Sam Friedman will be the first to admit that he never intended to become one of the most recognized names in social network epidemiology. He began his undergraduate studies as an Astronomy major but graduated with a Bachelor’s degree in Economics. After receiving a PhD in Sociology from the University of Michigan, he recalls having “virtually no interest in social networks—I was much more macro”. He researched social movements and related issues until 1979, when he left academia, though he continued to assist in others’ research projects. In 1983, he “blundered into a project about HIV among injectors” in New York City, which proved to be the catalyst for the next three decades of his research.
Though he may have fallen sideways into the field, Friedman has become a major voice in both HIV research and in advocacy for harm reduction and needle exchange programs. Early in his career, he realized that IDUs could mobilize their communities around HIV prevention just as gay men had. He became involved in activism and conducted social interventions that promoted community organization and attempted to change entrenched social susceptibilities to injection drug use. Friedman maintains that he has continued to work with injectors because that’s where his expertise lies, but admits that “once you’re into [activism], it never really quits.”
As the Black Death challenged
reigning religions and princes’ justice,
and as European bacteria
laid low empires and gods
West of the Atlantic,
our modern plague provokes
questions of fire,
questions of revolt
In the course of human events (excerpt)
It may come as no surprise, then, that working in HIV prevention in New York in the 80s uncovered Friedman’s artistic skills: he began writing poetry on his commutes in and out of the city, when the rhythm of the train provided a cadence for his reflections. Though in an interview Friedman spoke in a measured way about his advocacy for harm reduction, his poems reflect a clear and persistent frustration with the lack of credence and resources allocated to needle exchange programs, not to mention with the ongoing war on drugs. He describes years spent bargaining and providing proof of concept while new infections persisted and people died of AIDS.
In a piece on faltering HIV prevention in the United States, CCHE affiliate Dr. Harold Pollack references IDUs while discussing a chart showing new HIV infections in the past thirty years. Reflecting on the reasons for declining rates of new infections in injectors, Pollock writes: “You might presume that this trend reflects successful prevention among injection drug users and other populations at risk. I fear the truth is simpler: HIV has burned through these populations.” (Friedman, for the record, strongly disagrees—he feels that the decline does indicate the success of syringe exchange and harm reduction efforts.) Still, it is difficult not to get involved on a personal level with those affected by HIV/AIDS—an already stigmatizing disease—let alone with IDUs, who are among the most vilified high-risk groups. Furthermore, at the time that Friedman was becoming involved, few people were surviving infection.
They go nameless into that dark night,
nameless they go
as nameless they were meant to live,
known only as
their smiles eclipsed,
their thoughts erased,
their pains ignored
re-painting their nameless existence
as a total Big Lie.
They go nameless (excerpt), Autumn Leaves, January 1, 2010
These emotional verses may raise questions about how someone so invested in and connected to the lives of the people he bases his research on could stay neutral and objective. Friedman would tell you that he never intended to be, and that his research is better for it. “From the very beginning in AIDS,” he explains, “having come to the field from sociology, I was struck by the fact that medical science and epidemiology take sides. It’s not value-free, it’s against disease.” Sociology, as he was taught, attempts to study social and cultural states—or changes within them—in objective, nearly emotionless terms. Research may be experimental, observational, or demographic, but the sociologist is expected not to have opinions about the variables at play. In epidemiology, as in his earlier social movement research, Friedman found that you learn more and do better research when you do take sides and when the purpose is clear (“We’re against the virus! We’re trying to kill it!”). In other words, it is acceptable and even encouraged to conceive of the virus as an objective evil to be destroyed and to actively campaign on behalf of human health and rights, rather than to simply observe the progress and effects of troubling phenomena.
Friedman’s newest intervention, the Transmission Reduction Intervention Project (TRIP), is an innovative undertaking which targets the social circles of IDUs and men who have sex with men in the US (Chicago), Greece (Athens), and Ukraine (Kiev). This study is unique in its focus on newly infected people and in its approach to contact tracing. Health departments, Friedman says, tend to do a poor job of contact tracing and partner notification because “their concept of contacts is very narrow—it’s the direct partners of those who are infected, so they miss all the social network complexities of viral spread.” TRIP, on the other hand, will collect participant information on all social contacts (that is: friends, colleagues, and acquaintances not limited to partners in sex and drug use) instead of exclusively relying on risk networks. This is expected to draw a much richer representation of local social ties that can be used to alert the community when a member is acutely infected with HIV. The high likelihood of the virus spreading through injection and sexual ties within a recently-infected person’s social circles makes this depth of network investigation very important.
In fact, the above is one pillar of TRIP’s mission: find acutely or other recently infected individuals and provide anonymous community alerts to encourage people to engage in safe sex and drug use practices in times of high vulnerability. “You find a case and then you surround it,” says Friedman, and “even a partial success can cut down the rate of transmission a lot.” Another benefit to such thorough network analysis is that people not thought to be at high risk are found and brought into the study for testing. Friedman is concerned that bisexuals and lesbians, especially those who use drugs (even non-injection drugs), are currently being overlooked in prevention efforts, and is confident that TRIP will help to link them to testing and prevention programs.
Friedman’s most recent poetry chapbook, A Turnpike Utopia: Poems to Resist Environmental Destruction for Profit and War, isn’t about HIV at all—and yet the poems exude the same passion for justice and for preservation of life as do his elegies on behalf of those in the trenches of the fight against HIV/AIDS. It is fitting, then, that someone who has spent decades campaigning for the lives of disenfranchised and condemned drug users has also chosen to speak against the exploitation of the earth. CCHE is lucky to call him a colleague, and we look forward to the launch of his projects and the poems he has yet to write.
are to be used,
They are not syringes,
though they have a point,
though they needle the powerful
and alter your mood.
are not syringes.
They are to be
From the introduction to: Needles, drugs, and defiance: Poems to organize by