Treichler1987 AIDS MedicalHomofibia Anepidemicofsignification

AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification
Author(s): Paula A. Treichler

Source: October, Vol. 43, AIDS: Cultural Analysis/Cultural Activism (Winter, 1987), pp. 31-70
Published by: The MIT Press
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AIDS, Homophobia, and
Biomedical Discourse:
An Epidemic of Signification*
PAULA A. TREICHLER
An EpidemicofSignification
In multiple,fragmentary,and often contradictoryways we struggle to
achieve some sortof understandingof AIDS, a realitythatis frightening, widely
publicized,and yetfinallyneitherdirectlynor fullyknowable. AIDS is no differ-
ent in this respect fromother linguisticconstructions,which, in the common-
sense view of language, are thoughtto transmitpreexistingideas and represent
real-worldentitiesand yet,in fact,do neither.For the nature of the relationship
between language and realityis highlyproblematic;and AIDS is not merelyan
inventedlabel, provided to us by science and scientificnaming practices,for a
clear-cutdisease entitycaused by a virus. Rather, the very nature of AIDS is
constructedthroughlanguage and in particularthroughthe discoursesof medi-
cine and science; this constructionis "true" or "real" only in certain specific
ways-for example,insofaras it successfully guides researchor facilitatesclinical
controlover the illness.' The name AIDS in part constructs
the disease and helps
make it intelligible.We cannot thereforelook "through" language to determine
what AIDS "really" is. Rather we mustexplore the site where such determina-
tions really occur and intervene at the point where meaning is created: in
language.
*
ReprintedfromCulturalStudies,vol. 1, no. 3 (October 1987), pp. 263-305; minorchanges
and correctionshave been made for the presentpublication;informationand referenceshave not
been updated. Research for this essay was funded in part by grantsfromthe National Council of
Teachers of Englishand the Universityof Illinois Graduate College Research Board. My thanksto
Teresa Mangum, researchassistanton thisproject; to StephenJ. Kaufman,M. KerryO'Banion, Eve
KosofskySedgwick,and Michael Witkovskyforguidance and insight;and to those who have keptme
in touch withAIDS developmentsin diverse fields.An earlier versionof thisessay was presentedat
the annual meetingof the Modern Language Association,New York, December 1986.
1. Discussingthe validityof theirinterpretationof everydaylife in a science laboratory,Bruno
Latour and Steve Woolgar claim, similarly,thatthe "value and statusof any text(construction,fact,
claim,story,thisaccount) depend on more than its supposedly'inherent'qualities. . .. The degree
of accuracy(or fiction)of an account depends on what is subsequentlymade of the story,not on the
storyitself" (LaboratoryLife: The Construction Facts, Cambridge, England, Cambridge
of Scientific
UniversityPress, 1985, p. 284).
32 TREICHLER
Of course, AIDS is a real disease syndrome,damaging and killingreal

human beings. Because of this, it is tempting-perhaps in some instances
imperative-to view science and medicineas providinga discourseabout AIDS
closer to its "reality" than what we can provide ourselves. Yet the AIDS
epidemic--with its genuine potentialfor global devastation-is simultaneously
an epidemic of a transmissiblelethal disease and an epidemic of meanings or
Both epidemicsare equally crucial forus to understand,for,tryas
signification.2
we may to treat AIDS as "an infectiousdisease" and nothingmore, meanings
continue to multiplywildlyand at an extraordinaryrate.3 This epidemic of
meanings is readily apparent in the chaotic assemblage of understandingsof
AIDS thatby now exists.The mere enumerationof some of the waysAIDS has
been characterizedsuggestsits enormous power to generate meanings:
1. An irreversible,untreatable,and invariablyfatal infectiousdisease that
threatensto wipe out the whole world.
2. A creationof the media, whichhas sensationalizeda minorhealthprob-
lem for its own profitand pleasure.
3. A creationof the stateto legitimizewidespreadinvasionof people's lives
and sexual practices.
4. A creationof biomedicalscientistsand the CentersforDisease Controlto
generate fundingfor theiractivities.
5. A gay plague, probablyemanatingfromSan Francisco.
6. The crucible in which the fieldof immunologywill be tested.
7. The most extraordinarymedical chronicleof our times.
8. A condemnationto celibacy or death.
9. An Andromeda strainwith the transmissionefficiencyof the common
cold.
10. An imperialistplot to destroythe Third World.
11. A fascistplot to destroyhomosexuals.
2. I use the termepidemicto referto the exponentialcompoundingof meaningsas opposed to the

simplerspread of a termthrougha population.
3. The term signification, derived from the linguisticwork of Ferdinand de Saussure, calls
attentionto the wayin whichlanguage (or any other"signifying system")organizesratherthanlabels
experience (or the world). Linkingsignifiers(phoneticsegmentsor, more loosely,words) and signi-
fieds(concepts,meanings)in waysthatcome to seem "natural" to us, language createsthe illusionof
"transparency,"as thoughwe could look throughit to "facts" and "realities" thatare unproblema-
tic. Many scientistsand physicians,even thosesensitiveto the complexitiesof AIDS, believe that"the
facts" (or "science" or "reason") will resolve contradictionand supplant speculation; theyexpress
impatience with social interpretations,which they perceive as superfluousor incorrect.(See, for
example, Richard Restak, "AIDS Virus Has No Civil Rights," ChicagoSun-Times,September 15,
1985, pp. 1, 57-58.) EvenJacques Leibowitchwritesthat,withthe discoveryof the virus,AIDS loses
its "metaphysicalresonances" and becomes "now no more than one infectiousdisease among many"
(A StrangeVirusof UnknownOrigin,trans. Richard Howard, intro. by Robert C. Gallo, New York,
Ballantine, 1985, p. xiv). The position of this essay is that significationprocesses are not the
handmaidens of "the facts"; rather,"the facts" themselvesarise out of the signifyingpracticesof
biomedical discourse.
An EpidemicofSignification 33
12. A CIA plot to destroysubversives.

13. A capitalistplot to create new marketsfor pharmaceuticalproducts.
14. A Soviet plot to destroycapitalists.
15. The result of experimentson the immunologicalsystemof men not
likelyto reproduce.
16. The resultof genetic mutationscaused by "mixed marriages."
17. The resultof moral decay and a major forcedestroyingthe Boy Scouts.
18. A plague stored in King Tut's tomb and unleashed when the Tut
exhibittoured the US in 1976.
19. The perfectemblem of twentieth-century decadence, of fin-de-siecle
decadence, of postmoderndecadence.
20. A disease that turnsfruitsinto vegetables.
21. A disease introducedby aliens to weaken us before the takeover.
22. Nature's way of cleaning house.
23. America's Ideal Death Sentence.
24. An infectiousagent that has suppressed our immunityfromguilt.
25. A spiritualforce that is creativelydisruptingcivilization.
26. A sign that the end of the world is at hand.
27. God's punishmentof our weaknesses.
28. God's test of our strengths.
29. The price paid for the sixties.
30. The price paid for anal intercourse.
31. The price paid for genetic inferiority and male aggression.
32. An absolutelyunique disease for which there is no precedent.
33. Justanother venereal disease.
34. The most urgentand complex public health problem facingthe world
today.
35. A golden opportunityfor science and medicine.
36. Science fiction.
37. Strangerthan science fiction.
38. A terribleand expensive way to die.4
4. These conceptualizationsof AIDS come chieflyfromprintedsources (journals, news stories,

lettersto the editor,tracts)published since 1981. Many are common and discussed in the course of
thisessay; the more idiosyncraticreadings of AIDS (e.g., as a force destroyingthe Boy Scouts) are
cited to suggestthe dramaticsymbol-inducing power of thisillnessas well as our continuinglack of
social consensus about its meaning. Sources for the more idiosyncraticviews are as follows: (2)
Senator Jesse Helms; (6) Gallo's introductionto Leibowitch,A StrangeVirus,pp. xvi-xvii; (8) gay
rightsactiviston Channel 5 televisionbroadcast,Cincinnati,October 18, 1985 (compare the French
joke thatthe acronymforAIDS, SIDA in French,standsforSyndromeImaginairepour Decourager
les Amoureux [Newsweek, November 24, 1986, p. 47]); (9) one science writer'scharacterizationof the
popular view (John Langone, "AIDS: The Latest ScientificFacts," Discover,December 1985, pp.
27-52); (10) GRIA (Haitian RevolutionaryInternationalistGroup), "AIDS: Syndromeof an Imperi-
alist Era," undated flyerdistributedin New York City,Fall 1982 (and see Marcia Pally, "AIDS and
the Politics of Despair: Lighting Our Own Funeral Pyre," The Advocate,no. 436, December 24,
34 TREICHLER
Such diverse conceptualizationsof AIDS are coupled with fragmentary

interpretations of itsspecificelements.Confusionabout transmissionnow causes
approximately half the US population to refuseto giveblood. Many believe you
can "catch" AIDS through casual contact, such as sittingbeside an infected
person on a bus. Many believe that lesbians-a population relativelyfree of
sexuallytransmitted diseases in general-are as likelyto be infectedas gay men.
Other stereotypesabout homosexuals generate startlingdeductions about the
illness:"I thoughtAIDS was a gay disease," said a man interviewedby USA Today
in October 1985, "but if Rock Hudson's dead it can kill anyone."
We cannoteffectively analyze AIDS or develop intelligentsocial policyifwe
dismisssuch conceptionsas irrationalmythsand homophobicfantasiesthatdelib-
eratelyignore the "real scientificfacts." Rather theyare part of the necessary
workpeople do in attemptingto understand- howeverimperfectly - the com-
plex, puzzling,and quite terrifyingphenomenon of AIDS. No matter how much
we maydesire,withSusan Sontag, to resisttreatingillnessas metaphor,illnessis
metaphor,and thissemanticwork-this effortto "make sense of" AIDS-has
to be done. Further,thisworkis as necessaryand oftenas difficult and imperfect
for physiciansand scientistsas it is for "the rest of us."5
1985, p. 8); (12) Gary Lee, "AIDS in Moscow: It Comes fromthe CIA, or Maybe Africa,"Washington
PostNationalWeekly Edition,December 30, 1985, p. 16; (13) Langone, in Discover,citinga storyin a
Kenyan newspaper;(14) NationalInquirerstorycited in Brian Becher, "AIDS and the Media: A Case
Study of How the Press InfluencesPublic Opinion," unpublishedresearchpaper, College of Medi-
cine, Universityof Illinoisat Urbana-Champaign,1983; (15)John Rechy,"An Exchange on AIDS,"
Letter to the Editor,withreplybyJonathanLieberson,NewYorkReviewofBooks,October 13, 1983,
pp. 43-45; (16) Soviet view cited inJonathanLieberson, "The Realityof AIDS," New YorkReviewof
Books,January16, 1986, p. 45; (17)Jonathan Gathorne-Hardy,Letter to the Editor,NewYorkTimes
BookReview, June 29, 1986, p. 35; (18) cited in WilliamCheck, "Public Education on AIDS: Not Only
the Media's Responsibility,"HastingsCenterReport,Special Supplement,vol. 15, no. 4 (August 1985),
p. 28; (19) Toby Johnson,"AIDS and Moral Issues," The Advocate,no. 379, October 27, 1983, pp.
24 - 26: "Perhaps AIDS isjust the firstof a whole new class of diseasesresultingfromthe tremendous
changes human technologyhas wroughtin the earth's ecology"; (20) example of AIDS "humor"
cited in David Black, The Plague Years:A ChronicleofAIDS, The EpidemicofOur Times,New York,
Simon & Schuster, 1986; (23) acronym cited in Lindsy Van Gelder and Pam Brandt, "AIDS on
Campus," RollingStone,no. 483, 1986, p. 89; (24) RichardGoldstein,"Heartsick: Fear and Loving in
the Gay Community,"VillageVoice,June 28, 1983; (25) Black, The Plague Years,citingone view of
plagues; (31) cited in Pally, "AIDS and the Politicsof Despair"; (37) Robert C. Gallo, "The AIDS
Virus," ScientificAmerican, January 1987, pp. 47-56.
5. Sontag, in Illness as Metaphor,New York, Farrar, Strauss & Giroux, 1978, argues that the
confusionof illness with metaphor damages people who are ill, and certainlywith AIDS there is
ample evidence for this argument. Laurence R. Tancredi and Nora D. Volkow, for example, in
"AIDS: Its Symbolismand Ethical Implications,"MedicalHeritage,vol. 2, no. 1 (January-February
1986), pp. 12-18, arguingthat"the metaphoressentiallycreatesthe frameworkforthe individual's
experienceof the disease," cite studiesindicatingthatmanypeople withAIDS experiencea varietyof
psychologicaldifficultiesas a result of its symbolic (as opposed to its prognostic) message. But
metaphor cannot simplybe mandated away. Goldstein, in "Heartsick," writes: "Since we are so
vulnerableto the erotic potentialof metaphor,how can we hope to be less susceptiblewhen illness
intersectswithsex and death?" Sontag argues thatonce the cause and cure of a disease are knownit
I am arguing,then,not thatwe musttake both the social and the biological

dimensionsof AIDS intoaccount,but ratherthatthe social dimensionis farmore
pervasiveand centralthanwe are accustomedto believing.Science is not the true
material base generatingour merelysymbolicsuperstructure.Our social con-
structionsof AIDS (in termsof global devastation,threatto civilrights,emblem
of sex and death, the "gay plague," the postmoderncondition,whatever)are
based not upon objective,scientificallydetermined"reality" but upon what we
are told about this reality: that is, upon prior social constructionsroutinely
produced withinthe discoursesof biomedical science.6(AIDS as infectiousdis-
ease is one such construction.)There is a continuum,then, not a dichotomy,
betweenpopular and biomedical discourses(and, as Latour and Woolgar put it,
"a continuum between controversiesin daily life and those occurring in the
laboratory"),7and these play out in language. Consider, forexample, the ambi-
guitiesembedded withinthisstatementby an AIDS "expert" (an immunologist)
on a televisiondocumentaryin October 1985 designed to dispelmisconceptions
about AIDS:
The biggestmisconceptionthat we have encountered and that most
citiesthroughoutthe United States have seen is thatmanypeople feel
thatcasual contact-being in the same room withan AIDS victim-
will transmitthe virus and may infectthem. This has not been sub-
stantiated by any evidence whatsoever .... [This misconception
lingersbecause] thisis an extremelyemotionalissue. I thinkthatwhen
there are such strong emotions associated with a medical problem
such as thisit's verydifficult
forfactsto sinkin. I thinkalso there'sthe
problem that we cannot give any 100 percentassurances one way or
the otherabout these factors.There mayalwaysbe some exceptionto
ceases to be the kindof mysterythatgeneratesmetaphors.Her view thatbiomedical discoursehas a

special claim on the representationof "reality" implies as well that the entitiesit identifiesand
describesare themselvesfreefromsocial construction(metaphor).But as Stephen Durham and Susan
Williamsinsist,in "AIDS Hysteria:A MarxistAnalysis,"presentedat the PacificNorthwestMarxist
Scholars Conference, Universityof Washington,Seattle, April 11-13, 1986 (Freedom Socialist
Publications,5018 Rainier Ave. South, Seattle,WA 98118), despite the originsof the AIDS crisisin
the domain of microbiology,the "greatestobstacles to establishinga cure for AIDS and a rational,
humane approach to its ravages do not flowfromthe organic qualities of the [virus]."
6. Allan M. Brandt,in No Magic Bullet:A Social HistoryofVenerealDisease in theUnitedStatessince
1880, New York, Oxford UniversityPress, 1987 (expanded version of 1985 edition), p. 199,
summarizes the ways in which AIDS thus far recapitulates the social historyof other sexually
transmitteddiseases: the pervasivefearof contagion,concernsabout casual transmission, stigmatiza-
tion of victims,conflictbetween the protectionof public health and the protectionof civil liberties,
increasingpublic control over definitionand management,and the search for a "magic bullet."
Despite the supposed sexual revolution,Brandt writes,we continue throughthese social construc-
tions"to definethe sexuallytransmitteddiseases as uniquelysinful."This definitionis inaccuratebut
pervasive,and as long as disease is equated withsin "there can be no magic bullet" (p. 202).
7. Latour and Woolgar, Laboratory Life,p. 281.
36 TREICHLER
the rule. Anythingwe may say, someone could come up with an

exception. But as far as most of the medical-scientificcommunityis
concerned,thisis a virusthat is actuallyverydiffcultto transmitand
thereforethe general public should really not worryabout casual
contact-not even usingthe same silverwareand disheswould proba-
bly be a problem.8
Would you buy a scientificfact from this man? Can we expect to understand
AIDS transmissionwhen thisis part of what we have to workwith?The point is
not merelythatthisparticularscientisthas not yetlearned to "talk to the media,"
but thatambiguityand uncertaintyare featuresof scientificinquirythatmustbe
socially and linguisticallymanaged.9 What is at issue here is a fatal infectious
disease thatis simplynot fullyunderstood;questionsremainabout the natureof
the disease, its etiology,its transmission,
and what individualscan do about it. It
does not seem unreasonable that in the face of these uncertaintiespeople give
birth to many differentconceptions; to label them "misconceptions"implies
what?Wrongfulbirth?That only "facts" can give birthto proper conceptions
and only science can give birthto facts?In that case, we may wish to avert our
eyes fromsome of the "scientific"conceptionsthathave been born in the course
of the AIDS crisis:
consideringwhathomosexualmen do to each
AIDS could be anything,
other in gay baths.
Heroin addicts won't use clean needles because theywould ratherget

AIDS than give up the ritual of sharingthem.
Prostitutesdo not routinelykeep themselvesclean and are therefore

"reservoirs"of disease.
8. Allan Sollinger,PhD, Departmentof Immunology,Universityof CincinnatiMedical Center,

speakingas an expert guest on a televisiondocumentary,Cincinnati,October 1985. By this time a
numberof leadingauthoritieson AIDS had come to believe thatscientistshad to begin communicat-
ing to the public with greater clarityand certainty.The Centers for Disease Control issued a
"definitivestatement"in October 1985 that AIDS cannotbe spread by casual contact. Mathilde
Krim, PhD, directorof the American Foundation for AIDS Research, discussed transmissionwith
emphaticclarityon the MacNeil-Lehrer Newshour,September 4, 1985: "AIDS is contagious strictly
throughthe transmissionof a virus which passes fromone person to another during sexual inter-
course or withcontaminatedblood. It is not contagiousat all throughcasual interactionwithpeople,
in normalsocial conditionssuch as livingin a household witha patientor meetingpatientson the bus
or in the workingplace or in school." Interestingly,as Deborah Jones Merritt'scomprehensive
review makes clear, constitutionalprecedents for addressing public health problems give broad
latitudeto the state;strongscientific"evidence" is essentiallynot required as a basis forinterventions
("Communicable Disease and ConstitutionalLaw: ControllingAIDS," New YorkUniversity Law Re-
view,no. 61 [November 1986], pp. 739-799).
9. Nathan Fain and Check discuss turningpoints in AIDS-related communicationsas scientists
gained skill in reducing ambiguity.See Nathan Fain, "AIDS: An Antidote to Fear," VillageVoice,
October 1, 1985, p. 35, and Check, "Public Education on AIDS."
AIDS is homosexual; it can only be transmittedby males to males.
AIDS in Africa is heterosexual but uni-directional;it can only be

transmittedfrommales to females.
AIDS in Africais heterosexualbecause anal intercourseis a common

formof birthcontrol.10
The point here is that no clear line can be drawn between the facticityof
scientificand nonscientific
(mis)conceptions.Ambiguity,homophobia,stereotyp-
ing, confusion,doublethink,them-versus-us, blame-the-victim,wishfulthinking:
none of thesepopular formsof semanticlegerdemainabout AIDS is absent from
biomedicalcommunication.But scientificand medical discourseshave traditions
throughwhichthe semanticepidemic as well as the biological one is controlled,
and these may disguise contradictionand irrationality.In writingabout AIDS,
these traditionstypicallyinclude characterizingambiguityand contradictionas
"nonscientific"(a no-nonsense,lets-get-the-facts-on-the-table-and-clear-up-this-
muddle approach), invokingfaithin scientificinquiry,taking for granted the
realityof quantitativeand/or biomedical data, deducing social and behavioral
realityfrom quantitativeand/or biomedical data, settingforthfantasiesand
speculationsas thoughtheywere logical deductions,usingtechnicaleuphemisms
for sensitivesexual or political realities,and revisingboth past and futureto
conformto presentthinking.
Many of these traditionsare illustratedin an articlebyJohnLangone in the
December 1985 general science journal Discover." In this lengthyreview of
researchto date, entitled"AIDS: The Latest ScientificFacts," Langone suggests
that the virusenters the bloodstreamby way of the "vulnerable anus" and the
"fragileurethra"; in contrast,the "rugged vagina" (built to be abused by such
blunt instrumentsas penises and small babies) provides too tough a barrierfor
the AIDS virus to penetrate.12"Contrary to what you've heard," Langone
concludes-and his conclusion echoes a fair amount of medical and scientific
writingat the time-"AIDS isn't a threat to the vast majorityof heterosex-
uals. .. . It is now-and is likelyto remain--largely the fatalprice one can pay
for anal intercourse."'s (This excerpt from the article also ran as the cover
10. These conceptionsand others are widespread. For specificcitationsand discussion,see, for
example, Leibowitch,A StrangeVirus;Langone, "AIDS: The Latest ScientificFacts"; Wayne Barrett,
"StraightShooters: AIDS Targets Another Lifestyle,"VillageVoice,October 26, 1985, pp. 14-18;
Lawrence K. Altman,"Linking AIDS to AfricaProvokesBitterDebate," New YorkTimes,November
21, 1985, pp. 1, 8.
11. Langone, "AIDS: The Latest ScientificFacts."
12. Ibid., pp. 40-41.
13. Ibid., p. 52.
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Medical illustrations
December1985.
An Epidemic of Signification 39
blurb.) It sounded plausible; and detailed illustrations demonstrated the article's

conclusion.14
But by December 1986 the big news- what the major US news magazines
were running cover stories on-was the grave danger of AIDS to heterosex-
uals.'5 No dramatic discoveries during the intervening year had changed the
fundamental scientific conception of AIDS.16 What had changed was not "the
facts" but the way in which they were now used to construct the AIDS text and
the meanings we were now allowed - indeed, at last encouraged - to read from
that text.17 The AIDS story, in other words, is not merely the familiar story of
14. Visual representationsof AIDS are not the subjectof thisessay,yetit is worthnotingthatthey
have been a source of continuingcontroversy.In Watneyand Gupta's textualand visual "dossier" on
the rhetoricof AIDS, one writercalls the magnifiedelectronmicrographof the HTLV-III virus"the
spectreof the decade" (Simon Watneyand Sunil Gupta, "The Rhetoricof AIDS: A Dossier Com-
piled by Simon Watney,withPhotographsby Sunil Gupta," Screen,vol. 27, no. 1 [January-February
1986], pp. 72-85). The cover of Time,August 12, 1985, also treatsa photographof the virusas
proof of its reality; "magnified 135,000 times," the virus is pictured "destroyingT-cell"-cf.
Roberta McGrath's analysis of the cultural and political role of photographyin naturalizingthe
biomedical model ("Medical Police," Ten, no. 8 [1984], p. 14). Some membersof the San Francisco
gay communitycomplained early that public health warningsused euphemisticlanguage ("avoid
exchange of bodilyfluids")and throughinnocuous picturessubvertedthe message thatAIDS was a
deadly and physicallyravaging disease (Frances FitzGerald, Citieson a Hill, New York, Simon &
Schuster/Touchstone,1987, p. 93. Firstpublished as "A Reporter at Large: The Castro-II," The
NewYorker, July28, 1986). On otheraspectsof media coverage of AIDS, see Becher, "AIDS and the
Media"; Black, ThePlaque Years;Check, "Public Education on AIDS"; Barbara O'Dair, "Anatomyof
a Media Epidemic," Alternative Media, vol. 14, no. 3 (Fall 1983), pp. 10-13; HarrySchwartz,"AIDS
in the Media," in Sciencein theStreets:
A ReporttotheTwentieth Century Task Forceon theCommunication
ofScientificRisk,New York, PriorityPress, 1984. Controversiesover graphicswere not limitedto
popular journals: a photo published in Sciencepurportingto be an isolated strainof Gallo's "AIDS
virus" figuredin the internationaldispute over its discovery(Robert C. Gallo, et al., "HTLV-III
Legend Correction," Letter to the Editor,Science,no. 232 [April 18, 1986], p. 307; Colin Norman,
"A New Twist in AIDS Patent Fight," News and Comment,Science,no. 232 [April 18, 1986], pp.
308- 309).
15. See, for example, Newsweek, November 3, 1986, pp. 66-67, and November 24, 1986, pp.
30-47; Erik Eckholm, "Broad Alert on AIDS: Social Battle Is Shifting,"New YorkTimes,June 17,
1986, pp. 19-20; Kathleen McAuliffe,et al. "AIDS: At the Dawn of Fear," US News and World
Report, January12, 1987, pp. 60-69; MortimerB. Zuckerman,"AIDS: A CrisisIgnored," Editorial,
US Newsand WorldReport, January12, 1987, p. 76; Katie Leishman, "Heterosexuals and AIDS: The
Second Stage of the Epidemic," TheAtlantic,February1987, pp. 39- 58; "Science and the Citizen,"
American,
Scientific January1987, pp. 58-59.
16. The 2nd InternationalConferenceon AIDS, held in Paris in June 1986, revealed no major
scientificbreakthroughs(Deborah M. Barnes, "AIDS Research in New Phase," Science,no. 233 [July
18, 1986], p. 282); rather,answersto severalcrucialquestionswere clarifiedor strengthened.Check
notes that,as healthand science reportingon AIDS has evolved, "articlesabout the spread of AIDS
to the so-calledgeneral public do not have to be pegged to any specificnew data" ("Public Education
on AIDS," p. 31).
17. The Paris conferencewas one of several fact-poolingand consensus-buildingevents in 1986
that influencednew readings of existingevidence. Also influentialwere the US SurgeonGeneral's
Reporton AcquiredImmuneDeficiency Syndrome, Washington,D.C., Public Health Service, 1986, which
advocated intensifiedsex education in the schools; an investigationby the National Instituteof
Medicineand the National Academyof Sciences (David Baltimoreand Sheldon M. Wolff,Confronting
AIDS: Directionsfor Public Health,Health Care, and Research,Washington,D.C., National Academy
Press, 1986), which emphasized the dangers of heterosexual transmission;and a World Health
40 TREICHLER
heroic scientificdiscovery.And untilwe understandAIDS as both a materialand

a linguisticreality-a dualityinherentin all linguisticentitiesbut extraordinarily
exaggerated and potentiallydeadly in the case of AIDS-we cannot begin to
read the storyof this illnessaccuratelyor formulateintelligentinterventions.
Intelligentinterventionsfromoutsidebiomedicalsciencehave helped shape
the discourseon AIDS. Almostfromthe beginning,membersof the gay commu-
nity,throughintense interestand informedpolitical activism,have repeatedly
contestedthe terminology,meanings,and interpretations produced by scientific
inquiry. Such contestations had occurred a decade earlier in the struggleover
whetherhomosexualitywas to be officially classifiedas an illnessby the American
PsychiatricAssociation.'8 Gay men and lesbians in the succeeding period had
achieved considerable success in political organizing. AIDS, then, firststruck
membersof a relativelyseasoned and politicallysophisticatedcommunity.The
importanceof not relinquishingauthorityto medicine was articulatedearly in
the AIDS crisisby Michael Lynch:
Anothercrisisexistswiththe medicalone. It has gone largelyunexam-
ined, even by the gay press. Like helplessmice we have peremptorily,
almostinexplicably,relinquishedthe one power we so long foughtfor
in constructingour modern gay community:the power to determine
our own identity.And to whom have we relinquishedit? The very
authoritywe wrestedit fromin a strugglethat occupied us for more
than a hundred years: the medical profession.19
To challenge biomedical authority-whose meaningsare part of powerfuland
deeply entrenchedsocial and historicalcodes- has required considerabletenac-
ity and courage from people dependent in the AIDS crisis upon science and
medicine for protection,care, and the possibilityof cure. These contestations
provide the model fora broader social analysis,whichmovesaway fromAIDS as
a "life-style"issue and examinesitssignificanceforthiscountry,at thistime,with
the culturaland materialresourcesavailable to us. This, in turn,requires us to
acknowledge and examine the multipleways in which our social constructions
guide our visionsof materialreality.
Organization conferencethat concluded that AIDS must now be considered a pandemic of cata-
strophicproportions.(An epidemic disease is prevalentwithina specificcommunity,geographical
area, or populationat a particulartime,usuallyoriginatingelsewhere;a pandemic disease is present
over the whole of a country,a continent,or the world.) See also "AIDS: Public Health and Civil
Liberties," HastingsCenterReport,Special Supplement, vol. 16, no. 6 (December 1986); "AIDS:
vol. 2, no. 2 (Winter 1986), pp.
Science, Ethics, Policy," Forum, Issues in Scienceand Technology,
39-73.
18. See Ronald Bayer,Homosexuality and AmericanPsychiatry:The PoliticsofDiagnosis,New York,
Basic Books, 1981.
19. Michael Lynch, "Living withKaposi's," BodyPolitic,no. 88 (November 1982).
42) TREICHLER
AIDS and Homophobia:

the
Constructing TextoftheGay Male Body
Whatever else it may be, AIDS is a story,or multiplestories,read to a
surprisingextentfroma textthatdoes not exist: the body of the male homosex-
ual. It is a textpeople so want- need - to read thattheyhave gone so faras to
write it themselves.AIDS is a nexus where multiple meanings, stories, and
discoursesintersectand overlap,reinforce,and subvertone another. Yet clearly
thismysteriousmale homosexual text has figuredcentrallyin generatingwhat I
call here an epidemicof signification.Of course "the virus,"withmysteriesof its
own, has been a crucial influence.But we may recall Camus's novel: "The word
'plague' . . . conjured up in the doctor's mind not only what science chose to
put into it,but a whole seriesof fantasticpossibilitiesutterlyout of keeping" with
the bourgeois town of Oran, where the plague struck.20How could a disease so
extraordinaryas plague happen in a place so ordinaryand dull? AIDS, initially
strikingpeople perceived as alien and exotic by scientists,physicians, journalists,
and much of the US population, did not pose such a paradox. The "promiscu-
ous" gay male body-early reportsnoted thatAIDS "victims"reportedhaving
had as manyas 1,000 sexual partners-made clear thateven ifAIDS turnedout
to be a sexually transmitteddisease it would not be a commonplace one. The
connectionsbetween sex, death, and homosexualitymade the AIDS storyinevi-
tably,as David Black notes, able to be read as "the storyof a metaphor."21
20. Albert Camus, The Plague, trans. Stuart Gilbert, New York, Modern Library, 1948 (first
published Paris, Gallimard, 1947).
21. "I realized . . . that any account of AIDS was not just a medical storyand notjust a story
about the gay community,but also a storyabout the straightcommunity'sreaction to the disease.
More than that:it's a storyabout how the straightcommunityhas used and is using AIDS as a mask
forits feelingsabout gayness.It is a storyabout the ramifications of a metaphor" (Black, The Plague
Years,p. 30). AIDS is typicallycharacterizedas a "story,"but whose?For AIDS as a storyof scientific
progress,see Gallo, "The AIDS Virus"; Arnold Relman, "Introduction," HastingsCenterReport,
Special Supplement,vol. 15, no. 4 (August 1985), p. 1; Eve K. Nichols,MobilizingAgainstAIDS: The
Unfinished Storyofa Virus(Conferenceof the Instituteof Medicine/National Academy of Sciences),
Cambridge, Massachusetts,Harvard UniversityPress, 1986; Jonathan Lieberson, "Anatomy of an
Epidemic," New YorkReviewofBooks,August 18, 1983, pp. 17-22. But for Lynch ("Living with
Kaposi's"), Goldstein("Heartsick"), FitzGerald(Citieson a Hill), Larry Kramer ("1,112 and Count-
ing," NewYorkNative,March 1983, pp. 14-27), D. W. McLeod and Alan V. Miller("Medical, Social,
and Political Aspects of the AIDS Case: A Bibliography,"Canadian Gay Archives,no. 10), Thom
Gunn (Lament,Champaign, Illinois, Doe Press, 1985), Steve Ault ("AIDS: The Facts of Life,"
Guardian, March 26, 1986, pp. 1, 8), Dennis Altman (AIDS in theMind of America,New York,
Doubleday, 1986), the San Francisco A.I.D.S. Show-ArtistsInvolvedwithDeath and Survival(docu-
mentaryvideo produced by Peter Adair and Rob Epstein,directedby Leland Moss; based on theater
productionat Theatre Rhinoceros,San Francisco;aired on PBS, November 1986), and others,AIDS
is the storyof crisisand heroismin the gay community.In the tabloids,AIDS has become the storyof
Rock Hudson (ROCK IS DEAD, ran the headlines in the [London] Sun on October 3, 1985, THE
HUJNKWHO LIVED A LIE), Liberace, and otherindividuals.A documentaryfilmabout the Fabian
Bridges case, a young man with AIDS in Houston, is called Fabian's Story(see J. Ostrow, "AIDS
DocumentaryAddresses Agonizing Issues," DenverPost,March 24, 1986). For GeoffMains (Urban
Aboriginals:A CelebrationofLeathersexuality, San Francisco,Gay Sunshine Press, 1985), AIDS inter-
Ironically,a major turningpoint in US consciousness came when Rock

Hudson acknowledgedthathe was being treatedforAIDS. Through an extraor-
dinaryconflationof texts,the Rock Hudson case dramatizedthe possibilitythat
the disease could spread to the "general population."22In factthispossibilityhad
ruptsthe adventurestoryof leathersex, a "unique and valuable culturalexcursion" (p. 178). And in
Thom Gunn's poem, Lament,AIDS is a storyof change and the death of friends.The storieswe tell
help us determine what our own place in the story is to be. FitzGerald writes that the "new
mythology"about AIDS in the San Francisco gay community-that many gay men are changing
theirlives for the better-was "an antidote to the notion that AIDS was a punishment-a notion
that . . . lay so deep as to be unavailable to reason. And it helped people act against the threatof
AIDS" (Citieson a Hill, p. 116). But for Richard Mohr ("Of Deathbeds and Quarantines: AIDS
Funding,Gay Life and State Coercion," Raritan,vol. 6, no. 1 [Summer 1986], pp. 38-62), thisnew
mythology-in which the loving relationshipreplaces anonymoussex-is a dangerous one: "The
relationtypicallyis asked to bear more than is reasonable. The burden on the simpledyad is further
weighed down by the myth,both romanticand religious,thatone findsone's completionin a single
other.White knightsand messiahsnever come in clusters"(p. 56). For discussionof AIDS as a public
drama, see "AIDS: Public Health and Civil Liberties"; Ronald Bayer,"AIDS: The Public Contextof
an Epidemic," MillbankQuarterly,no. 64, Supplement 1, pp. 168-182; and McLeod and Miller,
"Medical, Social, and Political Aspects."
22. Articulatevoices had taken issue withthe CDC positionfromthe beginning,warningagainst
the public health consequences of treatingAIDS as a "gay disease" and separating"those at risk"
fromthe so-called"general population." See, forexample, commentsby Gary MacDonald, executive
directorof an AIDS action organizationin Washington:"I thinkthe momentmay have arrived to
desexualize the disease. AIDS is not a 'gay disease,' despite its epidemiology. . . . AIDS is not
transmittedbecause of who you are, but because of what you do. . . . By concentratingon gay and
bisexual men, people are able to ignore the fact that this disease has been present in what has
charminglycome to be called 'the general population'fromthebeginning. It was not spread fromone
of the other groups. It was there("AIDS: What Is to Be Done?" Forum,Harper'sMagazine,October
1985, p. 43).
One can extrapolatefromRuth Bleier's observationthatquestionsshape answers(Scienceand
Gender,London, Pergamon, 1986, p. 4), and suggest that the question "Why are all people with
AIDS sexuallyactive homosexual males?" mightmore appropriatelyhave been "Are all people with
AIDS sexually active homosexual males?" It is widelybelieved (not withoutevidence) that federal
fundingforAIDS researchwas long in comingbecause itschiefvictimswere gay or otherwisesocially
undesirable.Black describesa researcherwho made jokes aboutfagocytes (phagocytes),cells designed
"to killofffags" (The Plague Years,pp. 81-82). Secretaryof Health and Human Services Margaret
Heckler was onlyone of manyofficialswho expressed concern not about existingpeople withAIDS
but about the potentialspread of AIDS to "the communityat large" (withthe resultthatHeckler was
called "the Secretaryof Health and Heterosexual Services" by some gay activists;see "AIDS: What
Is to Be Done?" p. 51).
There is evidence thatthe "gay disease" mythinterfereswithdiagnosisand treatment.Many
believe that AIDS may be underdetectedand underreportedin part because people outside the
"classic" high-riskgroups are oftennot asked the rightquestions(physicianstypicallytake longer to
diagnose AIDS in women, forexample). Health professionalsand AIDS counselorssometimesavoid
the word gaybecause formanypeople thisimpliesan identityor life-style; even bisexualmay mean a
life-style.Although "homosexuallyactive" is officiallydefined as includingeven a single same-sex
sexual contactover the past fiveyears,manywho have had such contactdo not identifythemselvesas
"homosexual" and thereforeas being at risk for AIDS. Nancy Shaw ("California Models for
Women's AIDS Education and Services," report,San FranciscoAIDS Foundation [333 Valencia St.,
4th Floor, San Francisco,CA 94103], and "Women and AIDS: Theory and Politics,"presentedat
the annual meeting of the National Women's Studies Association, Universityof Illinois, Urbana,
June 1986) suggests that for women as well the homosexual/heterosexualdichotomyconfuses
diagnosisand treatmentas well as the perceptionof risk.Pally ("AIDS and the Politicsof Despair"),
44 TREICHLER
been evident for some time to anyone who wished to find it: as Jean Marx
summarized the evidence in Sciencein 1984, "Sexual intercourseboth of the
heterosexual and homosexual varietiesis a major pathwayof transmission."23
But only in late 1986 (and somewhat reluctantlyat that) did the Centers for
Disease Control expand upon their early "4-H list" of high-riskcategories:
HOMOSEXUALS, HEMOPHILIACS, HEROIN ADDICTS, and HAITIANS, and the sexual
partnersof people withinthese groups.24The original list, developed during
1981 and 1982, has structuredevidence collectionin the interveningyearsand
contributedto a view that the major risk factorin acquiring AIDS is being a
particular kind of person rather than doing particular things.25Ann Giudici
Fettnerpointed out in 1985 that "the CDC admits that at least 10 percent of
AIDS sufferers are gay and use IV drugs. Yet theyare automaticallycounted in
the homosexual and bisexual men category,regardlessof what mightbe known
--or not known-about how theybecame infected."26So the "gay" nature of
AIDS was in partan artifactof the wayin whichdata was collectedand reported.
Though almost fromthe beginningscientificpapers have cited AIDS cases that
appeared to falloutside the high-riskgroups,it has been generallyhypothesized
that these cases, assigned to the categoriesof UNKNOWN, UNCLASSIFIED, or OTHER,
Marea Murray("Too LittleAIDS Coverage," Letter to the Editors,Sojourner, July1985, p. 3), and
CindyPatton("FeministsHave Avoided the Issue of AIDS," Sojourner,October 1985, pp. 19-20) all
argue thatAIDS is a "women's issue" and should receivemore attentionin feministpublications(and
see COYOTE, Background Paper, 1985 COYOTE Convention Summary,May 30-June 2, 1985,
San Francisco; Ellen Switzer,"AIDS: What Women Can Do," Vogue,January1986, pp. 222-223,
264-265; Jane Sprague Zones, "AIDS: What Women Need to Know," The [National Women's
Health] Network News,vol. 11, no. 6 [November-December 1986], pp. 1, 3). The persistenceand
consequences of the perceptionthatAIDS is a disease of gay men and IV drug usersare documented
in a numberof recentpublications,notablyLeishman, "Heterosexuals and AIDS." CDC interviews
withmembersof two heterosexualsinglesclubs in Minneapolisdocumented thatas of late 1986 this
already infectedpopulation had made virtuallyno modificationsin theirsexual practices("Positive
HTLV-III/LAV AntibodyResultsfor Sexually Active Female Members of Social/Sexual Clubs-
Minnesota," Morbidity and MortalityWeeklyReport,no. 35 [1986], pp. 697-699). Ralph J. DiCle-
mente,JimZorn,and Lydia Temoshok ("Adolescents and AIDS: A Surveyof Knowledge,Attitudes,
and Beliefsabout AIDS in San Francisco,"American JournalofPublicHealth,vol. 76, no. 12 [1986],
pp. 1443-1445) found that manyadolescents in San Francisco,a citywhere public health informa-
tion about AIDS has been extensive,were not well informedabout the seriousnessof the disease, its
causes, or preventive measures.
23. Jean L. Marx, "Strong New Candidate for AIDS Agent," Research News, Science,May 4,
1984, p. 147.
24. Centers for Disease Control, "Update: Acquired ImmunodeficiencySyndrome-United
States," Morbidityand Mortality
Weekly Report,no. 35 (1986), pp. 757-760, 765-766.
25. JeffMinson, "The Assertion of Homosexuality," m/f nos. 5-6 (1981), pp. 19-39, and
JeffreyWeeks, Sexualityand Its Discontents:Meanings, Myths,and Modern Sexualities,London,
Routledge & Kegan Paul, 1985, analyze the evolutionof homosexualityas a coherentidentity.Bayer,
Homosexuality and AmericanPsychiatry,
and Ronald Bayer and Robert L. Spitzer,"Edited Correspon-
dence on the Statusof Homosexualityin DSM-III," JournaloftheHistory oftheBehavioralSciences,no.
18 (1982), pp. 32-52, document the intenseand acrimonious "contests for meaning" during the
American PsychiatricAssociation's 1970s debates over the officialclassificationof homosexuality.
26. Fettner,in "AIDS: What Is to Be Done?" p. 43.
would ultimatelyturn out to be one of the four H's.27 This commitmentto

categories based on stereotypedidentityfiltersout information.Nancy Shaw
argues that when women are asked in CDC protocols "Are you heterosexual?"
"this loses the diversityof behaviors that may have a bearing on infection."28
Even now, with established evidence that transmissioncan be heterosexual
(which begins with the letterH afterall), scientificdiscourse continues to con-
struct women as "inefficient" and "incompetent" transmitters of HIV, passive
receptacleswithoutthe projectilecapacityof a penis or syringe-stolid, uninter-
estingbarriersthatimpede the unrestrainedpassage of the virusfrombrotherto
brother.29Exceptionsinclude prostitutes,whose discursivelegacy-despite their
longstandingprofessionalknowledgeand continuedactivismabout AIDS-is to
be seen as so contaminatedthat theirbodies are virtuallaboratoryculturesfor
viral replication.30Other exceptions are Africanwomen, whose exotic bodies,
27. See Nichols,MobilizingAgainstAIDS, and Associated Press,"571 AIDS Cases Tied to Hetero-
sexual Causes," Champaign-Urbana News-Gazette,December 12, 1986, p. A-7, on the reclassification
in 1986 of the CDC's 571 previously"unexplained cases"; formerlyclassifiedas "none of the above"
(i.e., outside the knownhigh-riskcategories),some of these cases were reclassifiedas heterosexually
transmitted.
28. Shaw, "Women and AIDS."
29. Even after consensus in 1984 that AIDS was caused by a virus, there continued to be
conflictingviews on transmissionand differentexplanations for the epidemiological findingthat
AIDS and HIV infectionin the US were appearing predominantlyin gay males. One view holds that
thisis essentiallyan artifact("simple mathematics")created because the virus(for whateverreason)
infectedgay men firstand gay men tend to have sex witheach other.The second is thatbiomedical/
physiologicalfactorsmake gay men and/or the "passive receiver" more infectable.A thirdview is
thatthe viruscan be transmittedto anyone but that certain cofactorsfacilitatethe developmentof
infectionand/or clinical symptoms.For more information,see Leibowitch, A StrangeVirus,pp.
72-73, Leishman, "Heterosexuals and AIDS," and Mathilde Krim, "AIDS: The Challenge to
Science and Medicine," in AIDS: The EmergingEthicalDilemmas:A HastingsCenterReport,Special
Supplement, vol. 15, no. 4 (August 1985), p. 4. Many scientistssuggest that, whatever sex the
partnersmay be, infection,as Fain ("AIDS: An Antidote to Fear") put it, "requires a jolt injected
into the bloodstream,likelyseveraljolts over time, such as would occur with infectedneedles or
semen. In both cases, needle and penis are the instrumentsof contagion." Women, having no
penises, are therefore"inefficient"transmitters.For more detailed discussion, see my essay on
womenand AIDS, forthcoming in AIDS: TheBurdensofHistory, ed. Elizabeth Fee and Daniel M. Fox,
Berkeley,Universityof CaliforniaPress.
Evidence of heterosexualtransmissionwas at firstexplained away. When R. R. Redfield,etal.
("HeterosexuallyAcquired HTLV-III/LAV Disease [AIDS-Related Complex and AIDS]: Epidemio-
logical Evidence for Female-to-MaleTransmission,"JournaloftheAmericanMedical Association, no.
254 [1985], pp. 2094- 2096; "Female-to-MaleTransmissionof HTLV-III," JournaloftheAmerican
Medical Association,no. 255 [1986], pp. 1705-1706) identifiedinfectionin US servicemen who
claimed sexual contactonly withfemaleprostitutes,some hypothesized"quasi-homosexualcontact"
or called the data into question on the groundsthatservicemenwould be likelyto withholdinforma-
tion about homosexualityor drug use (some evidence for this is offeredbyJohnJ. Potterat,et al.,
"Lying to MilitaryPhysiciansabout Risk Factors for HIV Infections," Letter to Journal of the
AmericanMedicalAssociation, vol. 257, no. 13 [April 3, 1987], p. 1727). For discussionof the relation
of transmissionto funding,see Barnes, "AIDS Research in New Phase," p. 283, and "AIDS Funding
Boost Requested," Daily Illini, September 27, 1985, p. 7.
30. Brandt,No Magic Bullet,and JudithWalkowitz,Prostitution and Victorian Women,Class,
Society:
and theState,New York, Cambridge UniversityPress, 1983, review the longstandingequation of
416 TREICHLER
sexual practices,or who knows what are seen to be so radicallydifferentfrom

those of women in the US thatanythingcan happen in them.31The termexotic,
sometimesused to describe a virusthatappears to have originated"elsewhere"
(but "elsewhere," like "other" is not a fixed category),is an importanttheme
runningthroughAIDS literature.32 The factthatone of the more extensiveand
visuallyelegant analyses of AIDS appeared recentlyin National Geographicis
perhaps further evidence of its life on an idealized "exotic" terrain.33
The early hypothesesabout AIDS, when the firstcases appeared in New
York, Los Angeles, and Paris, were sociological, relatingit directlyto the sup-
posed "gay male life-style."In February1982, forexample, it was thoughtthata
particularsupplyof amyl nitrate(poppers) mightbe contaminated."The pop-
pers fable," writesJacques Leibowitch,becomes
a Grimmfairytale when the firstcases of AIDS-without-poppersare
discoveredamong homosexualsabsolutelyrepelled by the smellof the
product and among heterosexuals unfamiliarwith even the words
amylnitrateor poppers.But, as willbe habitual in the historyof AIDS,
rumors last longer than either common sense or the facts would
warrant. The odor of AIDS-poppers will hover in the air a long
time-long enough for dozens of mice in the Atlanta epidemiology
labs to be kept in restrictedcages on an obligatorysniffeddiet of
poppers 8 to 12 hours a day for several months,until,nauseated but
still healthy,withouta trace of AIDS, the wretched rodents were
released- provisionally - upon the announcementof a new hypoth-
esis: promiscuity.34
This new perspectivegeneratednumerouspossibilities.One was thatsperm
prostituteswithdisease, and the conceptual separationof infectedprostitutes(and other voluntarily

sexually active women) from "innocent victims"(see also COYOTE, "Background Paper"; Shaw,
"Women and AIDS"; Colin Douglas, The Intern'sTale, New York, Grove, 1975, repr. 1982; Erik
Ec]kholm,"Prostitutes'Impact on Spread of AIDS Debated," NewYorkTimes,November 5, 1985, pp.
15, 18; and Nancy Shaw and Lyn Paleo, "Women and AIDS," in WhattoDo aboutAIDS, ed. Leon
McKusick, Berkeley,Universityof CaliforniaPress, 1986, pp. 142-154).
31 Discussionsof AIDS and heterosexualtransmissionin Africainclude Lieberson, "The Reality
of AIDS"; Treichler,forthcomingin AIDS: The BurdensofHistory;Cindy Patton,Sex and Germs:The
PoliticsofAIDS, Boston,South End Press, 1985; June E. Osborn, "The AIDS Epidemic: An Overview
vol. 2, no. 2 (Winter 1986), pp. 40- 55;Jean L. Marx,
of the Science," Issuesin Scienceand Technology,
"New Relativesof AIDS Virus Found," Research News, Science,no. 232 (April 11, 1986), p. 157;
Fran P. Hosken, "Why AIDS PatternIs Differentin Africa,"Letterto theNew YorkTimes,December
15, 1986; Douglas A. Feldman, "Role of AfricanMutilationsin AIDS Discounted," Letter to the
New YorkTimes,January 7, 1987; Lawrence K. Altman, "Heterosexuals and AIDS: New Data
Examined," New YorkTimes,January22, 1985, pp. 19-20; and "New Human Retroviruses:One
Causes AIDS . . . and the Other Does Not," Nature,no. 320 (April 3, 1986), p. 385.
32. Leibowitch,A StrangeVirus,p. 73.
33. PeterJaret,"Our Immune System:The Wars Within,"National Geographic, June 1986, pp.
702-735.
itselfcould destroythe immunesystem."God's plan forman," afterall, "was for

Adam and Eve and not Adam and Steve."35Women, the "natural" receptacles
formale sperm,have evolved over the millenniaso thattheirbodies can deal with
these foreigninvaders; men, not thus blessed by nature, become vulnerable to
the "killer sperm" of other men. AIDS in the lay press became known as the
"toxic cock syndrome."36 While scientists and physicians tended initially to de-
fineAIDS as a gay sociologicalproblem,gay men, forotherreasons,also tended
to reject the possibilitythat AIDS was a new contagiousdisease. Not only could
thismake themsexual lepers,it didn't make sense: "How could a disease pickout
just gays?That had to be medical homophobia."37Importantto note here is a
profound ambivalence about the origins of illness. Does one preferan illness
caused by who one is and thereforeperhapspreventable,curable, or containable
through"self-control"-or an illnesscaused by some external "disease" which
has a respectable medical name and can be addressed strictlyas a medical
problem, beyond individual control?The townspeople of Oran in The Plague
experience reliefwhen the plague bacillus is identified:the odd happenings-
the dyingrats, the mysterioushuman illnesses-are caused by somethingthat
has originatedelsewhere,somethingexternal,something"objective," something
medicine can name, even if not cure. The tension between self and not-self
becomes importantas we tryto understandthe particularrole of virusesand
origin storiesin AIDS.
But thisanticipatesthe next chapter in the AIDS story.Another favored
possibilityin the early 1980s (stillnot universallydiscarded,for it is plausible so
long as the cases of AIDS among monogamoushomebodies are ignored)was the
notionof "cofactors": no singleinfectiousagent causes the disease; rather,some-
one who is sexuallyactive withmultiplepartnersis exposed to a kind of bacte-
rial/viraltidal wave thatcan crushthe immunesystem.38 Gay men on the sexual
35. Congressman WilliamDannemeyer, October1985,duringa debateon a homosexualrights

bill(quotedin Langone,"AIDS: The LatestScientific
Facts,"p. 29).
36. Black, The Plague Years,p. 29.
37. Ibid.,p. 40. In thegaycommunity, thefirstreactiontoAIDS wasdisbelief. FitzGerald quotesa
gayphysician in San Francisco:"A diseasethatkilledonlygaywhitemen?It seemedunbelievable. I
usedto teachepidemiology, and I had neverheardofa diseasethatselective.I thought, Theyare
makingthisup. It can'tbe true.Or ifthereis sucha diseaseitmustbe theworkofsomegovernment
agency-the F.B.I. or theC.I.A.-trying to killusall" (Cities
ona Hill,p. 98). In theSan Francisco
A.I.D.S.Show,one manis saidto havelearnedofhisdiagnosisandat oncewiredtheCIA: "I HAVE
AIDS. DO YOU HAVE AN ANTIDOTE?"
38. See Lieberson,"The RealityofAIDS," p. 43, foran exampleoftheviewthat,althoughthe
virusisthe"sinequa non"forAIDS, thesyndrome actuallydevelops"chiefly inthosewhoseimmune
systems are alreadyweakor defective." Forbroaderdiscussion ofpublichealthissuesin relationto
scientific
uncertaintiesandquestions see RonaldBayer,"AIDS andtheGayCommu-
ofcivilliberties,
nity:BetweentheSpecterand the Promiseof Medicine,"SocialResearch, vol. 52, no. 3 (Autumn
1985),pp. 581-606; MervynF. Silverman and DeborahB. Silverman, "AIDS and theThreatto
PublicHealth,"Hastings Center
Report, SpecialSupplement, vol. 15,no. 4 (August1985),pp. 19-22;
andGeneW. Matthews andVerlaS. Neslund,"The InitialImpactofAIDS on PublicHealthLaw in
48 TREICHLER
"fast-track"would be particularlysusceptiblebecause of the prevalence of spe-

cificpracticesthatwould maximizeexposure to pathogenicmicrobes.What were
considered potentiallyrelevantdata came to be routinelyincluded in scientific
papers and presentations,withthe resultthat the terminologyof these reports
was increasinglyscrutinizedby gay activists.39 Examples fromSciencefromJune
1981 throughDecember 1985 include "homosexual and bisexual men who are
extremelyactive sexually," "admitted homosexuals," "homosexual males with
multiplepartners,""homosexual men withmultiplepartners,""highlysexually
active homosexual men," and "promiscuous" versus "nonpromiscuous" homo-
sexual males.40Also documented (examples are also fromthe Sciencecollection)
are exotic travelsor practices: "a Caucasian who had visited Haiti," "persons
born in Haiti," "a favoritevacation spot for US homosexuals," rectal insemina-
tion, "bisexual men," "increased frequencyof use of nitriteinhalants," and
"receptiveanal intercourse."41
Out of this dense discursivejungle came the "fragile anus" hypothesis
(tested by Richards and his colleagues, who rectally inseminated laboratory
rabbits) as well as the vision of "multiple partners."42Even after sociological
explanations for AIDS gave way to biomedical ones involvinga transmissible
virus,these various images of AIDS as a "gay disease" proved too alluring to
abandon. It is easy to see both the scientific
and thepopular appeal of the "fragile
anus" hypothesis:scientifically, it confinesthe public healthdimensionsof AIDS
to an infected population in the millons-merely mind-boggling,that is-
the United States- 1986," JournaloftheAmericanMedical Association, vol. 257, no. 3 (January16,
1987), pp. 344-352.
39. L. Altman,"Heterosexuals and AIDS," and Black, ThePlague Years,discusschanges in specific
terminologyas a resultof gays' objections; "sexuallypromiscuous"generallyshifted,forexample, to
"sexuallyactive" or "contact withmultiplesex partners." A new classificationsystemfor AIDS and
AIDS/HIV-related symptoms(adopted at the 2nd InternationalAIDS Conference in Paris,June
1986) is based on the diverse clinical manifestationsof the syndromeand its documented natural
history;it avoids presumptiveterminologylike "pre-AIDS." J. Z. Grover's usefulreviewof Nichols's
MobilizingAgainstAIDS ("The 'Scientific'Regime of Truth," In These Times,December 10-16,
1986, pp. 18-19) pointsout a number of problematictermsand assumptionsthatoccur repeatedly
in thisbook and other scientificwritingon AIDS: (1) the termAIDS victimpresupposeshelplessness
(the termpersonwithAIDS or PWA was created to avoid this),preventionand cure are linkedwitha
conservativeagenda of "individual responsibility,"sex with multiplepartnersand/or strangersis
equated with "promiscuity,"and "safe" sexual practicesare conflatedwiththe culturalpracticeof
monogamy;(2) it differentiates "caregivers" from"victims,"scientific/medicalexpertisefromother
kindsof knowledge,and "those at risk" from"the restof us"; and (3) it notes but failsto challenge
existinginequitiesin the health-caresystem.Julie Dobrow, "The Symbolismof AIDS: Perspectives
on the Use of Language in the Popular Press," presented at the InternationalCommunication
Association annual meeting, Chicago, May 1986, notes the dramatic and commercial appeal of
common "cultural images" in popular press scenariosof AIDS.
40. Terms are quoted fromthe collectionAIDS: PapersfromScience1982-1985, ed. Ruth Kulstad,
Washington,D.C., AmericanAssociationforthe Advancementof Science, 1986, pp. 22, 40, 49, 65,
142, and 160, respectively.
41. Ibid., pp. 47, 130, 73, 142-146, 130, 611, 611, respectively.
42. Ibid., pp. 142-146.
enabling us to stop short of the impossible,the unthinkablebillions that wide-

spread heterosexual transmissionmight infect.Another appeal of thinkingof
AIDS as a "gay disease" is that it protects not only the sexual practices of
heterosexualitybut also its ideological superiority.In the serviceof thishypoth-
esis,both homophobiaand sexismare folded imperturbably into the language of
the scientifictext. Women, as I noted above, are characterizedin the scholarly
literatureas "inefficient"transmittersof AIDS; Leibowitchrefersto the "refrac-
toryimpermeabilityof the vaginal mucous membrane."43A studyof German
prostitutesthat appeared to demonstratefemale-to-maletransmissionof AIDS,
reportedin theJournaloftheAmericanMedicalAssociation, was interpretedby one
reader as actually representing"quasi-homosexual" transmission:Man A, in-
fectedwithHIV, has vaginal intercoursewithProstitute;she, "[performing]no
more than perfunctoryexternal cleansing between customers,"then has inter-
course withMan B; Man B is infectedwiththe virusvia the semen of Man A.44
The prostitute'svagina thus functionsmerelyas a reservoir,a passive holding
tank for semen that becomes infectiousonly when another penis is dipped into
it-like a swamp where mosquitoes come to breed.
But the conceptionand the conclusionare inaccurate.It is not monogamy
or abstentionper se that protectsone from AIDS infectionbut practicesand
protectionsthat prevent the virus from enteringone's bloodstream. Evidence
suggeststhat prostitutesare at greater risknot because they have multiplesex
partners,but because some of them use intravenousdrugs; at this point "they
may be betterprotectedthan the typicalwoman who is just going to a bar or a
woman who thinksof herselfas not sexuallyactive but who 'just happens to have
this relationship.'They may be more aware than women who are involved in
serial monogamyor those whose self-imageis 'I'm not at riskso I'm not going to
learn more about it.' 45 Indeed, COYOTE and other organizationsof prosti-
tutes have addressed the issue of AIDS ratheraggressivelyfor several years.46

44. Data on female-to-maletransmissionpresentedat the 1985 InternationalConferenceon AIDS
in Atlantaare summarizedby Marsha F. Goldsmith,"More Heterosexual Spread of HTLV-III Virus
Seen," JournaloftheAmericanMedical Association,no. 253 (1985), pp. 3377-3379. The hypothesis
that such data reflect "quasi-homosexual contact" is suggested by Harold Sanford Kant, "The
Transmissionof HTLV-III," Letterto the Editor,JournaloftheAmericanMedicalAssociation, no. 254
(1985), p. 1901.
45. Shaw and Paleo, "Women and AIDS," p. 144.
46. Kant's hypothesisinJAMAis quoted by Langone, "AIDS: The Latest ScientificFacts," p. 49,
to support his own "vulnerable anus" hypothesis:"It is not unlikelythat these prostituteshad
multiple partners during a very short time, and performedno more than perfunctoryexternal
cleansing between customers." Langone does not note that the source is a Letter to the Editor.
Meanwhile,reportsfromprostitutesin many countries,summarizedin the June 1986 WorldWide
Whores'News(publishedby the InternationalCommitteefor Prostitutes'Rights),indicatefamiliarity
withAIDS as well as concern withobtainingbetterprotectionfrominfectionand betterhealthcare.
See also COYOTE, "Background Paper."
50 TREICHLER
Donald Mager discusses the proliferationamong heterosexualsof visions

about homosexualityand theirstatusas fantasy:
Institutionsof privilege and power disenfranchiselesbians and gay
men because of stereotypic negative categorizations of them-
stereotypeswhich engage a societal fantasyof the illicit,the subver-
sive,and the taboo, particularlydue to assumptionsof radical sex role
parodies and inversions.This fantasyin turnbecomes both the object
of fear and of obsessed fascination,while its statusas fantasyis never
acknowledged; instead,the realityit pretendsto signifybecomes the
justificationof suppression both of the fantasyitselfand of those
actual persons who would seem to embody it. Homophobia as a cri-
tique of societalsexual fantasy,in turn,enforcesitsprimarylocationas
a gay discourse,separate and outside the site of the fantasywhich is
normativemale heterosexuality.47
Leibowitchcommentsas followson AIDS, fantasy,and "the realityit pretendsto

signify":
When theycome to writethe historyof AIDS, socio-ethnologistswill
have to decide whetherthe "practitioners"of homosexualityor its
heterosexual "onlookers" have been the more spectacular in their
extravagance.The homosexual "life style"is so blatantlyon displayto
the general public, so closelyscrutinized,thatit is likelywe never will
have been informedwithsuch technicophantasmalcomplacencyas to
how "other people" live their lives.48
It was widelybelieved in the gay communitythatthe connectionof AIDS to
homosexualitydelayed and problematizedvirtuallyeveryaspect of the country's
response to the crisis. That the response was delayed and problematic is the
conclusion of various investigators.49Attemptingto assess the degree to which
prejudice, fear, ignorance homosexualitymay have affectedpublic policy
or of
and researchefforts,Panem concluded thathomosexualityper se would not have
deterred scientistsfrom selectinginterestingand rewardingresearch projects.
But "the argumentof ignoranceappears to have more credibility."50 She quotes
47. Donald Mager, "The Discourse about Homophobia, Male and Female Contexts," presented
at the annual meetingof the Modern Language Association,New York, December 1986.
49. See, for example, Schwartz,"AIDS in the Media"; Baltimoreand Wolff,ConfrontingAIDS;
"AIDS Hearing," Committeeon Energyand Commerce,Subcommitteeon Health and the Environ-
ment, US House of Representatives,September 17, 1984 (Serial No. 98-105, Washington,D.C.,
US GovernmentPrintingOffice);and Officeof Technology Assessment,ReviewofthePublicHealth
Service'sResponsetoAIDS: A TechnicalMemorandum, OTA-TM-H-24, Congress of the US, Washing-
ton, D.C., US GovernmentPrintingOffice,February 1985.
50. Sandra Panem, "AIDS: Public Policy and Biomedical Research," Hastings CenterReport,
Special Supplement,vol. 15, no. 4 (August 1985), p. 24.
JamesCurran's 1984 judgment thatpolicy,funding,and communicationwere all

delayed because only people in New York and Californiahad any real sense of
crisisor comprehensionof the gay male community."Scientistsavoid issuesthat
relate to sex," he said, "and thereis not much understandingof homosexuality."
This was an understatement:according to Curran, manyeminentscientistsdur-
ing this period rejected the possibilitythat AIDS was an infectiousdisease be-
cause theyhad no idea how a man could transmitan infectiousagent to another
man.51Other instancesof ignoranceare reportedby Patton and Black.52Physi-
cian and scientistJoseph Sonnabend attributesthisignoranceto the sequestered
ivorytowers that many AIDS investigators(particularlythose who do straight
laboratoryresearchas opposed to clinicalwork) inhabitand argues instead that
AIDS needs to be studiedin itsculturaltotality.Gay male sexual practicesshould
not be dismissedout of hand because theyseem "unnatural" to the straight(in
both senses) scientist:"the rectumis a sexual organ, and it deserves the respect
thata penis gets and a vagina gets. Anal intercourseis a centralsexual activity,
and it should be supported,it should be celebrated."53A National Academy of
Sciences panel studyingthe AIDS crisisin 1986 citedan urgentneed foraccurate
and currentinformationabout sex and sexual practicesin the US, notingthatno
comprehensiveresearchhad been carriedout since Kinsey'sstudiesin the 1940s;
theyrecommended,as well,social science researchon a range of social behaviors
relevantto the transmissionand control of AIDS.54
It has been argued that the perceived gaynessof AIDS was ultimatelya
crucial political factorin obtaining funding.Dennis Altman observes that the
principleof providingadequate fundingforAIDS researchwas institutionalized
withinthe federalappropriationsprocess as a resultof the 1983 Congressional
hearingschairedby RepresentativesHenryWaxman and Theodore Weiss,mem-
bers of Congress representinglarge and visible gay communities.
Here one sees the effectof the mobilization and organization of
gays . . ; it is salutary to imagine the tardiness of the response had
IV usersand Haitians been the onlyvictimsof AIDS, had Republicans
controlled the House of Representativesas well as the Senate (and
hence chaired the relevantoversightand appropriationscommittees)
or, indeed, had AIDS struckten yearsearlier,beforethe existenceof
an organized gay movement,openly gay professionalswho could tes-
tifybefore the relevant committeesand openly gay congressional
staff.55
51. Ibid.
52. Patton, Sex and Germs;Patton, "Feminists Have Avoided the Issue of AIDS"; Black, The
Plague Years.
53. Joseph Sonnabend, "Looking at AIDS in Totality: A Conversation," New YorkNative, 129
(October 7-13, 1985).
54. Baltimoreand Wolff,Confronting AIDS.
55. D. Altman,AIDS in theMind ofAmerica,pp. 116-117.
52 TREICHLER
But these social and political issues were felt by many to be essentially
irrelevant.From the beginning,the hypothesisthat AIDS was caused by an
infectiousagent was favoredwithinthe US scientificcommunity.The hypothesis
was strengthenedwhen the syndromebegan to be identifiedin a diversityof
populationsand found to cause apparentlyidenticaldamage to the underlying
immune system.By May 1984 a viral etiology for AIDS had been generally
accepted, and the real question became preciselywhat kind of viral agent this
could be.
Rendezvouswith007
"Interpretations,"write Bruno Latour and Steve Woolgar in Laboratory

Life,theiranalysisof the constructionof factsin science, "do not so much inform
as perform."56And nowhere do we see interpretationshaped toward perform-
ance so clearlyas in the issues and controversiessurroundingthe identification
and naming of "the AIDS virus."
As earlyas 1979, gay men in New York and Californiawere comingdown
withand dyingfromillnessesunusual in younghealthypeople. One of the actors
who helped create the San Francisco A.I.D.S. Showrecalled that early period:
I had a friendwho died way way back in New York in 1981. He was
one of the firstto go. We didn't know what AIDS was, there was no
name forit. We didn't knowit was contagious-we had no idea it was
sexually transmitted-we didn't know it was anything. We just
thoughtthat he -alone -was ill. He was 26 years old and just had
one thingafteranother wrong withhim. . . . He was stillcoming to
work 'cause he didn't knowhe had a terminaldisease.57
The oddness of these namelessisolated eventsgave way to an even more terrify-

ing period in which gay men on both coasts graduallybegan to realize that too
many friendsand acquaintances were dying. As the numbers mounted, the
deaths became "cases" of what was informallycalled in New York hospitals
WOGS: the Wrath of God Syndrome.58It all became officialin 1981, when five
deaths in Los Angeles fromPneumocystis pneumoniawere describedin theJune 5
issue of the CDC's bulletinMorbidity
and Mortality
Weekly Reportwithan editorial
note explainingthat
the occurrence of pneumocystosisin these 5 previouslyhealthyindi-
viduals withouta clinicallyapparent underlyingimmunodeficiency is
unusual. The factthatthesepatientswere all homosexualssuggestsan
association between some aspect of a homosexual lifestyleor disease
56. Latour and Woolgar, Laboratory Life.

57. From The A.I.D.S. Show.
58. See Sontag, Illnessas Metaphor.
pneumonia in this
acquired throughsexual contact and Pneumocystis
population.59
Gottlieb's 1981 paper in the New England Journal of Medicinedescribed the
deaths of young,previouslyhealthygay men fromanother rare but rarelyfatal
disease.60The deaths were attributedto a breakdownof the immunesystemthat
leftthe body utterlyunable to defend itselfagainstinfectionsnot normallyfatal.
The syndromewas provisionallycalled GRID: gay-relatedimmunodeficiency.
These publishedreportsdrew similarinformationfromphysiciansin othercities,
and beforetoo long theserare diseases had been diagnosed in nongaypeople (for
example, hemophiliacsand people who had recentlyhad blood transfusions).61
Epidemiological follow-upinterviewsover the next several months confirmed
thatthe problem- whateverit was- was growingat epidemicrates,and a CDC
taskforcewas accordinglyestablishedto coordinatedata collection,communica-
tion,and research.The name AIDS was selected at a 1982 conferencein Wash-
ington(GRID was no longerapplicable now thatnongayswere also gettingsick):
acquired immune deficiencysyndrome("reasonably descriptive,"said Curran,
"without being pejorative").62
Over the next two years,epidemiologicaland clinicalevidence increasingly
pointed toward the role of some infectiousagent in AIDS. Researchersdivided
over this,withsome searchingfora singleagent,otherspositinga "multifactorial
cause." Most scientistsaffiliatedwith federal scientificagencies (primarilythe
National Institutesof Health and Centers for Disease Control) have tended
towardthe single-agenttheory(as though"cofactors"were a kindof deuces-wild
elementthatvulgarizedserious investigation),and thisview has tended to domi-
nate scientificreporting.Althoughsome independentresearchers,clinicians,and
non-US scientistsprotested the increasinglyrigid party line of what has been
called "the AIDS Mafia," multifactorialand environmentaltheorieswere subor-
dinated to the quest forthe singleagent.63The National Cancer Institute(NCI),
59. CentersforDiseaseControl,"Pneumocystis Pneumonia-Los Angeles,"Morbidity andMortal-

ityWeeklyReport, vol. 30, no. 21 (June5, 1981),pp. 250-252.
60. M. S. Gottlieb,R. Schroff, CariniiPneumoniaand
H. M. Schanker,et al., "Pneumocystis
MucosalCandidiasis in Previously HealthyHomosexualMen,"NewEnglandJournal 305
ofMedicine,
(1981),pp. 1425-1431.
61. See Centersfor Disease Control,"Kaposi's Sarcomaand Pneumocystis Pneumoniaamong
HomosexualMen-New YorkCityand California," MorbidityandMortality
WeeklyReport,vol. 30,
no. 25 (July3, 1981),pp. 305-308, and KeewhanChoi,"Assembling theAIDS Puzzle:Epidemiol-
ogy,"inAIDS: FactsandIssues,ed. VictorGongand NormanRudnick, NewBrunswick, NewJersey,
RutgersUniversity Press,1986.
62. Quotedin Black,ThePlagueYears.
63. Some scientists outsidethe federalhealthcare network chargethatthe US government-
"the AIDS Mafia"-dictates a partyline on AIDS. JosephSonnabend,MD, formerscientific
directorof the AIDS MedicalFoundation,begantheJournalofAIDS Research to printscientific
articleshe believedwerebeingsuppressed becausetheyarguedfora multifactorial
causeratherthan
a singlevirus.See Black,ThePlagueYears,pp. 112-118, fordiscussion.
54 TREICHLER
for example, developed a research strategythat focused on retroviruses,essen-

tiallyto the exclusion of other lines of research, while other US virologyand
immunologylaboratoriesput forwardtheirown favoredpossibilities.64 By 1983
the "leading candidate" for the AIDS virus seemed to be a member of the
human T-cell leukemiafamilyof viruses(HTLV), so called because theytypically
infecta particularkind of cell, the T-helper cells. But these were retroviruses,
and there was doubt that a retroviruscould cause immunosuppressionin
humans.65Yet by thistimeit was widelyagreed thatAIDS was, indeed, a "new"
This gener-
disease-neither a statisticalflukenor a featureof the gay life-style.
ated excitementin the medical and scientificcommunitynot only because truly
new diseases are rare, but also because its cause mightbe new as well. In 1983
Luc Montagnierat the Pasteur Institutein Paris identifiedwhathe called LAV,
lymphadenopathy-associated virus.66In 1984 Robert Gallo, at NCI, identified
what he called HTLV-III, human T-cell lymphotropicvirus type III (the third
type identifiedby his laboratory).67In accordance withKoch's postulates,both
64. Panem, "AIDS: Public Policy and Biomedical Research," p. 25.

65. The scientificaccount of retrovirusesgoes somethinglike this: A virus (from Latin virus,
"poison") cannotreproduce outside livingcells: itentersintoanotherorganism's"host" cell and uses
thatcell's biochemicalmachineryto replicateitself.These replicantvirusparticlesthen infectother
cells; thisprocessis repeated untilthe infectionis eitherbroughtunder controlby the host's immune
systemor the infectionoverwhelmsand killsor debilitatesthe host, making it susceptibleto other
infections(as HIV does). Alternatively, virusand host mayreach a stateof equilibriumin whichboth
coexist for years. The virus'sinitialentryinto the host cell may cause symptomsof viral infections.
Certain virusescan remain inactive,or latent,inside the host cell for long periods withoutcausing
problems; they can remain integratedwith the cell's DNA (genetic material) until triggered to
replicate(typicallywhen the organismis compromisedby old age, immunosuppressive drug therapy,
or infectionby anothervirusor bacteria);at thispoint the DNA is transcribedto RNA, whichin turn
becomes protein.
A retrovirusreplicates "backward," transferringgenetic informationfrom viral RNA into
DNA, the opposite of previouslyknownviralactions. The retroviruscarries RNA (instead of DNA)
as its geneticmaterialalong witha unique enzyme,reversetranscriptase(fromwhichthe name retro
comes); thisuses the RNA as a templateto generate(transcribe)a DNA copy. This viralDNA inserts
itselfamong the cell's own chromosomes; thus positioned to functionas a "new gene" for the
infectedhost, it can immediatelystartproducing viral RNAs (new viruses) or remain latent until
activated.In the case of HIV the latencyperiod can be as long as fourteenyears (as of thiswriting)
followed by a very sudden explosion of replicationactivitythat may directlykill the host's cell-
chieflythe T4-lymphocyte,a whiteblood cell thatregulatesthe body's immuneresponse. The rapid
depletion of T4-cells, characteristicof AIDS, leaves the human host vulnerable to manyinfections
that a normal immune systemwould repel. The HTLV isolated by Gallo in 1980 was the first
identifiedretrovirusassociated withhuman disease (see Osborn, "The AIDS Epidemic," p. 47).
66. F. Barre-Sinoussi,J. C. Chernann, F. Rey, et al., "Isolation of a T-LymphotropicRetrovirus
froma Patient at Risk for Acquired Immune DeficiencySyndrome," Science,no. 220 (1983), pp.
868-871; L. Montagnier,J. C. Chernann,F. Barre-Sinoussi,etal., "A New Human T-Lymphotropic
Retrovirus:Characterizationand Possible Role in Lymphadenopathyand Acquired Immune Defi-
ciencySyndromes,"in Human T-Cell LeukemialLymphomaVirus,ed. R. C. Gallo, M.E. Essex, and L.
Gross, Cold Spring Harbor, New York, Cold Spring Harbor Laboratory, 1984, pp. 363-379.
67. Gallo and his colleagues publishedfourpapers on the isolationof HTLV-III in Science,no. 224
(1984), pp. 497-508.
viruses were isolated in the blood and semen of AIDS patients;no trace was
found in the healthycontrolpopulation.6
These powerfulfindings-disputed and contentiousthough theywere to
be - narrowedalmostat once the basic biomedicalscienceagenda withregardto
AIDS. In the constructionof scientificfacts,the existence of a name plays a
crucial role in providinga coherentand unifiedsignifier-a shorthandway of
signifying whatmaybe a complex,inchoate,or little-understood concept. Latour
and Woolgar divide the researchtheystudied into the long and uncertainphase
thatled up to the identification,synthesis,and namingof TRF (H) (the thyrotro-
pin-releasing factor [hormone], a substance involved in neuroendocrine hor-
mone regulation)and the subsequentnarrowerand more routinephase in which
the concept's statusas "a fact" was takenforgranted(the disputeover namingis
relevant to the tussle over the names LAV and HTLV).69 So too with AIDS:
before the isolation of the virus, there were considerablymore universes of
inquiryand open-ended speculations.Evidence for a virus as agent intensified
scientificcontrolover signification and enabled scientiststo rule out less relevant
hypotheses and lines of research. Of course, the existenceof twonames- LAV
and HTLV-III- complicatedthe significationprocess: did two signifiersentail
two distinctsignifieds?Despite the wranglingover this point between the in-
volved parties, a clearer consensus neverthelessemerged that basic research
should now relate directlyto the hypothesisthata singleviruswas "the culprit"
responsiblefor AIDS. Importantissues included (1) etiology,(2) the identifica-
tion of the virus's genetic structureand precise shape, (3) clinical and other
informationabout transmission,(4) informationabout the clinicalexpressionof
the disease (discoverythatthe virusinfectedbrain cells encouraged itsrenaming,
since the names LAV and HTLV both presupposedan attackon lymphcells),(5)
the scope and naturalhistoryof the disease, (6) differencesamong "riskgroups,"
and (7) epidemiological informationincluding the long-termpicture (circum-
stantialevidence but importantnevertheless).
To most scientiststhis process of narrowing inquiry and relinquishing
peripherallines of thoughtis simplythe way science is done, the procedural sine
qua non for establishinganythingthat can be called a "fact." But "a statement
68. Koch's postulates,developed by bacteriologistRobert Koch, would require that,in order to

establisha specificvirusas the "cause" of the AIDS syndrome,the viruswould have to be presentin
all cases of the disease; antibodyto the virusmustbe shown to develop in constanttemporalrelation
to the developmentof AIDS; and transmissionof the same virusto a previouslyuninfectedanimal or
human must be demonstratedwith subsequent development of the disease and reisolationof the
infectiveagent. WithAIDS, a lethaldisease, thislast requirementcannot be testedon humans,but a
demonstrationthatthe viruscould be used to produce an effectivevaccine would more or less fulfill
thisrequirement.See Marx, "Strong New Candidate forAIDS Agent," p. 151, and P. M. Feorino, et
al., "LymphadenopathyAssociated Virus Infectionof a Blood Donor-RecipientPair withAcquired
ImmunodeficiencySyndrome," in Kulstad, ed., AIDS: PapersfromScience,p. 216.
69. Latour and Woolgar, Laboratory Life,pp. 105-150, esp. pp. 108-112.
56 TREICHLER
alwayshas borders peopled by other statements,"70 and it is importantforus to

keep in mind the provisionaland consensual nature of this US AIDS research
agenda, each area of which existswithina heavilypopulated social, cultural,and
ideological territory.Consider the hypothesisthatAIDS originatedin Africa,for
example (a view supported by the research of Gallo's colleague Myron Essex,
whose Africanvirusesare geneticallysimilarto the virusGallo's lab identified).
Not surprisingly, some "geographicbuck-passing"took place among the African
countriesthemselves(Rwanda and Zambia say AIDS originatedin Zaire, Uganda
says it came from Tanzania, and so on). Beneath such public maneuvering,
however,manyAfricansprivatelybelieve AIDS mayhave originatedsomewhere
else. And, despite Gallo's assertionthat he cannot "conceive of AIDS coming
fromelsewhereinto Africa,"the view is by no means universal,especiallyamong
non-US researchers.71Further,Americansrefuseto acknowledge the possibility
thatexportsof Americanblood productsmay have spread the disease to people
elsewhere.In the Soviet Union, AIDS is considereda "foreignproblem," attrib-
utable to the CIA or to tribesin Central Africa.72In the Caribbean, and even
withinthe US, AIDS is widelybelieved to come fromUS biologicaltesting.73 The
French firstbelieved AIDS was introducedby way of an "American pollutant,"
probably contaminatedamyl nitrate(they also believed AIDS came from Mo-
rocco).74The Soviet Union, Israel, Africa,Haiti, and the US Armed Forces deny
the existenceof indigenoushomosexualityand thusclaim thatAIDS mustalways
have originated"elsewhere."75
By 1986, five years after the initialarticle in the Morbidity and Mortality
WeeklyReport, a Human Retrovirus Subcommittee empowered by the Interna-
tional Committee on the Taxonomy of Viruses was at work "to propose an
appropriatename for the retrovirusisolatesrecentlyimplicatedas the causative
agentsof the acquired immunedeficiencysyndrome(AIDS)" -to consider,that
is, what "the AIDS virus" should officiallybe named. Aftermore than a year of
deliberation,the nomenclaturesubcommitteepublishedits recommendationsin
journals.76Their taskhas been made crucial,they
the formof a letterto scientific
note, by the widespread interestin AIDS and the multiplicity of names now in
use:
70. Michel Foucault, The Archaeology of Knowledge,trans. A. M. Sheridan Smith, New York,
Pantheon, 1972, p. 97.
71. Africandata are reviewed in L. Altman,"Linking AIDS to Africa," p. 8.
72. Lee, "AIDS in Moscow."
73. See Rechy, "An Exchange on AIDS."
74. LeibowitchdocumentsFrench views in A StrangeVirus.
75. For a fulleranalysisof the theoryand politicsof these originand alibi stories,see Patton,Sex
D. Altman,AIDS in theMind ofAmerica;Ann Guidici
and Germs;Weeks, Sexualityand Its Discontents;
Fettner and William Check, The TruthAboutAIDS: Evolutionof an Epidemic,New York, Holt,
Rinehart& Winston, 1985; and Leibowitch,A StrangeVirus.
76. The letterappeared in Science,no. 232, (May 9, 1986), p. 697.
LAV: lymphadenopathy-associated virus (1983-

Montagnier,Pasteur)
HTLV-III: human T-cell lymphotropicvirustype III (1984
- Gallo, NCI)
IDAV: immunodeficiency-associatedvirus
ARV: AIDS-associated retrovirus (1984- Levy,
UCSF)
HTLV-III/LAV compound names used to keep peace (the CDC's
and use was perhaps a reprimandto the NCI for its
LAV/HTLV-III: perceived uncooperativenessin sharingdata)
AIDS virus: popular press
The subcommitteeproposes HIV, "human immunodeficiencyviruses." They
reason thatthisconformsto the nomenclatureof other virusesin whichthe first
slot signals the host species (human), the second slot the major pathogenic
property(immunodeficiency), and the last slot V for virus. (For some viruses,
though not HIV, individualstrainsare distinguishedby the initialsof the thus
"immortalized"patientfromwhom theyoriginallycame and in whose "daugh-
ter cells" theyare perpetuated.)The multiplenames of "the AIDS virus" point
towarda successionof identitiesand offera fragmentedsense indeed of whatthis
virus,or familyof viruses,"really" is. The new name, in contrast,promisesto
unifythe politicalfragmentations of the scientificestablishmentand to certifythe
health of the single-virushypothesis.The subcommitteeargues in favor of its
proposed name that it does not incorporatethe term AIDS, on the advice of
many clinicians; it is distinctfrom all existing names and "has been chosen
withoutregard to priorityof discovery" (not insignificantly, Montagnier and
Levy signed the subcommitteeletterbut Gallo and Essex did not); and it distin-
guishes the HI virusesfromthose withdistinctlydifferentbiological properties,
forexample, the HTLV line (HTLV-I and HTLV-II), whichthissubcommittee
calls "human t-cellleukemia viruses,"perhaps to chastiseGallo forchangingthe
L in the nomenclature of the HTLVs from leukemiato lymphotropic so that
HTLV-III (the AIDS virus) would appear to fitgenericallyinto the same series
(and bear the stamp of his lab). In the same issue of Science,the editorschose to
discuss this letterin their "News and Comment" column: "Disputes over viral
nomenclaturedo not ordinarilycommandmuchattentionbeyondthe individuals
immediatelyinvolvedin the fray";but the currentdissension,part of the contin-
uing controversyover who should get credit for discoveringthe virus, "could
provide 6 monthsof scriptsfor the televisionseries 'Dallas."'77
Whysuch strugglesover namingand interpretation? Because, as the Science
77. Jean L. Marx, "AIDS Virus Has New Name-Perhaps," News and Comment,Science,no. 232
(May 9, 1986), pp. 699-700.
The disputeovernomenclature of "theAIDS virus,"
called LAV byLuc Montagnierand HTLV-III byRobert
Gallo, led to theinternational
adoptionin May 1986 of
a newname HIV; in April 1987, PrimeMinister
Chiracand PresidentReagan mettoannouncean
agreement for sharedpaternityofthevirus.(Photo:Jose'
R. Lopez.)
editorspoint out, there are high stakeswhere thisperformanceis concerned-

not onlypatentrightsto the lucrativetestkitsforthe "AIDS virus" (Gallo fears
thatloss of the HTLV-III designationwillweaken his claims)but the futureand
honor of immunology. Modern immunology,as Donna Haraway observes,
moved into the realm of high science when it reworked the militarycombat
metaphorsof World War II (battles,struggle,territory, enemy,truces)into the
language of postmodernwarfare:communicationcommand control- coding,
transmission,messages- interceptions,spies, lies.78Scientificdescriptionsfor
general readers,like thisone fromtheNationalGeographic articleon the immune
system,accentuate this shiftfromcombat to code:
Many of these enemies [of the body, or self] have evolved devious
methodsto escape detection.The virusesthatcause influenzaand the
common cold, forexample, constantlymutate,changingtheirfinger-
prints. The AIDS virus, most insidious of all, employs a range of
strategies,includinghidingout in healthycells. What makes it fatalis
the
itsabilityto invade and killhelper T cells,therebyshort-circuiting
entire immune response.79
No ground troopshere, no combat,not even generals:we see here the evolution

of a conceptionof the "AIDS virus" as a top-flight
secretagent- a James Bond
of secret agents,armed with "a range of strategies"and licensed to kill. "Like
Greeks hidden inside the Trojan horse," 007 entersthe body concealed insidea
helper T-cell froman infectedhost;80but "the virusis not an innocentpassenger
in the body of its victims":81
In the invaded victim,helper T's immediatelydetect the foreignT
cell. But as the two T's meet, the virus slips throughthe cell mem-
brane into the defendingcell. Before the defendingT cell can mobi-
lize the troops, the virus disables it. ... Once inside an inactiveT
cell, the virusmay lie dormantformonths,even years.Then, perhaps
when another, unrelated infectiontriggersthe invaded T cells to
divide, the AIDS virusalso begins to multiply.One by one, its clones
emerge to infectnearbyT cells. Slowlybut inexorablythe body loses
the very sentinelsthat should be alerting the rest of the immune
78. DonnaJ. Haraway, "The Biological Enterprise:Sex, Mind, and ProfitfromHuman Engineer-
ing to Sociobiology," Radical HistoryReview,no. 20 (Spring-Summer 1979), pp. 206-237, and "A
Manifestofor Cyborgs:Science, Technology,and Socialist Feminismin the 1980s," SocialistReview,
no. 80 (March-April 1985), pp. 65-108.
79. Jaret,"Our Immune System,"p. 709.
80. Ibid., p. 723; and see D. J. Anderson and E. J. Yunis, "'Trojan Horse' Leukocytesin AIDS,"
New EnglandJournalofMedicine,no. 309 (1983), pp. 984-985.
81. Krim, "AIDS: The Challenge to Science and Medicine."
60 TREICHLER
system.Phagocytesand killercells receive no call to arms. B cells are

not alerted to produce antibodies. The enemy can run free.82
But on no mundane battlefield.The January 1987 Scientific Americancolumn
"Science and the Citizen" warnsof the mutability-the "protean nature of the
AIDS virus"-that willmake verydifficult the developmentof a vaccine,as well
as the perfectscreeningof blood. "It is also possible," the column concludes,
"that a more virulentstraincould emerge"; even now "the envelope of the virus
seems to be changing."83Clearly, 007 is a spy's spy,capable of any deception:
evading the "fluid patrol officers"is child's play. Indeed, it is so shiftingand
uncertainwe mighteven acknowledgeour own historicalmomentmore specifi-
cally by givingthe AIDS virusa postmodernidentity:a terrorist'sterrorist,an
Abu Nidal of viruses.84
So long as AIDS was seen as a battleforthe body of the gay male-a battle
linked to "sociological" factorsat that-the biomedical establishmentwas not
tremendouslyinterestedin it. The firstprofessionalsinvolved tended to be
cliniciansin the large urban hospitalswhere men with AIDS firstturned up,
epidemiologists(AIDS, writesBlack, is an "epidemiologist'sdream"; a mystery
disease that is fatal),85and scientistsand clinicianswho were gay themselves.
Althoughfromthe beginningsome saw the theoreticalimplicationsof AIDS, the
possibilitythat AIDS was "merely" some unanticipatedside-effectof gay male
sexual practices(about which,as I've noted above, there was considerableigno-
rance) limiteditsappeal forbasic scientists.But withthe discoverythatthe agent
associated withAIDS appeared to be a virus-indeed, a novelretrovirus-what
82. Jaret,"Our Immune System,"pp. 723-724.

83. "Science and the Citizen," pp. 58-59.
84. Leibowitch,in A StrangeVirus,describes the scientificeffortto identifythe AIDS virusas a
"medico-biologicalInterpol" on the trailof an international"criminal" charged with"breakingand
entering" (pp. 41-42), and asks "Who is HTLV?" (p. 48). MervynB. Silverman,describingthe
mechanismof AIDS transmission at the CongressionalAIDS hearingin 1983, testifiedin comparable
language that "many believe that the virus does not act alone" ("AIDS Hearing," p. 125). In an
articleon a related findingin immunologicalresearch,Jos Van ("Cell ResearchersAim to Flush Out
Body's Terrorists," ChicagoTribune,October 5, 1986) refersto cells called "free radicals," which
serve as the body's "terrorists."A ConsumerReportsarticle entitled "AIDS: Deadly but Hard to
Catch" inadvertentlyinvokes the structuralambiguityof "catching" the virus (who is the catcher,
who is the catchee?). The policing metaphor(and the connectionbetween policyand policehas not
gone unnoticed)carriesover to effortsto controlthe spread of the virus.Lieberson ("The Realityof
AIDS," p. 47) reportsthatsome gay clubs have created "fluidpatrolofficers"who tryto ensure that
no "unsafe sex" takesplace. Mohr argues thatsuch attemptsto promote "safe" sexual behavior,like
recommendationsforcelibacy,seem "remote fromrealityand quite obliviousto the cussednessof sex
and culture." Further,Mohr argues, "though in midcrisisit is politicallyinjudiciousto say so, safe-sex
is poor sex" ("Of Deathbeds and Quarantines,"p. 52); as an epigramforhis essayhe quotes a former
gay "reprobate," now reformed:"Who wantsto suck a dick witha rubber on it?" (See also Richard
Goldstein,"The New Sobriety,"VillageVoice,December 30, 1986, pp. 23-28.)
85. Black, The Plague Years.
Virusas grenade.In thecoverarticleforScientific
American byRobertGallo, AIDS is inevitably a storyof
his own "discovery"ofwhathe called "theHTLV-III
virus." The stylized
graphicencouragesus tosee the
virusas a perfect mechanism,
inorganicmilitary primed
for detonation.
62 TREICHLER
had seemed predominantlya public healthphenomenon(clinicaland service-ori-

ented) suddenlycould be rewrittenin termsof hightheoryand highscience. The
performancemoved fromoff-off Broadway to the heart of the theater district
and the price of the ticketswent way up. Among other things,identifyingthe
viralagent made possible the developmentof a "definitivetest" foritspresence;
not only did this open new scientificavenues (for example, in enabling re-
searchersto map precise relationshipsamong diverse AIDS and AIDS-like clini-
it also created opportunitiesformonetaryrewards(forexam-
cal manifestations),
ple, in revenue from patents on the testing kits). For these reasons, AIDS
researchbecame a highlycompetitiveprofessionalfield.86Less-establishedassist-
ant professorswho had been workingon the AIDS problem out of commitment
suddenlyfound senior scientistspeering at theirdata, while in the public arena
the triumphsof pure basic science research were proclaimed. "Biomedical
science is going brilliantlywell," was how Dr. June Osborn summarizedAIDS
progress in mid-1986.87 "Indeed," writes one science reporter, "had AIDS
struck20 yearsago, we would have been utterlybaffledby it."88Ten yearsago
we had not even confirmedthe existence of human retroviruses,notes Scientific
American.Asked whether NCI's strategyof focusingexclusivelyon retrovirus
researchwas appropriate(consideringthatit mightnot have paid off),an official
said thiswouldn't have mattered:basic retroviralresearchwas NCI's priorityin
any case.89Because it did pay off,it can now be said (as it could not have been said
before 1984) that "AIDS may be a disease thathas arrivedat the righttime."9"
In the wordsof one biomedicalscientist,we face "an impendingArmageddon of
AIDS, and the salvationof the world throughmolecular genetics."91
86. For discussion and analysis of the growing competitionin AIDS research as the funding
increased,see D. Altman,AIDS in theMind ofAmerica;Black, ThePlague Years;Patton,Sex and Germs;
Panem, "AIDS: Public Policyand Biomedical Research"; Schwartz,"AIDS in the Media"; Officeof
Technology Assessment,Review;HastingsCenterReport,Special Supplements.For an account of the
case of French physicianWilly Rozenbaum, see Paul Raeburn, "Doctor Faces Politics of AIDS
Research," Champaign-Urbana News-Gazette, January25, 1986, p. A-8.
87. Cited in Eckholm, "Broad Alert on AIDS," p. 19.
88. Jaret,"Our Immune System,"p. 23.
89. Panem, "AIDS: Public Policy and Biomedical Research," p. 25.
90. "Science and the Citizen," p. 59.
91. Quoted in Morton Hunt, "Teaming Up against AIDS," New YorkTimesMagazine, March 2,
1986, p. 78. Despite whatevercriticismsbiomedicalscientistsmayhave had about AIDS research,an
ideology of heroism,progress,and faithin ultimatescientificconquest pervades discussions.Exam-
ples include Choi, "Assembling the AIDS Puzzle"; Relman, "Introduction"; Gallo, "The AIDS
Virus"; Donald S. Frederickson,"Where Do We Go fromHere?" in TheAIDS Epidemic,ed. Kevin M.
Cahill, New York, St. Martin's Press, 1983, pp. 151-161; Donald P. Francis,"The Search for the
Cause," in The AIDS Epidemic;American Medical Association Council on ScientificAffairs,"The
Acquired ImmunodeficiencySyndrome: Commentary,"Journal oftheAmericanMedical Association,
vol. 252, no. 15 (October 19, 1984), pp. 2037-2043; Sheldon H. Landesman, Harold M. Ginzburg,
and Stanley H. Weiss, "The AIDS Epidemic," New England Journal of Medicine,vol. 312, no. 8
(February21, 1985), pp. 521-525; and Merle A. Sande, "Transmissionof AIDS: The Case against
Casual Contagion," New England Journal of Medicine,vol. 314, no. 6 (February 6, 1986), pp.
380-382. Sonnabend ("Looking at AIDS in Totality") criticizesthe assumptionsof heroic science,
An Epidemic of Signification 63
Reconstructingthe AIDS Text: Rewritingthe Body

There is now broad consensus that AIDS-"plague of the millennium,"
"health disaster of pandemic proportions"-is the greatest public health prob-
lem of our era.92 The epidemic of signification that surrounds AIDS is neither
simple nor under control. AIDS exists at a point where many entrenched narra-
tives intersect, each with its own problematic and context in which AIDS acquires
meaning. It is extremely difficultto resist the lure, familiarity,and ubiquitous-
ness of these discourses. The AIDS virus enters the cell and integrates with its
genetic code, establishing a disinformation campaign at the highest level and
ensuring that replication and dissemination will be systemic. We inherit a series
of discursive dichotomies; the discourse of AIDS attaches itself to these other
systems of difference and plays itself out there:
self and not-self
the one and the other
homosexual and heterosexual
while Leibowitch(A StrangeVirus)is distinctivein his ironyand politicalself-consciousness about the

nature of the scientificenterprise.
92. As of December 1986, ten millionpeople were estimatedto carrythe virusworldwide;at least
a quarterof these people are expected to develop AIDS withinthe next fiveyearsand manymore to
develop illnessesrangingfrommildlydisablingto lethal.By the end of 1986, almost30,000 people in
the US had been diagnosed withAIDS, and halfof themhad alreadydied. The numberof diagnosed
cases is expected to reach 270,000 by the end of 1991, with a cumulativedeath toll of 179,000.
There will be a heavy financialtoll. With repeated hospitalizations,a person withAIDS may have
medical costsof up to $500,000. The cases of AIDS diagnosed in 1986 alone willeventuallycost the
nation $2.25 billion in health care costs and $7 billion in lost lifetimeearnings. Its expenses are
seventy-five timeswhatwe are currentlyspendingon it. (Costs varygreatlyfromcityto city:the CDC
estimatedin 1986 thateach case would average $147,000; the US Armyestimatedthata case could
cost as much as $500,000 to treat;but in San Francisco,use of nonphysiciancaretakers,home care,
and nursinghome servicescan bring the cost of a comparable case down to $42,000. See "AIDS
Hearing"; Patton,Sex and Germs;D. Altman,AIDS in theMind ofAmerica;David L. Wheeler, "More
Research Is Urged in FightagainstAIDS," ChronicleofHigherEducation,November 5, 1986, pp. 7,
10; and David Tuller, "Trying to Avoid an Insurance Debacle," NewYorkTimes,February22, 1987,
sec. 3, pp. 1, 8, for discussionof the politicsof AIDS funding.The National Academy of Sciences
Report [Baltimore and Wolff,Confronting AIDS] judges recent federal allocations to be "greatly
improved" but still "woefullyinadequate" and calls for spending $2 billion per year by 1990 for
education and the developmentof drugs and vaccines.) See American Medical AssociationCouncil
on ScientificAffairs,"Commentary,"Centers for Disease Control, "Update"; Edward S. Johnson
and JeffreyVieira, "Cause of AIDS: Etiology," in AIDS: Facts and Issues, ed. Victor Gong and
Norman Rudnick, New Brunswick,New Jersey,Rutgers UniversityPress, 1986, pp. 25-33; Red-
fieldetal., "HeterosexuallyAcquired HTLV-III/LAV," and "Female-to-MaleTransmission";Katie
Leishman, "Two Million Americans and Still Counting," review of Black, The Plague Years,and
Nichols, MobilizingAgainstAIDS, New YorkTimesBook Review,July 27, 1986, p. 12; Gong and
Rudnick,eds., AIDS: Factsand Issues;and Warren Winkelstein,Jr.,etal., "Sexual Practicesand Risk
of Infection by the Human ImmunodeficiencyVirus: The San Francisco Men's Health Study,"
Journal of theAmericanMedical Association, vol. 257, no. 3 (January 16, 1987), pp. 321-325, for
predictionsbased on currentdistributionof HIV antibodies.
64 TREICHLER
homosexual and "the general population"

active and passive, guiltyand innocent,perpetratorand victim
vice and virtue,us and them,anus and vagina
sins of the parent and innocence of the child
love and death, sex and death, sex and money,death and money
science and not-science,knowledgeand ignorance
doctor and patient,expert and patient,doctor and expert
addiction and abstention,contaminationand cleanliness
contagion and containment,life and death

injectionand reception,instrumentand receptacle
normal and abnormal, natural and alien
prostituteand paragon, whore and wife

safe sex and bad sex, safe sex and good sex
FirstWorld and Third World, free world and iron curtain
capitalistsand communists
certaintyand uncertainty
virusand victim,guest and host
As ChristineBrooke-Rose demonstrates,one mustpay close attentionto the way
in whichthese apparentlyfundamentaland naturalsemanticoppositionsare put
to work.93What is selfand what is not-self?Who wears the whiteand who the
black hat? (Or, in her discussion,perhaps, who wears the pants and who the
skirt?)As BryanTurner observes withregard to sexuallytransmitteddiseases in
general, the diseased are seen not as "victims" but as "agents" of biological
disaster.If Koch's postulatesmustbe fulfilledto identifya given microbewitha
given disease, perhaps it would be helpful,in rewritingthe AIDS text,to take
"Turner's postulates" into account: (1) disease is a language; (2) the body is a
representation;and (3) medicine is a political practice.94
93. ChristineBrooke-Rose,"Woman as a SemioticObject," in TheFemaleBodyin Western Culture:

Contemporary ed. Susan Rubin Suleiman,Cambridge,Massachusetts,Harvard University
Perspectives,
Press, 1986, pp. 305-316. See also Teresa de Lauretis, AliceDoesn't:Feminism,Semiotics,Cinema,
Bloomington,Indiana UniversityPress, 1984.
94. Bryan A. Turner, The Bodyand Society,New York, Basil Blackwell, 1984, pp. 221, 209.
There is littledoubt that for some people the AIDS crisis lends force to
their fear and hatred of gays; AIDS appears, for example, to be a significant
factorin the increasingviolence againstthem,and otherhomophobicacts in the
US.95 But to talk of "homophobia" as though it were a simpleand rathereasily
recognizedphenomenon is impossible.When we reviewthe various conceptions
of the gay male body produced withinscientificresearch by the signifierAIDS,
as to what AIDS "means." At first,some
we finda discourserich in signification
scientistsdoubted that AIDS could be an infectiousdisease because theycould
not imagine what gay men could do to each other to transmitinfection.But
intimateknowledgegenerated quite differentconceptions:
AIDS is caused by multipleand violentgay sexual encounters:expo-
sure to countless infectionsand pathogenic agents overwhelmsthe
immune system.
AIDS is caused by killersperm,shootingfromone man's penis to the

anus of another.
Gay men are as sexuallydriven as alcoholics or drug addicts.
AIDS cannot infect females because the virus can't penetrate the
tough mucous membranesof the vagina.
Women cannot transmitAIDS because theirbodies do not have the

strongprojectilecapacityof a penis or syringe.
Prostitutescan transmitthe virusbecause theircontaminatedbodies

harbor massivequantitiesof killermicrobes.
Repeated hints that the male body is sexually potent and adventurous
suggestthathomophobia in biomedicaldiscoursemightplay out as a literal"fear
of the same." The textconstructedaround the gay male body-the epidemic of
significationso evident in the conceptions cited above and elsewhere in this
essay-is driven in part by the need for constantflightfromsites of potential
identityand thus the successiveconstructionof new oppositionsthat will barri-
cade self fromnot-self.The homophobic meanings associated with AIDS con-
tinue to be layered into existingdiscourse: analysisdemonstratesways in which
the AIDS virusis linguistically identifiedwiththose it strikes:the penis is "frag-
ile," the urethrais "fragile," the virusis "fragile"; the Africanwoman's body is
"exotic," the virus is "exotic." The virus "penetrates" its victims;a carrierof
95. William R. Greer, "Violence against Homosexuals Rising, Groups Say in Seeking Protec-
tions," New YorkTimes,November 23, 1986, p. 15.
66 TREICHLER
death, it wearsan "innocent" disguise.AIDS is "caused" by homosexuals;AIDS

is "caused" by a virus. Homosexuality exists on a border between male and
female,the virusbetweenlifeand nonlife.This cross-cannibalization of language
is unsurprising.What greaterreliefthanto finda finalrefugefromthe specterof
gay sexualitywhere the language that has obsessivelyaccumulated around the
body can attach to its substitute:the virus. This is a signifierthat can be em-
braced forever.
The question is how to disruptand renegotiatethe powerfulculturalnarra-
tives surroundingAIDS. Homophobia is inscribedwithinother discoursesat a
high level,and it is at a high level thattheymustbe interruptedand challenged.
Why? The followingscenario for Armageddon (believed by some, desired by
many) makes clear why: AIDS will remain confined to the original high-risk
groups(primarilygay males and IV drug users)because of theirspecificpractices
(like anal intercourseand sharing needles). At the Paris InternationalAIDS
Conferencein June 1986, the ultimatespread of the disease was posed in terms
of "containment"and "saturation." "Only" gay males and drug addicts willget
infected-the viruswill use them up and then have nowhere to go-the "gen-
eral population" (who are also in epidemiologicalparlancea "virgin"population)
will remainuntouched. Even ifthisview is correct(whichseems doubtful,given
growingevidence of transmissionthroughplain old everydayheterosexualinter-
course), and the virus stops spreading once it has "saturated" the high-risk
population,we would stillbe talkingabout a significantnumber of US citizens:
2.5 milliongay men, 7 millionadditional men who have at some time in the last
ten years engaged in homosexual activity,750,000 habitual IV drug users,
750,000 occasional drug users, 10,000 hemophiliacsalready infected,the sex
partnersof thesepeople and the childrenof infectedwomen-in otherwords,a
total of more than 10 millionpeople (the figuresare fromtheJune 1986 Paris
conference).And "saturation" is currentlyconsidereda best-casescenario by the
public health authorities.
The factis that any separationof not-self("AIDS victims")fromself (the
"general population") is no longer possible. The US Surgeon General and
National Academy reportsmake clear that "that securityblankethas now been
strippedaway."96Yet the familiarsignifying practicesthatexercise controlover
meaning continue. The American
Scientific column goes on to note fearsthatthe
one-to-one Africanratio of females with AIDS to males may foreshadow US
statistics:"Experts point out, however, that such factorsas the prevalence of
other venereal diseases thatcause genitalsores,the use of unsterilizedneedles in
clinics,and the lack of blood-screeningtestsmayexplain the different epideiniol-
ogy of AIDS in Africa."97Thus the Africandata are reinterpretedto reinstate
96. "Science and the Citizen," p. 58.

97. Ibid., p. 59.
the "us"/"them" dichotomyand project a rosierscenario for "us" (well, maybe

it improveson comic Richard Belzer's narrative:"A monkeybites some guy on
the ass in Africaand he balls some guy in Haiti and now we're all gonna fuckin'
die. THANKS A LOT!").98
Meanwhileon the home frontmonogamyis comingback intoitsown,along
withabstention,the safestsex of all. The virusin itself-by whatevername -
has come to representthe momentof truthfor the sexual revolution:as though
God has once again sent his only beloved son to save us from our high-risk
behavior. Who would have thoughtHe would take the formof a virus:a viral
Terminatorready to die for our sins.99
The contestationspioneered by the gay communityover the past decade
offermodels for resistance.As old-fashionedmoralityincreasinglyinfectsthe
twentieth-century scenario, whether masquerading as "preventive health" or
spiritual transformation,a new samplercan be stitchedto hang on the bedroom
wall: BETTER WED THAN DEAD. "It's just like the fifties," complains a gay man in
San Francisco. "People are gettingmarriedagain forall the wrongreasons."'00
One disruptionof thisnarrativeoccurs in the San FranciscoA.I.D.S. Show:"I like
sex; I like to get drunkand smokegrassand use poppersand sleep withstrangers:
98. Though Lieberson insiststhat a "heterosexual pandemic [comparable to Africa's] has not
occurredin the United States" and criticizesthosewho suggestit is going to ("The Realityof AIDS,"
p. 44), current data based on tests for antibodies to HIV among 1986 army recruits(nongay,
non-drug-using, so far as researcherscould determine)argue for increasingheterosexualtransmis-
sion (Redfield,et al., "Female to Male Transmission"). For discussionand analysis,see L. Altman,
"Heterosexuals and AIDS"; D. Altman,AIDS in theMind ofAmerica;Marx, "New Relativesof AIDS
Virus Found"; Osborn, "The AIDS Epidemic"; Patton,Sex and Germs;Hosken, "Why AIDS Pattern
Is Differentin Africa"; Feldman, "Role of AfricanMutilationsin AIDS Discounted"; and Robert
Pear, "Ten-Fold Increase in AIDS Death Toll Is Expected by '91," New YorkTimes,June 13, 1986,
pp. A-l, A-17. See also Potterat,et al., "Lying to MilitaryPhysicians."It has been suggestedthat
malnutritionplaysan importantrole in the rapid spread of AIDS in Africa(worldwide,malnutrition
is the most common cause of acquired immunedeficiency).
99. We musteven, perhaps,identifywiththe virus,an extraordinarily successfulstructurethathas
been comfortablymakingthe acquaintance of livingorganismsformanymore millionsof yearsthan
we have. A virusthatentersthe human bloodstreamand circulatesthroughthe body mayultimately
negotiatewiththe host some mutuallylivable equilibrium.The relationshipmay be a close one: it is
difficultto separate the effectsof the virus from those of the body's defenses; and any poison
intended for the guest may kill the host as well. Any given species, includinghuman beings, may
sometimesprove to be an inhospitable,even unnaturalhost. To speak teleologicallyfora moment,it
is obvious that to kill the host is not in the microorganism'sbest interests;thissometimeshappens,
however,when a virusadapted to a nonhumanhostshifts,throughsome untowardturnof events,to
the human body. For the human immunodeficiencyvirus,believed to be a relative newcomer on
earth(the presence of antibodiesin storedblood now goes back to 1959 samplescollected in Africa,
to 1973 in US blood) and to have firstinhabitedAfricanmonkeys,we mighthave turnedout to be
inhospitable.But thoughfromour perspectivethe virusis indeed virulent,killingquickly,in factthe
long latencybetweeninfectionand theappearance of clinicaldamage providesplentyof time-often
years-for the virus to replicate and infecta new host. For the time being we are sufficiently
hospitableforthisvirusto live offus relatively"successfully";ifmutationoccurs,our relationshipto
the AIDS viruscould evolve into somethingrelativelybenign or mutuallydisastrous.
100. FitzGerald,Citieson a Hill, p. 115.
68 TREICHLER
Call me old-fashioned,but that'swhat I like!" A gay pastorin San Franciscotells

Frances FitzGerald that the moral transformationbeing forced upon the gay
communityremindshim of the days before Stonewall: "If I had to go back to
livingin the closet,I'd have to thinkveryclearlyabout whetheror not I'd rather
be dead."'10 For Michel Foucault, the "tragedy" of AIDS was not intrinsicallyits
lethal character,but rather that a group that has risked so much-gays-are
lookingto standardauthorities- doctors,the church- forguidance in a timeof
crisis."How can I be scared of AIDS when I could die in a car?" Foucault asked a
year or so before he died. "If sex witha boy gives me pleasure. ..." And he
added: "Don't cry for me if I die."102
For AIDS, where meaningsare overwhelmingin theirsheer volume and
often explicitlylinked to extreme political agendas, we do not know whose
meanings will become "the official story." We need an epidemiology of
signification-a comprehensive mapping and analysis of these multiple
meanings- to formthe basis foran officialdefinitionthatwillin turnconstitute
the policies, regulations,rules, and practicesthat will govern our behavior for
some timeto come. As we have seen, these mayrestupon "facts,"whichin turn
may restupon the deeply entrenchedculturalnarrativesI have been describing.
For this reason, what AIDS signifiesmust be democraticallydetermined: we
cannot afford to let scientistsor any other group of "experts" dismiss our
meaningsas "misconceptions"and our alternativeviewsas noise thatinterferes
withthe pure processesof scientificinquiry.Rather,we need to insistthatmany
voices contributeto the constructionof officialdefinitions-and specifically
certainvoices thatneed urgentlyto be heard. Althoughthe signification process
for AIDS is by now very broad-just about everyone,seemingly,has offered
"readings" of what AIDS means-one excluded group continuesto be usersof
illegal intravenousdrugs. Caught between the "firstwave" (gay men) and the
"second wave" (heterosexuals),drug users at high risk for AIDS remain silent
and invisible.One public health officialrecentlychallenged the rush to educate
heterosexuals about their risk when what is needed (and has been from the
beginning)is "a massiveeffortdirectedat intravenous-drug abusersand theirsex
partners. This means treatment for a disease-chemical dependence on drugs.
We have to preventand treat one disease, drug addiction,to preventanother,
AIDS."'10
101. Ibid., p. 104.

102. Philip Horvitz, "Don't Cry for Me, Academia," Interviewwith Michel Foucault,Jimmy and
Lucy'sHouse ofK (Berkeley),no. 2 (August 1985), pp. 78-80. This interview,conducted in Berkeley
to findout whatdid he know and when did
(and scrutinized,it's said, like the Watergatetranscripts,
he know it), concludes as Foucault enters the BART station:"Good luck," he tells Horvitz. "And
don't be scared!"
103. See also Barrett,"Straight Shooters"; Stephen C. Joseph, "Intravenous-DrugAbuse Is the
Front Line in the War on AIDS," Letter to the Editor,New YorkTimes,December 22, 1986, p. 18.
Though Check writesthat"it sometimesappears thatthe onlyriskgroup thathasn't raised a ruckus
If AIDS's dual lifeas both a materialand linguisticentityis important,the

emphasison dual is critical.Symbolicand social reconceptualizationsof AIDS are
necessarybut not sufficient to address the massivesocial questions AIDS raises.
The recognitionthatAIDS is heterosexuallyas well as homosexuallytransmitted
certainlyrepresentsprogress,but it does not interruptfantasy.It is fantasy,for
example, to believe that "safer sex" will protectus fromAIDS; it may save us
frombecoming infectedwiththe virus-New York City has institutedSingles
Night at the Blood Bank, where people can meet and share theirseropositivity
statusbefore they even exchange names.'04 But AIDS is to be a fundamental
forceof twentieth-century life,and no barrierin the world can make us "safe"
fromits complex materialrealities.Malnutrition,poverty,and hungerare unac-
ceptable,in our own countryand in the restof the world; the need foruniversal
health care is urgent. Ultimately,we cannot distinguishself fromnot-self:for
"plague is life,"and each of us has the plague withinus; "no one, no one on earth
is free fromit."'05
The discursivestructuresI have discussedin thisessayare familiarto those
of us in "the human sciences." We have learned that there is a disjunction
betweenhistoricalsubjectsand constructedscientificobjects. There is stilldebate
about whether,or to what extent,scientificdiscourse can be privileged-and
relied upon to transcendcontradiction.My own view is unequivocal: it cannot be
privilegedin thisway. Of course, where AIDS is concerned,science can usefully
-
performits interpretivepart: we can learn to live-indeed, mustlearn to live
as though there are such thingsas viruses.The virus-a constructedscientific
object-is also a historicalsubject, a "human immunodeficiency virus," a real
source of illnessand death thatcan be passed fromone person to another under
certain conditions that we can apparently-individually and collectively-
influence.The trickis to learn to live with this disjunction,but the lesson is
imperative.Dr. Rieux, the physician-narrator of Camus's novel, acknowledges
that by dealing medicallywith the plague he is allowing himselfthe luxuryof
"living in a world of abstractions."But not indefinitely;for "when abstraction
sets to killingyou, you've got to get busy withit."
But gettingbusy withit may require us to relinquishsome luxuriesof our
own: the luxury of accepting withoutreflectionthe "findings" science seems
is the IV drug users,who are not organized" ("Public Education on AIDS," p. 28), a fewcommenta-
tors are beginningto draw attentionto this criticalproblem: Barrett,"StraightShooters"; Joseph,
"IntravenousDrug Abuse"; Shaw and Paleo, "Women and AIDS"; Peg Byron,"Women withAIDS:
Untold Stories," VillageVoice,September24, 1985, pp. 16- 19; and FrancisX. Clines, "Via Addicts'
Needles, AIDS Spreads in Edinburgh,"New YorkTimes,January4, 1987, p. 8. In the last year, the
Gay Men's Health Crisisin New York, aware thatmanydrug users mayavoid informationcentersas
well as medical authorities,has taken responsibilityfor going to "shooting galleries," clinics,and
drug treatmentcentersto provide AIDS education and trainingto these people so that theycan in
turnwork withother drug users.
104. "A 'Social Card' to Reassure Sex Partners,"San FranciscoChronicle,October 17, 1985, p. 30.
105. Camus, The Plague, p. 229.
70 TREICHLER
effortlesslyable to provide us, the luxuryof avoiding vigilance,the luxuryof

hoping it will all go away. Rather, we need to use what science gives us in ways
thatare selective,self-conscious,and pragmatic("as though" theywere true). We
need to understand that AIDS is and will remain a provisional and deeply
problematicsignifier.Above all, we need to resist,at all costs, the luxury of
listeningto the thousands of language tapes playing in our heads, laden with
priordiscourse,thattell us withcompellingcertaintyand dizzyingcontradiction
what AIDS "really" means.

Treichler1987 AIDS MedicalHomofibia Anepidemicofsignification

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Treichler1987 AIDS MedicalHomofibia Anepidemicofsignification

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AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification

Author(s): Paula A. Treichler

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Of course, AIDS is a real disease syndrome,damaging and killingreal

2. I use the termepidemicto referto the exponentialcompoundingof meaningsas opposed to the

12. A CIA plot to destroysubversives.

4. These conceptualizationsof AIDS come chieflyfromprintedsources (journals, news stories,

Such diverse conceptualizationsof AIDS are coupled with fragmentary

I am arguing,then,not thatwe musttake both the social and the biological

ceases to be the kindof mysterythatgeneratesmetaphors.Her view thatbiomedical discoursehas a

the rule. Anythingwe may say, someone could come up with an

Heroin addicts won't use clean needles because theywould ratherget

Prostitutesdo not routinelykeep themselvesclean and are therefore

8. Allan Sollinger,PhD, Departmentof Immunology,Universityof CincinnatiMedical Center,

AIDS is homosexual; it can only be transmittedby males to males.

AIDS in Africa is heterosexual but uni-directional;it can only be

AIDS in Africais heterosexualbecause anal intercourseis a common

VulnerableRectumI Fragile UrethraI RuggedVagina.

blurb.) It sounded plausible; and detailed illustrations demonstrated the article's

heroic scientificdiscovery.And untilwe understandAIDS as both a materialand

AIDS and Homophobia:

Ironically,a major turningpoint in US consciousness came when Rock

would ultimatelyturn out to be one of the four H's.27 This commitmentto

sexual practices,or who knows what are seen to be so radicallydifferentfrom

prostituteswithdisease, and the conceptual separationof infectedprostitutes(and other voluntarily

itselfcould destroythe immunesystem."God's plan forman," afterall, "was for

35. Congressman WilliamDannemeyer, October1985,duringa debateon a homosexualrights

"fast-track"would be particularlysusceptiblebecause of the prevalence of spe-

enabling us to stop short of the impossible,the unthinkablebillions that wide-

43. Leibowitch,A StrangeVirus,p. 36.

Donald Mager discusses the proliferationamong heterosexualsof visions

Leibowitchcommentsas followson AIDS, fantasy,and "the realityit pretendsto

JamesCurran's 1984 judgment thatpolicy,funding,and communicationwere all

"Interpretations,"write Bruno Latour and Steve Woolgar in Laboratory

The oddness of these namelessisolated eventsgave way to an even more terrify-

56. Latour and Woolgar, Laboratory Life.

59. CentersforDiseaseControl,"Pneumocystis Pneumonia-Los Angeles,"Morbidity andMortal-

for example, developed a research strategythat focused on retroviruses,essen-

64. Panem, "AIDS: Public Policy and Biomedical Research," p. 25.

68. Koch's postulates,developed by bacteriologistRobert Koch, would require that,in order to

alwayshas borders peopled by other statements,"70 and it is importantforus to

LAV: lymphadenopathy-associated virus (1983-

editorspoint out, there are high stakeswhere thisperformanceis concerned-

No ground troopshere, no combat,not even generals:we see here the evolution

system.Phagocytesand killercells receive no call to arms. B cells are

82. Jaret,"Our Immune System,"pp. 723-724.

had seemed predominantlya public healthphenomenon(clinicaland service-ori-

Reconstructingthe AIDS Text: Rewritingthe Body

the one and the other

homosexual and heterosexual

while Leibowitch(A StrangeVirus)is distinctivein his ironyand politicalself-consciousness about the

homosexual and "the general population"

contagion and containment,life and death

prostituteand paragon, whore and wife

93. ChristineBrooke-Rose,"Woman as a SemioticObject," in TheFemaleBodyin Western Culture:

AIDS is caused by killersperm,shootingfromone man's penis to the

Gay men are as sexuallydriven as alcoholics or drug addicts.

Women cannot transmitAIDS because theirbodies do not have the

Prostitutescan transmitthe virusbecause theircontaminatedbodies

death, it wearsan "innocent" disguise.AIDS is "caused" by homosexuals;AIDS

96. "Science and the Citizen," p. 58.

the "us"/"them" dichotomyand project a rosierscenario for "us" (well, maybe

Call me old-fashioned,but that'swhat I like!" A gay pastorin San Franciscotells

101. Ibid., p. 104.