By Dr. phil. Philipp Hofstetter, Interdisciplinary Centre for Gender Studies, University of Bern

The shocking images of emaciated men in the prime of life, the unprecedented national awareness campaigns, the widespread use of condoms, anonymous images of blood bags, colorful charity events, and medical breakthroughs — all of this is etched into Switzerland’s collective memory. Yet the story runs deeper; it gets “under the skin.” At first, the virus was seen as a problem of marginalized groups. It soon became clear that HIV, as a sexually transmitted infection, could potentially affect anyone. With its spread, Switzerland was suddenly faced with an uncertain future. Society wasn’t just shaken to its core — it was struck to the blood.

Switzerland’s Response: A Mirror of Societal Values

The overarching narrative lies in the sequence and simultaneity of national coping strategies that Switzerland adopted — and continues to implement — to manage the crisis. Looking back to the early days: when the mysterious illness called AIDS appeared, it was quickly stigmatized as the "gay plague." The medieval notion of a plague as divine punishment had survived the centuries — just as with the Black Death, even prominent voices invoked a higher purpose behind the tragedy. God controls nature, and nature takes care of itself. For those who watched loved ones die, this narrative at least offered the illusion of meaning in suffering. But it was full of contradictions: why would divine punishment strike those already marginalized and discriminated against? Was it a double punishment — or a warning to others?

The fact that it primarily affected men who had sex with men intensified the moral condemnation. The gay community, having only recently begun to liberate itself from societal repression in the 1970s, became a primary target of this blame. But by the 1980s, the LGBTQ+ movement was strong enough to transform the AIDS tragedy into organized mutual support. Their push for sex education aligned with the interests of medical professionals — forming a powerful alliance.

Medicine, Prevention, and Social Solidarity

From the start, prevention was more than a medical strategy — it became an expression of social solidarity. A community took control of its own fate. Switzerland already had a history of public health initiatives. Large-scale national efforts, such as river corrections in the 19th century, not only prevented flooding but also reduced malaria risk. The fight against syphilis and other STIs around 1900 led to widespread education campaigns. So, society was already familiar with sexual health education. In the commercialized and media-saturated sexual culture of the 1980s, no one was better positioned to speak about taboo topics than the gay community and its allies, alongside preventive medicine experts. Sexuality was presented as a universal issue — even if HIV is not exclusively sexually transmitted. This insight was key to the success of Swiss public awareness campaigns.

Yet even prevention had its limits. Scientific progress had long fostered the illusion that hygiene, antibiotics, vaccines, and advanced treatments could permanently control diseases. But even cancer research at the time showed that human health is part of a far more complex interaction with the environment. Many health risks were invisible and ever-present. Researchers soon saw the need for new medical approaches. HIV itself exposed the limits of biomedical science: there was no quick breakthrough. Instead, HIV became a platform for testing new medications. Drug cocktails were repeatedly introduced, offering hope. Finally, in 1996, a major breakthrough came with combination therapy — using three classes of drugs — allowing people to live long-term with HIV.

Lessons from Drug Policy

The open drug scenes of the 1980s and 1990s — and the resulting sex work linked to addiction — provided additional painful but important insights. Beyond education, treatment, and repression, activists recognized the need for harm reduction strategies. The American model of “New Public Health Management” gained traction. Survival support became a priority. Measures such as controlled needle distribution and regular health checks allowed for early treatment. Today, there is no life untouched by HIV — but there is a society that has learned to live with it.

Living with HIV: A New Normal

Today, HIV is no longer seen as purely a collective challenge — it has become a matter of personal health management. The traditional principle of prevention has been supplemented with a resilience approach, aimed at strengthening the body to better resist infection. This shift has also led to a growing individualization of responsibility. Preventive tools like PrEP (pre-exposure prophylaxis) now allow people at higher risk to take daily medication to prevent infection. The line between “healthy” and “sick” is increasingly blurred as even uninfected individuals take medication as a precaution.

A Changing Set of Coping Strategies

The strategies described here will continue to be relevant in the future — often invisibly, as they’ve become deeply embedded in our societal fabric. These modern disaster coping mechanisms, developed on the level of the nation-state since the late 18th century, remain influential to this day. That’s why response patterns in comparable countries often resemble one another.

About 40 years ago, AIDS unsettled Swiss society — and profoundly changed it. The new knowledge about the virus, along with the uncertainty it brought, led to a shift in risk management where self-help played a central role. Neither the state nor the pharmaceutical industry could manage the epidemic alone. In Switzerland, the organization Aids-Hilfe Schweiz (Swiss AIDS Federation), founded in 1985, has played a key role in bridging the gap between affected individuals and the public.

The Global Dimension of HIV

Then as now, the HIV issue cannot be confined to national borders. Historical research highlights both colonial and postcolonial dimensions of the disease. At the same time, future risks in a globalized world will remain transnational — as the COVID-19 pandemic starkly reminded us. This has potential implications for the discrimination and stigmatization of people with HIV. There remains a vital need to educate and inform the public to combat prejudice. Such bias often leads to significantly higher levels of psychological stress among people with HIV compared to the general population. Aids-Hilfe Schweiz continues to face this reality, even after four decades.

Public Responsibility for Health

Aids-Hilfe Schweiz sees continued challenges in access to prevention materials, testing, and healthcare — especially for sex workers, trans individuals, people with ties to high-prevalence countries, and men who have sex with men. These groups often face limited access to resources and are therefore at higher risk for HIV and other STIs. In Switzerland as elsewhere, high costs present a barrier to timely diagnosis and preventive care, particularly for low-income and marginalized populations.