The Reconstitution of Identity
Victory or co-optation? Such a stark opposition is inadequate to capture the nuances and micropolitics of activist engagement with the ACTG. Activists certainly were aware of the risks; for some time, they had been elaborating a complex strategy of intervention as both "insiders" and "outsiders." The NIH demonstration was a case in point. Fauci told the New York Times that he "knew the leaders of the protest well and was surprised to hear 'irrational' language on the street from people he had worked with in meetings." But activists, and surely Fauci as well, knew that the language of the street and the language of the meeting room served different purposes and had different intended audiences. Activists, for their part, had been concerned about not jeopardizing the existing working relationships with NIH personnel, as Harrington later recalled: "When we did the NIH demo, Peter [Staley of ACT UP/New York] said, 'Oh, let's call Tony [Fauci] and go and have dinner with Tony and tell him about this demo.… In a way, we'll give him an advance heads-up. But we'll also be saying: "Look, even though we're doing this demo, we still want you to understand that we have a relationship where we can discuss and debate our issues.…"'"
Such maneuvering was a tricky business. Yet the politics of simultaneous insider and outsider activism might well have continued smoothly had it not been for two crosscutting sets of pressures. First, AIDS treatment activism was becoming increasingly diverse , and the establishment of the CCG would make it more so. But different constituencies had different priorities, goals, and degrees of access to federal officials—and, therefore, different opinions about the purposes and the relative merits of insider and outsider strategies. Second, AIDS treatment activism was becoming increasingly more complex (as John James had suggested in comparing NIH issues to FDA issues). The established treatment activists knew about much more than clinical trial methodology and design—by this point they could speak fluently about a host of technical issues that were surfacing in research on AIDS treatments. These activists had become experts of a sort, and
they could engage with researchers, government health officials, and pharmaceutical companies in a way that their fellow activists could not. The practical consequence was that it became harder for individual activists to locate themselves simultaneously on the inside and the outside. Activism tended toward a de facto division of labor—some people working on the inside, others on the outside—thus relocating the expert/lay divide to a position within the movement itself.