1. Colin Douglas, The Intern ' s Tale (1975, New York: Grove, 1982), 180-181. [BACK]

2. Two useful recent collections are Catherine Gallagher and Thomas Laqueur, eds., The Making of the Modern Body : Sexuality and Society in the Nineteenth Century (Berkeley and Los Angeles: University of California Press, 1987); and Susan Rubin Suleiman, ed., The Female Body in Western Culture (Cambridge: Harvard University Press, 1986). Mary Poovey, for example, "'Scenes of an Indelicate Character': The Medical 'Treatment' of Women," in Making of the Modern Body , ed. Gallagher and Laqueur, 137-168, documents the "longevity of [the] male aversion to female bodies" in quoting a nineteenth-century Boston physician who takes Hippocrates as his authority on women's illnesses ("What is woman?" asked Hippocrates: ''Disease.") and adds approvingly that "the wise old physician was not far wrong in his judgment" (166). See also Alain Corbin, "Commercial Sexuality in Nineteenth-Century France: A System of Images and Regulations," in Making of the Modern Body , ed. Gallagher and Laqueur, 209-219. Other useful sources on the historical specificity of representations of women include G. J. Barker-Benfield, The Horrors of the Half-Known Life : Male Attitudes Toward Women and Sexuality in Nineteenth-Century America (New York: Harper & Row, 1976); Caroll Smith-Rosenberg, Disorderly Conduct : Visions of Gender in Victorian America (New York: Knopf, 1985), 197-216; Mary Jacobus, "In Parentheses: Immaculate

Conceptions and Feminine Desire" (Paper presented at the Colloquium on Women, Science, and the Body: Discourses and Representations, Cornell University, May 1987); Ludmilla Jordanova, "Nature Unveiling before Science: Images of Women and Knowledge" (Paper presented at the Colloquium on Women, Science, and the Body: Discourses and Representations, Cornell University, May 1987); Jordanova, "Natural Facts: A Historical Perspective on Science and Sexuality," in Nature , Culture and Gender , ed. Carol P. MacCormack and Marilyn Strathern (Cambridge: Cambridge University Press, 1980), 42-69; Judith Walzer Leavitt, ed., Women and Health in America (Madison: University of Wisconsin Press, 1984).

Additional discursive links between women's bodies and disease are documented by Allan M. Brandt in No Magic Bullet : A Social History of Venereal Disease in the United States since 1880 , rev. ed. (New York: Oxford University Press, 1987). Venereal disease, in particular, has historically been given feminine personifications. One World War II army poster that Brandt reprints (following p. 164) shows the face of an attractive young woman. "SHE MAY LOOK CLEAN," the poster warns, "BUT PICK-UPS, 'GOOD TIME' GIRLS, PROSTITUTES SPREAD SYPHILIS AND GONORRHEA. You can't beat the Axis if you get VD." See also Cindy Patton, Sex and Germs : The Politics of AIDS (Boston: South End Press, 1985).

The characterization of women and women's bodies as diseased or pathological is not necessarily explicit. Sander L. Gilman, Difference and Pathology : Stereotypes of Sexuality , Race , and Madness (Ithaca, N.Y.: Cornell University Press, 1985) shows that even scientific and medical texts are pervaded by implicit cultural narratives about women's bodies (and black bodies). Emily Martin, The Woman in the Body : A Cultural Analysis of Reproduction (Boston: Beacon, 1987), identifies linguistic devices (metaphors, for example) in nineteenth- and twentieth-century medical texts used to describe human sexuality and reproduction; Martin's meticulous comparison of passages about women with comparable passages about men demonstrates the ways in which female functions are conceptualized negatively (for example, menopause is viewed as a breakdown in "production" or, in some recent texts, as a breakdown of "authority" and efficient communication) while male functions remain heroic and full of energy; her manipulation of the texts demonstrates how the same passages could be rewritten (but rarely are) to reverse the traditional conceptualizations.

Ruth Herschberger's Adam ' s Rib (1948; New York: Harper & Row, 1970), demonstrated earlier that a traditional—supposedly "objective"—account of male and female biological development is revealed as "patriarchal" only when a "matriarchal account" is created and placed beside it (75-82). Hilary Allen, ''At the Mercy of Her Hormones: Premenstrual Tension and the Law," m/f 9 (1984): 19-43, draws on the language and logic of recent British court decisions to show that they are founded on an implicit assumption that women are always already pathological (thus "premenstrual tension" is essentially a permanent—and potentially disqualifying—condition). Bryan Turner, The Body and Society (London: Basil Blackwell, 1984), 2-3, writes that disorders of the body, especially women's bodies, are often treated as disorders of society; order is pre-

served by the control of women's bodies under a system of patriarchy (see also 115-176, 204-226). See also Barbara Ehrenreich and Deirdre English, Complaints and Disorders : The Sexual Politics of Sickness (Old Westbury, N.Y.: Feminist Press, 1973).

The long-standing deployment of the human body as an image of society takes on special apocalyptic force in some recent "postmodern" accounts: like contemporary society, the body too is increasingly commodified and diseased, and frequently this diseased society / body is conceptualized as female: see, for example, Christine Buci-Glucksmann, "Catastrophic Utopia: The Feminine as Allegory of the Modern," in Making of the Modern Body , ed. Gallagher and Laqueur, 220-229; Arthur Kroker and David Cook, The Postmodern Scene : Excremental Culture and Hyper-Aesthetics (New York: St. Martin's, 1986); and Edward Shorter, A History of Women ' s Bodies , chap. 10 (New York: Basic Books, 1982). [BACK]

3. Thomas Laqueur, "Orgasm, Generation, and the Politics of Reproductive Biology," in Making of the Modern Body , ed. Gallagher and Laqueur, 31-32; and Martin, Woman in the Body , 35, cite the vivid language of Walter Heape, a nineteenth-century antifeminist, antisuffrage zoologist at Cambridge, to suggest how extreme male views of menstruation could become. In menstruation, writes Heape in the late nineteenth century, the entire epithelium is torn away, "leaving behind a ragged wreck of tissue, torn glands, ruptured vessels, jagged edges of stroma, and masses of blood corpuscles, which it would seem hardly possible to heal satisfactorily without the aid of surgical treatment" (Heape was the first to use the term estrus , a neologism from Latin for gadfly to mean ''frenzy, rut, heat"). As Laqueur notes, Heape did represent an extreme, but Martin observes that the 1977 edition of a widely used textbook of medical physiology disrupts its characteristically "emotionally subdued prose" to inform the reader that "to quote an old saying, 'menstruation is the uterus crying for lack of a baby."' [BACK]

4. The duplicitous female body is also signaled in The Intern ' s Tale when another woman successfully deceives Campbell into thinking she is a virgin and still another woman's apparent indigestion turns out to be appendicitis. This long-standing equation of women with acting is echoed in filmmaker Lizzie Borden's comment on Working Girls , her 1987 release about prostitutes: "Men's bodies are exposed and therefore vulnerable, whereas women have this ability to conceal. On some level, women have always dealt with theater" (Katherine Dieckmann, "Lizzie Borden: Adventures in the Skin Trade," Village Voice , 10 March 1987, 33). [BACK]

5. Poovey, "'Scenes of an Indelicate Character,"' cites a variety of ways in which women and their bodies are judged to be duplicitous, including the view of hysteria as mimicry, the "periodicity" of the menstrual cycle as creating inherent "instability," and the invisibility and mysteriousness of the origins of many "women's illnesses"; the female body, wrote one physician, "mocks the reality of truth," and another wrote of hysterics that "these patients are veritable actresses" whose lives are "one perpetual falsehood." Duplicity and change-ability are also typically attributed to venereal diseases, most classically to syphilis, the "Great Imitator," with its diverse array of symptoms; "if you know syphilis," it used to be said, "you know medicine." Writes Ludvik Fleck, Gene-

sis and Development of a Scientific Fact , ed. Thaddeus J. Trenn and Robert K. Merton, tr. Fred Bradley and Thaddeus J. Trenn (1935; Chicago: University of Chicago Press, 1979), 12, "Syphilis is an extremely pleomorphic disease of many aspects. We read in many treatises that it is a 'proteoform' disease, since with its many forms, it reminds one of 'Proteus or Chameleon.' . . .There was hardly any disease or symptom that was not attributed to syphilis." Mark Thomas Connelly, "Prostitution, Venereal Disease, and American Medicine," in Women and Health in America , ed. Leavitt, 196-221, 284, argues that early twentieth-century education, conceptualization, and views on regulation of venereal disease were curiously inconsistent: On the one hand, the antiprostitution crusade and call for premarital testing for both women and men clearly assumed that both women and men could transmit disease; this assumption was contradicted by the widespread view that men are always the authors of these social crimes, women always their victims. Connelly argues that ''to insist that women could not spread venereal disease simply because they were women embodied an attitude that, even by 1915, was becoming increasingly absurd." [BACK]

6. Blood and other liquids figure prominently in the history of sexually transmitted diseases. Fleck, Genesis and Development , discusses "bad blood" as a central concept in the history of syphilis. Brandt, No Magic Bullet , 23, quotes early twentieth-century physician Homer Kelly's description of the city as a massive civic circulatory system, its "countless currents flowing daily in our cities" distributing morality and disease equally throughout the body politic. The "rising tide" of venereal disease was thus linked to urbanization and to immigration—the "incessant inpouring of a large foreign population." Brandt notes that a "rare blood disease" was the euphemism of choice for venereal disease in the press. Connelly, "Prostitution, Venereal Disease, and American Medicine," 214, cites early twentieth-century rhetoric that linked syphilitic blood to insanity: "The red mills grind out men's brains." Patton, Sex and Germs , 23, observes that as old myths about blood resurface, AIDS triggers not only homophobia but also hemophobia—fear of hemophilia. As members of a still feared and stigmatized group, many people with hemophilia have chosen to keep it a secret; getting AIDS, one man with hemophilia told Patton, had forced him out of the "clot closet." In turn, when the National Hemophilia Foundation established a "gay blood ban" in 1983, the executive director of the National Gay Task Force objected: "I don't have to tell you what 'gay blood—bad blood' could mean to a community that has been historically discriminated against" ("National Gay Task Force, Others, Decry Gay Blood Ban by National Hemophilia Foundation," The Advocate , 20 January 1983, 8). [BACK]

7. Mary Ann Doane, "The Clinical Eye: Medical Discourses in the 'woman's film' of the 1940s," in The Female Body , ed. Suleiman, 152-174. [BACK]

8. Poovey, "'Scenes of an Indelicate Character,"' discusses at length the role of silence in the nineteenth-century medical debates about the use of chloroform during childbirth, specifically, the value of the "quiet and unresisting body" for the physician. Above all, Poovey argues, "the silenced female body can be made the vehicle for any medical man's assumptions and practices because its very silence opens a space in which meanings can proliferate" (152); she describes this as the "metaphorical promiscuity of the female body" (153). [BACK]

9. Sources for this analysis of gender in AIDS discourse are deliberately diverse, though primarily Anglo-American, and may be categorized as follows: (1) leading scientific and medical journals, (2) scientific and medical journals for general readers, (3) general circulation magazines and newspapers, (4) books and reports on AIDS and AIDS-related topics, (5) conservative journals, (6) leftist journals, (7) gay and lesbian journals and newspapers, (8) general circulation women's magazines, (9) feminist journals, (10) supermarket tabloids, (11) national radio and network television programs on AIDS; and (12) other specialized print media. By the term "biomedical discourse about AIDS" I mean, unless otherwise specified, writings and statements about AIDS found in leading U.S. medical and scientific journals as well as public statements made by AIDS researchers, clinicians, and public health officers (i.e., examples are drawn primarily from categories (1) to (4) above). It is within this discourse that what is now the Received View on AIDS (its viral etiology) has evolved. For definition and discussion of the evolution, politics, and coverage of AIDS, see Dennis Altman, AIDS in the Mind of America (Garden City, N.Y.: Anchor / Doubleday, 1986). David Black, The Plague Years : A Chronicle of AIDS , the Epidemic of Our Times (New York: Simon and Schuster, 1986) and Randy Shilts, And the Band Played On : People , Politics , and the AIDS Epidemic (New York: St. Martin's, 1987). (Conservative commentators typically consider "the AIDS Establishment" to include scientists and physicians, public health officials, government officials, gay activists, and the American Civil Liberties Union—all in league to sacrifice the health of "innocent citizens" for the civil rights of "AIDS victims." Nat Hentoff's list, for example, in "The New Priesthood of Death,'' Village Voice , 30 June 1987,35, includes "public health officials and researchers, supervisory hospital personnel, bioethicists, liberal members of Congress, and a representative of the National Gay and Lesbian Task Force.") [BACK]

10. A San Francisco female prostitute who died in 1978 appears to have been one of the earliest AIDS cases in the United States. Shilts, Band Played On , begins his chronicle of AIDS with the 1976 case of the Danish lesbian surgeon Grethe Rask, who became ill working in Zaire, describes AIDS's subsequent appearance and evolution in the United States—though in the United States only—as a "gay disease," and documents widespread resistance to evidence that women and babies could also develop AIDS. Ironically, however, the only entry for women in Shilts's detailed index is to the film Women in Love . Black, Plague Years , 74, reports one researcher who jokingly called the CDC's risk list the "4-H Club": "homos, heroin addicts, Haitians, and hookers." Several early studies explored whether prostitutes were at risk: Joyce Wallace, for example, "Acquired Immune Deficiency Syndrome (AIDS) in Prostitutes," in The Acquired Immune Deficiency Syndrome and Infections of Homosexual Men , ed. Pearl Ma and Donald Armstrong (New York: Yorke Medical Books, 1984), 253-258, concludes that despite normal T-cell ratios, working prostitutes in New York City could be at risk to develop AIDS; more precise studies (based on tests for HIV antibodies), however, remain inconclusive as to prostitutes' sexual risk because of high incidence of intravenous drug use in the same population (more on this below). When hemophiliacs and transfusion recipients started be-

coming ill, they bounced "hookers" off the 4-H list and simultaneously brought conventional "respectability" to the list. On the development of risk groups and conceptualization of AIDS, see Altman, Mind of America , esp. 30-37. Lawrence K. Altman, "Heterosexuals and AIDS: New Data Examined,'' New York Times , 22 January 1985, 1, 19, reports researchers' puzzlement over the heterosexual nature of AIDS in Africa as well as the small but confirmed number of heterosexually transmitted cases in the United States, and their disagreement over whether the public should be informed. There is still no real consensus among researchers or the public as to precisely why women may be "at risk," but evidence is now clear that women can become infected and can infect others. See Margaret A. Fischl et al., "Evaluation of Heterosexual Partners, Children, and Household Contacts of Adults with AIDS," Journal of the American Medical Association 257 (1987): 640-644; Mary Guinan and Ann Hardy, "Epidemiology of AIDS in Women in the United States: 1981 through 1986," Journal of the American Medical Association 257 (1987): 2039-2042; Constance B. Wofsy, "Human Immunodeficiency Virus Infection in Women," Journal of the American Medical Association 257 (1987): 2074-2076; and Marsha F. Goldsmith, "Sex Experts and Medical Scientists Join Forces against a Common Foe: AIDS," Journal of the American Medical Association 259 (1988): 641-643. See also Marilyn Chase's summary, "Spread of AIDS among Women Poses Widening Challenge to Medical Field," Wall Street Journal , 26 June 1986, and Matt Clark (with Mariana Gosnell) and Mary Hager, "Women and AIDS," Newsweek , 14 July 1986, 60-61. This information and more was amplified in Katie Leishman, "Heterosexuals and AIDS: The Second Stage of the Epidemic," The Atlantic (February 1987), 39-58. But Scott S. Smith's letter to the editor, The Atlantic (January 1988), 9-10, argues that the small number of women with AIDS to date hardly warrants the common "bubonic plague" comparison; Leishman replies that even with Smith's qualifiers (i.e., the "women" he counts are white, do not use intravenous drugs, never received transfusions, and are not sexual partners of high-risk men), the number represents only women with AIDS now, not the number who may be infected. A politically astute analysis is offered in Diane Richardson, Women and AIDS (New York: Methuen, 1987). [BACK]

11. The question of how AIDS is defined by the CDC, the agency responsible for surveillance, exemplifies the nontransparent nature of language in relation to reality: as knowledge of the "reality" of AIDS increases, redefinition is regularly called for; but a new definition reorganizes the reality now under surveillance. The 1986 reclassification of AIDS cases is reported in Centers for Disease Control, "Update: Acquired Immunodeficiency Syndrome—United States," Morbidity and Mortality Weekly Report 35 (12 December 1986): 757-760, 765-766, and discussed in Eve K. Nichols, Mobilizing Against AIDS : The Unfinished Story of a Virus (Cambridge: Harvard University Press, 1986); reports in the general media include Kathleen McAuliffe et al., "AIDS: At the Dawn of Fear," U . S . News and World Report , 12 January 1987, 60-69; and Associated Press, "571 AIDS Cases Tied to Heterosexual Cases," Champaign-Urbana News-Gazette , 12 December 1986, A-7. [BACK]

12. David Baltimore and Sheldon M. Wolff, Confronting AIDS : Directions for Public Health , Health Care , and Research (Washington, D.C.: National Academy Press, 1986). [BACK]

13. U.S. Surgeon General, U . S . Surgeon General ' s Report on Acquired Immune Deficiency Syndrome (Washington, D.C.: Public Health Service, 1986). [BACK]

14. See Thomas W. Netter, "Cases of AIDS Rise around the World," New York Times , 5 October 1986, 7. By May 1987 WHO reported at a press conference that 112 countries had reported cases of AIDS (see "Official Warns of 'Racist, Fascist' Approaches to AIDS," American Medical News , 12 June 1987, 19). [BACK]

15. See the cover of U . S . News and World Report , 12 January 1987, and the story in that issue by McAuliffe et al., "AIDS: At the Dawn of Fear." Accompanying the story, a graph showing rising numbers of AIDS cases cuts across a two-page photograph of the roofs of Manhattan apartment buildings, while a boxed insert lists U.S. "Hot Spots"—cities with high numbers of cases. These dual allusions to real estate and vacation spots function to domesticate AIDS for an upscale New York City readership. [BACK]

16. Pie-shaped charts (see, for example, the overview in Issues in Science and Technology 2 (1986): 2) "hid" cases of AIDS among women within the category "Other"—meaning unknown, no known risk factor, risk factor could not be established. Leslie Kirk Wright suggests that "Other" has moved from a benign euphemism for presumed heterosexuals in earlier publications to newly undesirable ''others" (personal communication). Stephanie Poggi, " In These Times : With Friends Like Us, Who Nee [sic] ," Gay Community News , 12-18 July 1987, 3, satirizes the ubiquitous AIDS pie-shaped charts in her attack on the leftist publication In These Times ' s endorsement of mandatory HIV testing. [BACK]

17. The extensive feminist literature on Woman as Other includes Simone de Beauvoir, The Second Sex , trans. and ed. H. M. Parshley (New York: Knopf, 1953); Shari Benstock, ed., Feminist Issues in Literary Scholarship (Bloomington: Indiana University Press, 1987); Luce Irigaray, Speculum of the Other Woman , trans. Gillian C. Gill (Ithaca, N.Y.: Cornell University Press, 1985); Virginia Woolf, A Room of One ' s Own (New York: Harcourt, Brace, 1929); Cary Nelson, "Envoys of Otherness: Differences and Continuity in Feminist Criticism," in For Alma Mater : Theory and Practice in Feminist Scholarship , ed. Paula A. Treichler, Cheris Kramarae, and Beth Stafford (Urbana: University of Illinois Press, 1985); Jonathan Culler, On Deconstruction : Theory and Criticism after Structuralism (Ithaca, N.Y.: Cornell University Press, 1982), 43-64; Toril Moi, Sexual Textual Politics : Feminist Literary Theory (New York: Methuen, 1985); and Catherine Belsey, Textual Practice (New York: Methuen, 1980).

Brandt, in No Magic Bullet , cites "otherness" in the history of venereal diseases, which are always said to originate in other races, other places, other classes; among the poor, among immigrants; among aliens. See also Judith Walkowitz, Prostitution and Victorian Society : Women , Class , and the State (New York: Cambridge University Press, 1983). During the Black plague of the fourteenth century, Jews were accused of "poisoning the wells" and were massacred. In the fifteenth and sixteenth centuries, the Spanish called syphilis "the

Portuguese disease," the Portuguese called it "the Moroccan disease" (Ladislav Zgusta, personal communication). According to Leslie Kirk Wright, "A Disease of the Other: AIDS Discourse and Homophobia" (Paper presented at the International Scientific Conference on Gay and Lesbian Issues, Amsterdam, December 1987), and Jamie Feldman, "Social Dialogue, Public Dilemma: French Research Perspectives on AIDS'' (Paper presented at the Medical Humanities and Social Sciences Seminar, University of Illinois College of Medicine, Urbana, January 1988), in France, where AIDS was at first called "the Moroccan plague," French researchers and clinicians have little difficulty incorporating Africans with AIDS into the French / European population of people with AIDS; American gay men, however, seem to remain the Other. In central Africa, meanwhile, AIDS is always said to have originated in one of the other countries. In Japan, "the other" is not homosexuals but foreigners; because Japan has never allowed "foreign" blood of any kind to be given to Japanese people, transfusion-related AIDS cases are nonexistent; see "AIDS Carrier's Baby Free from Virus, Gov't Confirms," Japan Times , 19 April 1987. On AIDS, plague, and Judaism, see Robert Kirschner, "Keeping AIDS in Perspective," Reform Judaism (Fall 1986): 12-14, and Angela Graboys, "The Courage of Sunnye Sherman," Reform Judaism (Fall 1986): 14-15, 36. Edward Albert, "Acquired Immune Deficiency Syndrome: The Victim and the Press," Studies in Communication 3 (1986): 135-158, reviews accounts of the general process through which communities create distinctions between the normal and the deviant; he uses this division to discuss media accounts of AIDS. For a theoretical account, see Gilman, Difference and Pathology . [BACK]

18. Peter Davis, "Exploring the Kingdom of AIDS," New York Times Magazine , 31 May 1987, 32-40; Patricia M. O'Kane, R.N., letter to the editor, 28 June 1987, 78. [BACK]

19. See Leishman, "Heterosexuals and AIDS"; Associated Press, "Doctors: Case Shows AIDS Can Spread Heterosexually," Champaign-Urbana News-Gazette , 10 April 1986, A-7; Thomas C. Quinn et al., "AIDS in Africa: An Epidemiologic Paradigm," Science 234 (November 1986): 955-963; Thomas A. Peterman et al., "Risk of Human Immunodeficiency Virus Transmission from Heterosexual Adults with Transfusion-Associated Infections," Journal of the American Medical Association 259 (1 January 1988): 55-58; L. H. Calabrese and K. V. Gopalakrishna, "Transmission of HTLV-III Infection from Man to Woman to Man," letter to the editor, New England Journal of Medicine 314 (1986): 987. Numerous papers on heterosexual transmission were presented at the Second International AIDS Conference, Paris, June 1986 (e.g., see the report by Lawrence K. Altman, "Study Says AIDS in Haiti Spreads Mainly by Heterosexual Activity," New York Times , 29 June 1986. Questions about routes of transmission continue; Daniel J. Lehmann and Suzy Schultz, "4 Women among New Cases Here in August," Chicago Sun-Times , 3 September 1987, 3, report that one woman was infected through heterosexual intercourse with a man who used intravenous drugs, two women were infected through blood transfusions, "and the fourth did not acknowledge risk factors for [AIDS]." To stress the potential danger of heterosexual relationships, graphic artist Milton Glaser designed a symbol for use in a World Health Organization AIDS prevention cam-

paign; the symbol shows two overlapping red hearts, and a blue skull within the intersecting space; Glaser said the image suggests that "the consequence of uncontrolled coupling is fearful" ("Official Warns of 'Racist, Fascist' Approaches to AIDS," 19). [BACK]

20. Paula A. Treichler, "AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification," Cultural Studies 1 (1987): 263-305. (Reprinted, October 43 [1987]: 31-70.) Connections between viral and linguistic contamination were paradigmatically, indeed clairvoyantly, represented by William S. Burroughs in Electronic Revolution (Cambridge, England: Blackmoor Head Press, 1971). In the AIDS crisis a 1987 MacNelly cartoon for the Chicago Tribune shows Ronald Reagan pulling on plastic gloves as he peers into a room marked "Speechwriters" and asks "The AIDS speech ready?" A 1987 AIDS public service announcement sponsored by Esprit clothing likewise links the two epidemics through its slogan "Spread the word, not the virus" (as Julian Halliday has suggested to me, this AIDS message seems to be framed by Esprit's larger interest in promoting the notion that health, like Esprit clothing, makes you look good). On the general question of the linguistic construction of scientific reality, see Susan Sontag, Illness as Metaphor (New York: Farrar, Straus & Giroux, 1978); Bruno Latour and Steve Woolgar, Laboratory Life : The Construction of Scientific Fact (Cambridge: Cambridge University Press, 1985); David Bloor, Knowledge and Social Imagery (London: Routledge & Kegan Paul, 1976); Barry Barnes and David Bloor, "Relativism, Rationalism and the Sociology of Knowledge,'' in Rationality and Relativism , ed. Martin Hollis and Steven Lukes (Cambridge: MIT Press, 1982), 21-47; Roger Cooter, "Anticontagionism and History's Medical Record," in The Problem of Medical Knowledge : Examining the Social Construction of Medicine , ed. Peter Wright and Andrew Treacher (Edinburgh: Edinburgh University Press, 1982), 87-108. With respect to the media, see Tony Bennett, "Media, 'Reality,' Signification," in Media , Culture , Society , ed. Michael Gurevitch, et al. (London: Methuen, 1982), 287-308; and Todd Gitlin, The Whole World Is Watching : Mass Media in the Making and Unmaking of the New Left (Berkeley and Los Angeles: University of California Press, 1980). Gitlin, 251, writes that news is, among other things, "the exercise of power over the interpretation of reality." [BACK]

21. Shilts, Band Played On , 67.

22. Ibid., 43. [BACK]

21. Shilts, Band Played On , 67.

22. Ibid., 43. [BACK]

23. Centers for Disease Control, " Pneumocystis Pneumonia—Los Angeles," Morbidity and Mortality Weekly Report 30 (5 June 1981): 250-252. [BACK]

24. Shilts, Band Played On , 171, describes the coining of the acronym AIDS. In Africa, posters warn against "'Slim' Disease / AIDS." Right-wing Lyndon LaRouche supporters in the Montreal airport post signs that play on the French acronym for AIDS: "Give our children SDI [Strategic Defense Initiative, or Star Wars], not SIDA." Joanne Edgar, "Iceland's Feminists: Power at the Top of the World," Ms . (December 1987), 30, notes that to preserve the purity of the Nordic languages, official policy in Iceland prohibits borrowed words; instead of the word AIDS, a public opinion poll chose the Icelandic word eydni "wasting" or "destruction." Black, Plague Years , 60, comments that CDC task force director James Curran called the new name "reasonably descriptive without

being pejorative"; but, Black adds, "names have power." According to Jim D. Hughey, Robert N. Norton, and Catherine Sullivan, "Confronting Danger: AIDS in the News" (Paper presented at the Annual Meeting of the Speech Communication Association, Chicago, November 1986), several companies have removed the word aid from their titles; Jennifer Dunning, ''Suit Filed over Benefit for AIDS," New York Times , 27 August 1987, 20, reports that an organization that raises funds for young adults with cancer through an annual benefit called Dance for Life is suing an organization planning an AIDS benefit called Dancing for Life. A spokesperson for the Dance for Life group said, "If we lose our primary funding source and our identity because we are identified with Dancing for Life, then it is the equivalent of our death." George Whitmore, "Bearing Witness," New York Times Magazine , 31 January 1988, reports that some black and Hispanic people prefer the specific diagnosis of Kaposi's sarcoma or Pneumocystic carinii pneumonia to AIDS. Whatever term is used acquires its own power. Patton, Sex and Germs , 24, writes that one man put a pink triangle on his hospital door with the sign "AIDS Camp." [BACK]

25. On the evolution and some of the problematic issues in characterizing "risk groups" for AIDS, see Keewhan Choi, "Assembling the AIDS Puzzle: Epidemiology," in AIDS : Facts and Issues , ed. Victor Gong and Norman Rudnick (New Brunswick, N.J.: Rutgers University Press, 1986), 15-24; and Ann Guidici Fettner and William Check, The Truth about AIDS : Evolution of an Epidemic (New York: Holt, Rinehart and Winston, 1985). Harry Schwartz, "AIDS in the Media," in Science in the Streets : Report of the Twentieth Century Task Force on the Communication of Scientific Risk (New York: Priority Press, 1984), 92, describes the complexity of "the Haitian connection." Catherine Ross and John Mirowsky, "Theory and Research in Social Epidemiology" (Paper presented at the Second Conference on Clinical Applications of the Social Sciences to Health, University of Illinois at Urbana-Champaign, October 1980), note that using discrete categories to measure variables that actually exist along a continuum "represents a loss of information that may make results ambiguous." Gender yields discrete categories; but sexual practice, such as heterosexual or homosexual behavior, in many cases does not. [BACK]

26. See Choi, "Assembling the AIDS Puzzle"; "Update: Acquired Immunodeficiency Syndrome" MMWR 35 (12 December 1986); "AIDS: What Is to Be Done?" Forum section, Harper ' s (October 1985), 39-52; and Altman, "Heterosexuals and AIDS." [BACK]

27. A reporter for the Wall Street Journal wrote a piece on the epidemic in 1981 that the editors refused to print; in February 1982 the paper did accept a story centered around twenty-three heterosexual cases, primarily intravenous drug users. According to Shilts, Band Played On , 126, publication thus occurred only after "bona fide heterosexuals" had been infected; the story was headlined "New, Often-Fatal Illness in Homosexuals Turns Up in Women, Heterosexual Males." Geoffrey Stokes, "Press Clips," Village Voice , 15 October 1985, argues that a similarly misleading focus was evident on "60 Minutes" that same month when Diane Sawyer interviewed Pat Burke, a heterosexual with hemophilia who became infected through contaminated blood products and subsequently infected his pregnant wife; their son also became infected.

Stokes suggests that Sawyer's focus undermined the fact that hemophiliacs represent a tiny percentage of the population.

Edward Albert, "AIDS: The Victim and the Press," and Brian Becher, "AIDS and the Media: A Case Study of How the Press Influences Public Opinion" (Research paper, University of Illinois College of Medicine-Urbana, 1983) discuss media treatment across a range of publications. Julie Dobrow, "The Symbolism of AIDS: Perspectives on the Use of Language in the Popular Press'' (Paper presented at the International Communication Association annual meeting, Chicago, May 1986) notes the dramatic and commercial appeal of the common "cultural images" in popular press scenarios of AIDS. A theoretical analysis of media accounts in relation to questions of identity and desire is offered by Simon Watney, Policing Desire : Pornography , AIDS , and the Media (Minneapolis: University of Minnesota Press, 1987). Continued monitoring of AIDS coverage is provided by Geoffrey Stokes in his Village Voice column "Press Clips" (e.g., 11 October 1985, 3, 10). [BACK]

29. For a reminder of how much was unknown in the early stages of the AIDS story, see Ruth Kulstad, ed., AIDS : Papers from Science , 1982-1985 (Washington, D.C.: American Association for the Advancement of Science, 1986); American Medical Association, AIDS : From the Beginning (Chicago: American Medical Association, 1987); and Fettner and Check, The Truth About AIDS . [BACK]

30. Altman, Mind of America ; Black, Plague Years . Other comprehensive accounts include Fettner and Check, The Truth About AIDS ; Jacques Leibowitch, A Strange Virus of Unknown Origin , trans. Richard Howard, introd. Robert C. Gallo (New York: Ballantine, 1984); John Green and David Miller, AIDS : The Story of a Disease (London: Grafton, 1986); Patton, Sex and Germs ; Richardson, Women and AIDS ; and Shilts, Band Played On . Brandt, No Magic Bullet , 199, summarizes the ways that AIDS thus far recapitulates the social history of other sexually transmitted diseases: the pervasive fear of contagion, concerns about casual transmission, stigmatization of victims, conflict between the protection of public health and the protection of civil liberties; increasing professional control over definition and management; and the search for a "magic bullet." Despite the supposed sexual revolution, Brandt writes, we continue through these social constructions "to define the sexually transmitted diseases as uniquely sinful" (202). This definition is inaccurate but pervasive: and as long as disease is equated with sin, "there can be no magic bullet." [BACK]

31. Sandra Panem, "AIDS: Public Policy and Biomedical Research," Hastings Center Report , special suppl., 15 (August 1985): 23-26. Public health policy is also addressed in Office of Technology Assessment, Review of the Public Health Service ' s Response to AIDS : A Technical Memorandum [Congress of the U.S.] (Washington, D.C.: Government Printing Office, 1985). [BACK]

32. See Larry Kramer, "1, 112 and Counting," New York Native , March 1983, 14-27; Michael Lynch, "Living with Kaposi's," Body Politic (November 1982), 88; and Richard Goldstein, ''Heartsick: Fear and Loving in the Gay Community," Village Voice , 28 June 1983, 13-16. The questioning of established authority had occurred earlier in the struggle over whether homosexuality was to be officially classified as an illness by the American Psychiatric Association. See Ronald Bayer, Homosexuality and American Psychiatry : The Politics of Diagnosis (New York: Basic Books, 1981), as well as Jeffrey Weeks, Sexuality and Its Discontents : Meanings , Myths and Modern Sexualities (London: Routledge & Kegan Paul, 1985). (Albert, "AIDS," 140, notes, however, that of 2,500 psychiatrists polled almost ten years after the official change, 69 percent still defined homosexuality as "pathological.") In any case, AIDS first struck members of a relatively seasoned and politically sophisticated community (many of whom were also professionals in science, medicine, and government) at a time when American culture at large was contesting medical and scientific authority—points addressed by Altman, AIDS in the Mind of America , and Daniel M. Fox, "AIDS and the American Health Polity: The History and Prospects of a Crisis in Authority," The Milbank Quarterly , suppl., 64 (1986): 7-33. As Shilts notes, 16, 356, AIDS is a real threat to closeted gay men, serving in a sense as a "double diagnosis" that jeopardizes their anonymity and their lives. This dilemma took the form of an early AIDS sick joke, reported by Black, Plague Years :

Q:" What's the hardest thing about getting AIDS?
A: Convincing your mother you're Haitian.

Elizabeth Kastor explores this problem in the case of conservative fundraiser Terry Dolan (head of the National Political Action Committee, NCPAC) and others, "The Conflict of a Gay Conservative," Washington Post National Weekly Edition , 8 June 1987, 11-12. [BACK]

33. Mary Poovey, "Speaking of the Body: A Discursive Division of Labor in Mid-Victorian Britain" (Paper presented at the Colloquium on Women, Science, and the Body: Discourses and Representations, Cornell University, May 1987). Poovey argues that in nineteenth-century Britain, womanhood was legally categorized with regard to both property and sex. Single women could own property but could not engage in sexual activity with men; married women could have sexual relations but could not own property. Prostitutes, Poovey argues, who could both own property and have sexual relations, can be seen as a "border case"—a case that contradicts or disrupts existing conceptions and stable dichotomies and generates discourse that is designed to restore a stable dichotomy. [BACK]

34. Leslie Kirk Wright suggests that some linguistic features of "the AIDS scare" seem to be modeled on the "red scare" of the McCarthy era, including

the notion of the virus as fellow traveler, secretly using cells to build power (cf. Peter Jaret, "Our Immune System: The Wars Within," National Geographic (June 1986), 702-735, 723, 724: "This strategy makes it even easier for the virus to pass from cell to cell undetected"; "the normal cell turns traitor''). Actor Dack Rambo drew an explicit parallel: "I am convinced we are seeing the return of witch-hunting and McCarthyism because of the fear AIDS has generated" (quoted by Scott Haller, "Fighting for Life," People , 23 September 1985, 28-33). [BACK]

35. Hypotheses about AIDS are reviewed by Altman, AIDS in the Mind of America ; Baltimore and Wolff, Confronting AIDS ; Kevin M. Cahill, ed., The AIDS Epidemic (New York: St. Martin's Press, 1983); and Gong and Rudnick, eds., AIDS : Facts and Issues . [BACK]

36. Journalistic gatekeeping in AIDS research is discussed by Shilts, Band Played On ; he notes, for example, 157, that by May 1982 one paper, "hypothesizing an infectious agent as the cause of GRID, had now been rejected by every major scientific journal in the country" because it contradicted the then—dominant view that AIDS was a "life-style" problem. Dorothy Nelkin, "Managing Biomedical News," Social Research 52 (1985): 3, discusses the so-called Ingelfinger rule of the New England Journal of Medicine , which prohibits release of findings prior to publication; Arnold Relman, however, the journal's current editor, discusses suspension of the Ingelfinger rule and other changes in editorial policy designed to speed up publication of AIDS-related research ("Introduction," Hastings Center Report , special suppl. (August 1985): 1-2—but see also Lawrence K. Altman, "Medical Guardians: Does New England Journal Exercise Undue Power on Information Flow?" New York Times , 28 January 1988, 1, 13).

On another front, Simon Watney, in "AIDS: The Outsiders," Marxism Today (January 1988), discusses censorship in the United Kingdom, where the government's aggressive prevention campaign is undermined by its other activities, including the recent banning of all "safer sex" instruction materials as pornography (because they "promote homosexuality"). On the role of institutionalized scientific authority and existing scientific networks during the AIDS crisis, see David Black's discussion of "the AIDS Mafia" and AIDS "gestapo" in Plague Years , 113, and Shilts, Band Played On . Shilts obtained thousands of government documents through the Freedom of Information Act and shows that despite bitter behind-the-scenes disagreements, most of the scientists connected with federal agencies have tended to display unanimity in public. Outside the federal health-care network, evidence of gatekeeping fuels charges of an AIDS "party line" and conspiracy theories from left, right, and center. Joseph Sonnabend, M.D., for example, a discoverer of interferon and former scientific director of the AIDS Medical Foundation, founded the Journal of AIDS Research to print scientific articles he believed were being suppressed because they argued for a multifactorial cause rather than a single virus (see Black, Plague Years , 112-118, for discussion). Raymond Keith Brown, author of AIDS , Cancer , and the Medical Establishment (New York: Robert Speller, 1986), has chaired two symposia on controversial aspects of AIDS. [BACK]

37. Leibowitch, Strange Virus , 5. [BACK]

38. Congressman William E. Dannemeyer (R.-Calif.), October 1985, during a legislative debate on a homosexual rights bill (quoted by Langone, "Latest Scientific Facts," 29). [BACK]

39. Anthropologist Carole S. Vance, who observed the Meese Commission on Pornography throughout its hearings and deliberations, analyzes the recurrent obsession with "natural receptacles" in her forthcoming book, A Vagina Surrounded by a Woman : The Meese Commission on Pornography , 1984-1985 . Compare the position on orifices held by Lyndon LaRouche, Jr., in "My Program against AIDS": ''I hold it to be true, that Creation has endowed our bodies with certain functions, including the body's orifices, each to be used in one way, and not contrary ways; . . . AIDS demonstrates afresh . . . that if society promotes the violation of the principles of our bodies' design, that society shall suffer in some way or another for this obscenity" (6). Whether blood transfusions violate "the principles of our bodies' design" is not addressed. [BACK]

40. Black, Plague Years , 29. Jaret, "The Wars Within," 731, posits that sperm, ejaculated into a woman, are "foreigners in a hostile body" who must deploy several strategies to "accomplish their mission." [BACK]

41. Black, Plague Years , 40. [BACK]

42. Frances FitzGerald, Cities on a Hill : A Journey Through Contemporary American Cultures (New York: Simon and Schuster / Touchstone, 1987), 98. [BACK]

43. "The A.I.D.S. Show-Artists Involved with Death and Survival," documentary produced by Peter Adair and Rob Epstein, directed by Leland Moss, based on production at Theatre Rhinoceros, San Francisco; aired on PBS, November 1986. [BACK]

44. A "cofactor" is something that causes, contributes to, or makes possible an illness. Resistance and susceptibility are typically influenced by age, general health status, nutrition, exposure to environmental toxins, and presence of other infectious or parasitic agents. As Fettner observes in "Bad Science," 26, the notion really means that illness involves the interaction between unique genetic programing and a lifetime of environmental influences and cannot be analyzed in a vacuum. Reviewing the cofactors presently thought most likely to contribute to HIV infection and clinical symptoms, Fettner suggests that genetics ultimately may be most important. [BACK]

45. Shilts, Band Played On , 131-132, reports that some gay men interviewed in the very early years were estimated to have had as many as twenty thousand sexual contacts; coupled with the likelihood of such men having a history of STDs and of going to bathhouses, the number of contacts created a network of men who were broadly exposed to numerous infectious agents. Some scientists came to use the term "amplification" to describe the role of the bathhouses in facilitating HIV infection and its geometric increase. [BACK]

46. Examples of "conspiracy theories" include Gary Null with Trudy Golobic, "The Secret Battle against AIDS," Penthouse (June 1987), 61-68; John Lauritsen, "Saying No to HIV," New York Native , 6 July 1987, 17-25; and Charles L. Ortleb, "HTLV in Lake Tahoe" (subtitled: "Disease Worse than Originally Thought. Is It AIDS?"); New York Native , 11 May 1987, 6-8. Alternative views among scientists outside the core federal AIDS network receive little attention; several of these, including Peter H. Duesberg, "Retroviruses as

Carcinogens and Pathogens: Expectations and Reality," Cancer Research 47 (1 March 1987): 1199-1220, are discussed by Lauritsen, "Saying No to HIV," and Ann Guidici Fettner, "Bad Science Makes Strange Bedfellows," Village Voice , 2 February 1988, 25-28. [BACK]

47. On the growing complexity of the clinical and epidemiological picture, see David G. Ostrow et al., "Classification of the Clinical Spectrum of HIV Infection in Adults," in Information on AIDS for the Practicing Physician , vol. 1 (Chicago: American Medical Association, July 1987), 7-16; Lawrence K. Altman, "AIDS Virus Always Fatal?" New York Times , 8 September 1987, 15-16. [BACK]

48. In February 1982 Dr. Arye Rubinstein, a pediatrician at Albert Einstein College of Medicine in the Bronx, was seeing sick babies who seemed to have all the symptoms then considered characteristic of AIDS. He sent a paper on the subject to the New England Journal , but heard nothing; meanwhile, other scientists were calling his hypothesis "improbable if not altogether impossible. By its very name, GRID was a homosexual disease, not a disease of babies or their mothers" (Shilts, Band Played On , 124). [BACK]

49. The titles of Nichols's Unfinished Story of a Virus and Leibowitch's A Strange Virus of Unknown Origin follow in the classic Microbe-as-Hero tradition of such biographers as Hans Zinsser, Rats , Lice and History : The Biography of a Bacillus (Boston: Little, Brown, 1934). In her interviews with French AIDS researchers, Jamie Feldman ("Social Dialogue, Public Dilemma") confirmed their perception of AIDS as the story of the virus (Feldman also concludes that for the French AIDS also became the story of "the underdogs outsmarting the big shots." Many famous French virologists and immunologists initially rejected the retrovirus theory of AIDS: "If it were a virus, the Americans would already have discovered it.") [BACK]

50. See Treichler, "An Epidemic of Signification," for perspectives on the uncertainties, politics, and competing accounts that established the virus as the "cause" of AIDS and stabilized it as a legitimate scientific "fact"; Latour and Woolgar in Laboratory Life provide a fuller account of the scientific process through which facts are constructed. Self-conscious attention to the construction and interpretation of biomedical science is also provided by Black, Plague Years ; Altman, Mind of America ; and Marek Kohn, ''Face the Virus: Essential 1980s Biology," The Face (April 1987), 64-71. [BACK]

51. Jaret, "The Wars Within." [BACK]

52. A summary of the scientific account of retroviruses is provided in my "Epidemic of Signification" as well as in many sources cited here. The HTLV-I, isolated by Gallo in 1980, was the first retrovirus to be identified with a human disease (June E. Osborn, "The AIDS Epidemic: An Overview of the Science," Issues in Science and Technology 2 (Winter 1986): 40-55). [BACK]

53. The name HIV specifies the pathological / clinical effect of the virus (immune deficiency) rather than (as HTLV or LAV does) the type of cell it attacks. The term HIV infection is now sometimes used as a generic name to signify the entire spectrum of possibilities (from asymptomatic infection to full-blown AIDS). Brown, AIDS , Cancer , and the Medical Establishment , objects to the name HIV as being "conciliatory" but too nonspecific because all microbes associated with AIDS are immunosuppressive. Duesberg, "Retroviruses," also

argues that HIV is at most a precipitating agent in AIDS; Duesberg told John Lauritsen of the New York Native that many respected scientists agreed with him in private but were afraid to do so in public. [BACK]

54. See "AIDS: What Is to Be Done?" and Shilts, Band Played On . [BACK]

55. Donna J. Haraway, in "The Biological Enterprise: Sex, Mind, and Profit from Human Engineering to Sociobiology," Radical History Review 20 (Spring-Summer 1979): 206-237, suggests a transformation within the field of immunology from the military combat metaphors of World War II to postwar conceptions of the body compatible with the postmodern cold war period in which communication and information are played for the highest stakes. (Cf. Jaret, "The Wars Within," 728: "Interleukin-2 is a lymphokine, one of a dozen or so known chemical 'words' with which immune cells communicate during battle." [BACK]

56. AIDS media coverage is discussed in William Check, "Public Education on AIDS: Not Only the Media's Responsibility," Hastings Center Report , special suppl. 15 (August 1985): 27-31; Barbara O'Dair, "Anatomy of a Media Epidemic," Alternative Media 14 (Fall 1983): 10-13; Jonathan Alter, "Sins of Omission," Newsweek , 23 September 1985, 25; Jay A. Winsten, ''Science and the Media: The Boundaries of Truth," Health Affairs 4 (Spring 1985): 5-23; Watney, "Visual AIDS: Advertising Ignorance," New Socialist (March 1987), 19-21; Simon Watney and Sunil Gupta, "The Rhetoric of AIDS: A Dossier Compiled by Simon Watney, with Photographs by Sunil Gupta," Screen 27 (January-February 1986): 72-85; Watney, Policing Desire . Schwartz, "AIDS in the Media," concluded that despite problems, the press had in the end not encouraged hysteria. One deduces that Shilts, Band Played On , would argue that a little hysteria might have helped. Leishman, too, in the September 1987 Atlantic , argues forcefully that overconcern is necessary. See also Simon Watney, "People's Perceptions of the Risk of AIDS and the Role of the Mass Media," Health Education Journal 46 (1987): 62-65. [BACK]

57. Fleck, Genesis and Development , 101, emphasis in original. [BACK]

58. Hughey, Norton, and Sullivan, "Confronting Danger." [BACK]

59. Public statements by scientists intended to reduce AIDS panic include Merle A. Sande, "Transmission of AIDS: The Case against Casual Contagion," New England Journal of Medicine 314 (6 February 1986): 380-382; and Erik Eckholm, "U.S. Officials Stress AIDS Is Not Spread by Casual Contact," New York Times , 27 June 1986, reports the strong statement issued by federal health officials asserting that "the AIDS virus cannot be spread through casual contact in the workplace." [BACK]

60. "Strong New Candidate for AIDS Agent," Science 230 (May 1984): 147. [BACK]

61. On the public health consequences of separating people "at risk" from the "general population," see Mathilde Krim, "AIDS: The Challenge to Science and Medicine," in "AIDS: The Emerging Ethical Dilemmas," Hastings Center Report , special suppl. 15 (August 1985): 2-7. [BACK]

62. In "AIDS: What Is to Be Done?" 51. [BACK]

63. Science and Gender (London: Pergamon, 1986), 4. [BACK]

64. Rock Hudson permitted a statement to be made in Paris confirming his diagnosis on 25 July 1985; Michael Gottlieb, his physician in Los Angeles, issued an official confirmation on 30 July, and it is at this point that Shilts ends And the

Band Played On , for he considers it the major turning point in public perception of and response to the AIDS epidemic. Hudson died on 2 October 1985. [BACK]

65. The treatment of Hudson's illness and death in the tabloids is revealing in this respect. The perceived natural division between the sexes ("women are women and men are men") is obviously challenged by the knowledge that Rock Hudson, a highly masculine screen actor, was homosexual. Discourse devoted to rendering this contradiction unproblematic takes the form of stories detailing Hudson's suffering from his gayness ("The Hunk Who Lived a Lie"), his supposed desire for a "normal" life with a wife and children, and his wish to be reunited with his mother. His underlying ''normalcy" is often signaled by showing him with his dogs (e.g., George Carpozi, Jr., "Rock: His Years of Triumph and Tragedy—In His Own Words," Star , 15 October 1985, 27-30). Indeed, a key figure in AIDS redemption stories is a pet; the presence in a photograph of a dog or a cat, or even a stuffed animal, seems designed to infantilize and render sympathetic the person with AIDS. In reporter George Whitmore's personal account of his struggle with HIV infection ("Bearing Witness"), a teddy bear functions as a recurrent talisman of hope, while a large color photograph shows Whitmore with his cat. [BACK]

66. Both sexual transmission and blood-borne transmission continue to raise questions, primarily because no consensus about the actual mechanisms of transmission has been achieved. See the report of recent public surveys in Science (January 1988). [BACK]

67. Krim, "AIDS: The Challenge to Science and Medicine," 4. [BACK]

68. Jonathan Lieberson, "The Reality of AIDS," New York Review of Books , 16 January 1986, 44. [BACK]

69. Leibowitch, Strange Virus , 72-73. [BACK]

70. Nathan Fain, "AIDS: An Antidote to Fear," Village Voice , 1 October 1985, 35. [BACK]

71. John Langone, "AIDS: The Latest Scientific Facts," Discover (December 1985), 40-41. [BACK]

72. Langone, "The Latest Scientific Facts," 52. Though more vivid and apodictic (i.e., presented as unarguable), Langone's conclusion parallels the conclusions of many scientists. (Joan K. Kreiss et al., "AIDS Virus Infection in Nairobi Prostitutes: Spread of the Epidemic to East Africa," New England Journal of Medicine 314 [13 February 1986]: 417, suggest that a history of STDs in homosexual men may "cause mucosal or squamous epithelial discontinuity or bleeding," thus compromising "epithelial integrity" as a barrier to viral transmission.) [BACK]

73. Weeks, Sexuality and Its Discontents ; see also Jeff Minson, "The Assertion of Homosexuality," m/f 5-6 (1981): 19-39; Wright, "A Disease of the Other"; and Mariana Valverde, Sex , Power and Pleasure (Philadelphia: New Society, 1987), ch. 4; "Bisexuality: Coping with Sexual Boundaries," 109-120. Valverde's discussion supports an argument that bisexuality, by challenging the binary normal / deviant model, furnishes another "border case."

Some health professionals and AIDS counselors avoid the word "gay" because for many people this implies a kind of identity or life-style; even "bisexual" may mean a kind of life-style. Although "homosexually active" is offi-

cially defined as having a single, same-sex sexual contact over the past five years, many who have had such contact do not identify themselves as "homosexual," and therefore as not at risk for AIDS. Nancy S. Shaw, "Women and AIDS: Theory and Politics" (Paper presented at the Annual Meeting of the National Women's Studies Association, University of Illinois, Urbana, June 1986), suggests that for women, too, the homosexual / heterosexual dichotomy confuses diagnosis and treatment in addition to the perception of risk. Many other examples of this fact have emerged in the course of the AIDS crisis. [BACK]

74. Fettner, in "AIDS: What Is to Be Done?" 43. [BACK]

75. Shaw and Paleo, "Women and AIDS." [BACK]

76. Langone, "The Latest Scientific Facts," summarizes why many were skeptical about the African data. See also Patton, Sex and Germs ; Lieberson, "The Reality of AIDS"; and Altman, "Heterosexuals and AIDS." [BACK]

77. Leibowitch, Strange Virus , 72-73. [BACK]

78. The question of silence pervades discussions of venereal disease. The "medical secret" of Victorian society referred to the collusion of "physicians and male patients, either husbands or prospective husbands, which resulted in unsuspecting women being infected with venereal disease" (Connelly, "Prostitution," 202). Feminist challenges to traditional medical conceptions of women and women's health—designed to make women's voices heard—have long since entered the mainstream of American society to change standard medical practice in such areas as breast-cancer treatment, childbirth, and prescription of psychoactive drugs. This is an extensive body of literature, yet one in which the voices of middle-class white women continue to predominate. As general background for the present discussion, see Elizabeth Fee, "Women and Health Care: A Comparison of Theories,'' in Women and Health : The Politics of Sex in Medicine , ed. Elizabeth Fee (Farmingdale, N.Y.: Baywood, 1982), 17-34. For Fee, and others in this collection, "women" is not taken as a white, middle-class category but one that is, rather, continually intersecting with race and class. [BACK]

79. The history of prostitutes in disease discourse is reviewed by Brandt, No Magic Bullet . Connelly, "Prostitution," 196, quotes Lavinia Dock's 1910 nursing manual which states that prostitution "is now as certainly the abiding place and inexhaustible source of . . . venereal disease, as the marshy swamp is the abode of the malaria-carrying mosquito, or the polluted water supply of the typhoid bacillus." The idea of marriage, Connelly argues, 200, and especially the middle-class married woman, was at the focal point of early twentieth-century discussions of venereal disease: "It was the fate of the married woman that became a master symbol of the disastrous consequences of venereal disease, its transmitters—profligate men—and its source—prostitution." [BACK]

80. Shaw and Paleo, "Women and AIDS"; Erik Eckholm, "Prostitutes' Impact on Spread of AIDS Debated," New York Times , 5 November 1985, 15, 18; Lawrence K. Altman, "Study Examines Prostitutes and AIDS Virus Infection," New York Times , 27 March 1987; Centers for Disease Control, "Antibody to HIV in Female Prostitutes," MMWR 36 (27 March 1987): 157-161. [BACK]

81. Quoted in Langone, "The Latest Scientific Facts," 51-52.

82. Quoted in ibid., 50. [BACK]

81. Quoted in Langone, "The Latest Scientific Facts," 51-52.

82. Quoted in ibid., 50. [BACK]

83. See R. R. Redfield et al., "Heterosexually Acquired HTLV-III / LAV Dis-

ease (AIDS-Related Complex and AIDS): Epidemiologic Evidence for Female-to-Male Transmission," Journal of the American Medical Association 254 (1985): 2094-2096; and R. R. Redfield et al., "Female-to-Male Transmission of HTLV-III," Journal of the American Medical Association 255 (1986): 1705-1706. [BACK]

84. John J. Potterat, Lynanne Phillips, and John B. Muth, "Lying to Military Physicians about Risk Factors for HIV Infections," letter to the editor, Journal of the American Medical Association 257 (3 April 1987): 1727, offer plausible evidence that servicemen do lie to officials. As I have indicated above, however, independent evidence exists for female-to-male transmission; lying, in other words, can account for only a portion of cases thought to be heterosexually transmitted. [BACK]

85. Harold Sanford Kant, "The Transmission of HTLV-III," letter to the editor, Journal of the American Medical Association 254 (1985): 1901. [BACK]

86. Kreiss et al., "AIDS in Nairobi Prostitutes," warn that urban prostitutes may well "constitute a major reservoir of AIDS virus in such African capitals as Nairobi, Kigali, and Kinshasa," with "heterosexual men serving as vectors of infection" throughout the African continent (417). See also L. J. D'Costa et al., "Prostitutes Are a Major Reservoir of Sexually Transmitted Diseases in Nairobi," Sexually Transmitted Disease 12 (1985): 64-67; P. Van de Perre et al., ''Female Prostitutes: A Risk Group for Infection with Human T-cell Lymphotropic Virus Type III," The Lancet 2 (1985): 24-27; P. Piot et al., "Acquired Immunodeficiency Syndrome in a Heterosexual Population in Zaire," The Lancet 2 (1984): 65-69. [BACK]

87. Studies continue to suggest that HIV infection in U.S. prostitutes is brought about primarily by intravenous drug use and not by sexual contact with multiple partners (see Shaw and Paleo, "Women and AIDS"). Kreiss et al., "AIDS in Nairobi Prostitutes," found, similarly, that among the ninety female prostitutes they studied in Nairobi, HIV antibody was not significantly associated with the number of sexual encounters per year; other nonrelevant factors included age, duration of prostitution, nationality, history of immunizations, injections of medication within the past five years, transfusions, scarification, operations, induced abortions, or dental extractions. Sexual exposure to partners of different nationalities, however, was associated with HIV seropositivity. [BACK]

88. Shaw and Paleo, "Women and AIDS," 144. [BACK]

89. Stephanie Salter, "AIDS, Rights," San Francisco Examiner , 16 August 1987, quotes Carol Leigh, a representative of COYOTE (Call Off Your Old Tired Ethics, a prostitutes' activist organization based in San Francisco) and of Citizens for Medical Justice. Leigh argues that studies linking HIV infection in prostitutes to multiple sexual contacts are not borne out by empirical evidence. Brandt, No Magic Bullet , reviews the historical links of prostitutes to disease and the conceptual separation of infected prostitutes (and other voluntarily sexually active women) from "innocent victims." In her important 1975 essay on sociological discourse, "She Did It All for Love: A Feminist View of the Sociology of Deviance," Marcia Millman observes that studies of male deviance often portray their subjects (e.g., jazz musicians) as interesting and articulate people; in contrast, studies of prostitutes (for researchers, the primary category

of "deviance" in women) silence their female subjects by quoting male "authorities" as often as the women themselves—even "in a supposedly empathetic study of prostitutes, the pimps are treated as more intelligent, observant, and trustworthy than the subjects of the study themselves!", in Another Voice : Feminist Perspectives on Social Life and Social Deviance , ed. Marcia Millman and Rosabeth Moss Kanter (Garden City, N.Y.: Anchor / Doubleday, 1975), 261; 251-279. [BACK]

90. Quoted in Langone, "The Latest Scientific Facts," 50. [BACK]

91. Associated Press, "AIDS Funding Boost Requested: Increase Would Bring $200 Million to Bear on the Disease," Daily Illini , 27 September 1985, 7. See also AIDS Hearing , House Committee on Energy and Commerce , Subcommittee on Health and the Environment , 17 September 1984, serial no. 98-105 (Washington, D.C.: Government Printing Office, 1985). [BACK]

92. John Green and David Miller, AIDS : The Story of a Disease (London: Grafton, 1986), 110, urge "extreme caution" in interpreting evidence that anal intercourse is more efficient than vaginal intercourse and that therefore male-to-male transmission is more efficient than male-to-female. Wofsy, "HIV Infection in Women," points out that we must be concerned for women both as potential "infectees" and ''infectors." [BACK]

93. On terminology and stereotyping connected with intravenous drug use, see Barrett, "Straight Shooters," Peg Byron, "Women with AIDS: Untold Stories," Village Voice , 24 September 1985, 16-19, and Steve Ault, "AIDS: The Facts of Life," Guardian , 26 March 1986, 1, 8. The list of drugs that can be "used" intravenously is long and by no means confined to either illegal or street drugs (e.g., prescription medications may also be injected). And as students of medical history-taking have long known, both the vocabulary and placement of questions can influence a client's answers (e.g., "Do you use medications?" and "Do you use drugs?" are not interchangeable, nor is the latter understood the same way when grouped with questions about the patient's current illnesses as opposed to questions about smoking and alcohol use). [BACK]

94. Studies in New York and San Francisco show a greater increase in HIV infection among intravenous drug users than among gay men. Stephen C. Joseph, "Intravenous-Drug Abuse Is the Front Line in the War on AIDS," letter to the editor, New York Times , 22 December 1986, 18; Ronald Sullivan, "Addicts' Deaths from AIDS Are Termed Underreported," New York Times , 26 March 1987, 15; "Pro and Con: Free Needles to Addicts," New York Times , 20 December 1987, 20; Chris Anne Raymond, "Combatting a Deadly Combination: Intravenous Drug Abuse, Acquired Immunodeficiency Syndrome," Journal of the American Medical Association 259 (January 1988): 329, 332. Francis X. Clines, "Via Addicts' Needles, AIDS Spreads in Edinburgh," New York Times , 4 January 1987, 8, describes a situation in which the demographics of intravenous drug use and AIDS infection are very different from those of New York; with blacks and Hispanics most heavily infected in New York and white working-class youth in Edinburgh, Clines notes that, in Glasgow, heroin addiction in this population is high but AIDS infection is low, presumably as a result of the decision to provide free sterilized needles—a decision recently reversed in response to conservative pressure. [BACK]

95. Shaw and Paleo, "Women and AIDS," discuss differences in AIDS epidemiology among women across the United States. Blood products and artificial insemination, for example, are the leading factors in HIV infection among women in California, whereas intravenous drug use is the leading factor in New York. [BACK]

96. Quoted in Robert Pear, "Tenfold Increase in AIDS Death Toll Is Expected by '91," New York Times , 13 June 1986, A1, A17. [BACK]

97. Shaw, "Women and AIDS: Theory and Politics." [BACK]

98. Restrained discussions of the statistics and potential causes of AIDS and HIV infection in Africa include Lawrence K. Altman, "Linking AIDS to Africa Provokes Bitter Debate," New York Times , 21 November 1985, 1, 8; Kreiss et al., "AIDS in Nairobi Prostitutes"; Jean L. Marx, "New Relatives of AIDS Virus Found''; Science 232 (April 1986): 157; June E. Osborn, "The AIDS Epidemic"; Patton, Sex and Germs ; Sam Siebert with Alma Guillermo and Ruth Marshall, "An Epidemic Like AIDS," Newsweek , 27 July 1987, 38; Blaine Harden, "AIDS May Replace Famine as the Continent's Worst Blight," Washington Post Weekly Review , 15 June 1987, 16-17. More problematic accounts include Jonathan Lieberson, "Reality of AIDS," and Robert E. Gould, "Reassuring News About AIDS: A Doctor Tells Why You May Not Be at Risk," Cosmopolitan (January 1988), 146-204; the latter is a particularly reckless example of unfettered speculation reassuring Cosmo readers that "ordinary sexual intercourse" would not place them at risk for infection. According to Gould, heterosexual AIDS in Africa exists because "many men in Africa take their women in a brutal way, so that some heterosexual activity regarded as normal by them would be closer to rape by our standards." [BACK]

99. Fran P. Hosken, "Why AIDS Pattern Is Different in Africa," letter to the editor, New York Times , 15 December 1986. [BACK]

100. Douglas A. Feldman, "Role of African Mutilations in AIDS Discounted," letter to the editor, New York Times , 7 January 1987. [BACK]

101. See, for example, Newsweek , 3 November 1986, 66-67, and 24 November 1986, 30-47; Jennifer Dunning, "Women and AIDS," New York Times , 3 November 1986, 22; McAuliffe, "AIDS: At the Dawn of Fear"; and Mortimer B. Zuckerman, "AIDS: A Crisis Ignored," U . S . News and World Report , 12 January 1987, 76; Leishman, "Heterosexuals and AIDS," and "Science and the Citizen," Scientific American 256 (January 1987): 58-59. [BACK]

102. James W. Carey, "Why and How? The Dark Continent of American Journalism," in Reading the News , ed. Robert Karl Manoff and Michael Schudson (New York: Pantheon, 1986), 146-196, discusses the reduction in continuing news stories of explanations to "boilerplate, a continuing thread of standard interpretation inserted in every story" (185). In a number of publications, including the New York Times , the boilerplate paragraph for AIDS began in 1984 to include mention of a viral etiology and in 1987 to talk about "sexual" rather than "homosexual" transmission.

The public's understanding of AIDS and HIV infection remains tenuous. By late 1987 an astonishing 99 percent of the cross-section of U.S. citizens surveyed had heard of AIDS, yet a substantial percentage expressed the belief that one could "catch" AIDS via giving blood, toilet seats, physical proximity to an in-

fected person, or mosquitoes. The AIDS story is complicated and fluid enough to require regular reporters assigned to "the AIDS beat." This was clear when Jeffrey Levi, director of the National Gay and Lesbian Task Force, addressed the National Press Club on 9 October 1987 during the Gay and Lesbian March on Washington, D.C. Following Levi's address, a clear but essentially generic review of familiar AIDS facts and issues, at least two reporters in the audience were uninformed enough to ask the following questions: (1) "Isn't AIDS a media disease? A few years ago the government tried to give people shots for Barré . . . Gwillian . . . and they got paralyzed. Isn't AIDS a media invention?" and (2) "What is an 'op-por-tu-nis-tic infection'?" The first question presumably referred to the government's swine flu vaccination program in which a small number of people developed Guillan-Barré syndrome as a side effect; the second question was asked with heavy skepticism, as though to imply that Levi had concocted the term for political purposes. [BACK]

103. As of January 1988 reported cases of AIDS in the United States totaled 50,265, 1,987 of which were reported to be caused by heterosexual transmission; 1,074 of this group were women. For a review of knowledge, statistics, and estimates of HIV infection in the United States as of December 1987, see MMWR 36, 18 December 1987, 801-804; the full report is available as MMWR , suppl., 36, 18 December 1987, S-6. Interviewed in January 1988, James W. Curran, director of the AIDS program at the CDC, predicted that although current "estimates of the total number of people infected remains complex and inexact, and the approaches used to compute a national HIV prevalence cannot be considered definitive. . . . The epidemic will get much worse before it gets better, both here and throughout the world." He continued: "We can expect the number of American AIDS cases to increase for the rest of this decade and that the problem will be with us for the rest of this century. Our best estimate is that between one million and 1.5 million Americans have been infected with the human immunodeficiency virus, and I am confident that this figure is neither too high nor too low." "Interview with James W. Curran," American Medical News , 15 January 1988, 1, 33-35. For more on current estimates and their potential consequences, see Klemens B. Meyer and Stephen G. Pauker, "Screening for HIV: Can We Afford the False Positive Rate?" New England Journal of Medicine 317 (July 1987): 238-241; and Gene W. Matthews and Verla S. Neslund, ''The Initial Impact of AIDS on Public Health Law in the United States—1986," Journal of the American Medical Association 257 (January 1987): 344-352.

The CDC has never predicted that AIDS or HIV infection would "explode" in the heterosexual population; though Harold Jaffe's denial of such an explosion was widely quoted in such a way that it appeared to reflect new evidence, Jaffe himself stressed that he was making "deductions" from current known evidence that 4 percent of AIDS cases were heterosexual, primarily in IV drug users; in line with previous CDC statements, Jaffe predicted that "the virus is more likely to spread gradually over a period of years, rather than explosively, into the heterosexual population." Lawrence K. Altman, "Anxiety Allayed on Heterosexual AIDS," New York Times , 5 June 1987, 11. See Redfield et al., "Heterosexuals and AIDS," and Warren Winkelstein, Jr., et al., "Sexual Prac-

tices and Risk of Infection by the Human Immunodeficiency Virus: The San Francisco Men's Health Study," Journal of the American Medical Association 257 (January 1987): 321-325, for predictions based on current distribution of HIV antibodies. [BACK]

104. See Relman, "Introduction"; June E. Osborn quoted in Erik Eckholm, "Broad Alert on AIDS: Social Battle Is Shifting," New York Times , 17 June 1986, 19-20; Morton Hunt, "Teaming Up Against AIDS," New York Times Magazine , 2 March 1986, 42-51, 78-83; "AIDS: Science, Ethics, Policy,'' Forum section, Issues in Science and Technology 2 (Winter 1986): 39-73; Robert C. Gallo, "The AIDS Virus," Scientific American 256 (January 1987): 47-56. Jaret, "The Wars Within," 723, writes: "Indeed, had AIDS struck 20 years ago, we would have been utterly baffled by it." [BACK]

105. Shilts, Band Played On , 191. [BACK]

106. Simon Watney, "A.I.D.S. U.S.A.," Square Peg (Autumn 1987), 17. [BACK]

107. Kulstad, ed., AIDS : Papers from Science ; AMA, AIDS : From the Beginning . [BACK]

108. J. Z. Grover, "The 'Scientific' Regime of Truth," In These Times , 10-16 December 1986, 18-19. Grover points out a number of problematic terms and assumptions that recur in scientific writing about AIDS: (1) the term "AIDS victim" presupposes helplessness (the term "person with AIDS," or PWA, was created to avoid this), prevention and cure are linked to a conservative agenda of "individual responsibility," sex with multiple partners and / or strangers is equated with "promiscuity," and "safe" sexual practices are conflated with the cultural practice of monogamy; (2) it emphasizes the differences between "caregivers" and "victims," between scientific / medical expertise and other kinds of knowledge, between "those at risk" and "the rest of us"; and (3) it notes but fails to challenge existing inequities in the health care system. [BACK]

109. On the subject of "AIDSspeak," see Richard Goldstein, "Visitation Rites: The Elusive Tradition of Plague Literature," Voice Literary Supplement 59 (October 1987); Leibowitch, Strange Virus ; Walter Kendrick, "AIDSspeak," Voice Literary Supplement 59 (October 1987); Patton, Sex and Germs ; Shilts, Band Played On , esp. 315-316; and Watney, "AIDS: The Cultural Agenda." Nor are texts the only point of debate. Some members of the San Francisco gay community complained early that public health warnings used euphemistic language ("avoid exchange of bodily fluids") and through innocuous pictures subverted the fact that AIDS was a deadly and physically ravaging disease (FitzGerald, Cities on a Hill ). [BACK]

110. Nichols, ed., Mobilizing against AIDS . [BACK]

111. Centers for Disease Control, "Update: Acquired Immunodeficiency Syndrome," MMWR 35 (December 12, 1986): 757. [BACK]

112. Guinan and Hardy, "Epidemiology of AIDS in Women." [BACK]

113. The mucous membrane is revisited by Helen Singer Kaplan, The Real Truth about Women and AIDS (New York: Simon and Schuster, 1987), 78: "the moist vulnerable mucous membranes" of the female genital organs. ACT-UP (AIDS Coalition to Unleash Power) protested an article by Dr. Robert E. Gould in the January 1988 Cosmopolitan magazine (described in n. 98) for promoting a sense of false security in women readers by claiming that there was

virtually no danger of contracting AIDS through "ordinary heterosexual intercourse." Condoms, Gould noted parenthetically, were relevant only to "anyone not sure whether she has any open vaginal lesions or infections." ACT-UP's protest flyer, however, counters that "in fact, most women have infections and internal lacerations that are asymptomatic and often caused by childbirth, IUDs, tampons, Herpes II, sex without lubrication, and other sexually transmitted diseases." Similarly, Ann Johnson, a London AIDS specialist quoted on the August 1987 BBC radio special, emphasized that "No trauma need be seen . . . There may be tiny areas of bleeding such as erosion on the neck of the womb which would be quite adequate for the virus to get into the bloodstream." [BACK]

114. Shilts, Band Played On , describes the CDC's discussions of how to establish categories and classifications for AIDS, how to arrange risk factors in a hierarchy, what to do about overlapping categories, and how to keep track of phenomena with no official relationship as yet to AIDS. Guinan and Hardy, "Epidemiology of AIDS in Women," demonstrate some of the consequences of these decisions. The question of how best to define and classify AIDS and AIDS-related conditions—which involve some thirty different clinical entities and a spectrum of symptoms—also complicates the identification of health problems and assessment of the scope of the crisis. Not only has the CDC's initial surveillance definition been revised and broadened, but continuum models of symptoms (not necessarily progressive in time) have in general replaced former classifications by discrete disease (e.g., Kaposi's sarcoma).

An overview of current systems is given by David G. Ostrow, Steven L. Solomon, Kenneth H. Mayer, and Harry Haverkos, "Classification of the Clinical Spectrum of HIV Infection in Adults," in Information on AIDS for the Practicing Physician , vol. 1 (Chicago: American Medical Association, July 1987), 7-16. The authors remark, however, that "none [of these systems] satisfies all of the criteria required by public health officials, epidemiologists, clinicians, and researchers. . . . The desire to have an ironclad system that fully explains the progression of immunodeficiency and clinical symptomatology after HIV infection is understandable; however, it is not realistic at this time" (14-15). [BACK]

115. The relatively few studies of women and AIDS are typically justified on the grounds that infected women may bear infected children and / or that measurement of infection in women provides an "index" to the spread of heterosexual AIDS. Guinan and Hardy, "Epidemiology of AIDS in Women," and the several studies by Redfield et al. use these justifications; similarly, Virginia Lehman and Noreen Russell, "Psychological and Social Issues of AIDS," in AIDS : Facts and Issues , ed. Gong and Rudnick, 246-263, mention women in a number of contexts but always under another heading-e.g., Children , or AIDS and Minorities . In part, this has to do with the politics of publishing and the convention of beginning scholarly articles with a clear and accepted raison d'être; thus, because research builds on other research, the invisibility of women in the AIDS narrative to date reinforces their invisibility in the future.

It is therefore important that researchers—those, at any rate, who do believe in the intrinsic importance of women—break this lineal citation pattern and insist on inserting women as women into biomedical discourse on AIDS. But the politics of pregnancy is also at work here. This emerges in a letter to JAMA

regarding the evolution of the CDC guidelines for preventing transmission of perinatal AIDS in HIV-positive women; Dr. David A. Grimes describes a series of meetings in which recommendations for counseling women about abortion as an option were progressively watered down and finally omitted altogether in the published version ( MMWR 34 [6 December 1985]: 721-726). Grimes's letter appeared in Journal of the American Medical Association 259 (January 1988): 217-218. [BACK]

116. Stephen R. Ell, "The Venetian Plague of 1630-1631: Assessment of a Human Disaster," Medical Heritage 2 (March-April 1986): 151-156. "The disease spared no one," writes Ell (155); "primitive epidemiologic data" indicate that in Venice and its surrounding area there were 93,661 mortalities (or about one-third of the total population), among them 11,486 pregnant women, "a catastrophic blow to the reproductive capacity of the city. Yet, this inclination toward pregnant women is quite in keeping with the fact that pregnancy acts as a non-specific immune-suppressant." Barbara Tuchman, A Distant Mirror : The Calamitous 14th Century (New York: Ballantine, 1978), 92-125, provides a dramatic account of the Black Death, tracing the social and economic consequences of curtailed reproduction (consequences borne out by modern epidemiology). [BACK]

117. Shaw and Paleo, "Women and AIDS," 150. We do not really know the clinical relevance of pregnancy, though one recent study of 120 pregnant women, reported in Center to Center 1 (1987): 5, concluded that HIV did not affect the clinical course of pregnancy, or vice versa. [BACK]

118. See Patton, Sex and Germs . In January 1983 the CDC officially added heterosexual partners of people with AIDS to the list of high-risk groups. The MMWR cited two known cases of AIDS in women who were long-time partners of men with AIDS, noting also forty-three reports of previously healthy women who had developed Pneumocystis or other AIDS-related conditions, primarily after sexual contact with intravenous drug users—none of whom, however, had yet developed AIDS. Shilts, Band Played On , 225, suggests that this was one turning point in AIDS media coverage. [BACK]

119. Reports of female-to-female transmission of HIV include Maria T. Sabatini, Kanu Patel, and Richard Hirschman, "Kaposi's Sarcoma and T-cell Lymphoma in an Immunodeficient Woman: A Case Report," AIDS Research 1 (1984): 135-137, on the case of a non-Haitian, non-drug-using thirty-seven-year-old black female who was a "lifelong homosexual" (as was her partner), and conclude that "this would suggest that females may harbor the AIDS agent as healthy carriers"; Michael Marmor et al., "Possible Female-to-Female Transmission of Human Immunodeficiency Virus," letter to the editor, Annals of Internal Medicine 105 (December 1986): 969. See also Vada Hart, ''Lesbians and AIDS," Gossip 2 (1986); and Ann Bristow, Andrea Devine, and Denise McWilliams, "AIDS and Women in Prison," Gay Community News , lesbian prisoner suppl., 23 August-5 September 1987, 10-11, who provide safer-sex guidelines for lesbians. [BACK]

120. In 1983 the women members of a San Francisco gay Jewish congregation, Sha'ar Zahev, donated blood as a way of expressing solidarity with gay men. In 1984 the Blood Sister Project of San Diego collected blood from hun-

dreds of lesbians to contribute to the diminishing supply in blood banks. As a group with virtually no cases of AIDS-related disorders, lesbians were among the very safest of donor groups. Nevertheless, the association of "gay" with "blood supply" triggered gender-blind homophobia: Not only were there objections within individual communities to this contamination of the blood supply by homosexuals but conservative groups flooded the White House with telegrams demanding that Assistant Secretary for Health Edward Brandt be fired if he attended a Fund for Human Dignity dinner to present the award to the San Diego group. See Altman, AIDS in the Mind of America , 95; Shilts, Band Played On , 455-456; and Richardson, Women and AIDS , 88-89. Today, Blood Sisters chapters exist in many cities. [BACK]

121. Altman, AIDS in the Mind of America , 94, notes both the "enormous energy and generosity" with which many lesbians have responded to the AIDS crisis. At the same time he suggests that solidarity has not been the uniform response: "Many lesbians feel resentment that gay men, who never showed any interest in questions of women's health, now seem to expect total commitment to AIDS activity from them." [BACK]

122. Examples include Cindy Patton, "Feminists Have Avoided the Issue of AIDS," Sojourner (October 1985), 19-20, Cindy Patton and Janis Kelly, Making It : A Woman ' s Guide to Sex in the Age of AIDS (Boston: Firebrand, 1987); Richardson, Women and AIDS ; Byron, "Untold Stories"; Grover, ''Scientific Regime of 'Truth',"; Katie Leishman, "Two Million Americans and Still Counting," New York Times Book Review , 27 July 1986, 12; Katie Leishman, "Heterosexuals and AIDS: The Second Stage of the Epidemic," The Atlantic (February 1987), 39-58; Marcia Pally, "AIDS and the Politics of Despair: Lighting Our Own Funeral Pyre," The Advocate , 24 December 1985,8; Nancy S. Shaw, "California Models for Women's AIDS Education and Services," Report, San Francisco AIDS Foundation [333 Valencia St., 4th fl., San Francisco, CA 94103], 1986, and "Women and AIDS." [BACK]

123. Examples include Altman, Mind of America ; Wayne Barrett, "Straight Shooters: AIDS Targets Another Lifestyle," Village Voice , 26 October 1985, 14-18; Richard Goldstein, "The Hidden Epidemic: AIDS and Race," Village Voice , 10 March 1987; Cindy Patton, "Resistance and the Erotic: Reclaiming History, Setting Strategy as We Face AIDS," Radical America , 68-78; Kramer, "Taking Responsibility for our Lives," Nancy Krieger and Rose Appleman, The Politics of AIDS (Oakland: Frontline Pamphlet, 1986). Kramer remains regularly enraged in print at what he perceives is the gay community's failure to play hardball politics (see, for example, "Taking Responsibility," as well as Watney's critique of it) and, after leaving Gay Men's Health Crisis, helped found ACT-UP, an activist zap group whose motto is SILENCE = DEATH. Both Patton and Watney have critiqued the left's general failure (despite differences in the United States and Britain) to contribute meaningfully to an AIDS political agenda. [BACK]

124. See Background Paper, 1985 COYOTE convention summary, San Francisco, 30 May-2 June 1985; World Wide Whores ' News , report of the 1985 conference; Laurie Bell, ed., Good Girls / Bad Girls : Feminists and Sex Trade Workers Face to Face (Seattle: Seal Press Toronto: Women's Press, 1987); Frederique Delacoste and Priscilla Alexander, eds., Sex Work : Writings by

Women in the Sex Industry (Pittsburgh: Cleis, 1987); Lizzie Borden, Working Girls ; Judith Miller, "Prostitutes Make Appeal for AIDS Prevention," New York Times , 5 October 1986, 6. See also Barrett, "Straight Shooters." In the BBC AIDS special on women and AIDS, Louise Hansen, a British prostitute, reports the growing desire by clients for alternatives to high-risk sex, including condoms, "nonpenetrative sex," fantasy scenes, lesbian scenes, and argues—as does Carol Leigh (interviewed in Salter, "AIDS, Rights")—that ''people can learn a lot from the working skills that prostitutes have—like how to be assertive and alternative sexual practices." Prostitutes, they argue, should be seen as a valuable resource for information about sexual practices. [BACK]

125. Erica Jong, "Women and AIDS," New Woman (April 1986), 42-48; Ellen Switzer, "AIDS: What Women Can Do," Vogue (January 1986), 222-223, 264-265; Jane Sprague Zones, "AIDS: What Women Need to Know," The [National Women ' s Health] Network News 11 (November-December 1986): 1, 3. [BACK]

126. "Too Little AIDS Coverage," letter to the editors, Sojourner 10 (July 1985): 3. [BACK]

127. Traditional roles available to women in the cultural narratives of AIDS include mother, spouse, lover, celebrity, Blessed Virgin, and, in the words of conservative Theresa Crenshaw (member of the White House AIDS commission), "mainstays in the resistance to this epidemic." [BACK]

128. Confusion as to innocence and guilt in relation to infection is evident in a 12 April 1987 story in Japan Times , reporting that a baby born to an infected woman did not itself appear to be infected ("Baby Born to AIDS Carrier Infection Free," 2); in an odd sentence construction that appears to separate "the AIDS carrier" from "the mother," the report added that the government's "public health division said that there is little danger that Japan's first baby born to a [AIDS] carrier was infected in the mother's womb." The story indicates that after the infected woman insisted on bearing her child against medical advice, a special medical team was appointed both to reduce the chances that the virus would be transmitted to the baby during delivery and to protect the mother from AIDS; but the story describes only the procedures and rationale for protecting the baby. [BACK]

129. On "saturation," see Altman, "Heterosexual Fears Allayed." [BACK]

130. Shilts, Band Played On , 124, reports that scientific papers about pediatric AIDS were rejected in 1982 by scientific and medical journals because of the widespread conception that "by its very name, GRID was a homosexual disease, not a disease of babies or their mothers." Yet even in 1987, when Shilts's book was published and publicized, attention was given to "Patient Zero," a figure of gay sex rampant in the person of a Canadian airline flight attendant who, Shilts suggests—and the media at large appear to have concluded—was the "man who brought us AIDS."

Yet Shilts's account begins in December 1976 with the story of the Danish lesbian physician Grethe Rask, who contracted Pneumocystis carinii pneumonia working in Zaire and died in December 1977; though her case was reported in a letter to The Lancet 2 (1983): 925, by her medical colleague and friend Dr. Ib Bygbjerg, her case has received little attention. For further analysis

of Shilts's book, see Douglas Crimp, "How to Have Promiscuity in an Epidemic," October 43 (1987). (In his letter, Bygbjerg, citing Robin M. Henig's discussion of AIDS as a tropical disease ["AIDS: A New Disease's Deadly Odyssey," New York Times Magazine , 6 February 1983, 28], notes the existence of endemic disease related to three ''acutely deadly viruses of central African origin" as well as Rask's exposure, through her work as a surgeon, to "blood and excretions of African patients"; he suggests possible connections to AIDS and urges investigation by U.S. and European epidemiologists and virologists.) [BACK]

131. A growing literature documents the placement of gay men in AIDS writing as the Contaminated Other, and there seems evidence that in some respects they do fill the role that women, especially prostitutes, have played in the past. It is not clear what effect AIDS is having on notions of masculinity and femininity in the gay community. Gay men's creation of the term "AIDS widows" to designate the men who survive their lovers is a small but positive use by men of a "feminine" linguistic form. On the other hand, sexism remains entrenched. Ned Weeks, the author's persona in Larry Kramer's play The Normal Heart (New York: Samuel French, 1985), denounces the members of Gay Men's Health Crisis for preferring deathbed scenes over politics: "I thought I was starting a bunch of Ralph Naders or Green Berets, and at the first instant they have to take a stand on a political issue and fight, almost in front of my eyes they turn into a bunch of nurse's aides" (62). Shilts, Band Played On , 556-557, discusses the play but makes no comment on the implicit sexism in lines like these.

In "Taking Responsibility," Kramer charges that gay men's failure to demand their rights "proves they are the sissies people have always accused them of being." Michael Musto, "Mandatory Macho," Village Voice , 30 June 1987, 30, deplores the repressive effect of this compulsory masculinity on the flamboyant drag tradition within gay life. On the general topic of relations among the sexes within the gay community, see Donald Mager, "The Discourse about Homophobia, Male and Female Contexts" (Paper presented at the Annual Meeting of the Modern Language Association, New York, December 1986), and Craig Owens, "Outlaws: Gay Men in Feminism," in Men in Feminism , ed. Alice Jardine and Paul Smith (New York: Methuen, 1987), 219-232. [BACK]

132. Watney observes that after any media message to heterosexuals, the phone hotlines—still staffed primarily by gay volunteers—are jammed far beyond their capacity by the mainly straight "worried well"; the same thing occurred after a 20 May 1987 front-page story by Robert Pear appeared in the New York Times : "3 Health Care Workers Found Infected by Blood of Patients with AIDS." Wofsy, "HIV Infection in Women," argues that although media representations of AIDS striking middle-class white women provide an important message to be careful, they reinforce the invisibility of, and may thus promote denial among, members of the groups most at risk—black and Hispanic women. [BACK]

133. No Magic Bullet , following p. 164. [BACK]

134. Treichler, "Epidemic of Signification," 281-282, 297, n. 28. The tendency of male scientists to keep themselves textually clean is well-documented. Martin, for example, in Woman and the Body , 50, notes that menstruation is commonly described in medical and scientific texts as a form of hemorrhaging,

and menstrual flow as "blood mixed with endometrial debris"; Martin points out that seminal fluid, too, picks up shredded material as it moves through various male ducts but is never characterized by so negative a term as "debris." [BACK]

135. Various metaphors in AIDS discourse are identified in Hughey, Norton, and Sullivan, "Confronting Danger"; Dobrow, "Symbolism of AIDS"; and Albert, ''AIDS: The Victim and the Press." [BACK]

136. June E. Osborn, quoted in Clark et al., "Women and AIDS," called intravenous drug users "the great gaping hole in the dike," and compared the spread of the virus through the drug-using community to "dropping red dye into a pond." Turner, Body in Society , 221, writes that "venereal disease is popularly conceptualized as an invasion of the body by alien germs, but the mechanism which, so to speak, opens the sluice-gates permitting nature to invade culture is the deviance of human populations from morality." Other common liquid metaphors about AIDS include waves , pools , islands , oceans , streams , reservoirs , pouring , spilling , and icebergs . Metaphors about liquid appear to flow easily into metaphors about women and disease: drain the red-light district, it was frequently argued in the venereal disease debates, and you drain the swamp (Brandt, No Magic Bullet , 72). Corbin, "Commercial Sexuality," 87, notes that the prostitute was considered to have a body that smelled bad and had rotten blood. One nineteenth-century analogy likened the body to a house and the prostitute to the house's cesspool; more broadly, her body is the sewer into which the social body excretes its excess (as a nineteenth-century physician put it, "the seminal drain"). Prostitutes therefore serve a crucial function in keeping the surrounding countryside clean. [BACK]

137. These roles are played out most graphically in the supermarket tabloids. [BACK]

138. The resurgence of discourse on "female promiscuity" raises pressing questions about women's health and women's pleasure. Opening a panel discussion on the erosion of civil rights and affirmative action under Reagan, Betty Friedan pointed to the film Fatal Attraction to suggest a widespread backlash against "liberated" women and the feminist agenda (The Sag Harbor Initiative, Maine, 10-12 October 1987). Gould, "Reassuring News," recycled data and old theories to reassure Cosmo readers that "ordinary sexual intercourse" would not place them at risk for AIDS; as noted above (n. 98), he explains heterosexual AIDS in Africa as the result of rough sexual practices. The inaccuracy, irresponsibility, racism, and sexism of Gould's article provoked ACT-UP to organize an international boycott of the magazine, asking women and men everywhere to "SAY NO TO COSMOPOLITAN." The need for such feminist commentary, activism, and discussion is pressing. Neither the search for safety nor the search for pleasure should be abandoned. As Carole S. Vance has eloquently argued on many occasions, "It is not safe to be a woman, and it never has been. Female attempts to claim pleasure are especially dangerous, attacked not only by men, but by women as well." "Pleasure and Danger," in Pleasure and Danger , ed. Carole S. Vance (New York: Routledge & Kegan Paul, 1984), 1-27. [BACK]

139. Leslie Kirk Wright reports that in early 1987 a small company introduced a device that enables women to urinate standing up. Advertisements appearing extensively in the MUNI Metro System (and particularly aimed, apparently, at the Financial District crowd) urged women to "Stand UP! for hygiene,"

and showed a smartly (but sedately) dressed woman holding a smallish box suggestive of tampons. Wright suggests to me that, like the condom ads aimed at women, this may reflect an appeal to the "new freedom." [BACK]

140. Other publications were quick to spread Langone's word. Speaking to audiences and friends (gay and straight, in many cities) who do not stay daily apprised of AIDS developments, I have found Langone's argument still widespread. [BACK]

141. HIV is believed to be a relative newcomer on earth (the presence of antibodies in stored blood now goes back to 1959 in samples collected in Africa, to 1973 in U.S. blood—though a case in St. Louis in 1968 has recently been verified). Though, from our perspective, the AIDS virus is indeed virulent, killing quickly, in fact, the long latency between infection and the appearance of clinical damage provides plenty of time—often years—for the virus to replicate and infect a new host. For the time being we are sufficiently hospitable so that this virus can live off us relatively "successfully"; if mutation occurs, our relationship to the AIDS virus could evolve into something relatively benign or mutually disastrous. [BACK]

142. "AIDS," Ms . (April 1987), 64-71. (See, in contrast, Lindsy Van Gelder and Pam Brandt, "AIDS on Campus," Rolling Stone (December 1986), 89-94. [BACK]

143. For examples of this burgeoning genre, see Mary Cantwell, "Who's Responsible for 'Safe Sex'?" New York Times , 8 July 1987,26, and Anna Quindlen, "For Women, the Condom Campaign Is a Bit Tardy," New York Times , 17 June 1987, 17, 19. [BACK]

144. Heterosexual white male commentary about AIDS comes from left and right. See Peter Davis, "Exploring the Kingdom of AIDS," and Nat Hentoff, "The New Priesthood of Death" for the former; William F. Buckley, Jr.'s, "Crucial Steps" and other columns on AIDS, and Michael Fumento's articles in Commentary . [BACK]

145. Peter Goldman, "The Face of AIDS," Newsweek , 10 August 1987, 22-37. Rex Wockner, "Back-door Homophobia," Chicago Outlines (Summer 1987). In contrast, Michael Shnayerson, "One by One," Vanity Fair (April 1987), 91-97, 152-153, uniformly captions each photo with occupation and age only. [BACK]

146. Chris Norwood, Advice for Life : A Woman ' s Guide to Aids Risks and Prevention (New York: Pantheon, 1987) and Helen Singer Kaplan, The Real Truth about Women and AIDS : How to Eliminate the Risks Without Giving Up Love and Sex (New York: Simon and Schuster, 1987). The two books are similar in their orientation toward white middle-class heterosexual childbearing women, for whom they recommend safe partners over safe practices. Kaplan is less skeptical in her analysis of official sources. For Norwood, one "risk" of AIDS for women is that they will find its name, in those four big capital letters, frightening, so she forswears the acronym in favor of user-friendly Aids . [BACK]

147. Kaplan, The Real Truth , app. C, 157-164. Kaplan does not provide information about the circumstances of the call. [BACK]

148. "Women and AIDS," radio program produced in London by the BBC, aired 13 September 1987 in central Illinois. [BACK]

149. Susan Ardill and Sue O'Sullivan, "AIDS and Women: Building a Feminist Framework," Spare Rib (May 1987), 40-43 (first in a projected series). [BACK]

150. Increasingly, other voices are demanding a forum for discourse on AIDS. Minority and women's organizations and journals now cover AIDS conferences, and do so vocally. An August 1987 federal conference on AIDS and minorities, for example, provoked nearly 100 of the black delegates to adopt and make public a resolution critical of the level and quality of information made available; as one spokesperson said, "They gave us a lesson in AIDS 101 when all of us traveled here for a graduate course" (Jon Nordheimer, "U.S. Officials Criticized on Efforts to Curb AIDS among Minorities," New York Times , 10 August 1987, 1, 9).

The involvement of intravenous drug users is also beginning. Though as William Check wrote in 1985 ("Public Education on AIDS," 28), that "it sometimes appears that the only risk group that hasn't raised a ruckus is the IV drug users, who are not organized," some organization is now taking place—in New York at any rate. Gay Men's Health Crisis, aware that some drug users may avoid AIDS information centers perceived as gay, as well as medical authorities, has been working with former addicts, who in turn go to "shooting galleries" and other hangouts and teach drug users how to clean needles with bleach. [BACK]

151. Only a suggestion of this diversification of AIDS discourse can be included here. Dooley Worth and Ruth Rodriguez, "Latina Women and AIDS," Radical America 20 (1987): 63-67, argue that AIDS education and risk reduction for U.S. Hispanics must begin using appropriate cultural forms: "Writers, newscasters, artists, actors, and producers, who successfully reach Latino households through Spanish language radio and television soap operas, 'foto-novelas' (a popular comic-book style depicting romantic stories with photographs), posters, and printed materials, must be tapped in developing an education campaign that is based on a firm understanding of the cultural possibilities for adaptive behavior," 67. Archie Comic Publications, Inc., plans a year-long AIDS education campaign in 1988.

Lisa H. Towle, "Learn to Read with 'Word Warriors,"' New York Times , 31 January 1988, 21. Jaret, "Wars Within," 705, describes a "Killer T-Cell Video Game" for cancer patients. AIDS : You Can ' t Catch It Holding Hands , written and illustrated by Niki de Saint Phalle (San Francisco: Lapis, 1987), is essentially an AIDS education and prevention manual, suitable for kids, with laminated jacket and drawings that are something like a combination of Matisse, subway graffitti, and the Babar books. AIDS is beginning to figure centrally in novels; several that feature women who are infected through heterosexual contact are Joseph Hansen's Early Graves (New York: Mysterious, 1987), Armistead Maupin's Significant Others (New York: Harper & Row, 1987), and Margaret Atwood, The Handmaid ' s Tale (Boston: Houghton Mifflin, 1986). [BACK]

152. Knowledge about AIDS is being produced, interpreted, and put to use in vastly diverse contexts, and to assume a simple, linear model of communication is not useful. Watney, in "AIDS: The Outsiders," writes that "for those of us living and working in the communities most devastated by AIDS it seems as if the rest of the population are like tourists, wandering casually through the

height of a blitz, totally unaware of what is going on all around them," and, indeed, stumbling through a blitz may be a more useful image when we try to account for the multiplicity of understandings and unpredictable cultural realignments that the AIDS crisis continues to generate. A well-known media researcher, for example, commenting on the unexpected consequences of his own research on AIDS, said, "I never dreamed as a communications scholar I'd be teaching people how to shoot up correctly with heroin" (Annual Meeting, International Communication Association, Chicago, May 1986).

The crisis has created widespread interest, even obsession, with scientific and medical information. Many journals, for example, have provided a short course in virology (Kohn, "Face the Virus"). As a gay composer in New York said to me recently, "Whoever thought I'd be reading about the glucose coatings on viruses and how to interpret T-cell ratios." Meanwhile, however, CDC interviews with members of two heterosexual singles clubs in Minneapolis documented that as of late 1986 this already-infected population had made virtually no modifications in their sexual practices (Centers for Disease Control, "Positive HTLV-III / LAV Antibody Results for Sexually Active Female Members of Social / Sexual Clubs—Minnesota," MMWR 35 (14 November 1986): 697-699. Ralph J. DiClemente, Jim Zorn, and Lydia Temoshok, "Adolescents and AIDS: A Survey of Knowledge, Attitudes and Beliefs about AIDS in San Francisco,'' American Journal of Public Health 76 (1986): 1443-1445, found that many adolescents in San Francisco, a city where public health information about AIDS has been extensive, were not well informed about its seriousness, causes, or prevention. [BACK]

153. See Simon Watney, "A.I.D.S. U.S.A.," for comments on the noncritical use of AIDS-related terminology among U.S. gay activists. [BACK]

154. See J. Z. Grover, "A Critique of AIDS Terminology," October 43 (Winter 1987). [BACK]

155. Models for this kind of attentive questioning, which is at once dense, critically self-conscious, and politically informed, can be found in writing about women and AIDS by Cindy Patton, Donna J. Haraway, and Diane Richardson. Far from being "idealist," it seems to me such questions set the stage for materialist interventions. [BACK]

156. The following "joke" illustrates a disjunction between women as ideal and socially constructed entities and women as "real people" who are subject to particular historical conditions:

A" guy named Joe was a regular at his neighborhood bar and one night he told his drinking buddies he was going to have sex-change surgery. "I just feel there's a woman inside me," he said, "and I'm going to let her out."

Joe" showed up at the bar a few months later transformed into a woman who introduced herself to her old buddies as Jane. The regulars recognized her, gave their welcomes, bought her a beer, and began asking questions about the surgery.

"What" hurt the most?" they asked. "Was it when they cut your penis?"

"No,"" said Jane, "that wasn't what hurt the most."

"Was" it when they cut your testicles, then?"

"No," that wasn't what hurt the most."

"Well," what was" it" that hurt the most?"

"What" hurt the most was when they cut my salary."

See Christine Brooke-Rose, "Woman as a Semiotic Object," in Female Body in Western Culture , ed. Suleiman, 305-316, and Teresa De Lauretis, Alice Doesn ' t : Feminism , Semiotics , Cinema (Bloomington: Indiana University Press, 1984). [BACK]

157. Shaw and Paleo, "Women and AIDS," discuss society's view of the preciousness of childbearing women and their likelihood of being among the first groups tested. They cite women's current reluctance, as caretakers in this life-and-death crisis, to raise concerns about sexism. [BACK]

158. Laurie Stone, "The New Femme Fatale," Ms. (December 1987), 78-79, 79, writes that Fatal Attraction "says good women stay at home . . . while single, working women are damaged, barely even human, and want to destroy the family they secretly covet . . . . This is a fairy tale for the age of AIDS if there ever was one," she concludes, and observes of the pathological femme fatale character that "we're meant to hate her so much we want her dead." [BACK]