History of AIDS
By Mirko Grmek
Princeton University Press
AIDS Demo Graphics
By Douglas Crimp with Alan Rolston
Bay Press
The privileges status of the medical establishment in our culture dictates that its body of knowledge is somehow free of superstition and myth, despite the fact they’ve fed off each other for centuries. Even Susan Sontag, in her otherwise brilliant work Illness as Metaphor, wrote that the extent to which a mythology is mobilized in connection to a disease, and the extent to which those with the illness are stigmatized and victimized, is an index of how little we actually know about a disease scientifically. Her supposition allows for that common myth: the purity of scientific knowledge, that rare conjuncture where inquiry is untarnished by any interest other than concern for the ill.
Of course medical discourse has always had its own fallacies, and although many people are inclined to believe that myth and medicine fortunately enjoyed a divorce some time ago, the case of AIDS, and the distillation of harmful myths around it, has proven otherwise.
In his introduction to History of AIDS, Mirko D. Grmek, a Yugoslavian professor who is currently Director of Studies at the Ecole Pratique des Hautes Etudes at the Sorbonne, identifies AIDS as an illness which “expresses our era,” but more correctly it has become the symbolic locus for our contemporary anxieties. Its social enigma has triggered a reactive power structure; in North America it’s a case of reacting to an altered concept of what constitutes a family, changing gender roles, and the legal gains of lesbians and gays.
In its perhaps premature attempt to trace the spread of the epidemic this history unfolds with the mannerisms of a very highbrow detective novel often encumbered by its medicalese; Grmek likens his work to Thucydides and his theory of history. Initially, as History reveals the characteristics of those who first showed signs of the disease in America, the discovery that they were gay is pure rhetorical device. Grmek works the logic of his writing into paragraphs that end with the reaffirmation of the patients’ homosexuality. Grmek is swelling with sympathy for those who have been referred to derogatively as the 4-H club: homosexuals, Haitians, heroin addicts and hemophiliacs.
Certain medical discoveries which would make it possible to discern what AIDS is caused by, namely Robert Gallo’s discovery of retroviruses in 1975, occurred only recently. Grmek argues persuasively that it doesn’t make sense that AIDS emerged concurrently with the development of methods for understanding it, that perhaps this disease had appeared somewhere, sometime earlier.
In tracing incidence and loci of the virus, and its adaptability, Grmek scans the ages, going so far as to wonder whether AIDS dates back to antiquity. Grmek concludes it did manifest itself previously, notably in cases of what was diagnosed in the ’50s as Kaposi’s sarcoma in central Africa. And contrary to popular belief, Grmek finds evidence of AIDS in Europe before its appearance in the United States. He also asserts that spread of HIV to Haiti was a consequence of the gay American visitors and the Haitian male prostitutes who continue to sleep with their female companions.
Where much of History courts speculation at best, it also finds itself falling into an archaic pothole or two. Aside from his saintly praise for the Centre for Disease Control in Atlanta, an institution with lab closets full of skeletons, Grmek also recalls the “Patient Zero” theory, elaborated by Randy Shilts in Played On. For Shilts’s purposes North American patient zero was the French Canadian Gaetan Dugas, conveniently enough an airline flight attendant. Shilts took great narrative pains to cast Dugas as one of the archetypal villains in the AIDS crisis: the irresponsible gay slut. To make it work, Shilts needed to establish Dugas as a modern vampire, and he did so quite amply with accounts of Dugas’s licentious escapades which, Shilts says, often ended with Dugas telling his “victims” that he was infected and that they were going to die. Of course by unraveling all this for an anxious mainstream media, Shilts established himself as one of the heroes of the epidemic: the sexually conservative gay man.
Both Grmek and Shilts apparently ignore reparks from Dugas’s case worker at the Center for Disease Control, that Dugas “had come down with Kaposi’s but no one ever told him it might be infectious. Even at CDC we didn’t know then that it was contagious. It is a general dogma that cancer isn’t transmissible [AIDS was originally thought to be a form of cancer].” Grmek is careful not to accept Dugas as Patient Zero per se; he admits it’s quite possible he got it from another American, but nonetheless uses Dugas as an example of promiscuous ruin.
Obviously this is no social history, not in any significant sense. As mentioned, Grmek alludes to the suffering of those with AIDS/HIV, and sympathizes with those against whom AIDS has occasioned bigotry and violence. It would seem that with such passages History of AIDS would be trying to be too many things to too many disciplines, though its attempt at sensitivity may be commendable. It is only when detailing the unfortunate controversies between Robert Gallo and the Pasteur Institute in France over naming of the virus does Grmek hint at the “unofficial” History of AIDS which remains to be written. And further, all the instances in which competition between research companies, and the amount of money and prestige at stake, determined the direction of AIDS research, and worse even, the public’s understanding of AIDS. But overwhelmingly, what flaws this history, this scientific investigation, is not just Grmek’s choice of the road most traveled; it is the obviousness of the cultural prejudices which infiltrate his own understanding of AIDS.
When it comes to assigning blame for the spread of AIDS in North America, hemophiliacs suffer from “bad luck,” while the promiscuity of gay men is sexually irresponsible. Grmek complains that among gay men, the “search for physical pleasure and multiple partners passed for fundamental expressions of individual rights.” What Grmek fails to supply, while passing his judgments, is the cultural context of the lesbian and gay civil rights movement of the ’60s and ’70s. Grmek’s horror and pity escalates to paranoiac nightmares of Sodom, when he speculates that before the San Francisco of the ’70s, “Never in human history had one city known such a concentration of homosexuals, nor such promiscuity.” He makes much of the “network of homosexual contacts,” or gay social scene, through which HIV spread.
He makes a similar argument in explaining the spread of HIV in Africa, where he says “certain ancestral customs may have contributed to the transmission of AIDS: clitoral circumcision, infibulation, scarification for esthetic and ritual purposes …” Grmek also mentions the role of “modernization” in Africa in expanding the sex trade. He concludes that generally the spread came about by use of syringes and vaccination. In one of the most insightful passages Grmek outlines the problems of western medicine grafted onto African culture:
In the eyes of Africa, the white man’s
medicine consists essentially of
giving injections. The physician’s
syringe is a quasi-magical instrument
… But in a poor country everything is
reserved and reused as much as
possible. So the disposable syringe,
and undeniable technological advantage
in one cultural milieu, becomes a
disadvantage.
Unfortunately, the conceptualization of a “cultural medium” which precipitated the epidemic’s spread in the U.S., though helpful in understanding the early dimensions of AIDS in America, allows Grmek and others to engage in a veiled instance of victim blaming once removed: the idea that the individual, once removed from his or her cultural context, is only then innocent—as though individuals are indeed separable from their culture. It also provides a neat pseudo-medical axis upon which people can attack the legitimacy of gay relationships and gay culture, something which for all of his sympathetic gestures, Grmek does little to protect against. Grmek rails against promiscuity, specifically gay promiscuity, as an inherently unsafe sexual behaviour despite the preventive measures of safe sex.
Speaking of safe sex, Grmek isn’t all too thrilled with the idea. He writes that the “obsession with safe sex will do more to assist the spread of telephone obscenity than it will to rein in the spread of AIDS.” Grmek, it would seem, chooses to pay little heed to reality; he refuses to acknowledge that without eroticizing information about AIDS, education is left to sterile government pamphlets directed at some uniform sexual audience or worse yet, scare tactics and moral indignation. Death bells to ward off the well not only tempt their passions, but they leave those living with the virus feeling like the living dead.
A history lesson in the nature of AIDS education may be of interest to Grmek. When governments finally began initiating AIDS education campaigns, after years of intransigence, their slogans typically exploited such fears and the mystery around AIDS. A British slogan was “AIDS: Don’t Die Of Ignorance.” Ironically, the disseminators of such facile rhetoric were the culpable parties in perpetuating that ignorance in the first place.
AIDS Demo Graphics is in many ways one of the unofficial, or oppositional histories of the epidemic, and a definite antidote to the crusty theorizing of Grmek’s History. Assembled and written by two members of AIDS Coalition to Unleash Power (ACT UP) in New York City, it’s part manifesto, part history and most interestingly the first thorough documentation of what has already proven to be one of the most aggressive social movements of the ’90s.
Remarkably, ACT UP has reinvigorated the concept of activism and articulated it alongside moderate doses of postmodern politics. Reversing the agenda which has seen bashing escalate in the tow of an epidemic, ACT UP has established an axis, connecting actions on AIDS with lesbian and gay rights. The now familiar SILENCE=DEATH logo symbolizes the calculation. As Douglas Crimp describes it:
Our emblem’s significance depends on
the foreknowledge of the use of the
pink triangle as the marker of gay men
in the concentration camps, its
appropriation by the gay movement to
remember a suppressed history of our
oppression, and now, an inversion of
its positioning (men in death camps
wore triangles that pointed down;
SILENCE=DEATH’s points up).
SILENCE=DEATH declares that silence
about the oppression and annihilation
of gay people, then and now, must be
broken as a matter of survival.
ACT UP was initially conceived by Larry Kramer in 1987 out of frustration with the lack of political will power of the Gay Men’s Health Crisis, an AIDS service organization he had helped found. Bemoaning the absence of an intensive lobbying group ACT UP was born.
ACT UP New York has since become renown for its early response actions called “zaps,” and its well-orchestrated and obviously symbolic “die-ins.” AIDS Demo Graphics traces the major actions undertaken with accompanying photos and their familiar demo posters, from Wall Street to Washington, where in 1987 during the Third International Conference on AIDS, demonstrators were met by a line of police wearing yellow rubber gloves. It also analyzes the posters in the context of the propaganda war over AIDS.
Demo Graphics concludes with “Stop The Church”—an excoriating lunge at the singularly most destructive barrier to AIDS education and research in New York City: Cardinal O’Connor. The intelligence of their action, choice of targets, and often the humour, though grim, of their tactics is a testament to the truth of writer Gary Indiana’s summation of the epidemic: “a litmus test of people’s humanity.”
