Notes

[1] See Douglas Crimp (ed) AIDS: Cultural Analysis, Cultural Activism (Cambridge, MIT, 1988), Nelkin, Willis & Parris (eds) A Disease of Society: Cultural and Institutional Responses to AIDS (Cambridge, Cambridge U., 1991), James Miller (ed) Fluid Exchanges: Artists & Critics in the AIDS Crisis (Toronto, U. Toronto, 1992), Simon Watney, Practices of Freedom: Selected Writings on HIV/AIDS (Durham, Duke U., 1994), Elizabeth Fee and Daniel Fox (eds) AIDS: the Burdens of History (Berkeley, U. California, 1988), Elizabeth Fee and Daniel Fox (eds) AIDS: The Making of a Chronic Disease (Berkeley, U. California, 1992), Erica Carter and Simon Watney (eds), Taking Liberties: AIDS and Cultural Politics (London, Serpent's Tail, 1989).

[2] See Douglas Crimp with Adam Rolston, AIDS Demographics (Seattle, Bay Press, 1990), Larry Kramer, Reports from the Holocaust: the Making of an AIDS Activist (New York, St. Martin's, 1989).

[3] Warren Greene, 'AIDS and the immune system,' Scientific American, (1993) 269 (3), p. 99.

[4] Notable critical exceptions include Paula Treichler's various writings on AIDS especially 'How to have theory in an epidemic: the evolution of AIDS treatment activism' in Constance Penley and Andrew Ross (eds), Technoculture (Minneapolis, U. Minnesota, 1991), Donna Haraway, 'The biopolitics of postmodern bodies: constitutions of self in immune system discourse' in Simians, Cyborgs and Women, (New York, Routledge, 1991) and Cindy Patton, Inventing AIDS (New York, Routledge, 1990), all of which view AIDS science as integrally constituted by a broader social field. Non-critical works, predominately attempting to provide alternative scientific accounts of the basic science of AIDS include activists such as Michael Callen, Surviving AIDS (New York, Harper Collins, 1990), Mark Harrington, 'Pathogenesis and activism' in Documents 3, (1993) pp. 4-12, Charles Caulfield with Billie Goldberg, The Anarchist AIDS Medical formulary: A Guide to Guerilla Immunology (Berkeley, North Atlantic, 1993), Marcus Boon, 'Pathogenesis,' PWA Newsline, 70, October 1991, pp. 46-49; scientists include Joseph Sonnabend, 'Fact and speculation about the cause of AIDS,' AIDS Forum, 2, 1, 3-12, 1989; Peter Duesberg, 'AIDS epidemiology: inconsistencies with human immunodeficiency virus and with infectious disease,' P.N.A.S., 88, 1575-79, 1991, Robert Root-Bernstein, Rethinking AIDS (New York, Macmillan, 1993). Journalist accounts stressing alternative scientific readings of AIDS include Jon Rappoport, AIDS Inc.: Scandal of the Century (San Bruno, Human Energy, 1988), Jad Adams, AIDS: The HIV Myth (New York, St. Martin's, 1989) and Bruce Nussbaum, Good Intentions: Big Business and the Medical Establishment are Corrupting the Fight Against AIDS (New York, Atlantic, 1990). Yet almost all of these accounts confine their critique of AIDS science to arguments that remain well within currently accepted biomedical formulations - however hotly disputed the actual content of these formulations may be.

[5] See Treichler (op. cit.) for an account. Alternatively, AIDS activists have acted as necessary if problematic messengers circulating between researchers, the HIV community, the media and the public, disseminating information in publications such as AIDS Treatment News (ongoing and collected in three volumes ed. John James (Celestial Arts, Berkeley, 1989, 1991, 1993), ACT UP Treatment & Data Digest, PWA Newsline, GMHC Treatment Issues, BETA, Notes from the Underground, and many others. Although inevitably (and unenviably) put in the position of having to be critical with regard to information, most of these journals focus on promising therapies, with little coverage of basic research issues.

[6] Anthony Fauci & Zeda Rosenberg, 'Immunopathogenesis of HIV infection,' Faseb J. (1991), 5, 2382-2390

[7] I once wrote a brief piece for PWA Newsline (#80, August 1992, p. 29) on this subject. A partial list of questions to be asked included: apologies (and thanks) if any of these questions have been answered:What causes AIDS? Why do people get the specific opportunistic infections that they do? Are OIs caused simply by the lack of an immune system, or because of specific conditions in the immune system that allow certain fungi, viruses and parasites to thrive? Why does AIDS take so long to happen? Why is the decline of the immune system so slow? What are the crucial events in this decline? Do they happen early or late? Are they reversible? What does being HIV positive mean? Are there people who are HIV infected but not seropositive? How many of them? Do they have a successful immune response to HIV? If so, why do some seroconvert? If HIV causes AIDS, how does it do so? Are other things neccesary? If so, what are they? Is AIDS a new disease? If HIV is a new virus causing a new disease called AIDS, why is the virus so well adapted to the human immune system? Why is it so difficult for women to give AIDS through sexual transmission to men? Is there a heterosexual epidemic of AIDS in America? Why do equal numbers of men and women have AIDS in Africa? What are the immunological, virological and epidemiological correlates of rapid and slow progression to AIDS?What causes the depletion of T helper cells seen in AIDS? Is the lack of T cells the primary problem in AIDS - or a side effect of some other more important problem? Are there specific groups of T helper cells that disappear? Which ones? Once a specific kind of T cell has been lost, can the body replace it? If not, are there other cells which can perform the functions of T helper cells? What is the relationship between the overactivation of T cells in HIV infection, their unresponsiveness, and their eventual depletion? Does a test tube demonstration of T cell death mean that the same thing is happening in the body?

Why is high general antibody production in HIV infection a bad sign, but high specific anti-HIV antibody production a good sign? What are the non-anti-HIV antibodies in HIV infection doing? How important are B cells in AIDS? Is there a small subset of B cells, as for the mouse version of AIDS, which expands and then causes disease? Is AIDS really an autoimmune disease? If so, how does one prove it? Are there significant numbers of antibodies aimed at parts of the immune system? If so, which parts are they aimed at? Are there killer T cells that attack the immune system? Why is it that people with certain autoimmune diseases (Sjogren's syndrome, rheumatoid arthritis, SLE) who are HIV infected don't progress to AIDS?

Why is it that people with extremely high numbers of T8 cells don't progress to AIDS? Why do T8 numbers in general reach their height just before development of AIDS? What are T8 cells anyway? Are suppressor T8s protective or disease causing? Do specific suppressor cells exist? Are there good animal models of AIDS? What do other retroviral animal infections tell us about AIDS? How useful is it to infect other animals with HIV? How useful is research conducted in a test tube?

How competent are the people that tell us what we know about the pathogenesis of AIDS? How can we make them more competent? Why don't pathogenesis researchers talk more to drug and clinical trial developers? Why do researchers wait until a fact is absolutely proven before thinking about therapies that could be developed from this potential fact? How much time has been wasted this way?

[8] For a broad survey of current opinion on these issues, see Luc Montagnier and Marie-Lise Gougeon (eds) New Concepts in AIDS Pathogenesis (New York, Dekker, 1993). See also Greene, op. cit., and the AIDS issue of Science: vol. 260, May 28, 1993. For an encyclopedic virocentric overview, see Jay Levy 'Pathogenesis of human immunodeficiency virus Infection,' Microbiological Rev. (1993), 57, 183-289.

[9] Protease inhibitors, currently in development by a number of pharmaceutical companies, are the newest generation of anti-HIV drugs: early results from studies look promising, as have the results from many other such studies. Long term effects of the drug on disease progression remain unknown.

[10] Max Horkheimer and Theodor Adorno, Dialectic of Enlightenment (New York, Continuum, 1991), p. 196

[11] From The AIDS Show, quoted in Paula Treichler, 'An Epidemic of Signification,' in AIDS: Cultural Analysis, Cultural Activism, op. cit., p. 52

[12] Randy Shilts, And the Band Played On (New York, Penguin, 1987), p. 41

[13] Mirko Grmek, History of AIDS (Princeton, Princeton U., 1990), p.5

[14] Stedman's Medical Dictionary, 25th Ed., (Baltimore, William & Wilkins, 1990), p. 1519

[15] Lancet, Sept 19, 1982, p. 598

[16] Lancet, ibid.

[17] Lancet, ibid.

[18] Science, 224, 475 (1984)

[19] Wong-Staal, F. et al, 'Genomic diversity of HTLV-III,' Science, 227, 759-762 (1985)

[20] Grmek, op. cit., p. 55

[21] Montagnier published research on isolation of virus from one patient; Gallo claimed to have isolated virus from many. Yet it later turned out that Gallo had probably used Montagnier's virus for his own work too.

[22] Shilts, op. cit., p. 299

[23] Shilts, op. cit., p. 322

[24] Horkheimer and Adorno, op. cit., p. 15

[25] Klaus Theweleit, Male Fantasies, Vol. 2 (Minneapolis, U. Minnesota, 1989), p. 6

[26] Perhaps the clearest indication of this is that the evaluation of the HIV genome and proteins is fairly complete. It is not at present known which cells in the body HIV infects, or how it affects these cells. Therapies based on interruption of HIV's replicative cycle have been developed (AZT, DDI, DDC, other reverse transcriptase inhibitors, TAT gene inhibitors etc), Very little that deals with the immunological abnormalities seen in AIDS has been developed - thankfully, this may be changing, with the study of various cytokine inhibitors, immune system overactivation inhibitors and immune stimulators.

[27] Estimates of the number of people who are HIV positive who will get AIDS are usually quoted at between 30-100% - a wide variation. No known virus kills all the animals infects: and there is no evidence that HIV should be different. To their credit, a number of scientists (including Montagnier and Gallo) have pointed this out - although, in a characteristic outburst Gallo at one point said that 'HIV kills like a truck'.

[28] Shilts, op. cit., p. 161

[29] Ibid., p. 285

[30] Ibid., p. 565

[31] Ibid., p. 334

[32] Ibid., p. 321

[33] Ibid., p. 565

[34] James Frazer, The Golden Bough (New York, MacMillan, 1951) p. 652

[35] Ibid., p. 667

[36] Casper Schmidt, 'The group-fantasy origins of AIDS,' J. Psychohistory, 12, 37-78 (1984)

[37] See Treichler, op. cit., p. 42-52. Treichler quotes Jacques Leibowitch: 'When they come to write the history of AIDS, socio-ethnologists will have to decide whether the 'practitioners' of homosexuality or its heterosexual 'onlookers' have been the more spectacular in their extravagance. The homosexual 'life style' is so blatantly on display to the general public, so closely scrutinized, that it is likely we never will have been informed with such technicophantasmal complacency as to how 'other people' live their lives.' (A Strange Virus of Unknown Origin, p. 3)

[38] Chinese for AIDS, 'disease spread by love' (Grmek, op. cit., p. 32-33)

[39] Michael Callen, 'An epidemic of acronyms,' PWA Newsline, 70, p. 25

[40] Walter Benjamin, 'A short history of photography' in One Way Street and Other Writings (London, New Left Books, 1979), p. 243

[41] Ibid.

[42] National Geographic, June 1986, 702-735

[43] Ibid., p. 714

[44] Lancet, 339, 824-828 (1992)

[45] Gallo, R. et al, 'Antibodies reactive with human T-lymphotrophic retroviruses (HTLV-III) in the serum of patients with AIDS,' Science, 224, p. 507 (1984)

[46] Grmek, op. cit., p. 63-4

[47] Stott...

[48] For the latest summary of the Gallo investigation, see C. Anderson, 'The aftermath of the Gallo case,' Science, 263, 1994, pp. 20-22.

[49] See Paul de Kruif, Microbe Hunters (New York, Harcourt, Brace, 1953) and Robert Gallo, Virus Hunting (?) for more on the great white male virus-hunter in all his glory.

[50] See Leslie Roberts, 'Why Watson Quit as Project Head,' Science, 256, 301-302 (1992)

[51] See also Bruno Latour, Science in Action (Cambridge, Harvard U., 1987) and We Have Never Been Modern (Cambridge, Harvard U., 1993). I came to Latour's work rather late in this project and would probably have incorporated more of work on human and non-human agents in scientific networks, had I read him earlier.

[52] Donna Haraway, op. cit., p. 211

[53] Haraway, op. cit., p. 209

[54] Haraway, op. cit., p. 203

[55] A partial list of these substances, some ignored because they're unpatentable (and thus difficult to make profits from) others because the rationale for their use is not widely accepted include: DHEA-S, chloroquine, cyclosporin, cyclophosphamide, DNCB, interferon inhibitors, IL-6 inhibitors, apoptosis inhibitors, thalidomide, beta carotene, essential fatty acids, miscellaneous anti-inflammatory drugs, transfer factors, a variety of Chinese herbal formulas.

[56] A current partial list of neglected avenues of research includes: the neuro-endocrinology of AIDS; psychoneuroimmunology; infectious co-factors including mycoplasma, heliminthic infections in African and other 3rd world populations, cross-population dynamics between different microbial species in AIDS, notably possible effects of CMV, EBV, HIV, tuberculosis, fungal infections, PCP on each other; nutrition and gastroenterology of AIDS, especially the importance of the spleen; mucosal immunology; network-model based immunological hypotheses; autoimmunity, notably possible contribution of autoreactive CD8+ cells, and autoantibodies; pharmacological issues relating to overall benefit of anti OI drugs, some possibly immunosuppressive, on death vs. clearance of specific diseases; epidemiological aspects of heterosexual AIDS in US and other populations; virology and immunology of pre-seroconversion HIV infection. See also the list of questions re. AIDS research above.

[57] For an excellent overview of these issues see Walt Odets, 'AIDS education and harm reduction for gay men: psychological approaches for the 21st Century,' Documents 6 (1995) pp. 4-23.