The Republic of Gilead struggles with infertility, making Offred's services as a Handmaid vital to producing children and thus reproducing the society. Handmaids themselves are "untouchable", but their ability to signify status is equated to that of slaves or servants throughout history. Atwood connects their concerns with infertility to real-life problems our world faces, such as radiation, chemical pollution, and venereal disease (HIV/AIDS is specifically mentioned in the "Historical Notes" section at the end of the novel, which was a relatively new disease at the time of Atwood's writing whose long-term impact was still unknown). Atwood's strong stance on environmental issues and their negative consequences for our society has presented itself in other works such as her MaddAddam trilogy, and refers back to her growing up with biologists and her own scientific curiosity.