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

Paula A. Treichler. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham, N.C.: Duke University Press, 1999. xi + 477 pp. Ill. $22.95 (cloth), $64.95 (paperbound).

Paula Treichler has gathered together a number of her essays, many published over the last two decades, and reshaped and rewritten them so that they fit together into a generally coherent narrative that crisscrosses territories traditionally belonging to the history of science and medicine, cultural theory, philosophy, politics, and linguistics. She argues, forcefully and repeatedly, that AIDS is an "epidemic of signification" (p. 1): as much a cultural and linguistic event as a biological and biomedical one. Close attention to the language and cultural meanings of the epidemic, she asserts, is necessary in order properly to understand the issues of policy and practice. The book makes an extended case for "theory" (generally interpreted as social constructionism) as an essential basis for "practice" (generally interpreted as social and political activism). One implication of the argument is that intellectuals in the social and political sciences who struggle to understand and interpret the flood of official and popular literature on AIDS are indeed doing something useful.

The organization of the book is roughly chronological; each chapter explores some specific time period around one of a number of central themes: the construction of AIDS as a "gay disease," the peculiar ways in which epidemiologists' risk categories have masked the epidemic's impact on women, the proliferation of stereotypes in discussions of AIDS in African nations, the media's efforts to find newsworthy yet minimally controversial ways of presenting the epidemic, the accomplishments of activists in influencing health policy. Some chapters seem more powerful and focused than others, but in every case Treichler displays an engaged scholarship marked by awareness of the nuances of language, a special attentiveness to the politics of race, sexuality, and gender, a voluminous reading of sources, and an impressive and appealing intellectual intensity.

In constructing her account of the multiple meanings of AIDS, Treichler draws on and cites scientific and popular magazines, international conferences, comics, videos, pamphlets, posters, television news and dramas, soap operas, plays, health education materials, and the speeches of AIDS activists--among other primary sources. Her dense, weaving, wandering narrative is rich and textured, studded with brilliant insights and surprising details. These sophisticated essays display her remarkable erudition, cultural sensitivity, and passionate engagement in the world of AIDS politics and cultural analysis.

Treichler's work is well known and readers are likely to have already-formed individual responses to her inimitable style: I personally find the experience of attempting to follow the dense spirals of her arguments alternately exhilarating and irritating. The text circles around on itself, multilayered, meandering, complicating and then clarifying, clarifying and then complicating, drawing on sources that even reasonably well educated persons who pay attention to the evolving questions and quarrels of the epidemic may find obscure. Treichler's sentences are intricate, her bibliography exhaustive, her footnotes a succession of polished little cultural essays. References, bibliography, and index together constitute about 150 pages of tiny type in this weighty and illuminating paperback.

Linear thinkers will no doubt have a difficult time following the twists and turns of Treichler's narrative. Nonetheless, this book is one of the most important and rewarding works published on the history of AIDS. It is well worth the effort to journey through the recent history of the epidemic in the company of such a talented and observant cultural commentator.

Elizabeth Fee
National Library of Medicine

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