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1. Models of Meaning and Ways of Knowing
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15 CHAPTER 1 Models of Meaning and Ways of Knowing HIV, the human immunodeficiency virus, is a pathogen with multiple magnifications . In microscopic imagery, HIV is a patterned geometry of interlacing circles and diamonds. Carried in the cells of semen, vaginal mucosa, blood, and milk, the virus attaches to DNA helixes and assails T-cells. HIV colonizes the most basic dimensions of human experience, exploiting our fertility and sexuality while gaining velocity through social structures and processes that map multiple routes of transmission. Far greater than a microorganism, HIV looms large in the social body as it is configured by discourses of sexuality, morality, risk, fear, and death. It is uncanny how a virus with no immediately visible manifestations has the capacity to make visible the ways people know themselves and to alter that knowing.1 Biomedical science has made possible an understanding of HIV pathology, how the virus damages the human immune system to the extent that infected bodies eventually die from the complications of AIDS, the acquired immune deficiency syndrome. But such knowledge has not been able to prevent the persistent spread of the virus throughout the world. Since the virus was first isolated and named in the early 1980s, the HIV epidemic gained rapid prominence as the most serious public health challenge in the contemporary world, expanding to all parts of the globe and reaching dramatic prevalence in many countries, with an estimated total of sixty million people having been infected by the virus and nearly twenty-five million deaths from HIV-related causes (UNAIDS 2010; UNAIDS and WHO 2009). This pandemic of staggering proportions has not occurred as a single global event. Rather, HIV infection proliferates into multiple epidemics within particular contexts of space and time (Mane and Aggleton 2001:23). Even as there is not one epidemic, there is not simply one virus. More accurately, complex viral strains have evolved in interaction with different biological, social, and structural environments (Hutchinson 2003; Singer and Clair 2003). The manifestations of HIV pathology are not revealed under a microscopic lens but in the way “social forces and processes come to be embodied as biological events” (Farmer 1999:14). Concurrent with the relentless spread of the viral infection over the last three decades are multiple ways of comprehending HIV and AIDS as different knowledge and belief systems converge and interact to coproduce meaning. These conjunctions reveal how the global phenomenon is “simultaneously an epidemic of a transmissible lethal disease and an epidemic of meanings or signification” (Treichler 1999:11). Discourses of sexuality, risk, and disease influence the interpretive process of making sense of HIV and AIDS and gain currency through 16 ISLANDS OF LOVE, ISLANDS OF RISK the public health policies and interventions that are put into place to respond to epidemics, with direct consequences for how HIV takes shape within specific contexts . Based persistently on biomedical models of disease, HIV programs infuse the language of prevention with predominantly Western assumptions and moralities about human sexuality and gender (Brummelhuis and Herdt, eds. 1995; Herdt and Lindenbaum, eds. 1992; Patton 2002; Pigg 2001b). The power of language to name and classify epidemics based on preconceived notions, and to construct categories of meaning for prescriptive responses, “is not merely symbolic, but has material outcomes that impinge on people’s lives” (Seidel and Vidal 1997:59). The global migration of this discursive epidemiology (Jolly and Manderson 1997:19) potentially affects people’s capacity to articulate local knowledge and form congruent links with new information to enable prevention within particular settings (see Adams and Pigg, eds. 2005:19–20). Biomedicine, itself a cultural construction based on deeply entrenched social and historical codes (Treichler 1999:18), inextricably influences how HIV is understood and represented. Focused on the “neutral terrain of the physical body” (Lock 1988:7), the biomedical paradigm of disease causation is historically derived from Western epistemic notions about the individual as an autonomous and bounded entity of bodily elements and functions, and about sexual behavior as a naturalized human drive (see Gordon 1988; Parker 1995; and Scheper-Hughes and Lock 1987). In conjunction with this paradigm, epidemiological surveillance is used to monitor and predict HIV transmission patterns and trends by conceptually isolating sexual behavior at the individual level as an independent variable. Such methodological individualism reduces sexual acts to units of measure, disembodied from cultural meanings and lived experience (Pirkle 2009; see also Clatts 1995; Kippax and Crawford 1993; Parker 2001). Reductionism disallows that “physically identical sexual acts may have varying social...