Medical Uncertainty and Gay Skepticism
As the number of AIDS cases continued to rise, increasingly fearful gay men struggled to make sense of the shifting and indeterminate medical claims and to sort out the implications for their everyday lives. Toward the end of 1982, Gay Community News (GCN ), a left-leaning weekly based in Boston, cited the "growing consensus among experts that AIDS is transmissible … and most likely through sexual contact."[75] Expressing the paper's sex-positive philosophy, writers in GCN were suspicious of views that blamed gay men for becoming sick, whether voiced by medical authorities or by gay men themselves. One prominent political analyst, Michael Bronski, wrote disapprovingly of the president of Gay Men's Health Crisis, quoting him as saying: "Something we have done to our bodies—and we still don't know what it is—has brought us closer to death."[76] Another writer in the same issue of GCN applauded the views of Jim Geary, head of the Shanti Project, a San Francisco organization: "The reason [we] get sexually transmitted diseases is not because we have multiple sexual partners. … It's because we don't take the necessary precautions in having sex."[77]
The question of how to translate etiological uncertainty into guidelines for personal safety was deeply troubling to gay communities across the United States. Nowhere did the debate rage more fiercely than in the pages of the Native in late 1982. The Native 's editor and publisher, Chuck Ortleb, introduced side-by-side commentaries by stressing the paper's democratic impulse and the need for the general public to assess scientific and public health debates: "The articles printed on these pages provide good examples of the level of debate prevailing in medical circles. … Confusing? Contradictory? Of course. But then, so is much of the discussion surrounding the present health crisis. It's a discussion that we feel virtually everyone should be involved in—gay people as well as non-gay, laymen as well as physicians, policy-makers as well as the citizenry. …"[78]
One view in the debate was offered by Peter Seitzman, president of New York Physicians for Human Rights, the gay doctors' association.[79] His argument was straightforward, if not altogether reassuring:
"The available evidence overwhelmingly suggests that AIDS is caused by some as yet undiscovered transmissable [sic ] agent," probably a virus. Since the transmission pattern appeared to be similar to that of the hepatitis B virus, prevention guidelines would be "precisely the same as those for avoiding hepatitis B," namely, never use a syringe used by someone else and reduce promiscuity. Eager to avoid any implication of antisex attitudes, Seitzman reassured his readers that he himself had been "no more of an angel than Mae West." But he concluded by affirming the virtues of "monogamy as a survival technique," declaring that promiscuity is not immoral "but simply dangerous."
The "opposing" commentary by Michael Callen and Richard Berkowitz in fact arrived at roughly similar, if far more forceful, conclusions, but began with radically different etiological premises. It was also quite different in tone. Callen and Berkowitz identified themselves as twenty-seven-year-old men, both "victims of AIDS," each with a history of having been "excessively promiscuous." Although the article didn't say it, they were also both patients of Dr. Sonnabend and they endorsed his immune overload hypothesis. (Callen would go on to become the most prominent "long-term survivor" of AIDS in the United States, a familiar figure at rallies and demonstrations; until his death in 1993, he remained an activist and an ally of Sonnabend's.) Entitled "We know Who We Are: Two Gay Men Declare War on Promiscuity," the article was nothing short of a manifesto: "Those of us who have lived a life of excessive promiscuity on the urban gay circuit of bathhouses, backrooms, balconies, sex clubs, meat racks, and tearooms know who we are. … Those of us who have been promiscuous have sat on the sidelines throughout this epidemic and by our silence have tacitly encouraged wild speculation about a new, mutant, Andromeda-strain virus. We have remained silent because we have been unwilling to accept responsibility for the role that our own excessiveness has played in our present health crisis. But, deep down, we know who we are and we know why we're sick."[80]
Turning to the medical evidence in favor of the different causal hypotheses—which they had evaluated on the basis of "personal experiences," their talks with researchers and doctors, and their "own readings in both the medical and the lay press"—Callen and Berkowitz argued that "AIDS is not 'spreading' the way one would expect a single-viral epidemic to spread." The confinement of AIDS to specific risk groups, they maintained, should lead us to look for the specific
explanation for each group's immunosuppression. In practical terms, whatever theory one chose to believe, "the obvious and immediate solution to the present crisis is the end of urban male promiscuity as we know it today," the authors concluded. "The party that was the '70s is over," and anyone who defended promiscuity on political or ideological grounds was simply in denial.
Sharp responses to Callen and Berkowitz were quickly forthcoming, both in the Native and in other lesbian and gay publications. Charles Jurrist, writing "In Defense of Promiscuity," argued in his reply that the uncertainty of scientific knowledge about causation had to be factored into any evaluation of personal risk. While granting that the immune overload hypothesis "is the most plausible of the several theories concerning the origins of AIDS," Jurrist reminded readers that the hypothesis was far from proven: "It therefore seems a little premature to be calling for an end to sexual freedom in the name of physical health."[81]
Others, such as Michael Lynch, writing in the pages of the Canadian lesbian and gay newspaper The Body Politic , were even more assertive in defending sexual freedom against medical moralism. These writers put the issue in historical and political context: The medical critique of gay promiscuity was simply the latest of many attempts to portray gay sexuality as diseased. At stake in the debate was "gay identity" itself. Gay men had fought to construct an affirmative identity, an essential part of which involved strong defense of sexual freedom and a critique of puritanical attitudes. And many of those they had fought against were doctors and medical researchers. Given this history, it followed that the debate about gay men and their sexual practices was thoroughly interwined with an older power struggle: who was to say what it meant to be gay—the doctors, or gay men themselves?[82] As Lynch poignantly expressed it: "Like helpless mice we have peremptorily, almost inexplicably, relinquished the one power we so long fought for in constructing our modern gay community: the power to determine our own gay identity. And to whom have we relinquished it? The very authority we wrested it from in a struggle that occupied us for more than a hundred years: the medical profession."[83]
In the absence of a cure for AIDS, or even an agreed upon cause—and in the aftermath of an initial scientific framing of AIDS as a "gay disease" linked to promiscuity, a formulation that aroused the wrath of many in gay and lesbian communities—the credibility of doctors,
biomedical researchers, and public health authorities suffered greatly in those communities. Increasingly gays were prompted to respond by insisting on their own right to intervene—to weigh the evidence, pass judgment, and remind the medical establishment at every pass whose lives were really on the line. Gay doctors like Mass sought a moderate position; writing in the Native in response to Lynch's commentary in The Body Politic , he acknowledged: "To an enormous extent, what Lynch is saying is true. Mainstream medicine and psychiatry have in fact been largely responsible for contemporary stereotypes of homosexuals as 'abnormal,' 'perverse,' and 'sick.' At the same time, however, mainstream medicine and psychiatry continue to serve vital health needs." Maintaining that the problem was not with medical science but with "the political abuse of that science," Mass advised his readers to "be critical but remain open to well-qualified medical advice."[84] But for those on either extreme of the promiscuity debate, from Lynch to Callen and Berkowitz, the watchword was self-reliance. Become your own expert: ultimately, that was the only reasonable hope gay people might have of surviving. "Rely on no single source for your information," exhorted Callen and Berkowitz: "not your doctor, not this newspaper, not the Gay Men's Health Crisis, not the Centers for Disease Control."[85]
Of course, it goes without saying that this strategy of collective empowerment presumed the existence of gay doctors, gay newspapers, and a Gay Men's Health Crisis. To be sure, the spreading disease would decimate the ranks of existing gay leadership. But ironically, the gay response to AIDS both presupposed and furthered the social development of lesbian and gay communities and their political clout—a process that Dennis Altman has called "legitimation through disaster."[86] Gay men and lesbians had long confronted homophobic attitudes, antigay discrimination, and heterosexist presumption on a daily basis in the workplace, in religious settings, in encounters with family members, on television, and in the movies. But in organizing to meet these challenges, lesbians and gay men had developed political and social institutions that were poised to respond to the new threat when it erupted. Moreover, gay communities were dominated by white, middle-class men—people with influence in society and access to an array of social, cultural, and political resources. It's no surprise that gays were hotly debating the details of causation theories while intravenous drug users—often the poorest of the poor—sat on the sidelines: these were the realities of power in the United States in
the 1980s. Even people with hemophilia, a diverse group that had the benefit of a preexisting national lobby, did not mobilize forcefully in response to the emergence of the epidemic. In this early period, Haitians were the only other group to challenge medical claims; they objected to the portrayal of Haiti as a possible origin of the epidemic and combated wild epidemiological speculation about the role of voodoo rituals in the transmission of AIDS. And most of the opposition came not from the grassroots but from politicians in Haiti and Haitian doctors living in the United States.[87]
The distinctiveness of gay communities' approaches to the emergence of the epidemic is brought out in Cathy Cohen's comparative analysis of gay and African-American responses. Although gay communities were hit harder, both gays and African-Americans came to be disproportionately represented in the statistics of illness and death as the epidemic proceeded. Both of these social groups were marginalized, and historical memory inclined both of them to distrust federal biomedical institutions. Yet "the indigenous norms and structures of these communities" promoted different political outcomes: "In the Gay community AIDS has become associated with the community's struggle for rights and entitlements. In the Black community much of the response to AIDS is based on a framing of the disease that still emphasizes behavior and the individual actions of those who have AIDS, making it much more difficult to transform AIDS into a political issue for the community."[88] As Cohen has described, established African-American organizations eschewed "ownership" of the problem of AIDS. It was often up to black gays and lesbians—those who stood at the intersection of these two social groups—to try to mobilize African-American communities and start up new organizations, while simultaneously confronting racism within gay communities.[89]