The “End” of AIDS?
To acknowledge that a particular period of the AIDS pandemic, with its specific historical structures of feeling, is now in the past does not equate with the assertion that we have reached the “end of AIDS.” Since 1996, when the success of protease inhibitors in keeping down viral levels became widely acknowledged, discourses around the “end of AIDS,” “post-AIDS” identities, and cultures “after AIDS” have burgeoned in both mainstream and lesbian and gay media (Román). Most notable amongst such declarations was Andrew Sullivan’s controversial article, “When Plagues End,” published in November 1996 as a cover story in The New York Times Magazine. Sullivan claims, “A difference between the end of AIDS and the end of many other plagues: for the first time in history, a large proportion of survivors will not simply be those who escaped infection, or were immune to the virus, but those who contracted the illness, contemplated their own death and still survived” (Sullivan, magazine cover, emphasis in original).
To posit that the AIDS crisis is over requires a complex set of disavowals and erasures be performed. First, one must ignore that the AIDS pandemic comprises many epidemics in different places, affecting different groups, each with its own temporality, its own historicity. The experience of AIDS for a white gay man in Manhattan differs greatly from that of a married woman in Nairobi. Access to medical care, social resources, and community support profoundly determine the shape and history of each epidemic. The current struggle by many countries, such as Brazil and South Africa, to secure rights under international trade treaties to generically produce these effective new drugs demonstrates the vast inequalities dividing the different AIDS epidemics around the globe. Second, even to declare the “end of AIDS” only in certain epidemics, such as the gay male epidemic in North America, requires one to disavow the differing rates of HIV infection amongst various groups within those epidemics. In the case of North American gay men, while a great many of the infected are responding successfully to combination therapies, HIV prevention programs are currently battling rising rates of seroconversion amongst younger gay men and gay men of color. Third, protease inhibitors and the new combination therapies they have spawned do not constitute a cure. They reduce the viral load, in the best cases, to a level at which HIV is undetectable in the blood. Many people with AIDS, however, have been unable to take these new therapies because either their bodies can no longer bear any further pharmaceutical toxicity or the therapies remain ineffective against drug-resistant strains of the retrovirus. Even for those who can benefit from these drugs, serious questions remain about their long-term efficacy and side effects.
As David Román has commented, these discourses about the “end of AIDS” consistently imply that “the need to talk about AIDS has ended as well” (1). In many cultural and political contexts, AIDS- and HIV-related issues have become, like the retrovirus itself, almost undetectable. Not restricted to the dominant media, this “unfashionability of AIDS,” as Robert Atkins puts it, similarly permeates contemporary gay culture. For instance, the shift in gay political mobilization towards the issues of gay marriage and military service in the Clinton era marked a significant displacement of the epidemic on the part of gay men. Douglas Crimp has pointed out how the fetishization of healthy white gay servicemen in the political struggle over lesbians and gay men in the U.S. military served to displace the gay male body with AIDS (238). By the late 1990s, the figure of the gay man with AIDS had itself undergone iconographic transformation in light of the relative successes of new combination drug therapies.
