Science, the Media, and the Construction of Social Reality

What cannot be overstated is that the HIV hypothesis was not simply a scientific powerhouse. It was also—crucially—a social phenomenon. Immediately after the discovery of the probable cause of AIDS was announced, the hypothesis began its work of transforming the world and reshaping people's lives. Within two years, the first patients began taking azidothymidine (AZT), an antiretroviral drug that—at least temporarily—prevented the virus from replicating;

prescribed for many thousands of patients, AZT has earned millions of dollars for its manufacturer, Burroughs Wellcome. Even before that, thousands of people were touched irrevocably by the machinery of antibody testing, which sorted them into polar categories of "positive" and "negative." Gay communities were quite simply split into two groups; and despite frequent and sincere criticism of the tendency, antibody status became a decisive marker of identity—the sort of attribute gay men mentioned in personal ads, along with skin color and sexual predilections, to describe who they were and who they sought. In response to a belief in the HIV hypothesis, thousands of people changed the way they had sex—supposedly one of the most intractable aspects of human behavior. Even a practice as thoroughly unthinkable, in the contemporary U.S. political context, as providing intravenous drug users with clean needles suddenly became a reasonable, if controversial, health strategy that sane politicians might propose or endorse. Within a few years, the HIV hypothesis quite simply restructured the world, altering what millions of people did and said.

The mass media both mirrored and facilitated the process by which HIV became a social fact.^[49] A content analysis of selected articles from the New York Times suggests the trend over the period from 1984 to 1986. (I examined all twenty-one articles published in the latter half of 1984 that discussed both AIDS and the virus; in 1985 and 1986 news coverage skyrocketed, and I examined every fifth such article, in chronological order: forty-three articles in 1985 and fifty-one in 1986.^[50] )

In the second half of 1984, articles that discussed both AIDS and the virus were cautious in their conclusions (see table 4). Out of twenty-one such articles, eighteen made only qualified claims about the virus as the cause. By 1985, a striking shift had occurred: Out of forty-three articles in the sample for the year, twelve made only qualified causal claims and eight made only unqualified claims. Seventeen articles (41 percent) made no explicit claims yet clearly conveyed their implicit endorsement—in sixteen of seventeen cases by the unqualified use of the phrase "the AIDS virus" in reference to HIV.^[51] By 1986, the number of articles making only qualified claims had dropped to five out of fifty-one; ten articles made only unqualified claims; and the number of implicit claims rose to thirty-three (65 percent of the total). The decline in the use of qualifiers and the growing reliance on phrases such as "the AIDS virus" (or, more problematically, "the AIDS test") tell a clear story: reporters took for granted that the cause of AIDS was known. They had their doubts, to be sure, about whether Gallo

was the one who should receive credit for discovering it, but that the virus was indeed the cause was only very rarely questioned.^[52]

Articles in the Times in mid-1984, such as one by Judy Glass on June 3, discussed the reports of a viral cause in tentative terms. Glass quoted a medical professor who asked whether the virus was "the chicken or the egg"—the real cause or just another opportunistic infection.^[53] In October, Lawrence Altman sounded a more definitive note: researchers had "taken a major step toward fulfilling Koch's postulates" by transmitting the virus to chimpanzees.^[54] From about that time onward, articles by Altman—the Times 's main authority on AIDS—stopped expressing any doubts. In the second half of 1984, Altman wrote six articles about AIDS and the virus which made only qualified claims about its causal role and one that made both unqualified and qualified claims. In 1986, out of the seven articles in the sample that were by Altman, none made any qualifications. Two made unqualified claims only, while five simply implied that the virus was the cause (in four cases by referring to HIV as "the AIDS virus"). Altman did, however, write articles that discussed some of the anomalies in the HIV hypothesis, such as the mystery of why so few T cells appeared to be infected with the virus.^[55]