Aids As A "Gay Disease"
The AIDS crisis challenged the most significant elements of the gay community as they had developed in the 1970s. The most obvious challenge was to its sexuality. Early in the epidemic scientists identified AIDS as a sexually transmitted disease, and the exuberant sexuality of the gay male community was implicated in its spread.[15]
Ronald Bayer, Private Acts, Social Consequences: AIDS and the Politics of Public Health (New York: Free Press, 1989).
In addition, the parts of the gay community that were most clearly affected were those that were most central to it; that is, the relatively sophisticated and self-conscious gay "ghettos" of New York, San Francisco, and Los Angeles. Finally, and most significantly for our purposes, the community was challenged in its newfound sense of identity and in its politics, especially the insistence on autonomy, self-determination, and the ending of discrimination against gay people. These and other "internal" problems were intensified through the manner in which AIDS was constructed in the minds of outsiders as a "gay disease."From the start, in 1981, AIDS was closely connected to homosexuals, since the first patients identified with the syndrome were gay men, and gay men have continued to form the largest single block of persons with AIDS. Early in the epidemic the connection seemed so self-evident that some researchers named the new disease "GRID" or gay-related immunodeficiency syndrome.[16]
Michael S. Gottlieb et al., "Gay-Related Immunodeficiency (GRID) Syndrome: Clinical and Autopsy Observations," Clinical Research 30 (1982): 349A.
The association of gay men with AIDS was, however, never quite so straightforward as it sometimes is made to seem. From the beginning, studies described non-gay persons with AIDS.[17]
Gerald M. Oppenheimer, "In the Eye of the Storm: The Epidemiological Construction of AIDS," in AIDS: The Burdens of History, ed. Elizabeth Fee and Daniel M. Fox (Berkeley: University of California Press, 1988), pp. 267-300.
For example, the first heterosexual patients, including the first women, were reported by the Centers for Disease Control (CDC) as early as August 1981.[18]Morbidity and Mortality Weekly Report 30 (1981): 250-52.
The first clinical descriptions of immunosuppression in heterosexual intravenous drug users appeared in December 1981. Interestingly, the editorial discussing these findings in the New England Journal of Medicine , while acknowledging the existence of heterosexual cases, systematically ignored them in developing a hypothetical causal model of the new syndrome in homosexual men.[19]David T. Durack, "Opportunistic Infections and Kaposi's Sarcoma in Homosexual Men," New England Journal of Medicine 305 (1981): 1466.
This example presaged the manner in which the epidemic would largely be handled in the first years: as a problem that mainly affected gay men that would be solved if particular attention was paid to the supposed characteristics of that population.In these circumstances it was probably inevitable that researchers should initially concentrate on what came to be known in both professional and popular discussion as "the gay life-style" in attempting to comprehend the etiology and epidemiology of the new disease.[20]
Morbidity and Mortality Weekly Report 30 (1981): 409-10.
By "gay life-style," however, they meant the narrow dimension of gay male sexual practice, abstracted from the community in which it took place and from that community's history and the meanings that it imparted to its sexuality.The identification of homosexuality with AIDS was underscored once scientists publicized the epidemiological concept of high-risk groups. High-risk groups were those whose members were at especially great risk of being infected and of infecting others.[21]
Oppenheimer, "In the Eye of the Storm," p. 282.
The designation of gay men as a high-risk group reinforced the notion that all gay men were diseased or at risk of being so. The effects were mitigated only to a small extent by the designation of additional groups as high risk (IV drug users, hemophiliacs, and Haitians, initially) and by the CDC claim that "each group contains many persons who probably have little risk of acquiring AIDS."[22]Morbidity and Mortality Weekly Report 32 (1983): 101.
Nonetheless, the designation of gay men as a high-risk group reinforced the notion that all gay men were diseased or at risk of being so.The belief that the gay male community in toto formed a risk group lost whatever rationale it had early in the epidemic as it became clear that only certain sexual acts put one at risk for AIDS and that, even in the context of those acts, a large measure of safety was achievable through the use of condoms and other precautions. Nevertheless, the idea that all gay men constituted a risk group was, for all practical purposes, never eliminated, even among professionals, who, as a group at least, had learned the weakness of such a belief and recognized that sexual practice varied among gay men as much as they did among non-gays. The persistence of the identification of the entire gay community as a risk group because of its sexual practices meant that gay sexuality itself was, in effect, identified as the "risky" factor. Scientific medicine thus appeared to support an old idea, largely discredited in the 1970s through the efforts of the gay community, that homosexuality was itself a disease.
Among the groups that were most significant in determining the varying interpretations of AIDS, right-wing ideologists (including leaders of conservative religious movements) were of particular importance. As they extended their anti-gay offensive of the late 1970s, AIDS was a powerful symbol for them, a way of negatively reinserting homosexuality into what one observer has called "a symbolic struggle between purity
and pollution."[23]
Steven Seiddman, "Transfiguring Sexual Identity: AIDS and the Contemporary Construction of Homosexuality," Social Text 19-20 (Fall 1988): 187-206; cf. Dennis Altman, AIDS in the Mind of America (New York: Doubleday, 1986), and Cindy Patton, Sex and Germs: The Politics of AIDS (Boston: South End Press, 1985).
In this type of discourse, punitive messages were central, as was the tendency to identify as the problem not a particular virus but those infected with it—in particular, homosexual men, who had supposedly introduced the virus into the country and served as a reservoir of contamination. These ideas were often echoed by the news media, which either publicized the notion of a "gay plague" during the early years of the epidemic or remained silent about AIDS, except when it appeared to threaten the "general population," implicitly defined as the heterosexual majority.[24]Cf. James Kinsella, Covering the Plague: AIDS and the American Media (New Brunswick, N.J.: Rutgers University Press, 1989).
The isolation felt by the gay community was further intensified by the ambivalent role played by the federal government. Normally a leader in the struggle against disease, and to some extent a mediator among competing groups, the executive branch under President Carter and, to a greater degree, under President Reagan had begun to dismantle institutions aimed at securing the health of the population and was loath to spend additional funds on a new disease that appeared to strike only or mainly at disliked populations.[25]
Daniel Fox, "Aids and the American Health Polity: The History and Prospects of a Crisis of Authority," in AIDS: The Burdens of History, ed. Fee and Fox, pp. 316-43.
In addition, it was not prepared, at least under Reagan, actively to combat a crisis in such a way as to seem to support the gay community, which it opposed on ideological grounds. Congress, the Public Health Service, and some states and localities were inclined to be more activist in the face of the epidemic, but in general government leadership was notable mainly for its absence.[26]Randy Shilts, And the Band Played On: Politics, People, and the AIDS Epidemic (New York: St. Martin's Press, 1987); D. Guston, Institutional Tensions in the Federal Government's Response to AIDS (Cambridge, Mass: Department of Political Science, Program in Science, Technology, and Society, Massachusetts Institute of Technology, 1989); U.S. Congress, Office of Technology Assessment, Review of the Public Health Service's Response to AIDS, document no. OTA-TM-H-24 (Washington, D.C.: U.S. Government Printing Office, February 1985); General Accounting Office, AIDS Education: Activities Aimed at the General Public Implemented Slowly, HRD-89-21 (Washington, D.C.: General Accounting Office, 1988).
The gay community thus quickly found itself in a difficult situation. By accepting the identification of gay men and AIDS, it would open itself to the social distancing, hostility, and loss of community empowerment such an identification would entail; by refusing the identification, it would allow AIDS to be ignored and its members to die needlessly. Consequently, the community had to find within itself—in its own institutions, identity, and history—the means to endure the epidemic and to save itself. Just as crucially, it also had to find allies among those groups, mainly heterosexual, that could ally with it for professional, ethical, or philanthropic reasons (such as public health personnel, medical researchers, elements of the political left and center, and representatives of liberal churches).[27]
Bayer, Private Acts, Social Consequences.
The intertwining of these two themes—internal resources and external alliances or compromises—would come to dominate the entire gay response to AIDS.