Circulation in the City Through the Tradition and Prescription of AIDS

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Circulation in the City Through the Tradition and Prescription of AIDS.

Part One: Reinaldo Arenas

[This is a draft of a work-in-progress.

Please do not circulate or cite without the author’s permission.]

“Yo tengo SIDA”. “I have AIDS”. This was the premise printed unto t-shirts by Argentine artist Roberto Jacoby and distributed in Buenos Aires during 1995. To seriously wear this shirt grew to be a matter of assertive showing and not merely saying transparently that someone, individually, had the Acquired Immunodeficiency Syndrome. The circulation of AIDS became as simply literal as possible and the shirts were a basic reminder of the suggestive force behind the cultural representation done by an artist in the 1990s. The person dressed in the shirt did not necessarily had AIDS or even the HIV that leads to AIDS. This was the principal axis of Jacoby’s campaign: the syndrome moves through the city without people necessarily acknowledging that they have it or are developing it within their bodies. AIDS radiates in a city reaching more people and more urban corners, but nevertheless the respective information is always slowly treading behind. If we indeed follow this artistic proposal of AIDS, the shirts will constantly amount to a lesser number of people living with AIDS, the number of cases will be smaller than the actual figure, and its distribution amongst a city will not even approximate a tangible reality.

AIDS becomes a problem of the city for the constitution of the city is founded upon circulation, which is also central to the contagiousness of the syndrome. Therefore, both the city and AIDS focus on the same issue, that is, their complex and inconstant movement. Urban foundations and subsequent development enterprises are modeled upon degrees of fluidness within the urban space. Under this umbrella, the tasks are comprised of two main knobs of circulation: increase and decrease, where maintaining a steady flow is the result of successful combination of public policy of these two actions. Increase and decrease function as units for measuring the success of a city. For example, policy for decrease looks to reduce crime, poverty, corruption, infant mortality, disease, analphabetism and so on. Increase, on the other hand, is for policy tied to a standard governmental cabinet composed of education, healthcare, housing, transportation, commerce, justice and defense. Taxes are one of the few issues in which both increase and decrease policies are constantly emerging. The prerogative for urban planning thus relies on dealing with the expansion, or reduction in some cases, of these city functions in relation to its population. The city operates on the changes that circulation almost imposes on the city itself. The same can be thought of AIDS, where reduction of circulation is the main goal of research on AIDS. Decline in AIDS would translate as a drop in the contacts with HIV-infected blood through sex, drugs, or mother to child. To study AIDS in any discipline becomes an inquiry on its circulation and our attempt to get a firm grasp on its related discrimination, stigmatization, reduction of cases and improvement on AIDS policies.

The city functions by rethinking its circulation and its objectives of increase and decrease. This daily urban action works by networking different components of city life. Urban planning and policy, in all its aspects, dialogues broadly with culture because the fabric of a city cannot elude its strong ties to the intellectual debates that take place from a cultural or academic standpoint. It is certainly clear that specific networks are stronger and more visible than others. Sasskia Sassen amazingly exposed this point by delving into the magnitude and magnificence of financial networks in The Global City. If one city had its own recombination of networks, it was enlightening to observe the reloading of such networks between cities as well within a clear-cut developed world. Sassen’s project on New York, London and Tokyo works visually in a horizontal line, where these cities become closely aligned in terms of their respective latitudes.

If we challenge such a powerful image vertically, the combination of cities might establish a different political, economic and cultural dialogue while proposing to study another permutation of urban networks. Latin America, or what has become the Latin American and Caribbean market, generates its own uneven web, in which politics and economics are the most perceptible yet different networks. The evident relegation of culture as part of networks in a city and between cities imperatively asks for a reconsideration of this issue as a vital one to discussions on the urban. The cities of Buenos Aires, São Paulo, San Juan, and New York can be observed as one of these interconnections within Latin America. These cities are some of the major points of circulation for their respective geographical regions of the Southern Cone, Luso-Brazilian territory, the Caribbean, and the continental United States. These four cities are central points to circulation as they are cardinal to migration, finance, and culture. When these cities are visually aligned, they propose a suicidal longitude, four cities between thirty degrees of longitude. Other main Latin American cities, like Caracas, are located between these thirty degrees of separation, and if the longitudinal extremes were enlarged cities such as Havana, Rio de Janeiro, Bogotá and Miami could be considered, but it is also significant for that these cities are very important for air traffic, the main means of circulation for people. New York is the westernmost point of the suicidal longitude at 73.58º West while São Paulo is at the other end at 46.38º West, passing by San Juan at 66.08º West and Buenos Aires at 58.30º West.

Longitudes and latitudes, used in maps and trips as indispensable for circulation, are modes of reading a place with the certitude that you will end up at the same place after coming back to the matching coordinates. Understandably, longitudes are imaginary, invisible lines, but also very close to tangibility in atlases and air control towers. Not represented by points like cities and towns, latitudes and longitudes are composed of an array of points that systematize space and become yet another organizational structure. Nonetheless the rationale behind using a longitude or latitude to observe the underpinnings of a network relies precisely on its functional power as a system and its concurrent frailty as it is based on an agreement of imperceptible lines. Networks of AIDS participate in this paradox: it works as a structured organism, but it is indiscernible to the eye. AIDS mechanism is known, cases are filed, deaths are quantified, but it is still unstoppable as a working network. This is a problem of circulation and by itself it is a problem of the city.

The sluggishness of research data regarding AIDS vigor – of people either living with AIDS or dying from any AIDS-related illnesses – is sadly unavoidable, as studies cannot expect to develop at the same rate as AIDS itself. In the end, the numbers are a certain kind of representation that looks back upon AIDS with two possible goals: to determinedly establish facts and statistics for a specific period, group or geographical region, or to use such substantial details in manner of a prescription. The former is the study of the tradition of the disease. The notion of tradition is indispensable for any serious inquiry on AIDS for the following reasons: tradition is the exchange – passive or not – of ideas and information; tradition is continuity, or the lack thereof; tradition is poetics, for its embedded character not only in culture, but in politics and economics as well; tradition is, in the end, the exchange, the continuity and the poetics of circulation.

The first goal of research on AIDS focuses on the inescapable urge of organizing the recent past of the syndrome. The American Centers for Disease Control and Prevention (CDC) exemplify this by closely arranging the number of the living and the dead since the public disclosure of the syndrome in 1981.[1] It falls upon the CDC to observe the tradition of AIDS in the United States. The tradition of AIDS, through the institutional eyes of the CDC and many other governmental and non-governmental organizations, is dubiously composed of statistical charts and management of information. The problem at hand regarding this information is not the figures per se, but its administration. The first year of public admission of AIDS in 1981 noticeably serves as part of the beginning of the circulation of the syndrome. In June 1981, the CDC confirmed the troubling detection of Pneumocystis carinii pneumonia among five gay men from Los Angeles, California. The diagnosis of this type of pneumonia hesitantly led to a dysfunction of the immune system. A month later, in July, the New York Times exposed that 41 gay men in New York and California had a rare cancer known as Kaposi’s sarcoma. By August 1981, more than 100 people had either the unusual pneumonia or cancer, or both. If people were getting sick, and if people were dying, it was nearly necessary to visibly define the distinction between the healthy and the unhealthy. In 1981, gay men became the unhealthy category, losing their sexual orientation to the name of this health problem known as the Gay-related Immunodeficiency (GRID).

As the numbers kept climbing, by 1982 the CDC started using a new name, AIDS, because the syndrome seemed uncontained exclusively by the gay community. The initial year of the public circulation of facts and speculations on AIDS had served to persistently localize the issue. The geography was New York and Los Angeles, the targets were gay men, and the sentence was probably imminent death. The CDC faced a challenge when the target was opened into other groups as well, but it quickly established the new circulation of AIDS among the infamous 4-H group: homosexuals, heroin users, hemophiliacs, and Haitians. From the beginning the categories deemed problematic, but served two main purposes: stigmatization and containment of circulation. Stigmatization was not the CDC’s explicit goal; it was more of an expected by-product. The force of stigmatization has transcended the initial tainted groups, as the case of pregnant women in Africa. By 1998 pregnant women could prevent HIV transmission to their unborn children by taking AZT, but one of the leading actors in the African AIDS arena, South Africa, decided not to pursue the drug deeming it as unaffordable. The issue brought to the forum that HIV+ mothers should not breastfeed their newborns and the use of formula by these mothers was read as the public disclosure of their HIV status, and thus the stigmatization of as an HIV+ mother.[2] The public announcement of AIDS was believed to be a well-built warning: AIDS is infectious through exchanges and circulation. These fluxes of contagion took place by flows of body fluids. The blood, as the carrier of circulation in the human body, served as transporter for AIDS. Blood contacts during gay sex, blood transfusions[3], or intravenous drug use, was at the center of AIDS and thus at the heart of stigmatization. This blood was tainted and its container, the body of any 4-H member, was carefully pinpointed by the CDC and consequently discredited. The CDC should not be furiously seen as the main culprit in imposing chaotic terror the beginnings of AIDS as it examined what was believed to be a fatal disease and acted accordingly as the traditions of diseases before it.

When Giovanni Boccaccio faces the 14th Century, the circulation of people in Florence is disrupted due to the Black Death, and a hundred stories are exchanged within the confines of a quarantined cluster. Extreme diseases, it seems, calls for extreme action. Boccaccio opts for enforced isolation in Il Decameron; the CDC selects the 4-H as the AIDS epicenter. Boccaccio presents a narrative and the CDC works on the numbers. This reference participates of an ample tradition of diseases and their historical, scientific and literary discussions. Where I have thought of Boccaccio, the European circulation of diseases stems from the Athenian plague in Sophocles’s Theban Plays and Euripides’s Helen to Albert Camus’s Mediterranean cross into Algeria in La peste. If we shift the anticipated perspective from Europe into Latin America, from the conquest to the founding of nations, contagious and challenging diseases abound menacing democracies and dictatorships indistinctly. It seems that when disease becomes a threat, it turns into a political concern.

If one goal of research on AIDS is to trace its tradition, the second one, not necessarily a consequence of tradition, entails a prescription. At this point, the notion of AIDS as threat becomes fundamental. By 1982, the CDC had made public its definition of AIDS, claiming its active and required involvement in the study of the new syndrome. A year later, the House of Representatives criticized the CDC for its secretive control of research data and its delay in prioritizing AIDS. The external or self-imposed pressure on the CDC was headed towards sharpening AIDS as a clear and present danger. 1985 proved pivotal for this task: the CDC revised its AIDS definition by including a list of diseases that would indicate the presence of AIDS.It was also in 1985, that the World Health Organization (WHO) along with the CDC insisted on screening blood donations to prevent the circulation of the virus, not known as HIV at the time (Human Immunodeficiency Virus), but as the HTLV-III / LAV.[4] The year closed with a warning directed towards health care workers, possibilities of transmission from pregnant mothers to their children at birth, and the testing of applicants for the U.S. military service. The prescription was set in motion even when particular details had been ambiguous. The vague cloud that surrounded AIDS throughout the 1980s resulted in an enraged increase of cases and deaths, with one basic piece of confirmed fact, that is, the blood as means of transport for the virus.

The development of research as prescription emerges from the constant evolution of the threat, as health and medical institutions revise the increased number of cases. The meticulous study of blood as a key factor in the circulation of AIDS enabled a prescription that consisted of the deterrence in blood traffic: HIV-infected blood leads to HIV, which can turn into AIDS.[5] Even though AIDS itself and its constitution as a syndrome was a characterization in progress, the prescription was geared to contain networks of infection. In the AIDS equation, control of circulation equaled being in command over both the virus and the syndrome regardless of the unsatisfactory knowledge of any possible attempt at a reliable cure. The act of prescribing primarily arises from medicine and scientific research, but a powerful institution such as the CDC tries to mesh the medical prescription with historical tradition. The Morbidity and Mortality Weekly Report (MMWR) and the HIV / AIDS surveillance reports are examples of two CDC publications that oscillate between tradition and prescription, providing comprehensive numbers of AIDS lives and deaths and strongly proposing new sets of actions regarding the circulation of AIDS within the geographical restraint of the U.S. and its territorial spread.[6] Finally, if the prescription was concisely dealing with the circulation of AIDS within local communities, it depended on the tradition of AIDS for the numbers that would support such prescription. Simply put, the consistent growth of AIDS put tradition and prescription in an intense dialogue where numbers and newfound facts were supposed to pave the difficult road for reducing in the 1990s the AIDS mayhem of the previous decade.

1990, as the beginning of a new decade, was also the beginning of the end of the century. After struggling throughout nine years of incessant research, 1990 was a round number for hopes of decline, but it ceded to political desertion and widespread lack of information. In the spring of 2003, a close friend disclosed his HIV+ status to me. Chances were, he clearly pointed out, that I knew more people living with HIV, but that I was just distantly unaware of it. By the summer of 2004, a second friend gave me the same news. This time my reaction was significantly different and reminded me of the vast scope and indispensability to reconsider AIDS not only through the admirable work of NGOs such as UNAIDS or the Global Fund for AIDS and Malaria, but by insisting on its closeness in our own cities. The number of AIDS cases had steadily increased over the earlier years of the 1990s, but the appearance of protease inhibitors in 1995 and the configuration of the triple therapy cocktail in 1996 helped in the numeric decline of people passing from HIV+ to AIDS. Again, policy along with medical progress had achieved a program of decline, that is, a slowdown in circulation of AIDS while maintaining more people on the HIV+ side. The CDC released the following figures of total AIDS cases for 1990, 1995 and 2000, respectively:

-State of New York: 8,399 → 12,399 → 6,204