Health and the Cold War

East German responses to HIV/AIDS unfolded primarily in the last few years of the 1980s, but to understand them it is necessary to go back to the earliest days of the GDR. The postwar Germanys were born in a state of public health crisis, as Jessica Reinisch and others have described.Footnote ⁸ From the beginning, health—and epidemic control in particular—was seen as a crucial indicator of the success or failure of the respective socioeconomic systems. Posters, postcards, and other forms of messaging in the GDR informed citizens that getting vaccinated was an integral part of building socialism.Footnote ⁹ East-West competition, moreover, was fierce both in terms of domestic health care and in the realm of international medical aid and cooperation, as evidenced by the fact that the Soviet Union was a key player in the establishment of the World Health Organization (WHO) after World War II but withdrew from the institution almost immediately after its founding due to rising Cold War tensions and disputes with the United States.Footnote ¹⁰

But major epidemiological threats such as polio soon began to change the playing field. Eastern bloc countries faced dire polio outbreaks in the 1950s and needed assistance, particularly in the form of supplies and vaccines. Western countries faced hurdles with the development of the new Sabin polio vaccine, especially after mistakes during the rollout of the American killed-virus vaccination program—the Salk vaccine—resulted in tens of thousands of children being accidentally infected with polio.Footnote ¹¹ Among the results of this scandal was a massive East-West collaboration on the testing of the Sabin vaccine in the Soviet bloc, spearheaded in part by policymakers running low on options and in part by scientists making personal connections with their Western counterparts—as, for example, when two Soviet virologists traveled to Ohio in 1956 to meet with Albert Sabin and brought back vials of his vaccine in their coat pockets.Footnote ¹² As Cold War tensions became the “new normal,” Soviet bloc scientists were learning to emphasize to their superiors the perks and material assistance they could extract from the West if they were allowed to cooperate; once abroad, these scientists sought common ground with their Western counterparts by participating in an emerging discourse of Cold War scientific universalism.

This dynamic became all the more salient as the Eastern bloc reasserted its role in the WHO in the 1950s. As Erez Manela has described, the first thing the Soviet Union did when it started the process of rejoining the WHO was propose a radical program of worldwide smallpox eradication.Footnote ¹³ What followed was a complex series of back-and-forth Cold War power plays, with the United States promoting its own flagship health initiative, malaria eradication. With East and West competing to be perceived as the most effective leader in global health promotion, a novel discursive framework arose in which virtue accrued to those who most effectively depicted themselves as prioritizing health and human advancement outside of the binary logic of the Cold War. Competition and collaboration were not mutually exclusive; this was increasingly a case of competition through collaboration.

This discourse became especially pronounced in the German-German context in debates surrounding East German membership in the WHO in the early 1970s. When objections from Bonn (with support from the United States) once again resulted in a deferral of the GDR's application in May 1972, the ruling Socialist Unity Party (SED) was full of vitriol, its official organ Neues Deutschland featuring front-page interviews with East German scientists and health officials about West Germany's “arbitrary” and “antihumanitarian” act. “Of one thing I'm certain,” wrote a prominent biologist. “We'll continue our progress in the realms of health care and medical research in spite of this shameful resolution out of Geneva.”Footnote ¹⁴ The ensuing international public relations campaign included articles and pamphlets published all over the world in several languages, including a Swedish-language booklet entitled Bonn's Politics of Extortion Will Fail:

As in the Neues Deutschland articles, this booklet stressed several themes: the West Germans were enemies of peace and cooperation, incapable of the “realistic politics” they espoused. For all the talk of Willy Brandt's Ostpolitik, he and his regime were engaging in “acts of Cold War” at the expense of “universal and equal cooperation toward the humanitarian goal of protecting the health of people and nations.”Footnote ¹⁶

Rhetoric of this kind sheds light on the relationships between Eastern bloc scientists and state institutions, and the ways in which scientists were able to find ways to advance their own careers within and beyond the state apparatus. Historical narratives commonly speak of “the state” and subsume scientists into that category simply because they worked for state-run institutions, but their motivations were often more complex and they took full advantage of whatever degrees of freedom they enjoyed within the parameters laid down by their superiors. Politicians on both sides of the Cold War, for their part, were competing to be the best at caring, and this often involved accusing the other side of not caring enough—of being too bogged down in Cold War politicking to see that children's lives were at stake. Interestingly, this meant their language sometimes dovetailed with that of a growing international culture of scientists and physicians who positioned themselves against the global Cold War nuclear suicide machine writ large—for example figures such as Carl Sagan and the International Physicians for the Prevention of Nuclear War.Footnote ¹⁷ There were thus opportunistic convergences in the way diverse groups of actors involved in collaboration between East and West talked about this enterprise. When Eastern bloc scientists framed their requests to travel to Western countries to go to conferences and collaborate internationally in the language of global health, the act of traveling became a way to transcend the very binary that made traveling to the West so fraught to begin with.

State-socialist momentum in the field of global health only accelerated throughout the 1970s, culminating in the Alma-Ata Conference in 1978, which was held in the Union of Soviet Socialist Republics and enshrined the principles of primary care and “health for all” into the WHO's official agenda. By the end of the 1970s, socialist health was ascendant. But Western opponents of these changes quickly reacted, radically altering the funding structures of the WHO in order to limit these new developments (because the Alma-Ata Declaration was seen as a threat to pharmaceutical intellectual property rights)Footnote ¹⁸ without having to take an overt stance against the notion of universal access to health care. All of this meant that when AIDS was finally recognized in 1981, it emerged in a world in which two Cold War blocs were facing off in an increasingly pitched battle for the soul of global health, in which competitive advantage could be obtained only by rising above the fray to work together with ideological rivals.

The AIDS Epidemic Emerges

After simmering at low incidence rates in central Africa for several decades, HIV began to proliferate rapidly around the world by the 1970s.Footnote ¹⁹ But it remained undetected by medical science until 1981, when American health authorities noticed a growing pattern of unexplained cancer and pneumonia deaths, especially among otherwise healthy gay and bisexual men. Clusters of AIDS cases were also identified early on among several other demographic groups, including hemophiliacs and people from Haiti. But a combination of homophobic sensationalism from the news media and homophobic inaction from the Reagan administration quickly solidified the notion of a “gay plague” that affected only those living in the “fast lane” of American urban life.Footnote ²⁰

Homophobic inaction also characterized the initial response of the SED, which initially viewed AIDS as a capitalist problem and said little apart from a few dismissive comments about what type of person—as one official put it, “not exactly Aunt Emma and Uncle Otto”—would likely be responsible if the disease ever did emerge in the GDR.Footnote ²¹ The SED did, however, encourage participation in international scientific collaboration, and as early as 1983 was willing to support a few doctors and scientists who had begun to read about AIDS in Western journals and discuss it with Western colleagues, as well as those who wanted to attend meetings or conferences about it in Denmark and elsewhere in Europe. It was often these professionals who supplied the driving force behind the state's response to the epidemic by lobbying for resources and attention until the reality of the global AIDS crisis became clearer to health officials and SED higher-ups. By 1984, the Ministry of Health's position was that the possibility of AIDS cases in the GDR couldn't be discounted, and by the time the first cases did appear in 1985 and 1986, official “AIDS updates” stated unequivocally that the only thing standing between the GDR and West German levels of HIV infection was a three-year head start.Footnote ²²

The state's awareness of a mounting global crisis did not, however, translate immediately into broad-based public education initiatives. Members of East Germany's LGBTQ community, who were increasingly organized and connected with their counterparts in the West since the early 1970s, began pressing for greater transparency and outreach.Footnote ²³ AIDS activism in the United States and other Western countries in the 1980s and 1990s was famously highly visible: after years of being ignored by the political establishment, the activists who formed ACT UP and other groups created novel ways of communicating the threat of AIDS to the public that were increasingly impossible to sideline, from occupying government buildings to throwing the ashes of dead friends and lovers over the White House fence and onto the president's lawn.Footnote ²⁴ Given the prominence of these images in the history and popular memory of global AIDS activism, what took place in East Germany appears comparatively tame. Yet East Germany was a challenging space for advocacy of any kind, and it is worth the closer look that is required in order to see the extent and subtle character of AIDS activism in the GDR.

Young people were among the first to actively press for more access to better information about AIDS. In March 1986, the director of the Kulturpalast Dresden wrote to Health Minister Ludwig Mecklinger reporting that he had asked younger visitors for help deciding on a theme for their upcoming educational summer youth event, and the answers had overwhelmingly favored a program that would teach people about “this new disease called AIDS.” He requested the support and participation of AIDS experts.Footnote ²⁵ It is noteworthy that these calls for broader outreach originated in Dresden, which for topographical reasons was famously unable to receive West German television signals (hence the region's nickname, “Valley of the Clueless”), suggesting that conversations about AIDS in the GDR were not just limited to those who saw news reports about AIDS in Western media.

Letters from East German citizens to health officials relating to the AIDS epidemic represented a wide variety of topics and strategies. There are letters on file, for example, containing mock-ups of brochures that the writer thought health officials should produce and distribute at gay bars and clubs.Footnote ²⁶ Some letter writers identified themselves pointedly as long-term, monogamous same-sex couples and pushed for a greater degree of public outreach from the state about the AIDS epidemic, especially in the years prior to the Ministry of Health's expanded educational programming in late 1987. One couple wrote the following in January 1986:

Other letters focused on East Germany's chronic shortage of condoms. One person wrote in the summer of 1987:

This was a cutting indictment of an ongoing concern for the Ministry of Health because the worldwide shortage of latex resulting from the AIDS epidemic had hit Eastern bloc countries, who struggled already with the lack of hard currency needed for global imports, particularly hard. A high-ranking health official answered that a massive acceleration in condom production was scheduled to take place that year and that health officials and the chemical industry were working together to address this problem swiftly.Footnote ²⁹ And although his tone was perfunctory and bureaucratic, internal correspondence indicates that health officials were indeed anxious to alleviate the shortage.Footnote ³⁰

In addition to white East German men who identified as gay or bisexual, the other group most affected by HIV/AIDS in the GDR consisted of students and guest workers from sub-Saharan Africa.Footnote ³¹ In East Germany between 1986 and 1990, there were approximately 200 confirmed cases of HIV in citizens of African countries. Out of the dozen or so who got sick with AIDS during their stay, many died in East German hospitals.Footnote ³² News of their deaths was urgently communicated to the highest levels of the government and the SED.Footnote ³³ Their encounters with the East German state, moreover, were in many ways shaped by the ways in which East German efforts to combat AIDS were initially framed as an aspect of socialist solidarity with Africa and with the rest of the state-socialist world.Footnote ³⁴ In the mid- to late 1980s, East German health officials made a concerted effort to help establish and (they hoped) ultimately lead a Warsaw Pact–based collective effort geared toward AIDS research and prevention. Socialist countries fighting the epidemic together would mean, according to Soviet and East German representatives, a strong stance against AIDS-related discrimination.Footnote ³⁵ It also meant that Warsaw Pact countries would be able to lobby together at the WHO for funds to be diverted to AIDS prevention and other programs that were “in the interest of health care in socialist countries and our friends in the developing world.”Footnote ³⁶

These were (potentially) meaningful symbolic gestures of socialist solidarity with the “third world,” but there were practical gestures as well. In some instances, local officials and school administrators sent letters up the SED chain of command seeking assurances that foreign students who had tested positive for HIV would be allowed to remain in the country and receive medical care.Footnote ³⁷ Correspondence that took place prior to 1987 about foreign students and workers who had tested positive for HIV was concerned mostly with the logistics of providing treatment. When a Zambian student of agricultural sciences at a regional college in Gera tested positive in 1985 for what were then called LAV/HTLV-III antibodies, for example, the Minister for Health filed a report that mentioned neither the individual's immigration status nor any ongoing contact between the ministry and the Zambian embassy about the student's condition. Instead, the student was referred to the Central AIDS Consultation Center at Charité Hospital in Berlin for further assessment and, potentially, long-term care.Footnote ³⁸ Likewise, around the same time, the Ministry of Health issued instructions regarding the care of foreign AIDS patients in which the ministry's (official) priorities included making specialized medical care available as efficiently as possible, guarding patient privacy, and being sensitive to cultural differences. Any decisions about a patient's repatriation, the document stated, would need to be made in consultation with Ministry of Health representatives and with doctors and administrators at the hospital where the patient was being treated.Footnote ³⁹

Although these efforts are relevant as a window into East German state priorities, they did not come close to significantly mitigating the racism and stigma that HIV-positive African students and guest workers faced in the GDR. Sara Pugach has documented the ambivalence tinged with suspicion that many East German authorities expressed regarding African sexuality; the AIDS crisis only exacerbated this.Footnote ⁴⁰ And in the 1980s, foreign workers and students were increasingly isolated from their East German colleagues in separate work collectives or housing facilities, in large part for fear of the political influence they might exert.Footnote ⁴¹ This isolation grew alongside the perceived threat of AIDS: when several Zambian students tested positive for HIV in 1987, for example, school officials reported that the student body's reaction had at first been a somber one, but showed increasing signs of unease and even “unrest” at the prospect of HIV in the community. At best, people were “keeping their distance.”Footnote ⁴²

Although the opportunities for advocacy were more limited for foreign students and workers than for East German citizens, those communities and worker brigades affected by HIV/AIDS frequently took matters into their own hands. Many of the people who were told to leave the country after a positive HIV test simply ignored the order, likely aware that deportation was supposed to be handled via “diplomatic methods”—that is, polite requests would be made to the embassy of a person's country of origin to arrange their return home because the SED didn't want to be seen deporting citizens of socialist and nonaligned allies.Footnote ⁴³ Some lobbied the Ministry of Health with the help of East German coworkers and managers, often crafting their arguments so as to appeal to the spirit of socialist internationalism that had ostensibly brought them there.Footnote ⁴⁴

Regardless of these efforts, the East German response to AIDS became increasingly racialized. Early indications of an internationalist AIDS response began to fall away, both in discourse and in practice. Pursuant to a new AIDS prevention plan drafted by the Ministry of Health in 1987, citizens of foreign countries (with explicit emphasis on Africa) had to be carefully screened and sent back if they turned out to be HIV positive.Footnote ⁴⁵ This policy was implemented delicately at first, with minimal enforcement provisions and special exceptions for “permanent” foreign residents of the GDR. The authors of the policy, moreover, clearly anticipated criticism from the West, noting that the WHO had come out strongly against HIV travel restrictions earlier that year and that the GDR's non-anonymous mandatory reporting policy (Meldepflicht), in force since 1985, had already been a source of international contention (although here they insisted that East German medical professionals had done at least as good a job or better at protecting patient privacy than in any of the nonsocialist countries).Footnote ⁴⁶

From early 1988 on, however, handling of repatriation cases was increasingly curt and matter of fact.Footnote ⁴⁷ The supply of HIV test kits distributed to the Global South seemed to have tapered off as well.Footnote ⁴⁸ In July 1989, the foreign minister argued to the health minister that it was not enough to handle “measures against citizens of high-risk countries entering the GDR” solely through “diplomatic activities,” but that the Ministry of the Interior and the Ministry of Justice should also be involved. To that end, the East German police force was officially briefed about the issue as well.Footnote ⁴⁹ Even a powerful family did not guarantee an automatic exception to the deportation rule. When a relative of a prominent African head of state traveled to the GDR to attend a UNESCO course and was found upon arrival to be HIV positive, it took persistent petitioning and a special request from the Minister of Health to Kurt Hager, the so-called “chief ideologue of the SED,” before an exception was granted.Footnote ⁵⁰

So what explains the increasing racialization of East German AIDS policy at the end of the 1980s? Racism on the part of East German officials is the most obvious explanation and may well be the most relevant factor. This was, after all, not the only time that the GDR's stated antiracist intentions gave way to hostility and discrimination in practice.Footnote ⁵¹ But latent prejudice on the part of health officials does not necessarily explain the shift that appears to have taken place: Why did the GDR's response to AIDS begin with a focus on socialist solidarity and then increasingly clamp down on HIV-positive African students and workers, even as it expanded outreach to East German citizens? The increasing urgency of the epidemic does not, by itself, explain this; infection rates in the GDR remained relatively stable and low until 1990, and there were few documented cases of foreign students or guest workers transmitting HIV during their stay in the GDR. To understand this shift, it's necessary to look at something that was changing during this period: the extent to which East German scientists and physicians were involved in Western-led efforts to combat the AIDS epidemic.

East German AIDS Science Goes Global

As more countries began devoting more resources to the AIDS crisis and a coordinated international response emerged, East German scientists became empowered to go abroad and participate. Already in 1983, East German AIDS scientists reached out to the National Institutes of Health in the United States for access to their massive bibliography of journal citations relating to the epidemic, and that same year one researcher traveled to Denmark as the first East German delegate at a major international AIDS workshop. He reported that the conference organizers unexpectedly waived his registration fees upon his arrival, apparently as a gesture of trans-bloc scientific professional solidarity.Footnote ⁵²

In the context of these early East German efforts, coordinating research and prevention with the rest of the Eastern bloc was high on the agenda, as was solidarity with Africa, which was emerging as a global epicenter. Niels Sönnichsen, Head of DermatologyFootnote ⁵³ at Charité Hospital and leader of the East German AIDS Advisory Group, participated in the International Conference on AIDS in Africa in Brussels in November 1985. In his report, while stressing the usefulness of the meeting for broadening his own understanding of the most up-to-date research, Sönnichsen also foregrounded “repeated” conversations he had had with several African colleagues who said they were “disappointed that the conference had been able to give them no real answers as to how to stem the spread of AIDS in their own countries” and that they were equally disappointed that the conference had no ideas about how to provide them with easy and cheap methods for [HIV] testing.” He also discussed being accosted by representatives of a West German pharmaceutical firm (and maker of HIV test kits) who said they wanted to hold “seminars”—and presumably product demonstrations—in the GDR at the Ministry of Health's earliest convenience, a suggestion Sönnichsen says he “received without comment.”Footnote ⁵⁴

By the middle of the decade, it was becoming increasingly clear that AIDS was not just an American problem and that a “global AIDS community” of scientists and health workers had formed and was becoming increasingly wide-ranging and tightly knit. Members of the AIDS Advisory Group presented their research at more and more international conferences on both sides of the Iron Curtain, including at the first International AIDS Conference in Atlanta in 1985, where Sönnichsen presented a paper before commencing a tour of the East Coast to give talks and meet with colleagues at Johns Hopkins and New York University.Footnote ⁵⁵ Yet even though internal East German communication about AIDS was increasing in frequency, talk of closing the border to “high-risk” travelers was rare. In a 1985 iteration of the official “AIDS updates” sent out to physicians and health officials, for example, no mention was made of using immigration restrictions as a mode of AIDS prevention, and African origins were not listed as a risk factor.Footnote ⁵⁶ The focus instead was on the ministry's plans for raising public awareness about the epidemic and the logistical problems associated with establishing cell lines for use in research on HIV. East German AIDS researchers were especially interested in developing the GDR's own antibody test because testing for the virus at that time required expensive equipment and supplies from the West as well as the hard currency required to import them.

It was also clearly a matter of great importance to the researchers and health officials involved in East German AIDS prevention that these efforts would afford them and their health system an opportunity to be exemplary on a global stage. This is evident from the GDR's earliest involvement in regional HIV/AIDS surveillance and information sharing. In May 1986, the prorector of the Humboldt University Medical School wrote a letter to an acquaintance, the deputy Minister of Health:

With some exceptions, these lobbying efforts were successful; Erich Honecker himself agreed that in the arena of AIDS prevention, “we can't afford to be left behind.”Footnote ⁵⁸

As infection rates continued to rise in the United States, western Europe, and sub-Saharan Africa, however, new structures and discourses of an emerging global response to the epidemic began to take shape. American health authorities wanted to take a leadership role within this response, and countries in the socialist and nonaligned worlds were often discussed in terms of how open or amenable they were to Western advice and aid.Footnote ⁵⁹ In Uganda, for example, President Yoweri Museveni announced not long after taking power in 1986 that he would welcome Western assistance and guidance in countering Uganda's devastating AIDS epidemic, one of the fastest growing in the world at the time. This decision was met with widespread praise and pledges of support and remains a celebrated example of international cooperation that likely saved many thousands of lives. At the same time, American evangelical involvement in these aid efforts helped pave the way for the long-term entanglement of the American religious right in Ugandan domestic politics that played a role in Uganda's draconian antigay legislation in the 2000s.Footnote ⁶⁰ The charismatic iconography of the global response to AIDS—of bringing the world together in a dark hour—seems to have made it all the more difficult to see that Western aid and experts came to Uganda with ideological baggage. Similarly, the claim of transcending the Iron Curtain in the name of the global effort against AIDS exerted a powerful appeal even as it masked complexities.Footnote ⁶¹

As the decade wore on, East German scientists tried to occupy a cautious middle ground even as the aims associated with socialist solidarity gave way to a new focus on joining the global response to AIDS. At the 1987 conference in Paris, for example, Niels Sönnichsen still paid considerable attention to concerns reported by African delegates, in particular their concerns about the unavailability of affordable antibody test kits.Footnote ⁶² That same year, Sönnichsen, who had made it clear in comments to colleagues at the Ministry of Health that he was entirely convinced by the growing international consensus regarding the origins of HIV, wrote gingerly in his more public-facing works that although most signs pointed to an emergence of the virus in twentieth-century sub-Saharan Africa, scientists were still considering many hypotheses, and it was worth withholding judgment for the time being. After all, he continued, medical personnel at Sönnichsen's own Charité Hospital in Berlin had, around the turn of the century, referred to syphilis as “the French disease” or “the Polish disease.” Sönnichsen went on to say that this, however, likely had more to do with prejudice than science.Footnote ⁶³

Yet as scientific collaboration increased surrounding the problem of AIDS, trans-bloc professional relationships were reinforced. Sönnichsen speaks, for example, of going on trips to West Germany and sneaking blood samples in his briefcase so that his friends could let him use their lab equipment, and reports from his attendance at the International AIDS Conferences in 1986 and 1987 to 1988 indicate a declining interest in the differences between socialist and capitalist approaches to science and AIDS.Footnote ⁶⁴ Perhaps most importantly, talks began in 1987 between East and West German scientists about the possibility of cross-border collaboration.

The rise of this German-German collaboration has sometimes been interpreted as evidence for East German insularity vis-à-vis HIV/AIDS, due to the prominence of Bavaria among the GDR's West German state-level partners. West Germany's largest and most populous state had implemented a notoriously harsh slate of AIDS prevention measures in 1987 that gave authorities the right to demand an HIV test of anyone “suspected” of being HIV positive, and which also included mandatory testing for foreigners from designated high-risk countries. It's telling that at a panel on AIDS and human rights at the 1987 US President's Commission on the HIV Epidemic, expert testimony on places in the world where there was a risk of serious human rights abuses in connection with HIV/AIDS mentioned only two places by name: Iraq and Bavaria. (The part about Bavaria is only in the unofficial transcript; it was removed for the publication of the final version.Footnote ⁶⁵)

Drawing a line between Bavaria and the GDR as ostensible partners in illiberal AIDS prevention is a stretch, however, not least because East German health officials launched HIV/AIDS initiatives with several other federal German states. If anything, accounts that emphasize the GDR's Bavarian connections have the effect of “cleansing” the Federal Republic of its most notorious AIDS prevention policies by coupling them with the East German program. Some scholars have implied that Bavarian leaders got the idea for an illiberal response to AIDS from East Germany, but there is little evidence for this aside from the fact that Peter Gauweiler, the architect of Bavarian AIDS policy, visited the GDR in 1988 and told East German health officials that he had been “observing East German measures against AIDS since 1985 and [was] very impressed.”Footnote ⁶⁶

The key to this relationship was not an ideological commonality between Bavaria and the GDR, but rather its mutual utility for each party—Bavarian politicians and East German health officials—in fighting their own internal conflicts. By reaching out to East Germany at a time when the German-German relationship was sensitive but increasingly complex, Gauweiler was establishing a new political-discursive base from which to engage in heated conflicts over his AIDS policies in the Bundestag.Footnote ⁶⁷ As more and more liberal German states vocally opposed Bavarian mandatory testing in the name of privacy and civil liberties, Gauweiler's countermove was to assert a humanitarian realism that superseded decades-old Cold War divisions through a partnership with the GDR. Judging from Stasi reports on the GDR-Bavarian meetings, the East German health minister and his colleagues had made a shrewd choice of partners. A representative of the West German government who attended some of these meetings even said explicitly that he wanted to make sure the GDR wasn't meeting only with the Bavarians.Footnote ⁶⁸ As soon as they agreed to a relationship with Bavaria, similar opportunities came forward from other West German states. There was PR value to be had on both sides of this arrangement: in a February 1988 op-ed, Gauweiler wrote that “containing the global plague of AIDS isn't a question of worldview, it's a question of biology. . . . Bavaria and the GDR clearly agree that AIDS can't be defeated just with pamphlets and rhetorical pronouncements.”Footnote ⁶⁹

Of course, the public pronouncements of both East and West German politicians are a problematic source of insight. It is more useful to examine the internal conversations and debates surrounding the formulation of the GDR's HIV travel ban in 1987. In the course of all their drafting, redrafting, deliberation, and handwringing, one overarching concern is apparent on the part of these policymakers: above all, health officials were worried about how the GDR would appear in the eyes of the international community because they wanted to be a part of that community. The WHO and key Western partners, West Germany in particular, were a constant topic of internal conversation, and over the course of the period in which these conversations were taking place, the GDR was integrating itself more and more closely with Western institutions and public health paradigms. By the time the East German travel ban went into effect, the WHO had clearly denounced immigration restrictions as a method for preventing HIV. But Western countries had also signaled their tolerance for such policies. Global opposition to the American travel ban came to a head in 1990 when it posed problems for HIV-positive people wanting to attend the Sixth International AIDS Conference in San Francisco. Reactions were especially fierce when a European scientist and activist was arrested in Minnesota after disclosing his serostatus to customs officials.Footnote ⁷⁰ Yet once allowances were made for scientists and activists, this opposition became largely symbolic, and the American HIV travel ban stayed in place until 2010. The West German state, moreover, had likewise already denied entry to people with HIV.Footnote ⁷¹

In discussing the GDR's mandatory reporting policy regarding all cases of HIV infection, AIDS, and AIDS-related deaths, health officials discussed in detail the fact that there were a variety of international stances on this matter and that many capitalist countries were opposed to mandatory reporting. However, they argued, HIV/AIDS reporting in the GDR was carried out under the strictest level of confidentiality and formed the basis for a system of AIDS surveillance that “corresponded to or even exceeded” the efficacy of AIDS surveillance in developed capitalist countries.Footnote ⁷² In other words, despite being an internal state document that contained several highly critical assessments of the GDR's prevention efforts up to that point, the text of the 1987 regulation was filled with talking points and apologia for use in trans-bloc conversations about AIDS prevention.

In the legal language of the HIV immigration ban section itself, the notion of the WHO as the primary authority in matters of health was likewise on display. Ministry bureaucrats had circulated multiple news reports in May 1987 that the WHO had come out against “HIV testing at the border.” Because the United States enacted its HIV travel ban only a month later, this recommendation clearly did not carry the moral weight of international consensus behind it. In singling out individuals from “high-risk countries” for the new mandatory testing policy, however, the ministry made sure to append the phrase “according to the WHO” wherever possible, couching its potentially unpopular policy choices in a framework supplied by the emerging Western epidemiological consensus. In fact, references to the WHO and its recommendations and reports are woven throughout the 1987 document. Even statistics about AIDS cases in the Soviet Union and other socialist countries came straight from Geneva rather than Moscow.

Accompanying the waning interest in a socialist-internationalist politics of AIDS was a simultaneously increasing participation in the language of global cooperation in fighting the epidemic. When East German scientists attended the landmark London AIDS Summit in 1988, their statement to the assembled delegations from roughly ninety health ministries from around the world was a telling amalgam of the rhetoric of state socialism and of the global AIDS community:

As East German scientists became more fluent in this language, however, early efforts to keep advocacy for the Global South at the center of medical-professional culture receded. Claims to transcending the border between East and West went along with erecting new borders between North and South. In 1988, the number of East German doctors and medical researchers attending conferences abroad, including nonsocialist countries, reached its highest since the construction of the Berlin Wall, despite tightening budget constraints and an SED leadership increasingly reluctant to approve foreign travel.Footnote ⁷⁴ Given the timing of the East German HIV entry ban, there is thus an inverse relationship between the amount of resources the GDR spent on cultivating trans-bloc scientific and medical partnerships and the amount of resources it spent on the African AIDS epidemic.