How to Have Theory in an Epidemic: Cultural Chronicles of AIDS (review)

Paula Treichler. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS.Durham, N.C.: Duke University Press, 1999. 477 pp. Paperback, $23.95.

This ambitious book expands on Paula Treichler's groundbreaking 1988 essay "AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification." In that essay, reprinted here as the book's first chapter, Treichler argues that "the very nature of AIDS is constructed through language and in particular through the discourses of medicine and science" (p. 11). The epidemic has generated "a chaotic assemblage of understandings of AIDS," "an epidemic of . . . signification." Insisting that our understandings of what AIDS and HIV infection mean be regarded as "culturally constructed," Treichler proposes that we pay careful attention to how language creates rather than simply reflects the meanings of illness. Far from being objective, biomedical definitions of AIDS are based "on prior social constructions routinely produced within the discourses of biomedical science" (p. 15). Familiar "semantic oppositions" derived from existing social constructions—oppositions such as those between "self and not-self," "homosexual and the 'general population'," "addiction and abstention," "normal and abnormal," "prostitute and paragon," "First World and Third World"—pervasively shape scientific as well as popular concepts of the material reality of HIV infection and AIDS (p. 35). In the opening essay Treichler draws particular attention to the intransigent mythic construction of the gay male body as the "not-self," a binary division that attempts to contain or "barricade" the pathogenic potency associated with homosexuality in order symbolically to protect the self, and by extension, the social body, from contamination (pp. 35-37). But Treichler's argument reaches beyond this specific insight to contend that, especially in the context of HIV infection and AIDS, medicine and science, along with the corresponding popular discourses of illness and disease, urgently need to be analyzed along cultural lines in the interests of working against such dichotomies and advocating for social justice.

The first four chapters of How to Have Theory in an Epidemic address the AIDS epidemic with respect to representation theories, gender, the Third World, and television narratives in the 1980s; then, after a chapter clarifying what is at stake in looking at the concepts of AIDS and HIV infection as "cultural constructions of reality," the remaining four chapters take on the same issues as they evolved in the 1990s—hence the appropriateness of the subtitle's description of the collected essays as "chronicles." In these several chapters, Treichler undertakes to analyze from a variety of angles two problems in particular: 1) how scientific theories of causality, public health information, sex education, and debates around treatment are permeated by preexisting discursive dichotomies that have damaging consequences and need to be resisted; and 2) how medical, epidemiological, and media authorities tend to obscure the importance of the cultural in determining the meanings of the epidemic, and are thus complicit in perpetuating "the powerful cultural narratives surrounding AIDS" (p. 37). How to Have Theory in an Epidemic is characterized by a tone of urgent ethical commitment to critical cultural analysis of the epidemic as a politically necessary and consequential endeavor. Although she acknowledges that there have been some significant positive changes in recent years in how AIDS and HIV infection are conceptualized and treated, Treichler demonstrates the persistence in the present of the same myths, based in binaristic constructions of social reality, that have been "articulated" (or linked) to the epidemic since it first became a subject of scientific and lay interpretation in the early 1980s: the discourse of HIV infection and AIDS is still invested, for example, in creating a category of innocent victims, and still overwhelmingly wants to see the disease as occurring elsewhere, outside North America and Europe (p. 5). The book's structure—a looping back to revisit the same sites of contestation a decade further along—reinforces a sense of continuity, and thus challenges the premature declaration in the 1990s of...