Tag Archives: combination therapy

“Cc…: CCC,” part 15

[Kendall Thomas, in continuation from “Cc…:  CCC, part 14]

My point here is that the landscape of “international AIDS” in the U.S. is, first and foremost, a psychic space whose field of action is the interiorized projection (Rorty’s “sentimental education”) that allows Americans to “feel” that they are part of the global culture of concern about the HIV pandemic.  Needless to say, the heightened sensitivity of the American public to the imagined pain of those who are living with (and dying from) AIDS in other parts of the world has yet to take the form of a collective public demand that the U.S. government increase its support for international treatment and prevention efforts.  (Tellingly, the Kaiser Foundation survey I mentioned earlier found that nearly half of those polled doubted that more money would result in any meaningful progress in the struggle against AIDS in Africa.)  If anything, the “international turn” in the U.S. domestic discourse on HIV/AIDS has served as an alibi for not addressing the intranational scandal of HIV infection and illness on our own shores.  Consider the following state of affairs.  The U.S. continues to record about 40,000 new infections each year.  Roughly one-half to two-thirds of the 800,000 to 900,000 Americans with HIV/AIDS do not receive regular medical care.  Up to one third of Americans do not know that they are infected.  African Americans, who represent 12% of the U.S. population, make up 47% of new AIDS cases.  African American women account for nearly two thirds of the new AIDS cases among women in the U.S.  Some 56% of the African Americans living with HIV are not on combination drug therapy.  They are 1.5 times more likely not to get preventive treatment for PCP.  Although they represent only 15% of the total U.S. population under the age of 13, African Americans make up 62% of the nation’s pediatric AIDS cases.  Half the new AIDS cases among young people between the ages of 13 and 19 are among African Americans.  AIDS continues to be the leading cause of death for African Americans between the ages of 25 and 44.  A recent study of young men who have sex with men suggests that in parts of the U.S., one in three gay African Americans are infected with HIV, a rate fully comparable to that of the hardest hit African countries.

Does this mean that AIDS analysis and activism in the U.S. should turn inward and cut itself off from the rest of the world?  Not at all.  I am not urging a narcissistic return to the isolationism that has characterized too much of the history of the U.S. response to HIV/AIDS.  I am saying that in engaging with the question of where to act now, we in the U.S. have a responsibility to continually think the global around the axis of the domestic.  We have a responsibility, too, to develop and defend a radical vision of solidarity across the mental borders that AIDS sentimentalism has drawn between the international pandemic and the intranational epidemic.  In my view, the measure of those of us who live in the U.S. must be taken by our willingness to fight AIDS as fiercely at home as we do abroad.

Kendall

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“the x factor” (“The West Wing,” part 3)

The more-than-questionable claim [that the “distribution of AIDS cocktails would be complicated by Africans’ inability to tell time”] was first made by a suitably “unnamed Treasury Department official” who told the New York Times in April, 2001 that Africans lack the “concept of time” required to adhere to the demanding protocols associated with combination therapies.  Shortly thereafter, in testimony before the international relations committee of the House of Representatives and again in an interview, both in June 2001, Andrew Natsios, head of the U.S. Agency for International Development, made a case against substantially increased funding for anti-retroviral drug treatment in Africa, where “People do not know what watches and clocks are.  They do not use Western means for telling time.  They use the sun” (Donnelly, A 14).

The comments, paraphrases rather than citations of The West Wing, were themselves cited as well as paraphrased in media coverage of the debate and again by activists protesting the failure of U.S. policy to meet the demands of a global crisis.  All of this unfolded as the world marked the twentieth anniversary of the pandemic’s official inception.  In an editorial entitled “Stinginess on AIDS,” the New York Times found fault with the Bush administration’s pledge in 2001 of a mere $200 million to the newly-instituted global fund for AIDS, tuberculosis and malaria (which had set a worldwide goal of ten billion dollars), suggesting that

the real problem is that AIDS overseas is a low priority for politicians.  Many believe, or find it convenient to echo, arguments that the money would be wasted.  People are still saying that Africans cannot take AIDS medicine because they do not own watches.

The newest AIDS medications, however, are simple to take, with two pills at sunup and two at sundown, and pilot programs show that African patients are perfectly able to take medicine on time when a steady supply is available.  [New York Times, August 19, 2001]

Donnelly’s report concluded on a comparable note:  “The comments by Mr. Natsios and the unnamed Treasury official assume that using the AIDS cocktails effectively requires taking a dozen pills or more at various times of the day.  But health experts say recent advances now allow people to take one or two pills daily, each containing several anti-AIDS drugs.  This regimen, now being used in several small African trials, means there is no need to tell time”  (Donnelly, A14).

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A sort of tomorrow (Stephen Andrews, part 7)

Biodegradation figures importantly, if obscurely, in the narrative of Lazarus, already alluded to in the line from Anne Carson’s poem cited as the epigraph of “A sort of tomorrow” [“And the second fact of his humanity began”], and again in Derrida’s evocation of the “intense effort of memory” located at the origin of drawing.  Perhaps inevitably, the story of Lazarus (along with other narratives of resurrection and rebirth) has been enlisted as an allegorical precursor by and for those, like Andrews himself, who have been granted a second chance, the new lease – or mortgage – on life afforded by the advent of combination antiretroviral therapies.  In de facto acknowledgement that no static portrait, however mediated, can render the contours of a prior narrative whose own diachrony comprises an unsettling anachrony – life after death, indeed life after four degrading days in the grave – Andrews turned to fresh materials and a reconfiguration of his signature media in his updating of the life and times of Lazarus.  The resulting work, “Untitled” (2000-2001), presents drawings and photocopy transfers of the artist’s own snapshots on vertical strips of transparent mylar that imitate the visual sequencing of analogue film.  In Andrews’ tripartite division of the cinematic succession of images into past, present and future, the narrative begins with a past that is subtitled “The End” (recalling, for readers of this blog, the parenthetical subtitle of Felix Gonzalez-Torres’ black-bordered paper stack  of 1990).  The work’s introductory sequence has recourse to the transcultural legend of the phoenix, a story of death and resurrection in which biodegradation is accelerated, aided and abetted in this instance by the artist’s application of a lighted match to a source photograph for earlier work:  an image of an anonymous crowd that figured significantly in his 1998 series hoi polloi.  The image yields, in a matter of several frames, to the destructive force of the flame, until the remaining ashes fade to black.

Subtitled “The First Part of the Second Half,” the central section opens with two mylar strips featuring sgraffito drawings in imitation of the optical soundtrack in analogue film, whose differential position vis-a-vis the image sequence it will accompany is calculated to compensate for the disparate times required for their respective routes through the projector.  The inscription of the optical soundtrack here recalls its precursor in the numerous installations of Facsimile‘s four parts since 1991:  Arrayed beneath the rows of portraits were unfurled player-piano scrolls stamped by the artist with the names of the men and women portrayed and featuring popular songs about love and loss, adumbrating a mute accompaniment.

In “Untitled,” the obscure sequence that marks the place of the optical soundtrack occludes the labour of mediation required to render it.  Andrews first recorded his own voice reading aloud the text of Anne Carson’s “TV Men:  Lazarus,” from the near-contemporaneous volume Men in the Off Hours, into a microphone attached to a computer.  The modulations of his voice were then translated as sine-wave printouts that the artist went on to replicate by hand in the ink-blackened margins of the transparent mylar film strips.  What resulted from a process that might be argued to take its cues from the poem itself (“I put tiny microphones all over the ground / to pick up / the magic / of the vermin in his ten fingers and I stand back to wait / for the miracle”) is modest in appearance (the inaudible soundtrack appears as illegible marginalia) and audacious in conception and ambition (Andrews is seeking, in effect, to draw poetry:  “mixed media,” indeed).

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A sort of tomorrow (Stephen Andrews, part 6)

In 1995, Andrews’ implication in the unfolding of the HIV/AIDS pandemic yielded a suite of drawings rendered in oil and pencil and exhibited under the title Album.  The works in this series cross a calendar with a commonplace book, manually reproducing snapshots, letters, sympathy notes and greeting-card images that amount to an inventory of dreams both fulfilled and betrayed, conducted at some distance from the youthful optimism often associated with the promise of the future.  The unframed parchment paper that serves as the drawings’ material support evokes skin, and hence the body that eventually encounters what Seneca, in “De brevitate vitae,” calls “death’s final constraint.”  In the following year, Andrews literalized the allusion to the body readable in Album‘s fragile parchment, resorting to pliant pig intestine as the receptive surface on which he silkscreened familiar, even clichéd images of meteorological phenomena in a series entitled The Weather.  The sunset, tornado, lightning-bolt and wind-tossed waves offer themselves to a cursory glance as givens.  In fact, their complexity resides not in what they represent, but in an interplay of image, medium and material whose effects are not only unpredictable, but incalculable.  These brief landscapes begin by skewing the terms of our received understanding of the figure-ground relationship, cunningly enlisting the body as the surface on which they unfold.  Nothing is more mundane than the weather; yet the artist’s treatment, both conceptually and materially, makes a fresh demand for reflection on what we are perhaps too prone to take for granted.

The diptych “Parenthesis (no gold),” for example, presents both ends of a rainbow, their symmetrical placement adumbrating the invisible arc whose antecedents are inextricably natural and cultural.  For it is virtually impossible to register such an image independently of its palimpsestic overlay, whether the reference point is Jesse Jackson’s coalition, the gay activist banner, or – perhaps most inevitably – The Wizard of Oz.  Thus the stakes of a potentially banal depiction are raised in a way that the work’s title itself confirms:  For what we encounter here is not so much the representation of a rainbow as the figuring of a dubious promise, in the fabled pot of gold.

Read in the context of the new generation of antiretroviral therapies that became selectively available in 1996, the promise figured here takes on a certain specificity.  If in Facsimile‘s commemorative portraits the promise in question was that of the survivor to the dead, emphatically pledging not to forget, “Parenthesis (no gold)” articulates a promise of a different order:  that of longer survival, and with it the prospect of yet more effective treatments, perhaps a vaccine and eventually a cure.  It staked its first claim to our attention at a time when combination therapies including protease inhibitors held out the possibility (predicated of course on access) of a future radically other than the one presumed to that point by the HIV-infected, including Andrews himself.  The Weather, then, administers to its viewers a Wordsworthian “shock of mild surprise,” for the putative landscapes become legible as portraits, and indeed self-portraits.

As Andrews notes in the artist’s statement that accompanied the exhibition of the series in New York in 1997, “New drugs have afforded a ray of hope.  Hope is a fantasy of a future that might continue to unfold before us.  Who can predict?”  The cliché enlisted here takes the specific form of a catachresis:  a “ray” of hope.  As it does so often (so often that we may fail to notice), the language of affect borrows from other realms – the weather, for example – to figure an experience that resists formulation and formalization.  This reliance on the resources of language is evident in another component of the same exhibition:  a series of cyanotypes of a handwritten alphabetical list of names (Arthur, Berta, Cesar….) by which the season’s hurricanes – the unpredictable tempests of 1996 – were anthropomorphized, their force linguistically domesticated.  Tacitly, then, another allusion to The Wizard of Oz emerges, especially if we recall that the film’s storied heroine also has a telling surname:  Gale.  Taken together, these works attest that the black-and-white of the past (which was all along multiple shades of grey) has been sucked up and dashed to pieces by a vortex that has transplanted the very horizon, depriving us of our bearings.  We find ourselves catapulted to unmapped terrain – if not over the rainbow (“no gold”), then at some other point beneath its arc of promise.  Like the artist’s earlier efforts, The Weather thus combines a certain skepticism about the durability of the work itself with an abiding optimism about what is to come.  If biodegradability dictates in advance that this corpus, with its fragile material support, is destined soon enough to return to dust, the force of its attestation, which is irreducible to sense, may prove more resistant to the ravages of time.

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Numbered Days (‘To the Friend Who Did Not Save My Life,’ part 9)

But the modality of the “perhaps” is also inscribed in the “something completely unexpected,” the hasard extraordinaire invoked in the first paragraph and repeatedly thereafter, that punctuates the fictional three months when Herve “had AIDS.”  It inhabits the possibility of a reprieve from his death sentence afforded by an experimental vaccine that, by an extraordinary chance, Herve’s friend Bill has a hand in developing.  On that fateful March 18, 1988 comes the news flash:  “[Bill] tells us right off the bat that in America they’ve just come up with an effective vaccine against AIDS, well not really a vaccine, since in principle a vaccine is preventive, so let’s call it a curative vaccine, obtained from the HIV virus and given to patients who are seropositive but don’t display any symptoms of the disease…to block the virus and keep it from beginning its destructive process….” [E 156; F 173].  In no time, the constative content of the unexpected bulletin is translated into the performativity of a promise, albeit one that is never issued as such, according to the linguistic laws that govern speech acts.  Bill’s unspoken promise is nothing less than a pledge to save the life of his dying friend by providing access to the experimental treatment (whose still unproven efficacy as a “curative vaccine” would come belatedly, after the fact of infection, since it is not properly preventive).  And the force of this implicit performative exceeds the limits that might be ascribed to the text’s self-declared genre, in keeping with the circumscription in some speech act theory of the gravity and consequence of fictional utterances.  For Bill’s tacit offer, sustained over a year and a half as Herve’s health suffers a precipitous decline, allegorizes, as part of a “work of fiction,” the very real promise of more effective treatment and, in the event, a cure for HIV/AIDS that has underwritten the history of the pandemic over nearly three decades.  It is the intervention of time into the configuration of the promise and its redemption that invites the perhaps, and with it the risk that time will run out before redemption can take place.

As we are now in a position to recognize, Herve’s terrible ambivalence as he enters the “new phase” inaugurated by Bill’s announcement prefigures the effect on many PLWAs of the advent of more promising treatment options, and specifically the new generation of combination therapies including protease inhibitors that became selectively available in and after 1996, transplanting death’s near horizon to a newly uncertain distance.

…I was afraid this new pact with fate might upset the slow advance – which was rather soothing actually – of inevitable death…. For though it was certainly an inexorable illness, it wasn’t immediately catastrophic, it was an illness in stages, a very long flight of steps that led assuredly to death, but whose every step represented a unique apprenticeship.  It was a disease that gave death time to live and its victims time to die, time to discover time, and in the end to discover life [c’etait une maladie qui donnait le temps de mourir, et qui donnait a la mort le temps de vivre, le temps de decouvrir le temps et de decouvrir enfin la vie]….  And unhappiness, once you were completely sunk in it, was a lot more livable than the presentiment of unhappiness, a lot less cruel, in fact, than one would have thought.  If life was nothing but the presentiment of death and the constant torture of wondering when the axe would fall, then AIDS, by setting an official limit to our life span – six years of seropositivity, plus two years with AZT in the best of cases, or a few months without it – made us men who were fully conscious of our lives, and freed us from our ignorance.  If Bill were to file an appeal against my death sentence with his vaccine, he’d plunge me back into my former state of ignorance.  [E 164-5; F 181-2]

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“Untitled” (I was here) (Felix Gonzalez-Torres, part 6)

The work presented in the gallery’s second room under the title “Travel #2” figures the waiting with that precedes the belated waiting for that Derrida calls the “contretemps of mourning” [Aporias, 66].  Rendered in graphite and gouache on paper, each of thirteen identical grids bears a diagonal red line tracing an unwavering descent from the upper left-hand corner to the lower right.  The series’ title, “Untitled” (Bloodwork – Steady Decline), refers the charts to an ominous tendency as monitored by doctor, patient, and anxious loved one, thus remarking, in Spector’s formulation, “the reality of AIDS’ destructive force in the most graphic of terms.  The repetitive nature of the work, whether it manifests the fate of one person [“day by day” for thirteen days – Ed.] or of thirteen, underscores the terminal character of this illness, another journey through time” [25].

The bloodwork graphs’ precise geometry is made possible and rendered legible through the abstraction of the body as well as of time – indeed, of the body in time, over time, hence ultimately of mortality.  Such abstraction, aspects of which remain indispensable for purposes of analysis and diagnosis, of course occurs before and outside the practice of contemporary western bio-science, which, however, takes it to new levels of sophistication.  Spector’s reading of “Untitled” (Bloodwork – Steady Decline) situates the series in the context of a regime in which the diseased body is routinely “defined, diagrammed, and controlled by a biomedical authority whose value system adheres to deeply entrenched cultural and historical precepts.  This ‘authority’ treats the AIDS patient – like others who suffer from life-threatening illnesses – as an abstraction, a compilation of symptoms and statistics in which there is no place, or need, for an account of the human side of infirmity.  Within the scopic regime of the medical system, the body is studied, treated, and hopefully cured, but this body will inevitably remain an object.  Biomedical authority demands a disembodied subject…in order to function at optimum efficiency.  The doctor must abstract the patient in order properly to diagnose physical pathology” [166-7].

But the Person Living With AIDS is and is not “like others who suffer from life-threatening illnesses.”  What authorizes the viewer to refer Gonzalez-Torres’ bloodwork graphs and the “steady decline” they chart specifically to an immune system under assault by HIV is the precision with which CD4 and T-cell counts, at the time the primary medical indicators of the virus’s effects, may be measured, and translated as clinical guidelines, social policy, and psychological conviction based on a number – 200 – that defined the point of diagnosis of the onset of AIDS.  (Subsequently, the indicators of HIV would come to include new, more accurate measures, among them “total viral load”; by this latter gauge, a “steady decline” would be a welcome development.)

While the work’s portentous descending lines do not correspond precisely to a declining T-cell count, they effectively figure the dire psychological, social and political realities of an era characterized by increasingly accurate diagnosis and reliable monitoring, but capable only of a promise of more effective treatments not yet made good.  In other words, the graphs’ rigid geometry situates the work both historically and geographically, recalling its origins in a time when the first generation of AZT treatments was becoming more widely available in parts of North America and Europe, while other potential medications remained in various stages of clinical trial.  The sharp red diagonals of “Untitled” (Bloodwork – Steady Decline) remark its provenance as an age preceding the introduction of combination therapies including protease inhibitors, which promised the possibility of outcomes – which is to say, of futures – that might be mapped otherwise.  Moreover, they attest that even those with access to the most advanced medical care on the planet were not sufficiently privileged to reverse the downward tendency, and concomitantly, that faith in the inevitability of bio-medical “progress” was likewise suffering a precipitous decline.

While the polemical force of “Untitled” (Bloodwork – Steady Decline) issues from a particular time and place, its reach surpasses its circumstances of origin.  In the absence of effective treatments in the 1980s and early 1990s, the vast multiplicity of identities and experiences of PLWAs could legitimately be abstracted in the form of a line that traced a shared “fate.”  With the subsequent advent of therapies that promised longer, higher-quality survival, the graphs redirect their force and acquire a new, arguably prophetic dimension.  Read a decade and more following its creation and initial exhibition, in a radically different clinical and political context, “Untitled” (Bloodwork – Steady Decline) figures not only the potential aftermath of HIV diagnosis, but also the matter of access, critically remarking the social, economic and geopolitical inequities that brutally divide the few who have it from the many who, to date, still lack it.  The series thus attests to the specificity of its origins, and then recasts that specificity in light of events, making the question of “whether it manifests the fate of one person or of thirteen” matter in a different way.

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