This semester I’m teaching a course on Global Crime and Public Health as a special lecture series (in fact I should be preparing material now instead of posting here). This course represents a culmination of 15 years’ research experience in the service of a general model of what constitutes a “good” response to the public health threat of movements in global crime. The key public health threat in the West is, of course, HIV spread by injecting drug use and/or sex work[1]. Both HIV and sex work have an international criminal connection, since the former is fed by international crime syndicates and international criminal connections drive the movement of women from high-HIV areas in Asia to low HIV areas in Oceania, to work in unregulated sweat shop-style brothels. The movement of these drug- and sex-work markets in Australia is also tied into its multicultural history and movement towards open markets and trade, so there’s a lot to take in, but basically it’s about HIV.

A lot of people – including quite a few in positions to know better – seem to think that HIV is no big deal, perhaps through their having looked at it through the prism of the developed world’s good luck, but in my wandering through this topic at the University I have had to review both the history, recent epidemiology and effects of HIV. It’s certainly the case that, had the developed world had the singular bad luck that Africa had, or reacted more slowly, our lives here in the pampered Western world would be very different. I wonder if our luck in dodging this bullet might be partly responsible for the growth of zombie/disease movies in the last 10 years, and while I was wondering at that it occurred to me that a slightly different set of historical circumstances could create an alternate history earth with a lot of cyberpunk elements, that could be an interesting setting for a gritty near-future cyberpunk campaign. To understand it, we should take a look at a brief potted history of HIV, and its effects.

The history of HIV

The first known death due to AIDS was a Norwegian sailor and his family, who died of AIDS in about 1972[2]. He almost certainly got his HIV while travelling through Africa, where it is believed to have appeared during the 50s at least, and from where it spread to Haiti in the 60s. It is then believed to have circulated through America, but it appears to have been confined to gay men at first in America. Unfortunately for the Africans, AIDS appeared simultaneously in 3 separate, geographically distinct locations in heterosexual populations in the early 80s, and it’s possible it was already endemic in those areas by that time.

In the USA, UK and Asia, however, it was not endemic – having come to those countries from other countries – and it did not appear first in the heterosexual community. The huge benefit of this is that it could be contained, because of the good luck of its originating in a separate community with different behaviours and a strong community identity. This combination meant that it wouldn’t spread fast outside of the group, and health behaviour messages were easily communicated within the group.

On the other hand, in Africa it appeared in the most diverse community possible – heterosexuals – and because of its incubation period (10 years) and the fact that it was native to the region, it was already endemic by the time it was identified. It’s very hard to control a disease that is already widespread in a group with a very vague shared identity, if the only form of prevention is behavioural change.

The Effects of HIV in Africa

HIV in the west is a scary disease that affects a small portion of the community. Strong public health systems can handle scary diseases in minority communities very easily. However, in Africa the disease has spread amongst heterosexual populations very quickly, and is now at epidemic level within nations. Prevalence of HIV in Swaziland is 26%, and in Lesotho 24%; even in countries with a model response, like Uganda, the prevalence is around 5-6%.

HIV exacts a cruel toll on its victims, both in terms of their horrible suffering as they die, and the effects on their family and friends. In Africa the disease’s high prevalence has also had economic effects, especially:

  • Reduced food production, as labourers either die or leave the land to care for relatives
  • Poverty, as people drop out of work to care for relatives
  • Reduced school enrolments, as children are withdrawn from school to support families whose main earners are sick or dead

In a lot of countries in Africa, HIV is expected to lead to long-term entrenched poverty, loss of food production, and loss of economic growth because businesses cannot find suitable labour. Recently Lesotho petitioned South Africa to be absorbed into the South African nation, because Lesotho itself is facing economic and social collapse specifically because of the HIV epidemic.

Alternate HIV History

Suppose, then, that the disease had developed in the USA rather than Africa, and appeared spontaneously in three areas in the heterosexual community, rather than the gay community. Suppose further that it was already endemic in these areas. Even if all three areas were rural, it’s hard to believe that the US could have done better than Uganda, and given the amount of travel in the US compared to Africa in the 70s and 80s, the sexual looseness of the time and the presence of the pill, it’s pretty easy to imagine the disease getting out of control. It would spread rapidly to the UK and Australia through travel, but not so rapidly to virgin Africa, since there wasn’t so much contact between the two at the time. By the time it was identified and isolated (and maybe first it was called “Heterosexual Related Immune Deficiency”?) the Africans would have been in a position to ban travel from the US, and gain a few years’ grace to teach Africans about safe sex. i.e. the situation that the West experienced, in reverse. It’s possible to imagine, too, that the economic costs could have been larger in the US than in Africa. Much of the economic cost of HIV in the early years in Africa was handled on the cheap, by letting people die or giving very basic palliative care, while in the US it would be all-hands-to-the-pump in what was then still a quite well-run system.

The difference, of course, is that the US and Europe were the key drivers of economic growth in the 80s and 90s, and if they suddenly collapsed in on themselves due to HIV, the world would have gone along a very different trajectory. Asia – or at least those countries untouched by HIV – would have been the key drivers of economic growth in the 90s, and those countries of course would be the nations isolated from US involvement, or relatively untouched – China, Vietnam, Korea and maybe Japan. Japan, if untouched, would have continued the development aid to the region which enabled most of Asia to grow during that time, and we would be looking at a world where the West was collapsing in on itself while Asia grew, and Africa went on its own, possibly quite isolated trajectory to growth. How would African growth be affected by a collapse in the West? Would trade with Asia be a less protected and more open affair, so Africa could grow out of its problems? Without Australian and Canadian wheat, would Africa become a major food supplier and thus grow in a way it didn’t in the real world?

The world that would come from this strikes me a lot like the world of Appleseed, where a few isolated Asian countries have achieved great wealth and security while Europe and the US struggle and collapse in on themselves. However, the cause wouldn’t be some kind of global war, but a global disease catastrophe that changed the economic development model of the last 30 years.

Some HIV-driven cyberpunk scenarios

A world where nuclear-armed, militarily sophisticated states collapse in on themselves under the burden of epidemic disease is a scary one indeed, and suggests a variety of interesting scenarios for adventuring:

  • The Isolated Survivor: Perhaps a couple of countries acted early to isolate themselves, and while the rest of the world (or the rest of the world that we’re interested in) struggles and dies, they soldier on. Such a society might be a lot like the world of Children of Men, grotty and nasty but trying to cling on to its past social structures while it slowly and inevitably decays into a post-apocalyptic mess. Adventuring in such a state would be something between cyberpunk and post-apocalypse, as the scenes in the refugee camp in Children of Men show. There would be many factional sides to take, and very little to be gained from being self-interested except power.
  • Dictatorship and War: With economies failing and populations in unrest, an obvious way for Western governments to reassert their authority, regain popularity, and regain resources, is to launch foreign wars, either for material gain or for the simple distracting power of a good, cleansing war. War overseas is a good excuse for dictatorship at home – as is a state of permanent disease – and the PCs could find themselves suddenly on the wrong (or the right) end of a fascist, communist, or even religious dictatorship. Dictatorships in a society slowly falling apart from the inside are an excellent dystopian cyberpunk setting, with the PCs able to position themselves as freedom fighters, spies, death squads, innocent victims of a plot, etc.
  • Homesteading and survivalism: With no cure in sight, and large parts of the populace infected, maybe the wealthy, the brave, or the stupid would try to set up their own kingdoms or survivalist enterprises. The best ones are always at sea, but there could be other places too – the arctic, the deep mountains, enclaves inside fast-collapsing cities. The PCs could be hired on as guards, or could be members of the original community who find themselves caught in a plot – or sent on a mission.
  • The Cure: Maybe someone finds a cure for the disease, and the PCs stumble on it or are enlisted to protect it. What do they do if they find that a local power-broker/government/corporation wants to keep it secret to use as a political tool, to assure world domination, etc? Do they go along with the plan for a slice of the goodies, steal the cure, or reveal the truth to the world? What if the cure is a bio-weapon that instantly kills the infected? Would the PCs disseminate it for the greater good, destroy the last sample, fight to prevent its use?
  • The Truth: Suppose that in fact HIV were not a natural disease at all, but one of the conspiracy theories about its origin proved to be more than true, and it was in fact a bioweapon gone wrong. A campaign leading up to this revelation could change the world – especially if a government of an uninfected country had secretly released it, and was sitting on the cure.
  • Drug dealing: In an America with a properly cyberpunk economic system, crumbling infrastructure and declining wealth, very few people would be able to afford anti-retroviral drugs, which would become a new kind of treasure. The PCs could be dealers in ART, or even Robin Hood style liberators of stashes of the drugs, constantly running from criminal rivals and the law. Or they could be dispatched by the government or a corporation to break up such a group.

My favourite is the first or second, or a combination of the two, though elements of any of the rest could be thrown in for effect. HIV-related collapse has the advantage of not being as catastrophic as modern disease/zombie movies, so it creates a crumbling cyberpunk society as opposed to a post-apocalyptic one, but it gives an opportunity to create a future with an economic order that has been changed in a semi-plausible way, and a reason for the moribund state of western nations. It also gives a plausible background against which genuinely fascist or radical, but powerful religious movements could be resurgent, and the slow development of the virus gives a  long time frame for corporations and governments to work their schemes, rather than the kind of disaster-management scenarios we often see in zombie/outbreak-type movies.

Beyond HIV

Of course, invented diseases could be more tailored to the scenario than HIV. A disease that causes madness, so that the victim never recovers and never dies, and is a constant burden on society, could create an even more disturbing future. Maybe the mad are easily contained, but in some places there are just too many… Diseases with catatonic or similar semi-stuporific states would create a challenge of an interesting sort, as do diseases that lower fertility or prematurely age the population. All that’s really needed is a disease that appears suddenly after a long latency, so it is insidious; that is highly contagious; and that creates a huge, irresolvable social burden out of its victims, sufficient to create the conditions of economic decay and apocalypse that would characterise the campaign world, because the purpose of the disease is not to create physical enemies of its victims, like zombies; but to create the context for a debilitated society, suspicious of its own members and falling from its previous greatness due to disease and rapid economic decay. Under these conditions one can create the backdrop for a game of gritty urban cyberpunk semi-apocalypse, which I think could be an interesting setting for some unpleasant and challenging adventures.





fn1: Though it’s of course not the only such problem. I’ve been thinking of setting my students an assignment based on the problems that the Italians are having with rubbish disposal and the mafia, but I suspect that there isn’t much published on this. Contraband olive oil created significant public health disasters in Spain under Franco, and there is now of course the potential health consequences of smuggling animals and plants. But I think these don’t compare to the real, identifiable effects of heroin importation to countries like Australia and Kyrgizstan.

fn2: Doesn’t even bother checking the lecture he gave last week for the exact date…