AIDS: an “epidemic of signification” ?

Cara Atkinson (2016), UCL, MA in Gender, Society and Representation

The concept of AIDS as an ‘epidemic of signification’ was first proposed by Paula Treichler in her 1987 essay, ‘AIDS, Homophobia and Biomedical Discourse: An Epidemic of Signification’. Treichler begins the essay by framing AIDS as a linguistic construction that creates the impression of the existence of a ‘clear-cut disease entity caused by a virus’ (263), rather than a syndrome that is made up of a collection of opportunistic infections that pre-exist AIDS itself (Agar 2015). ‘The name “AIDS”,’ Treichler writes, ‘in part constructs the disease and helps make it intelligible’ (263). Despite this, she does not draw a distinction between AIDS as a discursive construction that has no reality outside its name and HIV, a pathological entity that existed prior to the moment of its naming (Agar 2015). Throughout this essay, I use AIDS to refer to discursive constructions of HIV/AIDS that conflate the syndrome and its cause, and HIV to refer to the virus that causes the clinical markers that are read as signs of AIDS. Treichler goes on to extend the signifying power of AIDS out from its own construction. She usefully – and persuasively – draws attention to AIDS as a site around which meanings proliferate, listing thirty eight diverse conceptualisations of what AIDS ‘is’, ranging from the relatively reasonable (‘An irreversible, untreatable and invariably fatal infectious disease which threatens to wipe out the whole world’) to the bizarre (‘A plague stored in King Tut’s tomb and unleashed when the Tut exhibit toured the US in 1976’) (264).

However, in seeking to understand AIDS as an ‘epidemic of signification’, and thus by focusing on diversifying rather than consolidating meaning, Treichler can be charged with detracting from the argument that she lays out so succinctly in the title of her essay – that AIDS is a system of representation in which ‘homophobia and biomedical discourse’ meet. AIDS can be understood as a Foucaultian discourse, an institutionalised system of thought that ‘defines and produces the objects of our knowledge… govern[ing] the way that a topic can be meaningfully talked about and reasoned about’ (Hall 1997: 44). When linked to power (which, Foucault argues, cannot be understood as straightforwardly negative as it ‘produces reality’), knowledge gains authority, producing itself as truth (Foucault 1977: 194). Understanding the spread of HIV as a threat to established medical and social truths enables a reading of the initial construction of AIDS as a repressive discourse that limited the disordering power of HIV, confining it to (and simultaneously producing) what Treichler terms the ‘text’ of the male homosexual body (1987: 269). In this essay, I focus to a greater extent than Treichler on AIDS as a coherent and powerful discourse centred on the production of the homosexual body, rather than as a ‘chaotic assemblage of understandings’, and thereby adopt a somewhat Foucaultian lens (Treichler 1987: 264). Reframing AIDS as a ‘discursive epidemic’ enables a deeper understanding of its relations to knowledge and power than Treichler’s ‘epidemic of signification’ permits.

Conceptualising AIDS as a discursive epidemic requires an understanding of the ways in which silence, a crucial aspect of signification that Treichler overlooks, relates to discourse. Discussing the suppression of childhood sexuality in The History of Sexuality, Volume 1: An Introduction (1976), a text in which he also addresses the medicalisation of sexuality and the subsequent creation of ‘the homosexual’ as a distinct ‘type of life’, Foucault describes silence as (43), less the absolute limit of discourse, the other side from which it is separated by a strict boundary, than an element that functions alongside the things said, with them and in relation to them within overall strategies. There is no binary division to be made between what one says and what one does not say; we must try to determine the different ways of not saying such things, how those who can and those who cannot speak of them are distributed, which type of discourse is authorized, or which form of discretion is required in either case. There is not one but many silences, and they are an integral part of the strategies that underlie and permeate discourses (27).

Silence must be considered part of Foucaultian discourse and therefore central to conceiving of AIDS as a discursive epidemic. Writing in 1989, Douglas Crimp – an art historian, writer and AIDS activist – stated that, in relation to AIDS, ‘The violence we encounter is relentless, the violence of silence and omission almost as impossible to endure as the violence of unleashed hatred and outright murder’ (8-9). The ‘we’ Crimp refers to here is the gay community (I use the term gay throughout this essay in contrast with the medicalised understanding of the homosexual outlined by Foucault in The History of Sexuality), which he describes as being threatened by discursive silencing as much as by physical manifestations of socially regulatory power. During the 1980s, and within the dominant discourse of AIDS, the voices of the gay community were effectively subsumed under the spectre of the contaminated and contaminating homosexual body – like the rest of society, they generated meanings around AIDS, but these meanings were not institutionalised and, as such, did not come to be recognised as truths.

The articulations and protestations of the gay community, like the disordering power of HIV, contained subversive potential that required containment. AIDS, as discursive epidemic, must be thought of in terms of an effort to limit damage to fields of knowledge, including biomedical knowledge and the ‘emotionally loaded’ knowledge of the self as securely bounded, through the formation of AIDS as an object of knowledge (Quam 1990: 39). This is because epidemics disrupt conceptual and physical boundaries – as disease spreads through the population, it crosses social divisions, and it does so by penetrating the sacred inner spaces of the body. In effect, epidemics render all people at risk, as disease vectors do not differentiate their hosts according to any kind of social or moral index. All epidemics therefore consist of a crossing of boundaries that has lethal potential, blurring the boundaries between self and other. No individual can fully ensure their own (physical) inviolability, but social inviolability can be imagined as truth through the formation of discourses that identify disease as stemming from some form of the Other (McCombie 1990: 15). Through the development of discourse, biomedical efforts to create knowledge about a disease slip into efforts to create knowledge about particular social groups to the extent that a reciprocal relationship between the two develops. In the case of AIDS discourse, knowledge about AIDS was identified with knowledge about the imagined homosexual population and their textualised, signifying body.

In the case of AIDS, the drive to contain the subversive potential of HIV was particularly acute as the virus and its symptoms were unidentified by medical science when the first signs of infection emerged within the American population (and were therefore, quite literally, outside knowledge). The emergence of a mysteriously transmittable disease challenged the widespread belief that ‘the practical application of the principles developed by a series of clear thinkers and brilliant investigators… has forever banished from the earth the major plagues and pestilences of the past’ (Winslow 1943: 380). Infectious diseases were a thing of the past, contemporary biomedical discourse argued, eradicated by the expertise of the medical profession. This was regarded as a biomedical truth to the extent that research and funding had turned away from infectious diseases towards chronic and degenerative diseases (McCombie 1990: 9). As such, the presence of a lethal infectious virus within the US population was rendered quite literally unthinkable within the parameters of contemporary biomedical knowledge.

Yet what could be thought was not the same as what was actively occurring – discourses can construct reality, but they cannot alter what exists. Instead, they can merely obscure it. In 1981, five young, previously healthy gay men were admitted to three different US hospitals with Pneumocystis pneumonia (PCP), an opportunistic infection usually found only in people with a suppressed immune system. In the same year, reports were also made to the Centre of Disease Control and Prevention of other opportunistic infections apparently affecting gay men, including an aggressive and rare form of skin cancer, Kaposi’s sarcoma (KS) (Agar 2015). KS had until this point in time been found almost exclusively in elderly men of Mediterranean origin – now it was affecting young men and, as in the reported PCP cases, the shared factor appeared to be the men’s sexual orientation. Despite the fact that almost all epidemics and diseases emerge in specific populations first, before spreading into the wider population, the shared sexual orientation of the men was posited as the main characteristic of the syndrome and also as its main form of transmission. The immunosuppression and collection of opportunistic infections the men shared was named Gay-Related Immune Deficiency (GRID) in 1982 (Agar 2015). The act of naming this syndrome positioned it within medical discourse as an identifiable entity – an object of knowledge – yet marked it, falsely, as only being a threat to the gay population. Sexuality, as identity rather than just sexual activity, was positioned as the defining aspect of the syndrome, and implicitly as the causal factor. Questions posed by the syndrome about ‘the entire framing of knowledge about the human body’ were effectively silenced through language, and the syndrome’s actual origins constrained within a structure of marginalisation designed to make infectious disease thinkable once again (Watney 1987a: 9).

Even when GRID became known as Acquired Immune Deficiency Syndrome (AIDS) later that same year, the association between sexuality and HIV/AIDS persisted, creating a new discourse that straddled the border between fields of knowledge. There was a widespread understanding that, as Patrick Buchanan, the former director of White House communications, put it in a 1983 column, ‘The poor homosexuals — they have declared war upon nature, and now nature is enacting an awful retribution’ (cited in Shilts 1987: 311). In other words, AIDS came to be understood as a punishment that ‘flushe[d] out’ not only identity, but sexual ‘perversity’ as well (Sontag 1989: 113-114). This new discourse could only be built by reshaping pre-existing discourses about disease. In ‘Illness as Metaphor’ (1978), Susan Sontag describes how tuberculosis and cancer – both ‘mysterious’ diseases that challenge medical efficacy – are encoded through metaphor as moral, even punitive, diseases that render the patient culpable for their own illness and recovery (3).

Extending her thinking in AIDS and Its Metaphors (1989), Sontag claims that AIDS, like tuberculosis and cancer before it, ‘has provided a large-scale occasion for the metaphorizing of illness’ (104), in which AIDS is perceived as affecting ‘the already stigmatized’ (116). The long-standing taboo against homosexuality was conjoined with the idea of disease as a form of discipline, at a time when, as Douglas A. Feldman (1990) notes, the heterosexual population had ‘begun to view the gay community as a viable sociocultural alternative, functioning as if it were a cohesive ethnic group within a pluralistic society’ (3). The form of cultural acceptance that Feldman describes is predicated on the gay community existing as a discrete yet socially integrated grouping that can be readily identified – and, if needed, set apart and silenced. But, as Sontag points out, the construction of AIDS as discursive illness relies upon the separation of groups of people ‘while implying the imminent dissolution of these distinctions’ (emphasis mine) (1989: 119). AIDS, as a discourse of ‘sexual danger’, is therefore also symbolic ‘of the relation between parts of society… mirroring designs of hierarchy or symmetry which apply in the larger social system’, but which are felt to be in danger of slippage, dissolution or overthrow (Douglas 1996: 4).

Early theories about the cause of AIDS brought AIDS into being as a morally-inflected field of knowledge, rooted in the imagined homosexual body – immunosuppression, it was suggested, could be a direct result of anal intercourse; there was also suspicion that the use of akyl nitrates (drugs known as poppers associated with gay culture, particularly with the facilitation of anal intercourse) might cause immunosuppression (McCombie 1990: 11). When combined, these two theories point to the notion of an pathological, infectious homosexual lifestyle that ultimately results in the destruction of the body in which it is expressed.

Foucault’s insights into the way in which the sexual confession – the transformation of sex into discourse and a key process in the creation of the homosexual – came to be expressed and understood in scientific terms during the nineteenth century are particularly pertinent here in relation to the formation of AIDS as a discourse that incorporates and produces a medicalised knowledge of the (homo)sexual body. In the first volume of The History of Sexuality, Foucault argues that scientific understanding of the sexual confession was achieved through a range of different methods: the clinical codification of confession; the endowment of sex with extensive causal power; the notion of sexual desires being hidden even from the self; the use of interpretation as a method of scientific evaluation; and the appearance of sex as an unstable pathological field in which sex derived meaning through medical intervention (65-7). As a result, sexuality became a field of knowledge and medical treatment, underpinned by processes of signification and interpretation (68). The early years of the AIDS epidemic can be seen to express this, as it was during this time that the clinical markers of AIDS (which, like KS, often physically marked the exterior of the body) began to be constituted as signs of so-called sexual deviancy, of invisible desires and sexual truths that confessed themselves to the authority figures of the medical establishment via the medically readable surface of the homosexual body. The individual identified as having AIDS did not even need to speak for their condition (and their sexuality) to be read and understood – the voice the body spoke in became the voice of the discursive epidemic.

As a result, the discourse of AIDS produces knowledge about sexual activity as well as physiological symptoms, leading to what Simon Watney calls the ‘veneralizing’ of HIV transmission (1987b: 82). HIV, like many common (and often innocuous) illnesses, is not transmitted exclusively through sexual contact, yet it is often spoken about and categorised as if it were a (homo)sexually-transmitted disease (84). Framing transmission in this way has led to the invisibility in the AIDS discourse of individuals infected through intravenous drug use, blood transfusions, or non-homosexual intercourse (Treichler 1987: 287). Although these forms of transmission have, in recent years, been incorporated into AIDS discourse, the extent to which AIDS was originally constructed as a disease of homosexuality can be seen in the struggle during the early years of the epidemic to recognise non-homosexual sexual transmission as a possibility.

As early as 1982, ‘women with AIDS had been identified who reported no other potential source of infection than sexual contact with a male partner; likewise, a small number of men with AIDS claimed no other source of exposure than female sexual partners’, and by 1984 it was clear that in some areas HIV was being transmitted largely through heterosexual contact (Treichler 1999: 47). Yet strictly heterosexual transmission was literally unconceivable at this point in the development of AIDS as a discourse – S. C. McCombie describes a 1985 study of HIV transmission between prostitutes and clients in which the possibility of female to male transmission was discarded in favour of the explanation that men were being infected by sperm deposited by the previous client in the prostitute’s vagina (1990: 17). In this theory, the prostitute’s body is a site where an obliquely homosexual encounter is performed. Previous characterisations of prostitutes as ‘contaminated vessels’, stemming from nineteenth century concerns about venereal diseases such as syphilis, remained active, but the contamination, as it were, stemmed from sexual behaviours that were perceived to threaten the ideological security, power, and moral purity of heterosexuality itself (Bersani 1987: 211).

As the epidemic continued, and the existence of non-homosexual transmission became undeniable, the kinds of sexual deviance that were posited as routes of morally inflected infection multiplied, but all were tied to fictions of what male homosexual sex was. Women who were infected through heterosexual intercourse were evidently promiscuous, a behaviour largely associated with gay men. Lesbians who were infected through sex with other women were not thought to be participating in the kind of ‘gentle and non-ejaculatory’ sex that had led them to be disregarded by the medical community as being at risk of HIV infection – instead, according to medical reports of these cases, they were engaging in sadomasochism and fisting, ‘devian[t]’ forms of sexuality that were again imagined as being part of homosexual sex (Treichler 1999: 66). The veneralizing of HIV/AIDS thereby had the effect of framing all sexual transmission of the virus in terms of pseudo-homosexual, deviant sex, collapsing the ideological boundaries between ‘good’ (heterosexual) sex and ‘bad’ homosexual (and otherwise socially deviant) sex.

Thus, it can be seen that AIDS is more than simply an ‘epidemic of signification’. It can be considered an epidemic of a single image, which Leo Bersani describes as that of ‘a grown man, legs high in the air, unable to refuse the suicidal ecstasy of being a woman’, that shapes all other encounters and imaginings of the epidemic and those affected by it (1987: 212). In this sense, then, AIDS must be considered more strictly as a discursive epidemic that, through the formation of knowledge and the related exercise of power through discourse, disciplines individuals (specifically the bodies of individuals) engaged in forms of sexual activity and sexual identity labelled socially deviant. This is not to deny the existence of other meanings generated by and attached to AIDS – rather, it is to point out the ways in which AIDS has silenced these other meanings through its discovery and constitution as a field of knowledge in relation to the imagined body of the male homosexual, and the way in which the body of the male homosexual has been medically constituted through AIDS.


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Treichler, P. (1987) ‘AIDS, Homophobia and Biomedical Discourse: An Epidemic of Signification.’ Cultural Studies, 1(3), pp.263-305.

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