Ignorance = Fear, Keith Haring, 1989
Encountering Keith Haring as an artist-activist, a voice rising from and elucidating the AIDS crisis, was crucial to the earliest stages of my identity formation as an aspiring doctor. Like many others, and perhaps intentionally on the part of the artist, I had previously only known Haring from seeing his graphic figures on T-shirts, skateboards, and mugs (Boaden, 2019). That changed in 2012 when I undertook a two-week placement at GMHC (formerly Gay Men’s Health Crisis), one of the oldest HIV/AIDs advocacy organisations in New York CIty. Haring’s murals and prints graced the hallways, and offices of GMHC, creating a sense of movement, energy, history, and collective effort.
Attending patient advocacy groups, developing educational materials, and sitting in on community clinics during my time at GMHC helped me to understand the kind of doctor I wanted to be: someone who understood the political and social contexts I was operating in, who listened to patients and saw them as complete and complex individuals, and who understood that well-being was about much more than any one of the interventions I would be able to provide as a doctor.
The personal significance of my time at GMHC and the prominence of Haring’s work and legacy in the organisation created, for me, an indelible connection between this artist and my sense of purpose as an aspiring medic, a healthcare assistant, and now a medical student. Haring’s 1989 work for the AIDS Coalition to Unleash Power (ACT UP), Ignorance = fear, demands that viewers in general, and perhaps medical students and doctors in particular, interrogate their own anxieties and role in perpetuating stigmas that produce real harm. Ignorance = fear invites me to question my biases, listen meaningfully to my patients, and embrace the power of both my professional and personal identities.
Scholars of Haring’s work universally reject the oversimplification of his creations as unequivocally joyful or optimistic. As Melcher (2012) argues, the “pictures of pleasure and enjoyment of life with which Haring’s name is always unfairly linked, are unthinkable without the visions of horror and death.” In Ignorance = fear, this duality is evident in the co-existence of bright colours and the figures that first appear to be almost dancing and the black text on the top and bottom of the image, which states the deadly consequences of stigma’s key ingredients – ignorance, fear and silence, and the detail that each figure covers either its eyes (see no evil), ears (hear no evil), or mouth (speak no evil) and is marked with a pink ‘X.’ This pink X refers to ACT UP’s reappropriation of the pink triangle that the Nazi regime used to label gay and trans prisoners (Joseph, 2021.)
Haring created Ignorance = fear in 1989, two years before his own death, from AIDS, at the age of 31. In centring figures marked with the pink X, Haring makes it clear that he is calling to members of the gay community, who were most devastatingly affected in those early years of the AIDS crisis, to speak up for themselves, shake off the chains of self-stigma, and reject ignorance. This artwork and the organisation it was created for both grew out of an understanding that being pushed to the margins of health research and of society as a whole was a deadly injustice. But what is the role of doctors and medical students in disrupting these negative societal forces? And what is their relevance here in the UK and today, when HIV has transformed from a death sentence to a survivable, even potentially minimally disruptive, chronic illness?
In many important ways, the future that ACT UP and Haring worked for, in which people living with HIV (PLWH) with access to antiretroviral therapy (ART) can expect to live long, healthy lives has come to pass (Katz and Brown, 2017.) Yet, the sentiment of Ignorance = fear remains pertinent. I know this from my work as a health care assistant on Ron Johnson ward, a specialist HIV/oncology service in London. Virtually all the patients I met on Ron Johnson faced life-threatening illness resulting from not taking their medications. Given that modern ART requires taking just one or two tablets daily with minimal side-effects, how can I understand the barriers that led to advanced HIV? Ignorance = fear plainly an answer – by viewing PLWH through a purely biomedical lens (as patients who should take their medications) I embody ‘see no evil, hear no evil, speak no evil’ ignorance and hence, produce real harm.
Most patients I met on Ron Johnson hold marginalised identities that compound their experience of HIV-related stigma – as asylum seekers, people who use drugs, and sex workers. Katz and Brown (2017) highlight that these key groups are not benefitting from the improvements in life expectancy that the overall population of PLWH has experienced. Yet more research shows that there is a statistically significant association between HIV stigma, depressive symptoms, and increased viral load, which is a measure of how well the virus is controlled and correlates with the risk that it will cause symptoms (Mugo et al., 2023).
Thus, reducing HIV-related stigma is a matter of great clinical importance. In their review of effective strategies for achieving this aim, Nyblade et. al (2009) highlight the importance of healthcare worker education. Hearing a fellow health care assistant on Ron Johnson worry about ‘catching AIDS from the air,’ I was too stunned to offer a persuasive correction. Along with stigmatising language and casual disclosure of HIV status by healthcare workers, these kinds of misconceptions about the transmission and pathology of HIV are both harmful and easily corrected through educational initiatives.
The review also emphasises the vital importance of involving PLWH in educational and stigma-combatting campaigns. This principle is particularly aligned with the message of ACT UP and of Ignorance = fear. Along with the development of PLWH-led awareness-raising materials, Foote (2023) argues that providing person-centred care for PLWH requires allowing patients to define for themselves what constitutes a ‘good’ quality of life. This reflects the key principle that the right decision for a patient may not be the one that the person providing care agrees with. This person-centredness similarly aligns with what Haring and ACT UP demanded and places the onus on me, as a future doctor, to hold myself to account and listen deeply to my patients to understand their goals and needs.
Finally, I am thinking about what is missing, or perhaps elided through, in Ignorance = fear and in the work of Haring and ACT UP overall. Haring was a white, cisgender man who moved smoothly though commercial, studio, and street art spaces (Melcher, 2012.) He boldly used his positionality to make art in public spaces that would likely have been derided as graffiti and had him detained were he one of his Black, less institutionally embedded contemporaries. Speaking about her time as an activist during the AIDS crisis, Alisa Lebow states “I had a sense that [ACT UP] would not be able to reach the most at-risk people… They may have been queer and fabulous but their race and class issues seemed firmly in place.” (quoted in Juhasz, 2012.) As a medical student with many privileged identities, I must learn from Haring to use my voice and expertise to advocate for and with my patients for what is right. Yet, ongoing interrogation of my biases and blind spots, as Lebow suggests, is equally central to becoming the kind of doctor GMHC, ACT UP, and the patients I have worked with so far, have shown me I want to be.
Words by Jyoti Graber, Year 1 MMBS Student