofyouthcount.org/brief/national-estimates-of-youth-homelessness/.

Moreau, Julie. “‘Religious Freedom’ Rule Could Cause ‘Significant Damage’ to LGBTQ Health Care, Advocates Say.” NBCNews.com, NBCUniversal News Group, 4 May 2019, www.nbcnews.com/feature/nbc-out/religious-freedom-rule-could-cause-significant-damage-lgbtq-health-care-n1001996.

Nowaskie, Dustin Z, and John S Sowinski. “Primary Care Providers’ Attitudes, Practices, and Knowledge in Treating LGBTQ Communities.” Journal of homosexuality vol. 66, no. 13, 2019. doi:10.1080/00918369.2018.1519304

Rivas, Jorge. “The Gay Pay Gap: Gays Get Paid Less, Lesbians Earn More.” Splinter, Splinter, 2 Apr. 2015, www.splinternews.com/the-gay-pay-gap-gays-get-paid-less-lesbians-earn-more-1793846825.

Segarra, Verónica A., Natalizio, Barbara., Falkenberg, Cibele. V., Pulford, Stephanie., and Holmes, Raquell M. “STEAM: Using the Arts to Train Well-Rounded and Creative Scientists.” Journal of Microbiology & Biology Education, vol. 19, no. 1, 2018. doi:10.1128/jmbe.v19i1.1360.

Simmons-Duffin, Selena. “Transgender Health Protections Reversed By Trump Administration.” NPR, NPR, 12 June 2020, www.npr.org/sections/health-shots/2020/06/12/868073068/transgender-health-protections-reversed-by-trump-administration.

Snow, C. P. The Two Cultures and the Scientific Revolution. Cambridge University Press, 1959.

“Stigma and Discrimination Affects Gay and Bisexual Men’s Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 Feb. 2016, www.cdc.gov/msmhealth/stigma-and-discrimination.htm.

Thakarar, Kinna, Morgan, Jake R., Gaeta, Jessie M., Hohl, Carole, and Drainoni, Mari-Lynn.

“Homelessness, HIV, and Incomplete Viral Suppression.” Journal of health care for the poor and underserved vol. 27, no. 1, 2016. doi:10.1353/hpu.2016.0020.

Thoreson, Ryan. “‘You Don’t Want Second Best.’” Human Rights Watch, Human Rights Watch, 23 July 2018, www.hrw.org/report/2018/07/23/you-dont-want-second-best/anti-lgbt-discrimination-us-health-care.

Thurley, Christopher. “Infusing the Arts into Science and the Sciences into the Arts: An Argument for Interdisciplinary STEAM in Higher Education Pathways.” STEAM, vol. 2, no. 2, 2016., doi:10.5642/steam.20160202.18.

“US: LGBT People Face Healthcare Barriers.” Human Rights Watch, Human Rights Watch, 28 Oct. 2020, www.hrw.org/news/2018/07/23/us-lgbt-people-face-healthcare-barriers.