Naming the Enemy: AIDS Research, Contagion and the Discovery of HIV

In memory of Casper Schmidt

Marcus Boon



Introduction

Susan Sontag, as is well known, has written a book called AIDS and its Metaphors, addressing on the one hand, the medical condition called AIDS; on the other hand, the social meanings that the medical condition takes on. The last decade has seen a thorough evaluation of these social meanings by critics [1], and groups like ACT UP, who have contested the social meanings of AIDS on the streets and in the courts. [2] Although these remain issues to be struggled with on a daily basis, they are issues of which the community of people intimately affected by AIDS are aware.

It is usually assumed by activists and scientists that under the sludge of the social meanings of AIDS lies a pure, intelligible object called HIV, 'the virus that causes of AIDS' [3], ready to yield itself to the full unleashed power of modern science. In this context activism means clearing away the social or bureaucratic blocks that prevent this flourishing of an objective science. Because of this yearning for an objective site of disease that can be isolated from contamination by the social, very little critical questioning of the actual science used to give us knowledge of the causes of AIDS has occured [4]. Even AIDS treatment activists have, with exceptions, concerned themselves with the speed at which already designed therapies or theories of disease are developed, leaving basic research and development agendas in the hands of scientists [5]. In view of the highly technical nature of AIDS research, activists either reach a point at which they must defer to the expertise of researchers, go to medical school and enter the profession along with its legitimated discourse, or accept the status of heretics or 'AIDS dissidents,' delegitimated scientists, who despite their claims to radicalism, often display the same faith in the objectivity of their own theories about AIDS that orthodox researchers and activists have in the conventional wisdom.

European and American mass media, along with many of its consumers, including many HIV positive individuals, do not deviate from this pattern. AIDS is a fait accomplis, the virus a mark of death, and to prove it, electron microscope photos of the virus replicating in a blood cell, usually accompanied by a labelled, symmetrical, elaborately ordered and simplified computer graphic illustration, are periodically displayed in the media. These images, which technically mean as little to the audience viewing them as a description of the physics of the atom bomb does to a population under 'deterrence,' nevertheless exert extraordinary influence. If the exact order of the terror inspired by AIDS is questioned, it is to these images that the questioner is referred. Yet it is by no means the case that the meaning of these images is understood even by the scientific community.

In a recent article on the subject, NIAID director Anthony Fauci writes that 'although a direct relationship between HIV burden and CD4+ T cell loss has been established, the precise mechanisms by which HIV causes a decrease in the number of CD4+ T cells is presently not well understood' [6]. Sentences such as this, which are repeated over and over in medical journals and at conferences, conveniently obscure the abyss of knowledge about AIDS [7]. Nor, it would seem, does this lack of knowledge about HIV imply the need for caution in postulating the virus as the cause of AIDS. The depletion of CD4+ subset of white blood cells is probably crucial to the development of AIDS; theories as to the reasons for this depletion proliferate without any conclusions being reached. In terms of virology, many fundamental issues, such as location of HIV in the body, effects of virus on different cells, reasons for the long and highly variable period between seroconversion and AIDS remain unresolved [8].

Possible cofactors in AIDS, be they social, viral or enviromental, continue to be neglected. Disease-defining conditions such as Kaposi's Sarcoma are postulated by some scientists to be produced by HIV, only for other scientists to postulate that other viruses cause them. On the drug front, the FDA has approved four controversial drugs, AZT, DDI, DDC and D4T which at best delay onset of AIDS by months, and at worst may contribute to sickness through toxicities [9]. In the absence of leadership by researchers or rigorous opposition by activists, many small sub-cultures flourish around particular drugs and theories - 'all with their own academies, hierarchies and special jargons, the fetishized forms of science and religion' [10]: bootleg TAT inhibitor, oral alpha interferon, Compound Q, vitamins, immunosuppressive drugs, immune stimulating drugs. It might be possible to celebrate the diversity of approaches to this disease if it were not for the dismal fact that since we know so little about AIDS, even after fifteen years of research, all approaches to it remain, more or less, shots in the dark. So far, definitive proof that HIV is the 'cause of AIDS,' in the form of a successful treatment or a comprehensive theory of AIDS pathology has not appeared.

It is this paradox that I wish to examine. I do not wish to suggest that scientific knowledge is 'wrong,' or that such knowledge can simply be dismissed or 'situated' as a cultural construction. To do so would be again to leave the field of science unexamined precisely in the place where it makes its strongest claims on us: in the ability to classify and order matter. Nor do I wish to suggest that HIV is 'not the cause of AIDS'. Critical work on the science of AIDS must take two forms: one, a critique conducted within the discourse of current biomedical science, aimed at expanding, refining and expediting research programs; the other, less talked about but no less necessary, a critique of the ways by which the science of AIDS is formulated within a broader techno-scientific and social milieu. In this essay, I show how this milieu produced the formulation of HIV as a cause for AIDS, how such a formulation effectively erased other possible ways of formulating the cause(s) of AIDS, and some hitherto neglected reasons for this drive towards a single 'cause of AIDS'. I hope this paper contributes in some way to the formulation of a science that is more responsive to the needs of people.

II -- A Historical Virus

I had a friend who died way back in New York in 1981. he was one of the first to go. We didn't know what AIDS was, there was no name for it. We didn't know it was contagious -- we had no idea it was sexually transmitted -- we didn't know it was anything. We just thought that he -- alone -- was ill. He was 26 years old and just had one thing after another wrong with him....He was still coming to work -- 'cause he didn't know he had a terminal disease. [11]

The history of AIDS is reasonably well known by now from a number of different perspectives. I would like to recap some of that history and the points at which major clashes of interpretation have occured, specifically those of a scientific nature. AIDS appears first in people's bodies and in doctors' offices in the late seventies in New York and California. What is it that appears exactly? Not the word AIDS, which is coined for the first time much later; probably not the medical condition which comes to be known as AIDS, whose origin, open to a multitude of hypotheses, must be earlier; but the observation by medical authorities of something perceived as novel in a population which comes under its gaze. The moment is mythologized in a characteristic way in Randy Shilts' And the Band Played On:

A neurologist had found three massive lesions on the young man's brain during a CAT scan. Lange had been called in as an infectious disease specialist. Nick was slumped on one side of the bed. His gray eyes were covered with a milky white film and the left side of his face seemed to sag...Nick had been dying slow motion for a year, the doctors told Lange, and nobody could say why....It was November 1, 1980, the beginning of a month in which single frames of tragedy in this and that corner of the world would begin to flicker fast enough to reveal the movement of something new and horrible rising slowly from the biological landscape. [12]

From body to technology: the 'milky white film' covering Nick's eyes becomes a frame of a film which must be composed of enough similar images to allow it to be run through at a speed fast enough to reveal a 'new and horrible' image of Nature. The metaphor is an apt one, bringing together bodies, collectives, visual and communication technologies.

AIDS is first mentioned in the medical press in the US federal epidemiological agency, the CDC's Morbidity and Mortality Weekly Report of June 5, 1981. Grmek notes 'if this document was not the birth certificate of AIDS, it was certainly the witness to its civil birth registration' [13]. The article describes the observation in three Los Angeles hospitals, of five cases of pneumocystis (PCP), a pneumonia caused by a ubiquitous protozoan which very rarely causes disease in humans except when immunosuppressed through malnutrition or drugs. These observations become part of a network of perceived disease when an unusual number of requests for pentamidine, an anti-pneumocystis pneumonia drug so rarely used that it is no longer commercially available, are observed at the government agency responsible for dispensing all remaining stocks of the drug.

In September, the first reports of the syndrome appeared in the Lancet followed by the New England Journal of Medicine in December. AIDS appears in the midst of an epidemic of sexually transmitted diseases in the gay community. It takes the form of a group of already known but rather obscure diseases. What makes this novel is the particular combination of clinical, laboratory and epidemiological categories by which it is characterized. The division of disease definition into these categories shows a distribution and hierarchization of methods of describing the body. Clinical means 'symptoms,' defined in Stedman's Medical Dictionary as 'any morbid phenomenon or departure from the normal in structure, function, or sensation, experienced by the patient and indicative of disease.' [14] The clinical is defined by the relationship between the sick person (who becomes the 'patient') and the doctor and represents a sensuous history of the body. Consider the cancer like skin-lesions known as Kaposi's sarcoma in The Lancet. Observe how their surfaces are measured and described by the 'naked' eye:

Case 8 had two discrete lesions on admission but more than twenty new lesions developed during his 3 months in hospital. The skin lesions consisted of nodules and papules in seven patients, and of plaques in case 8. All the skin tumors were non-tender, purplish and non-ulcerating, and ranged in size from several millimeters to several centimeters in diameter. In several patients the lesions tended to coalesce. [15]

This history must defer at some point to the laboratory, and its more 'precise' measurements and observations. The laboratory markers define a relationship between the sick person and research technology, the movement from symptoms to final causes and definitions, from a sensual history of the body to a history of the fragments of that body seen through technology. The description moves from surfaces perceivable by the naked eye to that which lies beneath the surface, too small to be seen other than by technological means:

All eight patients had histologically proven cutaneous and lymph-node involvement. The histological features were typical of Kaposi's sarcoma. Skin lesions showed proliferation of small vessels lined by endothelium and interspersed groups of spindle-shaped pleomorphic cells....There were red blood cells within slit-like spaces not lined by endothelial cells, and haemosiderin-laden macrophages. [16]

Epidemiology cuts across this fragmentation of the body, viewing it as a fragment of a collective of bodies:

All eight patients with Kaposi's sarcoma reported in the study were homosexual men aged 27-45 years and had multiple sexual partners. All had histories of a variety of sexually transmitted diseases....Four of the eight patients were Jewish and one was Italian. The only Black patient in the study was born in America and had never been to Africa. [17]

The epidemiological studies gave the disease its first name: GRID or 'Gay Related Immune Deficiency' and began its long and problematic history as a 'gay disease'. The condition becomes known as AIDS in summer 1982 at a meeting of the Center for Disease Control in Atlanta.

Even after a reasonably precise definition of the clinical symptoms of AIDS was obtained in the early eighties, the search for an infectious agent -- a cause -- continued. It might be said that a cause had to be found in order to find a cure and to prevent further spread. But the description of the clinical, laboratory and epidemiological phenomena already discovered could also have served for treatment research and for preventative measures to be taken: measures to protect the blood supply, to promote safe sex, treatment of opportunistic infections, therapies to correct serologic abnormalities - a whole range of initiatives that gradually made appearances over the last ten years could have been made at this time. Instead the search for an infectious cause, one that transcended the social body continued, and in 1983 or 1984, this research resulted in the discovery of a virus (now called HIV) which appeared to 'settle the matter' [18].

The research that is generally considered to describe the discovery of the cause of AIDS appears in a set of papers by Robert Gallo et al in the May 4 1984 issue of Science, along with Luc Montagnier's paper of May 20, 1983, also published in Science. Gallo's work was first officially announced by Margaret Heckler, Secretary of the U.S. Department of Health and Human Services at a press conference held in Washington on April 24, 1984 -- election year. Both Montagnier and Gallo describe the isolation of a new virus from the body of someone with AIDS, yet it was Gallo's work, published a year later than Montagnier's, that was taken as proof. I shall return to this curious phenomenon. The editorial that accompanies Gallo's work says that until the discovery of the virus, the definition of AIDS was 'descriptive' -- in other words, symptomatic -- and that this symptomatic description of AIDS 'may represent just the tip of the iceberg'. A prodrome called 'pre-AIDS,' later to be known as 'ARC' is also described. The virus which Gallo calls HTLV-III is isolated from a variety of PWAs and people with ARC, 'high risk' people and not from controls. This isolation is achieved by the following methods:

  1. By detection in sera of people with AIDS, of an enzyme called reverse transcriptase, which is produced only by retroviruses, of which HTLV III is one.
  2. By the ability to transmit this reverse transcriptase activity and therefore the virus from infected to uninfected cells.
  3. Study of cells by electron microscopy, revealing virus budding from infected cells.
  4. Discovery of novel viral antigens in sera of infected people and newly infected cells using indirect immunofluorescence assays (sending out fluorescent antibodies against particular viral proteins, 'washing' of sample, then studying infected cell culture through fluorescent microscope to see if they stuck to anything), and of antibodies to HTLV-III in a 'high proportion' of PWAs.
This almost completes the movement from the patient's body to an isolatable 'other'. All that remained to be done was genetic sequencing of the virus: which would ultimately determine its fixing as an object with an identity and a name. This was achieved in 1985 [19].

Much of the technology and knowledge used to detect HIV in blood cells was rather new at the time. The helper subset of T cells which HIV infects preferentially was discovered in the 1970s. Reverse transcriptase, the enzyme which both defines and allows the detection of retroviruses was discovered in 1975 [20]. Gallo himself discovered the first apparently pathogenic human retroviruses, HTLV I and II, in the late seventies -- only after discovering a way to culture T cells long enough to allow viral production to be observed. Western blotting and other methods of detecting specific viral proteins were discovered in the late seventies. DNA and RNA themselves were only discovered in the sixties.

It is surely more than a happy coincidence that an epidemic of a new type of virus should occur at precisely the moment when the tools necessary for perceiving this virus are developed. A classical view of scientific progress would describe an evolutionary dialogue between science and nature, always moving up to newer levels of complexity in knowledge. In opposition to this view, I would like to suggest that a set of scientific and non-scientific factors, including these technological advances, but also the distribution of resources and power in American research establishments in the early eighties, the politics of the Reagan era, from the backlash against liberal ideology to the deregulation of industry, all refracted through various media, produced or constituted this scientific discovery, pulling a group of previously obscure images together into a particular historical configuration, which is that of the 'AIDS virus': HIV.

Why were Gallo's papers of May 1984 considered to be the discovery of the cause of AIDS? Because they made something previously invisible visible, or at least detectable, and therefore subject to control, or if not control, processes of prediction -- an important distinction. These papers say very little about why HIV specifically would cause AIDS; they only note its presence in people with or at risk for AIDS. Montagnier, in his paper published a year earlier, did little less [21], yet he was ignored. The year between the two papers was an important one. In June 1983, AIDS was diagnosed in the wife of a hemophiliac and the general public erupted in its first fit of hysteria at the prospect of heterosexual AIDS. An editorial by NIAID director Anthony Fauci in the JAMA speculated that 'routine household contact' [22] might spread the disease. Pat Buchanan wrote his first column on AIDS. Police in San Francisco donned protective gloves and masks in dealing with suspected 'gay criminals'. Shoe vendors in Florida refused to let Haitians (a high risk group) try on shoes, for fear of contagion. Moral Majority spokesman, the Reverend Greg Dixon said: 'if homosexuals are not stopped, they will in time infect the entire nation, and America will be destroyed.' [23] Infect the nation with what -- a virus, or 'homosexuality'? It was in this hysterical environment that the virus was discovered.

III -- The Scapegoat

The gasp of surprise which accompanies the experience of the unusual becomes its name...it fixes the transcendence of the unknown in relation to the known, and therefore terror as sacredness. The dualization of nature as appearance and sequence, effort and power, which first makes possible both myth and science, originates in human fear, the expression of which becomes explanation.

Max Horkheimer and Theodor Adorno [24] Horkheimer and Adorno's Dialectic of Enlightenment, written in 1944 (a year whose historical resonance is all too clear to people living and dying through AIDS), provides an answer to some of the puzzles surrounding the way science is used as a response to AIDS. When I say that it is fear that drives this response I don't mean that this fear causes a loss of objectivity: precisely the opposite in fact. What is remarkable about the response is its rigidity, the very force with which it formulates itself as an answer, as the image of a disease, as knowledge. Klaus Theweleit notes:

It is surely in this sense that we are to understand the function of the over-explicitness of the fascist language of symbol: it safeguards both writer and reader against the experiences they fear. [25]

For scientists, most research into AIDS became research into HIV, understanding its life cycle and its genetics [26]. For the 'public,' the “language of symbol” meant that at the very moment when it became clear that heterosexuals could get AIDS, 'the homosexual' became the image and vector of AIDS, his 'lifestyle' the cause of AIDS, focusing all fears into this image. The virus itself remained invisible -- and since anyone apparently could become infected with it, the carrier was also invisible. Hence the development of the image of the carrier, taken to its extreme with William F. Buckley's proposal that all people who are HIV positive should be tattooed: a proposal appropriated by some HIV positive individuals who have tattooed themselves with large '+' symbols.

An estimated million people were infected with HIV, yet only a small percentage of these people actually had AIDS. Even today many people who are HIV positive are healthy. But because of the need to focus the fears which AIDS induced onto an object, and then to fetishize this fear as scientific knowledge, the virus became 'a death sentence' -- its presence an indicator of 'early' or 'slow and lingering' death [27].

At the same time as the fear of AIDS is focussed in the image of 'the homosexual,' this fear is capable of jumping in spectacular ways to other objects -- as some examples from Randy Shilts' And the Band Played On show: In the early years of the epidemic, the virus is 'out there,' unknown. 'The fucking thing didn't even have a name.' [28] While nameless, it is most terrifying. Naming comes as a relief, bringing order to disorder. 'People now said so-and-so was 'diagnosed' and you didn't have to ask what with; for gay men, it had become a verb that needed no object.' [29] This is because the subject of the verb has now become its object. As the hysteria increases, juries refuse to be in the same room as a PWA. In England, telephone workers refuse to supply service to PWAs for fear of being infected through their telephone wiring. [30] Any channel of communication that opens up humans to each other is a potential route for the virus-image. After San Francisco's 1983 Gay Freedom Day parade, 'four of the city employees assigned to sweep up the trash showed up in surgical masks and disposable paper suits. They were afraid they might get AIDS from the litter strewn on the streets.' [31] The New York State Funeral Directors Association recommends its members 'refuse to embalm anyone' who has died of AIDS. [32] Most amazingly, 'the guide to the British aristocracy, Burke's Peerage, announced that, in an effort to preserve 'the purity of the human race,' it would not list any family in which any member was known to have AIDS. 'We are worried that AIDS may not be a simple infection, even if conveyed in an unusual way,' its publishing director said, 'but an indication of a genetic defect.' [33]

Clearly there is more going on here than rational hygiene practices, used to combat the spread of an infectious disease.

If it is objected that AIDS is a special case in the history of scientific knowledge, it should be pointed out that the milieu of scientific discoveries is always social: that developments in medicine occur alongside epidemics; in physics, alongside wars and economic struggles. Fear is always there. Knowledge must always be related to its insufficiency in a situation and its inscription as image or name to fill a lack. Science maps the possible lines that can be drawn between image or name and matter, lines which have potential to refine or transform the image. These lines are extended into, or drawn by the non-scientific world, deconstructing the distinction between the 'scientific' and the 'non-scientific'.

The image of the scapegoat from Frazer's anthropological study The Golden Bough, helps define the network of disease, image, science and population that I am thinking of:

In Munzerabad, a district of Mysore in Southern India, when cholera or smallpox has broken out in a parish, the inhabitants assemble and conjure the demon of the disease into a wooden image, which they carry, generally at midnight, into the next parish. The people inhabitants of that parish in like manner pass the image on to their neighbors, and thus the demon is expelled from one village after another, until he comes to the bank of a river into which he is finally thrown. [34]

The scapegoat is the person or thing that becomes the image of the disease and is then expelled from the community. In AIDS the scapegoat is both object and person, and indeed, the object which contains the disease is itself contagious. It can easily pass its contagion on to anyone who touches it. Hence the easy confusion between a virus and the body infected by the virus. Frazer describes how, preceding the scapegoating, a period of 'extraordinary relaxation of all ordinary rules of conduct' [35] occurs. How is the scapegoat chosen? Often he or she is a marginal figure: a slave, a criminal, a prostitute or a madman. In AIDS, a revisionist history and media has twisted the sixties and early seventies from a period of general 'licentiousness' to one solely of indulgence on the part of gay men and drug addicts -- who later become scapegoats in AIDS. Casper Schmidt has documented the rise of the Moral Majority and right wing reaction in the late seventies and the 'backlash' against various liberation movements of the sixties, but especially those of drugs and homosexuality [36]. As with the scapegoating of Jews by the Nazis, this right wing backlash propagated a folklore of 'the homosexual' -- a focus for expelling in an image of otherness, all that the emerging Right could not tolerate of its own recent history. AIDS served as both intensifier and extensor of the readability of 'the homosexual' [37] . Newsweek, in its 'Sex in the Eighties' article quipped that with AIDS, the Scarlet Letter has taken on a new meaning The word 'AIDS' on the other hand, is illuminated by Puritan history.

Consider the acronym 'AIDS' or 'SIDA' or 'ai zi' [38] and the proliferation of other acronyms associated with AIDS: . The need to transmit a meaning (and an energy, impulse) makes these abbreviations into pronounceable words, and fetish-like objects capable of containing meanings. 'HIV,' which is often referred to as the 'HIV virus' (or 'human immunodeficiency virus' virus) displays this quality too [39]. The term 'Acquired Immune Deficiency Syndrome' becomes the acronym 'A.I.D.S,' then loses its dots to become 'AIDS'. In Britain it then becomes the proper noun 'Aids' and sometimes even the noun 'aids'. These terms struggle to retain their descriptive quality, and are all too quickly fused into acronyms in which linguistic emptiness provides a vessel to fill with whatever the user brings to the word -- in the case of AIDS, a fear of contagion, of being invaded by an other, of becoming other. These words, and what they carry with them, become scapegoats.

IV -- Aesthetics of Laboratory Technique

What is it that someone other than a specialized research scientist sees when he or she looks at an electron micrograph of a virus, or reads a report on a new discovery? Walter Benjamin uses the word 'aura' to describe a kind of 'magical value' such as is found in 'nature' which reappears with 'the most precise technology'. This value is a 'tiny spark of contingency, of the Here and Now, with which reality has so to speak seared the subject.' [40] When applied to 'cellular tissue':

... photography reveals in this material the physiognomic aspects of visual worlds which dwell in the smallest things, meaningful yet covert enough to find a hiding place in waking dreams, but which, enlarged enough and capable of formulation, make the difference between technology and magic visible as a thoroughly historical variable.' [41]

This oscillation between aura and what might be called 'disenchantment' of the aura through formulation makes itself apparent in AIDS research. Technology reveals images of matter, or data. These images are instantly inscribed in the discourse of the scientific paper and thus disenchanted. However, they are simultaneously disseminated through the mass media, including the news section and covers of the same journals that 'present' the studies. This media re-enchants these images since it removes them from their specific scientific context and places them in a milieu where they are received as nature, their aura in itself celebrated as signifying the power of technology. This is seen at its most extreme in National Geographic's color spread 'The Wars Within' [42], in Scientific American, and in the advertisements for medical products in the journals. A note in National Geographic spread says that:

All of Lennart Nilsson's scanning electron micrographs in this article were transformed from black and white to color by Swedish artist-photographer Gillis Haagg, who has developed innovative color-enhancement techniques using light filters and dyes. [43]

These pictures invite the reader to make analogies: volcanoes, lava flows, strange, luxuriant plant foliage and roots. And yet the captions that accompany these images are precise, pointing out a T cell here, a viral particle there. The airbrushed illustrations that accompany Scientific American take this a stage further, simultaneously more precise in their annotations and identification of 'parts,' and more aestheticized: a serpent coil of RNA in the heart of a grenade, all smooth, symmetrical machinery (Ill. 1).In this aestheticization there is a vestige of the awe and fear with which nature was once worshipped -- this awe and fear now mastered by captions and explanation, ready for the marketplace.

Not all images are likely to be re-enchanted in the mass media though. Shots of people's diseased bodies, not seen through a microscope or in a social context, but merely a recognizable arm or lip, a Herpes lesion disrupting the homogeneous surface of the skin, are not displayed in daily papers, 'general interest journals' or even the more image-struck of the scientific journals, such as Scientific American. The standardization of these body shots, in which all individual characteristics are effaced, gives science its ability to make generalizations from them. At the same time, this standardization is profoundly disturbing for the viewer, who finds it correspondingly difficult to maintain the otherness of these images. They seem to leap directly into the viewers body, and so, in reaction to this, they are thrown back by the viewer and pinned down with annotations.

It is impossible for science to maintain a disenchantment of the aura of the objects of its research, because of the place of science within the world. As soon as science is disseminated into the world, at the very moment of conceptualization or experimentation, it begins to carry out its own re-enchantment. A 1992 research report in the Lancet on new theories of AIDS pathogenesis is entitled 'T-cell receptor variable gene products and early HIV-1 infection' [44]. It is also described in the editorial section of the journal under the title 'AIDS: how can a pussy cat kill?' Moreover, even the process of disenchantment, or formulation which science engages matter in, is subject to its own micro-auras, misunderstandings, false-objectifications whose power must again reveal itself as other than scientific. As a result, a complex language of procedures is developed to keep refining and redefining the nature of the matter under observation and to prevent this return of the image and its aura which the electron microscope, without assistance, reveals. The electron microscope has limitations as a scientific instrument: it can only give an impression of a surface, a physiognomy. To read nature more precisely, some kind of inscription on the virus or cell must be found: a language which can be fixed and interpreted. So we have the following:

Identification of HTLV-III antigens recognized by the sera of AIDS patients. HTLV-III was lysed and fractionated by electrophoresis on a 12 percent polyacylamide slab gel in the presence of SDS. The protein bands on the gel were electrophoretically transferred to a nitrocellulose sheet according to the procedure of Towbin et al. Strip solid-phase radioimmunoassays were then performed as described. The sheet was incubated at 37 degrees C for 2 hours with 5 percent bovine serum albumin in 10 mM tris-HCl, pH 7.5 containing 0.9 percent NaCl and cut into 0.5-cm strips. Each strip was incubated for 2 hours at 37 degrees C and 2 hours at room temperature in a screw cap tube containing 2.5 ml of buffer-1 (20mM tris-HCl, pH 7.5, ImM EDTA, 0.2M NaCl, 0.3 percent Triton X-100 and 2 mg of bovine serum albumin and 0.2 mg of human Fab per milliliter). Test sera (25microl) were then added to individual tubes containing the strips and incubation was continued for 1 hour at room temperature and overnight in the cold. The strips were washed three times with a solution containing 0.5 percent sodium deoxycholate, 0.1M NaCl, O.5 percent Triton Z-100, 1mM phenylmethylsulfonyl fluoride, and 10mM sodium phosphate, pH 7.5. The strips were incubated for 1 hour at room temperature with 2.4ml of buffer-1 and 0.1ml of normal goat serum. Affinity-purified and I-labeled goat antiserum to human immunoglobulin (Mu chain and Fc fragment) (1.25 x 10 to the six count/min) were added to the reaction mixture and the incubation was continued for 30 minutes at room temperature. The strips were washed as described, dried, mounted, and exposed to x-ray film. [45]

This is called the Western Blot test, generally considered the most reliable way to determine whether someone is HIV positive. It is obviously not an easy matter to find a coherent language to describe matter. In order to find something out about matter (here 'HTLV-III' and 'test sera'), that matter must be stripped of misinterpretations through a variety of processes into a simplified and hopefully coherent language. This language is always trying to penetrate a surface: and every time it penetrates, it creates a new surface -- like any other language. It is attempting to see, yet seeing is not enough. Viral proteins must be touched to be known -- and this knowledge must be translated back into something visual. Hence the movement from the physical hooking of viral antigen (or protein) and antibody, to the bands that the Blot displays visually. But in spite of the endless fragmenting of definitions that critical theory has made us so aware of, the power of namings, of the persistence of names and meanings, should be acknowledged. There is something in the nature of technologies and especially technologies of vision and detection that desires to name a virus, name a disease, name a human being -- and associate them. The first strain of HIV identified by Luc Montagnier in 1983 was named 'BRU,' after a man called Frederic Brugière, who donated the lymph node in which the virus was discovered [46]. This desire is eminently concerned with what is called the mimetic faculty - that which detects likenesses and connections: which seeks to make nature coherent -- in a way suitable to the observer.

Yet even at the level of this antibody test, there are false positives by the Western Blot test. This occurs because there are other things, foreign white blood cells, some vaccines etc which have almost identical molecular configurations to HIV -- and therefore provoke almost identical antibody responses [47]. Viruses, which also have the mimetic faculty, mimic cell surface receptors in order to gain access to them. They use cellular mechanisms in order to replicate. They look the same, yet they are not. Therefore probes for the viral genetic sequence are developed -- and these involve the most complicated attempt to turn matter into a language yet, as shown in the accompanying print out of a part of the virus' genome and an image displaying the stage where viral matter is trans-substantiated into code.

V -- Names

When HIV was discovered, it was called 'LAV-1' (standing for 'lymphadenopathy associated virus') by the French team and HTLV-III by the American team, thus setting the scene for the interminable fight between the countries over who discovered the virus. Gallo, who had discovered HTLV's I and II, claimed, in the same issue of Science that Montagnier announced LAV, that the AIDS virus was HTLV-I. Then, a year later, he named the virus that would eventually be known as HIV HTLV-III, a part of the 'HTLV family,' giving the virus an aetiology of discovery even though most scientists are agreed that HIV is unrelated to HTLV-I. 'HTLV' had originally stood for 'human T-cell leukemia virus' and an association with a proliferative disorder of T cells. Gallo's Science papers on 'HTLV-III' affected a subtle change in the acronym. 'HTLV' now stood for 'Human T-lymphotrophic virus' -- a shift in meaning that undercut the paradox that HTLV-I made T cells proliferate, while HTLV-III apparently killed them. The rewards for successfully naming and placing this virus were ample: Election year gave the government good reason to throw its weight behind Gallo and his American discovery; the market for antibody test kits and projected vaccines gave powerful economic incentives; the Nobel Prize and the competitive structuring of research science with its discourse of 'quests' and 'hunts' gave strong personal incentives. Recent inquiry into this situation have revealed that it is strongly likely that not only are 'LAV' and 'HTLV-III' members of the same species, but that they were in fact the identical virus. Montagnier had sent a sample of his virus to Gallo in 1983 and whether through contamination or fraud, it was this virus that Gallo used for his Science papers: DNA studies reveal them as probably identical [48]. Perhaps the most alarming question is why the 'scientific community,' who certainly possessed the skills to understand what was going on, said nothing about it.

This politics of naming pervades modern science, driven largely by pharmaceutical companies for whom a discovery is inseparable from a product. Medical journals half-heartedly struggle with this problem, striving to maintain a 'pure' medical discourse in dull black and white drably typeset pages which cannot compete with the lavish full-color adverts, often for the same products described in the text of the journals, which accompany them. The medical texts give their drugs and interpretations of nature one name (not without its own politics as we have seen), the companies give these same substances another name. Hence AZT ('zidovudine' or 'azidothymidine') is also known as 'Retrovir'. Interestingly, hardly anyone uses the trade names for the drugs, perhaps reflecting the superior magic of 'hard' science for both consumers and practitioners.

This conflict of names appeared at the earliest moments in the AIDS epidemic in the struggle over whether KS (a cancer) or OIs (opportunistic infections) were more important in AIDS. If KS was what was important, AIDS would be considered a 'cancer' and NIH funding would go to cancer research institutes. If it was OIs, the National Institute of Allergy and Infectious Diseases would get the funding. Similarly (as happened in the mid eighties), if AIDS was a viral disease, funding would go to virologists (like Gallo), whereas if it was an immunological disorder (which it is) the money should have gone to immunologists. Until now, virologists have had the upper hand in defining AIDS: it is often said in activist circles that immunologists are a shy, retiring group of individuals in contrast to the brash combativeness of the virologists. Whether this is the case or not, current paradigms of pathology certainly favor virology in terms of developing a forceful image of a nameable, locateable other. A virus is an object to be hunted like big game [49]; the 'immune system,' as Donna Haraway points out, is a complex, shifting artifact, neither subject nor object, arcane and multiplicit in its constitution.

The conflict-of-interest controversies which Gallo and a number of major government researchers (David Baltimore, Salahuddin and most recently, James Watson of DNA fame [50]) have been tangled up in during the eighties point to the problems of this area. If the 'AIDS virus' as aetiological agent presents us with the problem that HIV was named and patented before anyone understood how it worked, this problem is found all the more in DNA research where chromosome sections are patented (and named) as soon as they are sequenced, without any knowledge of their function. It might strike one absurd that anyone should have the patent on a piece of DNA (in other words, a piece of the human body). To be able to see DNA, to sequence it, turn it into information constitutes ownership at present. To change this would be as enormous a task as the overthrow of the whole system of ownership in this society. There may be other ways to negotiate this problem.

Donna Haraway has written persuasively on this subject [51]. She describes the replacement of an 'old' organic unity of body and knowledge replaced by a 'biopolitics of the body' envisioned as 'a coded text, organized as an engineered communications system, ordered by a fluid and dispersed command-control-intelligence system' [52]. In response to this new situation, 'our hopes for accountability....turn on revisioning the world as coding trickster with whom we must learn to converse' [53]. In the context of AIDS, this means never forgetting that, as much as we yearn for it, the power of modern medical science 'does not flow from a consensus about symbols and actions in the face of suffering' [54].

Such a consensus may become possible at certain moments: but only through as thorough a knowledge as possible of who the consensus makers are and what they want. These wants are various: pharmaceutical companies make money from people's fears. A PWA may cling to belief in a drug even as it kills him or her, ignoring demonstrable toxicities in the belief that any form of medical intervention must be a positive one. A research scientist out for glory is subject to the same fears of contagion as everyone else - and this may influence his or her conclusions. Furthermore, fears of contagion are easily manipulated to make a research grant application seem more compelling. The networking of beliefs about AIDS makes the meaning of consensus very complex.

All the various methods of 'knowing' AIDS connect with one another in a vast shifting structure of different languages, all eager to find expressivity in a stable signifier of one kind or another. The image of Magic Johnson on the Arsenio Hall Show intersects with an electron micrograph of an infected cell, a Fundamentalist radio sermon, a drug company funded subway ad for the HIV test and a lung biopsy. Where a consensus made between diverse constituencies is possible, whether driven by fear or by knowledge, an image rises up in the media, and a mythical location of disease is isolated. Hence, the scapegoat.

What is clear is that a single image of the disease, be it virus or (obviously) carrier does nothing for PWAs unless it comes with a cure that validates it. There is a price to pay for premature consensus, the price of roads available but not taken: Many are the drugs that languish untested, because they do not fit currently acceptable paradigms of AIDS pathogenesis [55]; many are the hypotheses about the pathogenesis of AIDS that are underexplored because they cannot be answered in a way that integrates into an overdetermined HIV/virus based model of AIDS [56]. Effective public health measures to contain the spread of an infectious disease such as AIDS do not necessarily imply a monolithic public image of the disease. Although scientists and activists have rightly critiqued Duesberg for his assertion that AIDS is not spread infectiously, it does not necessarily follow that all questioning of the science of AIDS is likely to cause a lapse in public belief in the need for appropriate protective measures. Recent studies indicating the resurgence of unsafe sex practices and the rise of novel HIV infections in some gay populations suggest that the image of absolute deterrence implied by the formula 'HIV causes AIDS, which equals death' are inadequate, and that the full complexity of AIDS, with both it's knowns and its unknowns, must be addressed in educational efforts [57].

Similarly, with respect to the basic science of AIDS, it is possible that all that is necessary to solve the AIDS crisis is a rearrangement and expansion of current scientifc research with respect to HIV and AIDS. In view of the failure, until now, of this strategy, one is forced to ask the question: given the fact that we still do not know how AIDS is caused, would it not be better to base research agendas on a diversity of approaches aimed at exploring that which is unknown, rather than fetishizing what is known, expending ever greater resources on the refining of that which is known? Subject to the contingencies of proof, all possible scientific paths to understanding what is happening in the bodies of people with AIDS must be pursued.

(Many thanks to Joseph Sonnabend, Kate Hunter, Michael Taussig and John Ende, for helping me develop the ideas in this paper.)

Notes