How to Have Theory in an Epidemic: Cultural Chronicles of AIDS.

Paula Treichler. Durham NC: Duke University Press, 1999, pp.496, Cloth US$64.95. ISBN: 0-8223-2286-2; Paperback US$23.95. ISBN: 0-8223-2318-4.

Cindy Patton

Winship Distinguished Research Professor, Graduate Institute of Liberal Arts, S-402 Callaway Building, Emory University, Atlanta Ga 30322, USA

In the early 1980s, a new medical phenomenon emerged, an event now widely documented in clinical, social scientific, and epidemiological literature as the ‘discovery of AIDS’. Acquired Immunodeficiency Syndrome, as the complex would soon be named, represented not only a different kind of disease process from a clinical point of view, but also marked a cultural shift in social understanding of sexuality. AIDS achieved popular recognition in an historically unique context: it was first identified among homosexually active men in the first world, who had achieved some political visibility as a ‘gay liberation movement’, but at the same moment a conservative, Christian movement was altering the secularizing and liberalizing trends in Europe and America. The combination of a little understood disease, sex, death, and the clash of political values on an increasingly global scale made AIDS an ongoingly popular media topic, covered in political, medical, and, as educational efforts sought to humanize those affected, entertainment columns of newspapers.

The medical disciplines were grappling with the need for new theories and methods for dealing with a retrovirus, and epidemiology, itself undergoing a crisis about its status among the biomedical disciplines, was more than usually dependent on the more qualitative social scientific methods. The research paradigms for describing and explaining human sexuality were undergoing massive changes as ‘social construction theory’ and innovations in understanding ‘new social movements’, including those concerned with sexuality, emerged on the academic horizon. Perhaps unique among social phenomena, individual respondents and media consumers considered themselves to be as expert on sexuality as the researchers. Thus, while academic research on sexuality was confident that sexual behaviour and identity were quite fluid, those whom researchers questioned in their studies, and those who read popular versions of the studies in the media, were more convinced that sexuality was fixed and unchangeable.

Few medical writers, much less political analysts, were really in a position to interpret these complex scientific and cultural events. The biomedical disciplines, but especially epidemiology, were in unprecedented communication with non-specialist readers and viewers of the world's news media. Under early pressure to quickly get a handle on—and explain—what would in short order prove not to be a transient crisis but a new order of disease spread and policy reaction, reporting of epidemiological and clinical findings were, in a brutal and fatal way, ‘dumbed down’ for a public presumed to be unable to understand the complexities of medicine, human sexuality and health policy.

This is the context in which Professor Paula Treichler began to write the essays that now comprise her collection How to Have Theory in an Epidemic. As a professor of communications studies who worked in close collaboration with the medical faculty of the University of Illinois, Treichler had respect and sympathy toward, but also the disciplinary distance from biomedicine to realize that major cultural disjunction was occurring as the science of AIDS was rewritten for a lay audience. Significantly, Treichler was involved as an observer and activist in local and international AIDS policy forums, and so was able early in the epidemic to get a feel for the results of the harried and often bizarre representation of the new epidemic. Unlike many media researchers, Treichler did not believe that there was a unidirectional relationship between the knowledge of science and the ignorance of the public: instead, she argues—following the past 30 years of research in the social study of science—that scientists mix their expert understanding and their own ‘lay impressions’ of the wide-ranging phenomenon that they study. For example, in the sentinel and widely cited early essay, ‘AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification’, Treichler argues that:

AIDS is not merely an invented label, provided to us by science and scientific naming practices, for a clear-cut disease entity caused by a virus. Rather, the very nature of AIDS is constructed through language and in particular through the discourses of medicine and science; this construction is "true" or "real" only in certain specific ways—for example, insofar as it successfully guides research or facilitates clinical control over the illness.’

Readers who are unfamiliar with the technical jargon of cultural studies might be more impressed—and perhaps affronted—by the notion that scientific truths are constructions. However, it is important to recognize that Treichler is not suggesting an anti-scientific or relativist position. Rather, she works from the basic findings of ethnographic study of laboratory and clinical practice (for example, that of Steven Woolgar or Karin Knorr-Cetina); that science, because it works on the principle of falsifiability, only ever has provisional and working ‘truths’, however certain is the voice that articulates these findings to the lay public. Thus, as she says above, science is ‘true’ and an understanding of a disease ‘real’ when researchers are able to make practical good of their conceptions. Analysing the early scientific discussion of AIDS, Treichler is able to show the corollary result of the scientific method for constituting provisional truths. When scientific frames prove impractical for explanation and control, there is an increase in the use of non-scientific rationales and explanations, and, in a critical case like the first decade of the AIDS epidemic, these become intermingled with fragmentary scientific truths to produce misleading accounts of the ‘real’ disease and the actual state of scientific understanding.

In the same essay, she provides a brilliant analysis of this kind of intermingled thinking gone awry, and in a way that, readers will recall, had a long-lasting effect on the scientific and popular conceptualization of the potential for ‘heterosexual’ transmission of HIV. She takes aim at an article in Discover magazine (one of many like it to appear in popular scientific journals), that explains ‘Why AIDS is likely to remain largely a gay disease’. The graphics accompanying the Discover article appear objective and scientific—textbook-line illustrations of male and female reproduction anatomy accompanied by ‘blow-up’ renderings of the types of tissue that line the walls of each. Using imagery that, Treichler establishes, echoes from 19th century understanding of reproduction, the article tries to convince readers that the ‘vulnerable rectum’ and ‘fragile (male) urethra’ do not stand a chance of providing body armour against HIV, while the ‘rugged vagina’ will repel virus because it is ‘designed to withstand the trauma of intercourse as well as childbirth’. Treichler notes the way in which the combination of rectum/penis is constituted as dangerous and unnatural while penile-vaginal intercourse goes according to a natural design. In addition, she notes that the text makes much of the prevalence of penile-anal intercourse between men while ignoring its significance in the sexual lives of many heterosexually active men and women.

While it may seem an easy task all these years later to make fun of an article like this one, Treichler's work—whether on heterosexual transmission, the patterns of disease in African nations, or campaigns for condom use—links the unscientific assumptions propounded in popular scientific accounts with specific policy outcomes. Convinced that vaginal intercourse was its own protection, many women had difficulty understanding that they might well become infected even if they did not engage in anal intercourse. (Interviewers heard this time and again, ‘I don’t have sex there’, a fatal misperception related to the reinforcing effect of popular science on already-existing cultural taboos about anal sex.) In the case of African educational policy and extension of care, Treichler shows that the early mystification of heterosexual transmission (Africans were accused of engaging in bizarre practices that neutralized the protective capacity of the ‘rugged vagina’), combined with claims that African political and health systems were too dysfunctional to respond to the epidemic, delayed response in Africa until the epidemic had reached truly unmanageable proportions. In another analysis of condom advocacy, Treichler begins the enormous task of uncovering the social history of condom use and cultural beliefs about condoms. Here, she suggests that it is not individual recalcitrance or recidivism or lack of knowledge but the pervasive negative association of condoms with immorality, lack of relationship commitment, and a sense of being repressed that makes it so difficult for American men to inaugurate and sustain condom use.

Treichler, currently training students pursuing a joint MD and PhD in Cultural Studies, is one of the few scholars of the last 20 years to combine astute and sympathetic understanding of science as practised, with analysis of the actual consequences of the translation of science in the media and as policy. Her analyses are specific, lively, and enlightening, and also connected to the live issues in the HIV pandemic. As clinical or social scientists, we are always embarrassed to discover our own peculiar biases. Rather than aiming for a state of ideological purity, Treichler suggests that we view the imbrication of science and non-science as an ongoing cultural process that is intrinsic to the production of a better understanding of human affairs. It is not in achieving value-neutral language that we come closer to the truth, but through understanding how and when we transform science into culture, culture into science.





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