How to have history in an epidemic

By Dr Dean Murphy, Research Fellow, Kirby Institute, UNSW, Sydney and Alfred Health, Melbourne.

Reflecting on current discussions about COVID-19 within the HIV and LGBTQ community health sectors it’s difficult not to reflect back on the early days of the HIV epidemic, and two works in particular.

How to Have Sex in an Epidemic: One Approach was a seminal text by Richard Berkowitz and Michael Callen, published in 1983, providing information to gay men about how to have sex in ways that might prevent AIDS. This work, alongside another published around the same time, was the origin of ‘safe sex’ – a radical intervention at the time – and one based largely on lay expertise, in the face of calls for sexual abstinence. The authors located their intervention within a particular strand of AIDS activism called ‘confrontational activism’, which takes as one of its principles that society is generally indifferent to the well-being of sexual minorities. Therefore, communities have no choice but to take responsibility for their own protection. (The other strand, ‘collaborationist activism’, works more closely with government and institutions and largely accepts the scientific and medical directions they set.) The name of this text is an interesting provocation in the current context.

How to Have Theory in an Epidemic: Cultural Chronicles of AIDS, published in 1999, was a collection of essays written by Paula Treichler in the 1980s and 90s. The name of this collection was a deliberate nod to Berkowitz and Callen, and ‘theory’, she insisted, simply meant a kind of ‘intelligence’ – a thoughtful and engaged dialectic between the brain, the body, and the world that the brain and the body inhabit.’ (p. 2). The essays in the collection, in particular those such as AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification, are a reminder that ‘AIDS’ is constructed through language and in particular through the discourses of medicine and science. Her work provides valuable insights into how scientists themselves mixed expert understanding with their own ‘lay impressions’ to explain the phenomena they were studying. Treichler argues that ‘[t]he apparatus of contemporary critical and cultural theory prepares us to analyze AIDS in relation to questions of language, representation, interpretation, narrative, ideology, social and intellectual difference, binary division, and contests for meaning.’ (p. 2)

Both these texts remind us that epidemics are times of urgency, and times of exception – times when the imperative to take action can override consideration of different paths, and different ways of knowing the problem. Reflecting on what she terms the ‘AIDS event’, in France, the speculative philosopher, Isabelle Stengers argues that those most affected by it – including social scientists – made ‘the choice of not yielding to the urgency of the strictly medical problem’ and of ‘trying to actually pose the problem clearly’ (Stengers, 1997, p. 216.7). However, as Marsha Rosengarten and I wrote in a recent article, ‘with few exceptions […] an explicit account of the important role of the social sciences and humanities in this initial phase has largely been neglected’ (Rosengarten & Murphy, 2020, p. 3)

There are many differences between COVID-19 (or SARS-CoV-2) and HIV of course. It’s transmitted differently, it’s no more prevalent among LGBTQ communities than anywhere else, most people recover from infection, and those who have recovered are likely to have immunity (at least for some time). The questions posed by Berkowitz, Callen and Treichler in their titles, however, are still interesting ones to reflect on at this time. Given that biomedicine cannot provide a solution (i.e. vaccine or effective treatment) in the foreseeable future, drawing on approaches such as social science and community-based activism that are not entirely premised on public health, are important. These approaches may require pragmatic ways of engaging with the problem and its practical dynamics (Race, 2012), as well as consideration of things – such as sex, friendship, sociality, and culture – that have importance for individuals and communities.

Berkowitz, R. & Callen, M. (1983). How to Have Sex in an Epidemic: One Approach.

Race, K. (2012). Framing Responsibility: HIV, Biomedical Prevention, and the Performativity of the Law. Journal of Bioethical Inquiry 9 (3): 327–338.

Rosengarten, M & Murphy, D. (2020). A wager on the future: a practicable response to HIV pre-exposure prophylaxis (PrEP) and the stubborn fact of process. Social Theory & Health 18, 1–15 (2020).

Stengers, I. (1997). Power and Invention: Situating Science (trans: Bains, P.). Minneapolis: University of Minnesota Press.

Treichler, P. (1999). How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham: Duke University Press.