Rock Hudson and the Crisis in Gender
Ironically, a major turning point in America's consciousness came in the summer of 1985 when Rock Hudson acknowledged he was being treated for AIDS.[64] Through an extraordinary conflation of texts, Rock Hudson's illness dramatized the possibility that the disease could spread to the "general population." "I thought AIDS was a gay disease," said a man interviewed by USA Today , "but if Rock Hudson can get it, anyone can." Hudson was, I would argue, another "border case" (in Poovey's sense) in which such textual conflations became common: When an event contradicts the perceived natural order of things, it becomes a cultural dispute that generates vast quantities of discourse designed to shore up existing distinctions and resolve contradictions.[65]
Another site of continuous dispute is the mechanism through which the virus is transmitted, as well as the different explanations for the epidemiological finding that AIDS and HIV infection in the United States were appearing predominantly in gay men. One view holds that the prevalence among the latter is essentially an artifact ("simple mathematics") because the virus, for whatever reason, infected gay men first and gay men tend to have sex with each other. The second is that biomedical/physiological factors make sexually active gay men and/or the "passive receiver" more infectable. A third view is that the virus can be transmitted to anyone, but that certain cofactors predispose the development of infection and/or clinical symptoms in particular individuals.[66] There are also speculations about the quantity of virus that is needed to cause infection (virus is both a count and a mass noun). Dr. Mathilde Krim, then of the AIDS Medical Foundation, for example, suggested that because the virus "must be virtually injected into the bloodstream" male-to-female transmission is more likely.[67] Jonathan Lieberson, likewise, concluded in 1986 that infection requires "direct transfusion into the bloodstream."[68] Dr. Jacques Leibowitch, however, relates transmission patterns, on the one hand, to the fact that homosexual men have sex with other homosexual men and, on the other hand, to the male homosexual "duality." A man, that is, can be a "receiver" of the virus from one man and then be a "donor" of the virus to another, in contrast to the "relative intransitivity of heterosexual propagation." By virtue of their "natural anatomy," women receive but do not give.[69] Indeed, many scientists have come to hold the view that, as Nathan Fain put it, "infection requires a jolt injected into the bloodstream, likely sev-
eral jolts over time, such as would occur with infected needles or semen. In both cases, needle and penis are the instruments of contagion."[70]
All this generated considerable confusion as to who was likely, even capable, of becoming infected and just what it was that increased or decreased that likelihood. Much of the uncertainty in the science and medical journals obviously turned (as, indeed, it still does) on the precise mechanisms of transmission. Nevertheless, even in the journal literature, and certainly as presented to the general public, questions about transmission were interpreted in part as questions—anxious questions—about sexual difference (male/female; heterosexual/homosexual; active/passive).
To the rescue came John Langone in the December 1985 issue of Discover magazine. In this lengthy review of research to date, Langone suggests that the virus enters the bloodstream by way of the "vulnerable anus" and the "fragile urethra." The "rugged vagina" (built to be abused by such blunt instruments as penises and small babies), in contrast, provides too tough a barrier for the AIDS virus to penetrate.[71] "Contrary to what you've heard," Langone concludes—echoing a fair amount of medical and scientific writing at the time—"AIDS isn't a threat to the vast majority of heterosexuals . . . . It is now—and is likely to remain—largely the fatal price one can pay for anal intercourse."[72] (This excerpt from the article also ran as the cover blurb.) Detailed cross-sectional drawings of anus, urethra, and vagina illustrated the article's conclusion.
The Discover article reassured many people about the continuing validity of the CDC's original 4-H list of high-risk categories. But categories of risk, of behavioral practice, and of identity may be quite distinct, or may overlap with each other—an ongoing problem in AIDS epidemiology and research. Sociologist Jeffrey Weeks, for example, analyzes the evolution of homosexuality as a coherent identity. "The gay identity," he writes, "is no more a product of nature than any other sexual identity. It has developed through a complex history of definition and self-definition," and "there is no necessary connection between sexual practices and sexual identity."[73] The problems with the CDC list were known to some science reporters, at least to the few who were knowledgeable and tenacious enough to take their analysis beyond the official party line. Ann Giudici Fettner, for example, pointed out in 1985 that "the CDC admits that at least 10 percent of AIDS sufferers are gay and use IV drugs. Yet they are automatically counted in the homosexual and bisexual men category, regardless of what might be known—or not known—about how they became infected."[74] So the "gay" nature of
AIDS was in part an artifact of the way data were collected and reported, though it was generally hypothesized until 1986 that the cases assigned to the category OTHER (or UNKNOWN, or UNCLASSIFIED) would ultimately turn out to be one of the four Hs. As Shaw and Paleo point out, however, the number of women in this category remains much larger than men; they point out, among other things, that the category "homosexual" was not broken down by sex despite potential risk for lesbians via sexual activity and artificial insemination.[75] Data from Africa were showing that women and men were infected in equal numbers; yet the practice of medicine and resources for data collection in Africa, especially outside urban areas, made the data questionable on a variety of grounds.[76] And even as evidence accumulated that transmission could be heterosexual (which begins with the letter H, after all), scientific and popular discourse continued to construct women as "inefficient" and "incompetent" transmitters of HIV, stolid barriers that impede the passage of the virus from brother to brother.[77]
In the discourse of this period (from approximately mid-1985 to December 1986), there were exceptions, which will probably not surprise us. As evidence of AIDS in women mounted, speculation linked the disease to prostitutes, intravenous drug users, and women in the Third World (primarily Haiti and countries in central Africa). It was not that these three groups were synonymous but, rather, that their differentness of race, class, or national origin made speculation about transmission possible—unlike middle-class American feminists, for example. American feminists also by this point had considerable access to public forums from which to protest ways in which they were represented, while these other groups of women were, for all practical purposes, silenced categories so far as public or biomedical discourse was concerned (fig. 2).[78]
Prostitutes—despite their long-standing professional knowledge of STDs and continued activism about AIDS—have long been portrayed as so contaminated that their bodies are, like "bloody Maggie's" in the passage at the beginning of this chapter, "always dripping," virtual laboratory cultures for viral replication.[79] Early failures to find AIDS cases among prostitutes, however, supported the "gay disease" hypothesis.[80] "Women in general," concluded a Johns Hopkins professor of medicine, "seem to be less efficient transmitters of the disease."[81] Immunologist Paula Strickland concurred: "I think AIDS would be containable and would pose no threat to heterosexuals if there weren't any bisexuals in our society."[82]
Commitment to this view of AIDS as a male disease was so strong
2. Against a dark, ominous background, prostitutes are shown "working the
streets in New York." Despite many qualifiers in the caption and lack of
scientific evidence, Newsweek 's use of this photograph (12 August 1985,
p. 28) lent credibility to the familiar belief that prostitutes would inevitably
figure largely in the spread of AIDS. Courtesy of Ethan Hoffmann Archive.
that when R. R. Redfield and his colleagues reported a study in the Journal of the American Medical Association demonstrating infection in U.S. servicemen who claimed heterosexual contact only—with female prostitutes in Germany—various attempts were made to discredit or dismiss this new evidence:[83] Servicemen, for instance, would be punished for revealing homosexual behavior or intravenous drug use; they really had gone to male prostitutes, and so on.[84] If women were merely passive vessels without the efficient capacities of a projectile penis or syringe for "efficiently" shooting large quantities of the virus into another organism, the transmission to U.S. servicemen from German prostitutes must be only apparent. Indeed, one reader suggested, transmission was not really from women to men but was rather "quasihomosexual": Man A, infected with HIV, had sexual intercourse with a prostitute; she, "[performing] no more than perfunctory external cleansing between customers," then has intercourse with Man B; he is infected with the virus by way of Man A's semen still in the vagina of the prostitute.[85] It was taken for granted that the prostitute took no preventive or cleansing measures, and, one must suppose, that the projectile penis could also function as a kind of proboscis, sucking up quantities of virus from a contaminated pool. A similar metaphor, and one we shall meet again, occurs in a study of urban prostitutes in central Africa; the prostitutes are called "major reservoir of AIDS virus," African heterosexual males are "vectors of infection."[86]
Evidence suggests, however, that prostitutes are not at greater risk because they have multiple sex partners, but because they are likely to use intravenous drugs.[87] Shaw and Paleo, for example, write:
There is no evidence that prostitutes constitute a special risk category. . . . Some prostitutes do get AIDS. To the extent that researchers have been able to isolate prostitution and/or multiple sexual contacts from such issues as IV drug use, however, neither the number of sexual contacts nor the receipt of money . . . seems to put women at a higher risk for getting AIDS. Many women who are in paid sexual activity were concerned about sexually transmitted diseases even before the AIDS epidemic. They protected themselves and continue to protect themselves by being somewhat alert to new medical developments in sexually transmitted diseases and how to avoid them.[88]
COYOTE and other organizations of prostitutes have addressed the issue of AIDS rather aggressively for several years.[89] Some scientists have also attempted to counter the prevailing view that AIDS is predominantly and inherently a gay disease. Virologist William Haseltine, for example, dismisses exotic explanations of the African data: "To think that we're so different from people in the Congo is a more comfortable position, but it probably isn't so."[90] Haseltine successfully used this argument to obtain increased AIDS funding, citing Redfield's data on the U.S. servicemen in Germany at a congressional hearing: "These aren't homosexuals. These aren't drug abusers. These are normal, young guys who visited prostitutes. Half the prostitutes are infected, and these guys got infected."[91] Interestingly, he explicitly separates "normal, young guys" from gays and drug users, shifting in the last clause to the passive voice, a construction that reinforces their lack of culpability, representing them as innocent "receivers" of the infection, not problematic "donors." The "young guys" are the infectees, the prostitutes the infectors (compare this with the syntax of Shaw and Paleo, above, where prostitutes protect themselves and remain alert to medical news).[92]
A second exception were infected female intravenous drug users, or, as they are commonly called, "drug abusers" or "drug addicts" (though it is during use , not necessarily abuse , that transmission occurs).[93] Scientific and popular accounts have tended to show little interest in or sympathy for this group: It should be noted, however, that statistics are problematic in part because these individuals are hard to reach, and in part because drug use is compounded by other conditions. For example, HIV infection in prostitutes is often attributed to sexual contact with multiple partners (and especially to paying multiple partners), although, as I have noted, the sharing of needles in the course of intravenous drug
3. Live or stuffed animals in photos of persons with AIDS distinguish the "innocent"
from the "guilty," or at least normalize their "otherness." After Rock Hudson's death,
many publications ran sympathetic stories accompanied by photos of him playing with
his dogs: He had AIDS, ran the subtext, but he was still a good person. In early stories
on AIDS, researchers like the CDC's Jim Curran were often photographed with their
spouses and children: He may study AIDS, but he's as heterosexual as the next guy.
Photograph of Ryan White by Max Winter for Picture Group; photograph of Matthew
Kozup and his mother by Tim Dillon for USA Today . Both ran in Newsweek , 12 August
1985, p. 29.
use is the more likely source of exposure. Of the women with AIDS in New York City, for example, 62 percent are intravenous drug users and most of the others are sex partners of drug users; of the 183 cases of heterosexually transmitted AIDS, 88 percent were identified as sex partners of intravenous users, and fewer than 9 percent as the sex partners of bisexual males. Of the female HIV-positive prostitutes, almost all were intravenous drug users. Of the 156 children with AIDS as of December 1986, 80 percent had one or both parents who were intravenous drug users; the number of infected babies born at risk will rise each year.[94] In San Francisco, where a different epidemiological picture exists, transfusion-related AIDS is the most common source of infection for women; drug use and heterosexual contact come second.[95] Sex partners of "drug addicts," who, like transfusion cases, are often infected without their knowledge (even knowledge that their partner may be at risk for AIDS), are sympathetic "victims"—up to the point that they become
pregnant, when they become baby killers. Mothers with transfusion-caused AIDS remain sympathetic figures (fig. 3). But the CDC's James W. Curran in June 1986 pointed the finger directly at the "invidious transmission" made possible when female drug users and drug users' sex partners allow themselves to get pregnant.[96] With this act the passive receiver again becomes a culpable agent who transmits her infected blood "vertically" to her unborn child or (perhaps) after birth through breast milk. But as Shaw notes, little information is available about this phenomenon or about the effects of pregnancy on the woman herself; pregnant women may be both more likely to get infected if they are sexually active or, if already infected, pregnancy might activate the dormant virus.[97]
A third exception were women from central Africa and other areas of the world (primarily Haiti), where heterosexual transmission is more common. Again, no conceptually coherent explanation was offered for why a sexually transmitted illness should be homosexual in one country and heterosexual in another, although ad hoc speculations supported by virtually no documentation attribute the African statistics to "quasihomosexual" transmission of the kind noted above, refusal by African men to admit to homosexuality or drug use, the practice of anal intercourse as a method of birth control, or the widespread use of unsterilized needles in clinics and hospitals.[98] A debate in the letters column of the New York Times over the role of genital mutilation regarding AIDS in Africa illuminates the phantasmic projections of exotica that AIDS has stimulated. Fran P. Hosken suggested in December 1986 that widespread female "circumcision" (clitoridectomy and infibulation) is the main reason why the disease pattern is different in Africa (a 1: 1 ratio of women to men).[99] Douglas A. Feldman, acting executive director of the Queens AIDS Center, responded as follows: "Certainly, female genital mutilation is a brutal, sexist practice that should be strongly discouraged" but , he argued, the epidemiological pattern does not conform to the hypothesis of a relationship. In the countries where AIDS is widespread—Burundi, the Congo, Rwanda, Tanzania, Uganda, Zaire, and Zambia—clitoridectomies are rare. Where the procedure is common—from Senegal in the west to Somalia in the east—AIDS is generally not found. "However, as AIDS spreads into Kenya and eastern Tanzania, where the removal of the clitoris and labia majora is common, often resulting in genitourinary infections, it is likely that the practice may facilitate the spread of the disease." But after this potentially sensible comment—sensible because a history of infection is known to be rele-
vant to immune-system deficiencies—Feldman embarks on his own speculations, suggesting that the following factors may cause higher AIDS rates in African women: (1) higher rates of prior immunosuppression (but in relation to what? the infections he has just mentioned? poverty, malnutrition?); (2) intestinal parasite infestation; (3) greater likelihood of urban African women to engage in sex during menstruation (greater than rural women, or than American women? and is it yet established that this is relevant?); (4) "possibly the common practice by prepubescent girls in parts of central Africa of elongating the labia majora through continual stretching" (does this make it thin and "fragile" like the anal tract?); and (5) possible existence of an "immunosuppressive viral co-factor" (deuces wild). "But I fear," writes the doctor, "it is just a matter of time before the pattern of heterosexually transmitted AIDS in the singles bars along First Avenue, as well as the sidewalks of Queens Boulevard, will begin to look a lot like the pandemic in Africa today."[100]
This was December 1986, and suddenly the big news—cover stories for the major U.S. news magazines—was the grave danger of AIDS to heterosexuals. Major stories on AIDS as a threat to "all of us" appeared, for example, in Newsweek , U .S . News and World Report , Time , Scientific American , The Atlantic , and the Village Voice .[101] In a four-part series beginning March 19, 1987, the New York Times gave front-page coverage to several dimensions of AIDS; significantly, the boilerplate explanatory paragraph in each story made no mention of gay men or intravenous drug users. Although these groups were mentioned in the stories themselves, they were no longer considered intrinsic to the definition of AIDS.[102] No dramatic discoveries in the intervening year had changed the fundamental scientific conception of AIDS. What had changed was not "the facts" but the way they were now used to construct the AIDS text and the meanings we were now allowed—indeed, at last encouraged—to read from that text.
By the fall of 1986 virtually all theories of AIDS, no matter how remarkable their semantic underpinnings, had to confront the same bottom line: AIDS can be transmitted through heterosexual intercourse and other sexual activities to and from both women and men. It is important to emphasize that the gay community and (especially in New York City) the black and Hispanic communities continue to be most devastated by AIDS and most urgently in need of help. This does not mitigate the need to stress the possibility of widespread heterosexual transmission, and the current obsession with precise statistics—with
whether or not HIV infection is about to "explode" in the "general population," or with whether the entire epidemic itself is over—is, in my view, a dangerous diversion from questions of far greater importance.[103] My own concern continues to be with the evolution of "the facts," how these facts are constructed and represented, and, finally, how it has happened that the politically sophisticated feminist community has remained oblivious so long not simply to the potential risk to women but to AIDS as a massive social crisis.