The Republican Candidate

The topic of AIDS was introduced by a member of the panel of journalists whose questions structured the first 1992 presidential "debate." Although candidates' responses during the forum were constrained by time, format, and election strategy, their remarks there indicate their conception of the responsibility of government in the epidemic. The question about AIDS was directed to George Bush, with the understanding that Ross Perot and Bill Clinton would also have time to respond: "Mr. President, yesterday tens of thousands of people paraded past the White House to demonstrate their concern abut the disease AIDS; a celebrated member of your commission, Magic Johnson, quit, saying that there was too much inaction. Where is this widespread feeling coming from that your Administration is not doing enough about AIDS?"^[3] President Bush spoke at greater length than the other two candidates:

It's coming from the political process. We have increased funding on AIDS, we've doubled it, on research and on every other aspect. My request for this year was $4.9 billion for AIDS, ten times as much per AIDS victim as per cancer victim.

I think we're showing the proper compassion and concern, so I can't tell you where it's coming from, but I am very much concerned about AIDS and I believe that we've got the best researchers in the world out there at NIH working the problem. We're funding them. I wish there was more money, but we're funding them far more than any time in the past, and we're going to keep on doing that.

I don't know. I was a little disappointed in Magic because he came to me and I said, "Now, if you see something we're not doing, get a hold of me, call me, let me know." He went to one meeting, and then we heard that he was stepping down. So he's been replaced by Mary Fisher, who electrified the Republican convention by talking about the compassion and the concern that we feel. It was a beautiful moment and I think she'll do a first-class job on that commission.

It is, of course, a standard rhetorical tactic in politics to suggest as Bush did that public dissatisfaction with a given administration's policy on any topic is the result of antagonism generated by the opposition. This allegation is, however, buttressed by Bush's subsequent explanation that outlined a program centering AIDS at the heart of a nationally coordinated effort supported by the best researchers with more money at their disposal than is available for any other biomedical effort. Despite the significant measures already under way, Bush nevertheless expressed

regret that he could not do more, signaling that his intentions in this regard are constrained by the limits of federal government. He did vow to continue funding NIH researchers in significant ways following his reelection.

Bush treated the question of Johnson's resignation from the AIDS commission as regrettable, but the president shifted blame away from himself. Bush maintained that he had made it clear that Johnson had access to him and that he expected Johnson's help in making suggestions. As Johnson's replacement, Bush proposed Mary Fisher, who is said to be qualified for the commission because of her ability to express the compassion and concern that "we" feel.^[4]

In an apparent attempt to score points against Bill Clinton, Bush then wandered off the topic of AIDS (these discussions are not quoted here) with some remarks about civil rights legislation, discrimination, and a denial of Ross Perot's contention that "we" don't have the will to fight drugs. Bush returned to the topic of AIDS by linking it with behavior:

And I once called on somebody, "Well, change your behavior; if the behavior you're using is prone to cause AIDS, change the behavior."

Next thing I know, one of these ACT Up groups is out saying, "Bush ought to change his behavior." You can't talk about it rationally; the extremes are hurting the AIDS cause. To go into a Catholic mass, in a beautiful cathedral in New York, under the cause of helping in AIDS and start throwing condoms around in the mass, I'm sorry, I think it sets back the cause. We cannot move to the extreme. We've got to care, we've got to continue everything we can at the federal and the local level. Barbara, I think, is doing a superb job in destroying the myth about AIDS. And all of us are in this fight together, all of us care. Do not go to the extreme.

So I think the appeal is, yes, we care. And the other thing is part of AIDS—it's [the sense] people cannot be brought together, we can't turn this country around. If we can come together, nothing, nothing, can stop us.

In many ways Bush's latter statements contain views that have pervaded discussion and silence about AIDS since the onset of the epidemic.

In discussing AIDS as comparable to issues of drug use, civil rights, and discrimination Bush situated AIDS as a problem outside the domain of biomedicine: AIDS is a problem that has its origins in individual behavior. Bush thus espoused the sentiment that if only people took more responsibility for their choices, if only they walked away from endangering behaviors, then AIDS could be controlled not by biomedical intervention but by attrition, by eliminating new cases of HIV infection. The implication of this view is that while the government is

operating full-tilt in its biomedical research capacities, individuals are personally evading responsibility for avoidance of HIV infection. The guilty behavior implied but not enunciated by Bush includes unprotected sexual intercourse and shared needles. Bush's counsel thus becomes a variant of the "Just say no" tactics associated with Nancy Reagan's campaign against drug use.

Yet this kind of "solution" to the epidemic proposes a kind of personal responsibility that functions as an ideal little reflected in the sexual and drug lives of human beings. Certainly, espousing a "Just say no" policy reveals a great deal about the temptations a sexagenarian president does not face or even understand. That he finds the solution to AIDS in "just" changing behavior suggests that he cannot acknowledge the place of such risks as drug use and receptive anal intercourse in the lives of others. In addition, such a simplistic "solution" suggests that these risks are not only trivial but avoidable through a kind of common sense supposed to be sufficiently present across the breadth of American society.

Changing behavior, however, is a highly complex matter. Even where motivation is high, changes do not always follow human efforts. It is simply unknown, for example, what kind of educational efforts will enable a gay man to avoid risk behavior throughout his life or what knowledge will help a heterosexual, drug-using woman from putting others at risk of infection when she knows herself to be HIV-infected. We simply do not know what kind of psychosocial supports are necessary to help gay and straight teenagers grappling with drugs avoid centering their lives around drug culture and its HIV risks. Given human fallibility, is it fair to single out and blame people who incur an HIV infection any more than people who, for instance, court the dangers of a nutritionally impoverished diet? The accusation that HIV infection is self-incurred is not adequate justification for the general conclusion that people can protect themselves from HIV infection any more than people can protect themselves from the smoking or diet-related illness and death. This is certainly not to say that people shouldn't change their behavior where they can or that educational efforts should not be exerted toward this extremely important goal, but it is to say that human decisions are complex matters often intractable even to the best advice.

Bush's use of the term victim, of course, offends all sensibilities attuned to the victimizing effects of that word's connotations of passivity and helplessness. Though this point has been made repeatedly, the language of victimology continues to pervade public discussion about

AIDS. It is, though, more important to note that the way in which Bush framed the question of AIDS funding opened the door to invidious comparisons: Why is AIDS getting so much more money per "victim" if in fact people could avoid it? Why aren't people with other diseases getting more money for the study and treatment of the involuntary conditions that afflict so many? By framing the issue this way, Bush in effect undercut his own claim that he would like to do more for AIDS because in identifying the amount of money spent "on AIDS," he drew attention to the way in which other diseases were not equivalently funded. He set the stage for a consideration of whether AIDS isn't in fact preferentially treated, especially given its alleged avoidability. And if such was not the president's intention, then it may be interpreted another way: as suggesting that other diseases are under funded and that perhaps they should be better funded. Such an interpretation, though, is unlikely for a candidate who vowed—for a famous second time—no new taxes.

What Mr. Bush did not reveal during this debate was his own record. While he was vice-president under Ronald Reagan, Bush was chairman of the President's Task Force on Regulatory Relief, which recommended planning at the Food and Drug Administration (FDA) that led to greater accessibility of experimental drugs. He also recommended the creation of another committee to study and streamline new procedures for the approval of new drugs for AIDS and cancer.^[5] While the role of AIDS activists in spurring federal interest in drug development and experimentation has certainly been a formidable one, the antiregulatory and antibureaucratic spirit brought to the federal government under Reagan and Bush administrations also contributed to the opening of experimental AIDS drugs to persons outside formal drug trials, even if the motives of government minimalists were quite different from those of AIDS activists. Perhaps Bush did not find time under the constraints of the debate to note his role, but he had in fact a certain claim to the status of AIDS activist.

But Bush had only harsh words for AIDS activists. His remarks on ACT UP label them extremists who are unable to talk about AIDS rationally. In this way he suspends any requirement to take their views and actions seriously; in his discourse they are figuratively and literally irrational and others are thereby better situated to formulate AIDS policies. This characterization of activists also invites psychological remedies for them, not political remedies for the epidemic. After labeling AIDS activists as irrational, he then paints them as political extremists by

referring in a disappointed fashion to the 1989 disruption of a Roman Catholic mass at New York's St. Patrick's Cathedral, a confrontation that protested Catholic views of sexuality and AIDS education.^[6] To raise the image of AIDS activists in violation of ecclesiastical sanctuary was to raise the specter of an uncontrollable political group in a way that would undercut sympathy for AIDS activists efforts. In sum, George Bush's depiction of AIDS activists recalls the characteristics of activists most likely to offend; he does not mention any of their efforts directed at health-care reform. Bush does not see ACT UP in the long tradition of American dissent and political reformism; he sees only extremism.^[7] His final words on the topic of AIDS propose not the reform of any social attitudes or practices but the reform of AIDS activists themselves: "Do not go to the extreme." Do we have any reason to believe that "moderation" by itself will lead to control of the AIDS epidemic?

Bush's public remarks are often disjointed, even mangled, and the remarks he offered by way of answer to the original question are typical in this regard. He does emphasize that "we" care and that if united there is nothing that can stop "us." Who is "us," of course, is a question that preoccupied the 1992 Republican national convention speakers who stressed the divisions in American culture. In contrast to the rules of eligibility for "God's country" stressed at that convention, Bush's "us" here is an undifferentiated us, and the optimism he expressed is of a general nature available to all and applicable to all things. That he invoked such optimism does not disclose whether he genuinely believes that AIDS can be stopped if only we all come together. He did, however, vow to continue funding research at unprecedented levels. For all his general beliefs in a limited role of government, George Bush obviously put more hope for the control of the epidemic in federally supported institutions in the rolling Maryland hills of Bethesda than in the political and cultural efforts of individual AIDS activists.