1—
The Once and Future Epidemic
In And the Band Played On gay journalist Randy Shilts introduces one of the figures central to his history of the origins of the AIDS epidemic—Gaetan Dugas—at the 1980 San Francisco gay pride parade: Dugas's diagnosis of Kaposi's sarcoma just a few weeks before had not dampened his spirits since he expected the blemishes to disappear.[1] In the pages that follow, Shilts paints a picture of a self-absorbed profligate from whom AIDS radiated outward in an expanding circle, whose vainglorious sexuality enclosed others in the involuntary grip of AIDS. Mostly through And the Band Played On Dugas became known as "Patient Zero," the man whose erotic penchants and compulsions put him causally at ground zero of the American AIDS epidemic.[2] Shilts's portrait of Dugas recalls the literary visions of "anointers" who in earlier times "spread" bubonic plague,[3] and mass-media reports were quick to pick up the Dugas story in their headlines. Indeed, even the publisher's press release noted Dugas's story as one of the most salient features of the book.[4]
Others have also tried their hand at identifying the various forces that made the epidemic possible,[5] but And the Band Played On remains the most ambitious account thus far about the origins of the epidemic, about what persons and circumstances were responsible for the emergence of the unprecedented syndrome. And if there have been discussions about the origins of the epidemic, there have also been discussions about its future. In often dire and foreboding language many of these discussions conjure a future despoiled not only of health by the epidemic. Public
health analyst Ronald Bayer's Private Acts, Social Consequences: AIDS and the Politics of Public Health, for example, summons a future beset by trials of immense consequence and gravity in matters of civil rights should progress against the epidemic not keep pace with public expectation.[6] In law professor Monroe Price's Shattered Mirrors there is also augury of a future fatalistically vulnerable to moral desperation and political derangement.[7] Part of Price's haruspicy here is achieved through word choice. The following words, for example, occur on a single page of Shattered Mirrors chosen at random: enemy, virus, bacteria, parasites, vulnerable, puzzle, change, pessimism, AIDS, unrelenting, mocking, resistant, microbes, quarantine, illness, incubated, infectious, poor, disgrace, unchecked, infection, problem, doubtful, competition, survival.[8] The connotative force of page after page of dire language of this kind suggests a viral cataclysm whose outcome will determine the moral and medical perfectibility of man.[9]
The description of a figure who "spreads" AIDS is worth conjoining with considerations about the future of AIDS for what the conjunction reveals about the way responsibility is understood and assigned in the AIDS epidemic, about the way we think of the epidemic as a catastrophe, and about what remedies it requires. Its future turns out to be even more problematic than its present.
The "Spread" of AIDS
In describing the figure central to his account Shilts describes Dugas as "ideal for this community," the pretty-boy gay community, that is, by virtue of his sandy hair, inviting smile, trendy Paris and London clothes, and soft Quebec accent. By Shilts's account Dugas lived a life of parties, cocaine, Quaaludes, bars, baths, "poppers" (amyl nitrate), and travel. Once "the major sissy of his neighborhood in Quebec City," Dugas was an ugly duckling who became a swan, who could say with confidence: "I am the prettiest one."[10] But his dangerous sexual liaisons, not his looks, earned Dugas prominence in Shilts's account. Dugas kept, for example, an address book that amounted to an archeological record of his sexual history, with strata so old that he sometimes did not recall the fossilized names he unearthed there. He was unapologetic about his wide circle of lovers, an erotic life all the more attractive to him—according
to Shilts—as emotional compensation for an unhappy childhood. After years of taunting and torment by neighborhood bullies, he had carved "his own niche in the royalty of gay beauty, as a star of the homosexual jet set."[11] Dugas's mortal sin in Shilts's account was his unwillingness to abdicate his eminence in gay erotic hierarchy when doctors wondered whether his disease might be communicable. He not only ignored doctors' counsel to abstain from sex but after sex he even showed partners his lesions: "'Gay cancer,' he said, almost as if talking to himself. 'I've got gay cancer,' he'd say. 'I'm going to die and so are you.'"[12]
That he had been epidemiologically linked to 40 of the first 248 men identified with what was then called "Gay-Related Infectious Disease" (GRID) and that he ignored counsels to refrain from sexual relations made Dugas a prime target for explanations requiring a villain behind the epidemic. And acceptance of the characterization of Dugas as a villain has carried over even to accounts otherwise critical of Shilts's work. English professor James Miller, for example, observes, "I still shudder—whether with voyeuristic pleasure or zero-at-the-bone fright I can't tell—whenever I recall the lurid bathhouse scene where Patient Zero exchanges bodily fluids with a Castro Street clone and then cackles vampirically as he reveals his fulminant lesions: 'I've got gay cancer. . . . I'm going to die and so are you.'"[13] In describing Dugas's behavior in bathhouses, however, Shilts uses adverbs and adjectives sparingly. Only in describing Dugas's sexual willfulness does Shilts freely avail himself of a more expansive characterization, offering motives and attitudes.[14] Thus the spare description of the bathhouse scenes permits and elicits varying reactions. Though some readers have found Dugas a vengeful, viral sadist, it is not clear whether Dugas's remark that his partner is going to die means that Dugas has successfully caused disease in this partner or whether, in the fullness of sexual time, the partner cannot hope to avoid the disease because gay life is the way it is, because the partner already has the disease, or because the disease is unavoidable in any case.[15] Certainly, Shilts does not have Dugas cackling; on the contrary, he is talking almost to himself, whatever that might mean to a partner dressing hastily at his side, whatever that partner might have known—if anything—about gay cancer and its meaning for his own fate.
Despite the caution Shilts exhibits about directly attributing malevolent motives to Dugas in bathhouse scenes, he nevertheless stacks the narrative cards against Dugas from the beginning. There is little in Shilts's presentation that might exculpate Dugas or mitigate the view that Dugas, either in his person or in the ideals he epitomized, bore significant
responsibility for the epidemic. It even appears that Shilts has characterized Dugas as the Aristotelian efficient cause of the epidemic, insofar as he appears as its mechanism of transmission in this country, and gay ideals were the formal cause of the epidemic insofar as they shaped the culture in which transmission could occur easily. Shilts directs the reader's blame toward Dugas when he reports that one physician investigated legal measures to prevent Dugas from having sex and that strangers accosted Dugas on the street and told him to leave town. The narrative, moreover, cues the reader to identify with Dugas's "innocent" sexual partner. At one point, for example, Shilts describes Dugas's behavior in a bathhouse this way: "He would have sex with you, turn up the lights in the cubicle, and point out his Kaposi's sarcoma lesions."[16] By breaking the third-person narrative form here—the form typical of journalistic reporting—Shilts invites the reader to imagine being Dugas's victim. Such an invitation would be more readily accepted, of course, by readers prepared to imagine themselves open to gay sex and to bathhouses. Such an invitation may work in other readers to elicit a homophobic overlay to whatever other moral hostility they may feel about Dugas's behavior. The scenes even invite a conflation of homosexuality with promiscuity with callous, endangering behavior. This identification is amplified in its evocative force since Shilts never once cues the reader to empathize with whatever doubt and suffering Dugas must have endured during his sickness. Even Dugas's incredulity about the communicability of his condition—who had ever known cancer could be contagious?—is cast as denial; precious little sympathy is given to the skepticism Dugas might have had about the communicability of a hitherto unknown pathologic syndrome.[17] The social prestige and moral authority of medicine are powerful forces to be sure, but even so it would be hard to believe that medicine could produce new categories of disease. Shilts did not in fact interview Dugas (if such an interview was possible before Dugas's death), and there is no sympathetic word uttered by anyone on his behalf in the entire massive volume. In fact, Shilts does not offer Dugas as a portrait in biography so much as a one-dimensional scoundrel in a gothic novel, an occasion for lamentation about the evils of (gay) men.
Dugas's individual failings are not Shilts's only targets of criticism. Despite the claim that he is merely reporting, Shilts clearly fictionalizes Dugas's life as an emblem and symbol for gay life and especially for excesses imputed to it. If Dugas is blameworthy in the origins of the epidemic, by extension so too is the sexual ethos of gay life itself, because Shilts uses Dugas, and especially his willful sexuality, as a figure for all
gay men. Shilts says, for example, that Dugas had achieved what every man wanted from gay life. In his liberated life-style Dugas had freedom, travel, drugs, and plenty of sex. He was therefore the incarnation of gay male desire; only accidents of circumstance block other gay men from living like, desiring like, and being desired like Dugas. According to such a characterization, Dugas represented and gay culture pursued as its ideal that promiscuous, emotionally and materially unencumbered hedonism that opened the door to the epidemic. Fleshy immersion in sexuality was not merely accidental to Dugas's nature. Shilts says: "Sex wasn't just sex to Gaetan; sex was who Gaetan was—it was the basis of his identity."[18] To the extent then that Shilts uses Dugas as a figure for gay men—no other gay man in And the Band Played On is said to represent what every man wanted from gay life; not an activist, not a politician, not a journalist—the very defining properties of gay life provide the conditions of the epidemic's possibility. In an ideal gay world it would only be a matter of time before everyone slept with everyone—"so many men, so little time," lamented the motto of the age—with the result that there was nothing in gay sexual identity or its pursuits that would be a natural obstacle to or conscriptable ally against the epidemic.
According to this psychofictional characterization of gay life in And the Band Played On, gay males were not only vulnerable to the epidemic because of the ways in which they shared their bodies but also because they would be individually (like Dugas) and collectively (like bathhouse owners) compelled to resist measures to control the epidemic because of the way in which gay identity had been so narrowly defined and constructed. Control of the epidemic thus meant an undermining of gay identity by asking gay men to give up the sexual habits that had given them self-identification, self-affirmation, escape from oppressive personal histories, and the possibility of new forms of community.[19] By this logic any counsel or legal mandate to refrain from sex would have to be opposed by gay men as an assault on the foundations of individual and collective gay identity. It would follow that gay men would find counsel against gay sex, even if intended to protect their health, fulsomely resonant with echoes of moralistic and medical judgments that condemned gay sex as immoral, illegal, and even mentally disordered. So if the very nature of gay identity proved an obstacle to its own protection from the epidemic, then the conceptual foundations are laid for the protection of gay men from themselves by others, by public health authorities, for example, who would have to disregard gay protest. And indeed Shilts plots the bathhouse controversy in his analysis exactly along these lines.
Shilts concludes his "description" of Dugas, saying: "In any event, there's no doubt that Gaetan played a key role in spreading the new virus from one end of the United States to the other. The bathhouse controversy, peaking so dramatically in San Francisco on the morning of his death, was also linked to Gaetan's own exploits in those sex palaces and his recalcitrance in changing his ways."[20] Shilts sees Dugas here less as a person than as a kind of sexual constellation whose points of infection across the nation had been connected by the departure and arrival schedules of airline timetables. Certainly, Shilts sees Dugas as having achieved what every man desired from gay life, but at his death, Shilts says, "he had become what every man feared."[21] Dugas no longer belonged to gay culture in particular as its ideal but instead belonged to the world as a universal human threat, joining an elite rank of global terrors alongside nuclear destruction, biochemical warfare, and ecological calamity, every one of them linked with the specter of mass death.
Is Dugas what every man need fear? Even if one adopts a purely journalistic stance in regard to the life of Gaetan Dugas, there are other ways in which the story might have been told. Dugas was, after all, but a flight attendant without any particular history of moral strength; he lived unascetically in a culture that does not require sexual self-mortification. Claims about the transmissibility of cancer and of a new, previously unknown immune disorder would have been hard to believe even among those inclined to sexual asceticism. And even if Dugas had acknowledged his condition, in advance, to his sexual partners, it is unclear whether there would have been any more or any fewer cases of AIDS in the United States. Shilts offers no evidence that Dugas was specifically responsible for a diagnosis of AIDS in another person after being advised to refrain from sex. He does not cite a case of AIDS that would not have occurred otherwise except for the sinister bathhouse malevolence of that Canadian flight attendant betraying the obligatory altruism of his profession. In some respects too it was purely accidental that Gaetan Dugas became "Patient Zero." There were (and are) other gay men whose lives and exploits replicated his, whose address books held as many if not more names and telephone numbers, who were addicted in the etymological sense of the word (addicted meaning "assenting") to bathhouses, whose looks and sexuality were equally a career unto themselves. In many ways Dugas lived no differently from many of the continent-hopping, urban peers of his time. Why therefore should the hammer of judgment fall as heavily on Dugas as Shilts's narrative requires, especially since such a judgment replicates the homophobia that equates
homoeroticism with AIDS, especially since a large measure of Dugas's "fault" was not that he lived differently from others but merely that he—not they—got "it" first?
The claim that links Dugas to the emergence of AIDS in the United States is worth considering critically. Shilts reports that "at least 40 of the first 248 gay men diagnosed with GRID in the United States, as of April 12, 1982, either had sex with Gaetan Dugas or had sex with someone who did."[22] He further remarks that "a [Centers for Disease Control (CDC)] statistician calculated the odds on whether it could be coincidental that 40 of the first 248 gay men to get GRID might all have had sex either with the same man or with men sexually linked to him. The statistician figured that the chance did not approach zero—it was zero."[23] We do not know how the statistician made his or her calculations, but at one point a mean incubation period for the disease—the time between infection and emergence of symptoms—is stipulated as 10.5 months.[24] Such an assumption might support the claim that Dugas's role in infection in others could not be coincidental, but the measurement of latency in this way is meaningless since Shilts himself reports that infections could in fact date to 1976 (four years prior to Dugas's diagnosis), in which case the attributions of AIDS to sex with Dugas cannot be proved. A long latency period would in fact increase the likelihood of coincidence and diminish the certainty of causal connection. Certainly, the case for Dugas's causal role in the epidemic is far less convincing than Shilts represents it.
Dugas was certainly not exemplary in his behavior, but it is hard to say that his weaknesses were especially glaring given the times, given the nature and nurture of homoerotic desire in the United States. And whatever moral weaknesses he may have had were certainly amplified by the contrivances of contemporary culture. Easy airline flights across oceans and continents, for example, have had as much to do with the communicability of AIDS as much as any other epidemiological vector, including erotic ones. Perhaps the interesting question to ask about Dugas is not how one man continued to engage in risky behavior even after learning of his dangerous, communicable condition but why this story made its way into media reports and histories of the epidemic rather than reports on the deaths of gay men and analyses of the oppressive conditions of culture that contributed in a prejudicial way to the forms of gay identity in the United States which made gay men susceptible to infection. Why is it so easy to believe that the villainy of a few persons (or a class of persons) caused an epidemic through their deliberate be-
havior? Why is it that social contributions to the epidemic (in the form of increasing opportunities for sexual interaction) and medical contributions (in the form of increased control of other sexually communicable diseases) are ignored as relevant in assessing the "causes" of the epidemic? Focusing on Gaetan Dugas and his "personal" responsibility serves only to mystify the many forces that are the context, the unacknowledged preconditions, and sometimes the unknowable impetus of all human choices. Moreover, the synecdochic use of Dugas for gay men in general clearly risks making an anti-AIDS campaign into an antigay campaign.
There are, of course, people diagnosed with HIV infection or AIDS who do share beds and needles with unwarned others. But to focus on specific persons—individually or as a group—as responsible for the epidemic structures the analysis so as to avoid identifying other important preconditions of HIV infection. While condemnation of people who "spread AIDS," for example, is common, discussion about people who "contract" HIV by reason of failure to protect themselves is infinitely less common. Certain social responses show that even among people with HIV, blame is assigned in morally revealing ways. The ovations confirming Earvin "Magic" Johnson's standing as a national hero following the announcement of his HIV infection, for example, suggest that if there is villainy to be assigned in the epidemic, it does not very often go to the people who are "innocently" on the receiving end of an infection. The very terminology of "spreading" AIDS—terminology that is ubiquitously, unconsciously prevalent—suggests the premeditated, active transmission of disease to passive, innocent victims. The asymmetry revealed in the prevalence of language about "spreading" HIV and the comparative dearth of language about "contracting" the infection suggests that a cultural assumption is at work which believes that but for a malevolent few individuals—like Dugas—there would be no further "spread" of HIV. Such a presumption, however, is not only untrue to the facts of human nature, because it fails to acknowledge the way in which all persons are susceptible to some degree of erotic risks of infection, but also works as an obstacle for HIV education by imposing the responsibility for "containment" of the epidemic on a few persons whose duty it is to remain isolated in their viral quarantine. This kind of moral expectation—that people with HIV bear the burden of protecting all others—strategically relieves all others of duties in their own behalf, and the world is thus made safe once again for the noninfected and made safe in a way that requires no effort from the uninfected other than their contribution to the conceptual design of a moral quarantine.
We might also ask why Gaetan Dugas is represented as a greater social evil than, say, educational failures that even today leave teenagers confused about and unskilled in effective ways of protecting themselves against HIV infection. Some people (including prostitutes) with HIV infection have in fact been jailed here and there around the country when they have been found to have had sexual relations with others, and bathhouses have been closed in some cities. But what is the import of these events? That "johns" and bathhouse patrons have a right to sex without risks of HIV? That the duty of the public is to be outraged at sex and needle use among people with HIV? That public authority should be omnipresent to guarantee that all sex and needle use is without risk of HIV infection?
Narratives about individuals who "spread" AIDS offer easily identifiable culprits on whom to pin the blame for the epidemic and its continuing calamities. Shilts does make clear in his narrative that there is plenty of blame to go around for the epidemic—and he certainly does not spare some gay activists in this regard—but his depiction of Dugas's involvement with its beginnings is too facile. Shilts does not show, for example, the way in which human lives are socially intertwined and the extent to which human "choices" or identities are artifacts of culture. He does not read Dugas against the background of human fallibility, that fallibility that has sunk the best of both persons and nations, their best intentions notwithstanding. He does not read the sexual "fast lane" against the difficult emergence of gay culture in Western history.[25] Instead, the life of Gaetan Dugas is "reported" as a kind of sexual vortex whirling in a moral solipsism indifferent to the health and lives of others. Dugas hovers as a menacing, inverted incubus over the sleepy, dreamy sex play of gay men. To the extent that such a picture emerges and to the extent that Dugas serves as a figure for all gay men in this narrative, responsibility for the epidemic not unsurprisingly falls to individuals rather than to culture at large. Such a depiction also suggests that the reform or control of certain persons and places would restore what is otherwise a planet and a civilization in preordained moral and immunological equilibrium.
AIDS and the Body Politic
The conceptualization of the origins of the epidemic is instructive in the way in which blame is fixed and the catastrophe understood. If AIDS is
thought to follow the collapse of will—in either individuals or in the class of gay men and drug-users as a whole—such a view invites speculation about the necessity of controls that would restrict the range of sexual and civic choices traditionally respected in moral and political philosophy. Monroe Price's Shattered Mirrors , for example, fleshes out this kind of speculation, foretelling what the epidemic might mean for the future understanding of citizenship, rights, and freedom. Put at risk by AIDS, he says, are the equation between autonomy and sexual expression; the accustomed, limited role of government authority in shaping public thinking and morality; the fragile standing of minorities in American society; and the circumspect and rational use of government power. Given such a view, the continued elusiveness of either cure or vaccine may yet further wither faith in the state and its ideals; in desperation, public opinion may swing in favor of more drastic measures of control.[26] Price's book is full of proleptic prophecy that fear of the epidemic, limited success in containing the "spread" of AIDS, the traditional wide berth given to government action justified in the name of public well-being, and a brooding public opinion all threaten to provoke an assault on civil liberties as well as reconfigure an understanding of the meaning of American civic traditions.
Ronald Bayer has also advanced the view that AIDS may prove a pivot on which the nation could turn against its commitment to reason and civic traditions: Will reason, balance, and a search for modest but effective intervention, he wonders, fall victim to a rancorous din?[27] Thus we can understand the gloss he puts on a California referendum that would have put restrictions on the employment of people with HIV infections. Although the bill was in fact defeated, Bayer says, the referendum "revealed how popular discontent might be exploited in the years ahead as the absolute numbers of AIDS cases mounted. It had also demonstrated the existence of a popular base that could be mobilized for a repressive turn in public policy."[28] The conclusion of Bayer's Private Acts, Social Consequences also raises the question of whether the American public will at some time demand tougher, less voluntary measures against AIDS; it also points out the ease with which a voluntarist strategy for prevention of infection might be subverted.[29]
In one sense these kinds of analyses are merely tautologies that AIDS cannot but change the future. Time and again they fall back on the language of "may," "could," "can," and "might" and thus trade in the realm of logical possibilities. Fear of the endangerment of the nation "by" AIDS can, as Price says, muffle concern about constitutional
formalities and the protection of rights, but such a claim would be true about any durable and deep fear held in the nation, whether about AIDS or oil supplies.[30] It is always true that society might suffer mood swings in which it is prepared to jettison its carefully crafted legal precedents, its civic traditions, and the roles it expects of government, and this is no less true in and because of the AIDS epidemic. Yet society might respond otherwise to AIDS. Society might come to accept the burdens of AIDS as part of the human condition and not see the disease as requiring a special moral interpretation or the imposition of coercive measures. The epidemic might elicit untapped reserves of social altruism rather than transmogrify society into a punitive if "enlightened" garrison. Gay philosopher Richard D. Mohr has suggested that "ideas, thoughts, reason, and argument will have no significant role to play either in the formation of public policy or in changing individual behavior in the AIDS crisis."[31] His view of the future suggests that profoundly antigay values and structures in society will work to confound an honest confrontation of the epidemic. In this foretelling, a future beset by AIDS becomes not an aberration of contemporary society but its logical conclusion. At their worst, analyses, which raise dark visions of the future but do not equivalently argue against the evils of such a future, risk being self-fulfilling prophecies by reason of the very fears they create and popularize.
Looming behind many analyses of the influence of AIDS on the future is the sense that the real damages of the epidemic have yet to transpire. These analyses are often cast in terms of protecting the future from the present epidemic, as if the evils of the epidemic belonged most significantly, perhaps even exclusively, to the future. For example, one of the most alarmist analyses of AIDS is to be found in Gene Antonio's The AIDS Cover-Up?[32] which was published during a 1986 peak in national AIDS anxiety. Antonio argued that AIDS is more dangerous than plague or a major war because of the silent way in which it "spreads." In what he called "optimistic" projections, based on his own calculations, Antonio estimated that by the end of 1990 there would be sixty-four million infected Americans in addition to mass death, mass sickness, and a crushed and wasted health system.[33] Along the same lines, Finnish philosophers Heta Häyry and Matti Häyry called for action against AIDS in the name of the millions of people in the future who may fall victim to it. To make their point, they aver that "nuclear holocaust, the main source of fear among people today, will tomorrow look like the only peaceful way out of our misery if governments do not care to stop the
triumphant march of AIDS now ."[34] What dangers AIDS must pose if nuclear holocaust could in any way ever be a consolation! But if the dangers of the epidemic do belong primarily to the future, is not the political and moral effect to dismiss the urgency of AIDS? Rhetoric of this kind and pitch—ranged alongside the hyperbole typical in political analyses competing with all other world events for attention—could suggest that AIDS is not yet sufficiently important to require systematic concern, that it has not yet killed enough persons to justify trimming the budgets of other, important government expenses. Viewing the epidemic as a future harm not only provokes exaggerated depictions of its gravity but it also and ironically drains off energy and resources by situating the epidemic in some remote period distant from the interests and concerns of present life. Certainly, depicting nuclear holocaust as a "solution" preferable to a future with AIDS risks writing AIDS into the order of fate as a cataclysm against which no human effort could prevail regardless of how much money government set aside for AIDS-prevention programs. Situating the epidemic primarily in the future permits both an exaggeration and trivialization of the epidemic and in either case risks muting the current significance of AIDS.
Conjoined with a view of the future despoiled by the misuse of civil liberties meant for pursuits far nobler than bathhouse sex and drug use, it is little surprising that there would be analyses like those of Price and Bayer regarding the possibility of extensive civic revisionism which would brusquely assert public control over individual choice. Price observes that "law becomes a gracious song that can be sung when it is possible to sing but abandoned when it is not."[35] If people with HIV continue to threaten society with their disease, the subtext of this message reads, society must revert to an atavistic standard somehow morally superior to the excesses of contemporary civic traditions that are special and apparently temporary dispensations from a more compelling moral authority whose name is the public health or common weal. A concomitant consequence of depictions of "future AIDS" is that the moral and social intensity they would ostensibly marshall may be defused by the oracular futurity of their messages.
A "Scientific" Future
Discussions about the future of AIDS do not belong, of course, only to historians and political moralists. They are also to be found in science and
the media. Reports from the 1992 international AIDS conference, held in Amsterdam,[36] raised the future of AIDS in ways that not only replayed earlier forms of AIDS discussion but that also situated the import of the epidemic in the future.
Researchers at that conference held out little hope for an immediate cure or a vaccine,[37] and they forecast a disheartening AIDS toll. Since many predictions were prepared for the year 2000 the feared future of AIDS draws nearer all the time. An article in U.S. News & World Report , for example, said: "Researchers at the Harvard AIDS Institute expect that by the year 2000, the number of Thais afflicted with HIV will balloon to 2 to 4 million out of a current population of 58 million, largely through heterosexual intercourse."[38] The same piece said of AIDS in India: "Despite official statistics that calculate just 125 victims, an uncounted 6,000 people are now believed to be dying of AIDS in the country, with another 500,000 to 1 million people infected with HIV."[39] Worldwide estimates for the year 2000 were put at between 30 and 110 million people with HIV infection by 2000. By now, of course, ever-worsening prognostications are standard features of narratives about AIDS in almost all disciplines. The costs of treating people with AIDS also form part of the archetype of AIDS forecasting.[40] The future of the world's economy is often called into question as well: "The pernicious plague, now spreading misery around the world at an alarming rate, may also plunder the global economy over the next decade."[41] Litanies about the evils of AIDS offered by political commentators, religious leaders, and writers to Dear Abby invariably include AIDS among the woes of our age which imperil the future.
Beyond these fairly typical features of AIDS discussions, reports from the Amsterdam conference also raised the specter of a third virus responsible for patients with apparent AIDS who failed to demonstrate evidence of HIV infection. Several AIDS researchers reported the existence of such patients,[42] and one researcher said that he had even isolated a new virus from the patients.[43] Other researchers withheld comment about their findings pending the publication of reports in scientific journals.[44] The possibility of a novel pathogen fueled even further speculation about the future of worldwide AIDS. First, such reports called into question the state of biomedical knowledge about the pathogenesis of AIDS; they raised questions about the aggressiveness of the CDC in monitoring information and trends in this epidemic and about the worth of embargoes against release of research data to the media prior to publication in biomedical journals. Mostly, though, these
reports questioned whether current measures taken to protect blood products can be effective against an unidentified pathogen. Even the earliest reports about a possible third pathogen responsible for AIDS took pains to stave off panic about an "uncontrolled" epidemic. Several researchers pointed out, for example, that the new cases of "AIDS" may prove to be other forms of unrecognized immune disorders, the product of an increased vigilance for such disorders. Others pointed out that blood banks should be protected by virtue of the steps they already take to avoid pathogen-bearing blood. A New York Times lead editorial cautioned against panic at the identification of a new "AIDS virus." The thirty-some cases of idiopathic AIDS, the Times concluded, are not yet a threat and may never be: "The strange new AIDS-like cases may yet turn out to be more a scientific curiosity than a public health hazard."[45]
Contradictory reports about the contagiousness of AIDS viruses, however many of them there may be, also appeared in 1992. Newsweek , for example, said: "If there is a new AIDS virus, it doesn't appear any more contagious than HIV. Some of the stricken patients may deny having HIV risk factors, but there's no evidence that they have contracted, or transmitted, their illness through casual contact."[46] A report of HIV in Thailand, however, suggested that there were HIV "subtypes" that differed not only in "virulence" but also in contagiousness.[47]
The combined effect of all these reports is striking inasmuch as they underscore the role of authority and science in predicting AIDS ills and deepening the mystery over the disease without being able to offer any substantive biomedical control over the current and future epidemic. Against a predicted, global catastrophe of proportions not yet imaginable, the reports of novel occurrences of AIDS outside the reigning explanatory paradigm threaten a revolution against the confident authority of AIDS expertise. It is as if medicine owes as much to Cassandra as to Asklepios. Hence the rush to calm the public is accompanied by reports of a new virus that might elude the barriers ensuring the safety of blood used in transfusions and other medical applications. Uncertainty invites speculation, and where there is speculation people will see in the future what salvific qualities they think necessary for the redemption of the present as well as what catastrophes they think inevitable from current, objectionable practices. Certainly it is true that there have been many false leads regarding the pathogenesis of AIDS, and there are many reasons not to rush to judgment about the significance of cases of idiopathic AIDS and about questions of subtype virulence and transmissibility. Nonetheless, that the future remains the pervasive worry
about AIDS suggests the many ways in which AIDS is not felt in the present, the many ways in which the epidemic is undervalued as the evil that it is at present. It is certainly telling that in all the major media reports about a possible new pathogen, no one thought to mention the significance of that conjecture for people who suffered from that kind of disorder. Amid all the speculations about future victims of this virus, there was no mention of those who might already be affected.[48] Medicine and moral civilization apparently have no interest in such PWAs or their loss is already without significance. They are already apparently beyond the pale in a sense consonant with the origins of that phrase: pale, from the Latin word for stake and thus fence, in a phrase originally referring to the limits of the English empire in Ireland; a boundary beyond which civilization has no interest.
Conceptualizing the relationship between AIDS and the future is a problematic task. Certainly there is much to be done to protect future generations from the ravages of the epidemic. Yet invocation of the future may in fact serve other strategies that work against such protection, strategies that distance the epidemic from its immediacy, strategies whose hyperbole corrodes commitment to or even belief in the possibility of overcoming the epidemic, and strategies that in sum write off the present as beyond redemption. Such strategies may also "read" the epidemic into nature, suggesting that it is the order of nature, not the social order, that stretches the epidemic over the globe and concluding that human efforts of resistance are as of little use as trying to halt continental drift. We must even consider motives for the protection of the future: Is "public health" merely the continuation of politics by other means? Does "the future" have the same kind of coded meaning as "family values" and imply specific moral arrangements of human relations and only those?
The future, of course, has not been imagined only as an immunological dystopia in the style of, for example, German novelist Peter Zingler's Die Seuche (The Plague), in which a future society is highly polarized by HIV and Germany's extremist "solutions" to the epidemic.[49] On the contrary, there have been works of imagination which have tried to foresee a future protected from AIDS without at the same time invoking specters of mass death, of foretelling a world laid waste by bodily fluids. Often focusing on the political activism of people with AIDS, gay men, and their allies,[50] these works try to imagine a future without AIDS which links past and future in community with the present. One such act of imagination may be found in the final moments of the
1990 movie Longtime Companion , by Craig Lucas and Norman René. In that scene two lovers, Willy and Fuzzy, walk the beach with Fuzzy's sister and discuss demonstrations, arrests, their losses, and their conceits. "I just wanna be there if they ever do find a cure," Willy tells his companions. "Can you imagine what it would be like?" Fuzzy wonders. A pregnant moment later a swarm of the "dead" rushes over the hill toward the trio, full of sound, color, and life. James Miller has observed that in such an ending "all losses are restored and sorrows end in an extemporaneous party scene that recaptures the joie de vivre of the Fire Island revelers at the beginning of the film, minus, of course, the poppers and booze and virus."[51] As an act of imagination and as one of the very few, sustained cinematic features about AIDS, Longtime Companion could not be expected to fulfill all hopes, and the movie faced criticism not only for its rich, white character demographics but also for the escapism of its all-too-utopian ending.[52] Longtime Companion does not offer a future ravaged medically and politically by AIDS. Neither, though, does it offer merely an escapist, apolitical revery, merely an AZT-laced opiate for the masses. The future envisioned by these longtime companions is no religiously earned "compensation" for present trials and sufferings, no delayed gratification deserved through virtuous living. Instead, the ending of Longtime Companion enacts a momentary dissolution of time and thereby robs it of any capacity to frame invidious conflicts between the past, present, and future. Judgments about the origin of AIDS disappear as insignificant because some future cure has for a moment reached into the past. The protection of the future cannot serve as a pretext for any political cause since there is no other moment but this one. Questions about blame for the past and responsibility for the future also collapse in this scene because—except that these terms are no longer meaningful—the "living" embrace the "dead" in a temporally indivisible community.
An observation by the seventeenth-century French philosopher Blaise Pascal may have an uncanny relevance to this postmodern epidemic. In the Pensées Pascal commented on the human condition: "We almost never think of the present, and if we do think of it, it is only to see what light it throws on our plans for the future. The present is never our end. The past and present are our means, the future alone our end." In our studied avoidance of the present, Pascal observed, we (whom he called "thinking reeds") fill our lives with vanities and diversions: "Thus we never actually live, but hope to live."[53] Controlling our penchant to see our lives through lenses of the past and future can itself determine
whether we live or only and merely hope to live in and with the epidemic. There are many ways in which to tell the story of the origin of AIDS, and there are many ways to imagine its future. But there is certainly a lethal combination in the view that people with HIV are themselves alone morally responsible for the "spread" of the epidemic and in the view that the "real" dangers of the epidemic have yet to transpire. Against such narratives, we would be wise to underscore human fallibility in determining responsibility for the emergence of this divisive epidemic. It would certainly be unwise and unfair to hold out a future so damaged by AIDS as to indulge rightist fantasies of stern "anti-AIDS" measures or to characterize the evils of the epidemic as not yet having "really" happened. Shilt's depiction of Gaetan Dugas may satisfy the anthropomorphizing desire for an explanation of evil, and the lure of "get tough" politics may satisfy the hunger for assurance that "something" will be done to protect the immunological and economic purity of the future, but narratives emphasizing "individual responsibility" and "future damage" prevent seeing the many complex social forces that to this day conspire to permit further HIV infection as well as ways in which the epidemic has yet—future damage apart—to be appreciated as the damage it already, irrevocably is. In this epidemic imagined another way, time does not have to be viewed as either the engine of willful conspiracy or the horizon of inevitable tragedy. In an epidemic thus understood as something other than an antagonism between the past and the future, hope may proceed in the name of a people undivided by time.