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“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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“Cc…: CCC,” part 14

I’ve been thinking about the original question Deb posed about how we might read and respond to the “concluding imperative” of Piot’s preface to the UNAIDS report:  Now act!”  Ensuing discussions have raised other questions that are nested in Piot’s injunction (I’m thinking in particular of Gregg’s intervention, which, as Deb notes, takes up the issues of “What,” “Who,” and “When”).  I keep returning, though, to a question (or rather a set of questions) that, to my mind, is at least as urgent as the questions of agency and temporality on which Piot’s imperative invites reflection.  That question is simply this:  “Where?”  Where is the space or field or geography of the action(s) “we” are enjoined to take?

The document in which Piot’s injunction appears is called the Report on the global HIV/AIDS pandemic.  The nominative anachronism of this title is worth remarking, since it takes us back to an earlier time in the history of the naming practices that have enveloped the life of the virus (which, as Cindy Patton has recently reminded us, includes the pre-history before “The Name” of the virus itself).  We all remember the moment in the 1990s when we began to speak of the “HIV/AIDS epidemic” as the “pandemic,” in order to register the emerging consciousness that this was a cluster of epidemics that covered, or would soon come to cover, the entire world.  In the U.S. context, this new nomination has over time had the important and salutary effect of opening the national consciousness about HIV/AIDS.  My sense is that U.S. based global AIDS activists have been able to use the language of an international HIV pandemic to expand the domestic discursive space accorded to HIV.  The recognition that “we are not the world” has enlarged the national conversation about AIDS on issues from U.S. government spending abroad to the drug pricing policies of the transnational pharmaceutical corporations.

This shift in the U.S. public imagination has increasingly made it impossible not to think about HIV/AIDS in international terms.  Surely that is a good thing.  However, it would probably be a mistake to read too much into the broadened public perception of the AIDS crisis in the U.S.  For example, a recent survey by the Kaiser Family Foundation found that a majority of Americans are able to correctly identify Africa as the region of the world with the largest population of people living with HIV/AIDS.  However, only a minority of those surveyed believed that the U.S. government should be more involved than it has been in responding to AIDS in Africa.  To paraphrase Richard Rorty, the “globalization” of the U.S. public’s perception of AIDS has meant little more than an increased interest in “hearing sad and sentimental stories.”  During the first two decades, the “face” of AIDS in the American mind was the headshot of the “ravaged” Rock Hudson or the “courageous” Ryan White; by the third, that “face” belongs to the “frail” South African Nkosi Johnson.  In many ways, the image of the “international AIDS pandemic” in the collective U.S. consciousness serves  much the same purpose as that of “international human rights”:  it is a tool (to borrow again from Rorty) for “manipulating sentiments, [for] sentimental education.”

[Kendall Thomas’ e-mail continues in the following post]

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“Cc…: CCC,” part 11

[John Greyson, in continuation]

In late July [2002], Zackie was scheduled as a plenary speaker at the Barcelona [International AIDS] conference.  (This is very much Jack, TAC and Zackie’s story; I’m only contributing it now because they’re upstairs sleeping, and I’m sure they’ll throw in their corrections at all my errors and misinterpretations!)  Because he was too sick to attend, a video was shot and edited by Jack and his Beat It! crew a couple of nights before.  The tape was couriered to the conference, where it was played on huge monitors to the thousand-odd delegates.

International news teams shot clips off the screen; some broadcasters even carried it live.  The world thus saw Zackie, explaining how HIV and the epidemic had prevented him from addressing the conference in person, live.  It was an unforgettable intervention, rife with urgency:  the real toll of the epidemic, illuminated by technology, portrayed by a voice nearly silenced by AIDS, able to speak only on a screen, thousands of miles and several days distant from the real event.

Because of this mediated moment, the Archbishop of Cape Town, Njongonkhulu Ndungane, visited Zackie the next week, to convey concern, best wishes and blessings.  Coincidentally, a TV crew was in attendance.  The blessing thus went out live to the nation, a broadcast that was seen by millions, and also by Mandela.  Who picked up the phone and invited himself over for tea.  Which led to the tea party, and discussions of how Mandela’s AIDS foundation and TAC could work together to set up treatment clinics, despite governmental resistance.  Which of course was carried by every TV station and newspaper in the country, and, to a much lesser degree, around the world.  (I myself participated in a bit of real-time posturing, boasting to friends how I was the lucky recipient of the Zackie/Nelson pic, courtesy of Jack’s email J-peg, an hour after the tea party, and hours before the mass media had circulated any images).

In this way, the necessities of illness triggered a chain of reactions, all mediated by miles and technologies and urgency, mediated most of all by the poignancies of time, which resulted in a tangible step forward in the war against AIDS.

In their press release, TAC also called for the meaningful inclusion of PLWAs at every level of decision-making in Africa’s pandemic.  For artists, there has been since the early eighties a related implicit corollary (one that too many institutions and power-brokers have thoughtlessly ignored):  to give special priority to the words and pictures created by PLWAs.  Earlier, we mentioned Andrew Sullivan’s notorious and nonsensical contention that for North American artists, AIDS is now passe.  As much as there is a need for northern artists to continue to vigourously interrogate AIDS and all its meanings, it is equally important that we work right now to hear the voices of African artists, addressing AIDS through myriad paradigms and aesthetic strategies.  The voices are emphatically there – why does the north not hear them more, encourage them more, assist them more?  Why was there so little AIDS work in this year’s Documenta, especially when so much of the show revolved around questions of culture and activism in a global context?  Why aren’t there more commissions, exchanges, exibitions, grants, specifically for African artists addressing HIV/AIDS?  What have we done, or more likely, not done?

Following this, how can northern artists contribute to a meaningful dialogue, without falling back on patronizing missionary tropes?  We all have relationships (so often fraught!) with various institutions, schools, arts centres, granting bodies.  How can they be mobilized?  Art exhibitions:  can these contribute to a truly two-way exchange of aesthetics and ideas?  Video residencies:  what makes these viable and effective?  Should video artists be brought to the Banff Centres and Charles Streets, or should the priority be given to getting more state-of-the-art tech and training to African artists?  Why wasn’t the massive African AIDS series Steps for the Future (whatever limitations it might have), which included episodes by/about Jack, TAC and Zackie, not shown in its entirety in North America?  How can art supplies be collected, shipped and distributed to PLWA artists most effectively?  And so on:  as many questions as there are ideas, but equally, as many things to act on.  Now.

XXX  John

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“Cc…: CCC,” part 9

Hi guys.

Prompted by John’s allusion to the intensity of activity in Cape Town last weekend, I just logged on to TAC’s website [ http://www.tac.org.za ] and read the following (excerpted, again for the record).

Deborah

@@@@@

25 August 2002

Dear All:

Over 70 delegates from 21 African countries met in Cape Town from 22 to 24 August to begin developing a Pan-African HIV/AIDS treatment access movement.  The following declaration is an outcome of that meeting.  Please distribute far and wide.

PAN-AFRICAN HIV/AIDS TREATMENT ACCESS MOVEMENT

DECLARATION OF ACTION

We are angry.  Our people are dying.

Without treatment, the 28 million people living with HIV/AIDS (PLWAs) on our continent today will die predictable and avoidable deaths over the next decade.  More than 2 million have died of HIV/AIDS in Africa just this year.  This constitutes a crime against humanity.  Governments, multilateral institutions, the private sector, and civil society must intervene without delay to prevent a holocaust against the poor.  We must ensure access to antiretroviral (ARV) treatment as part of a comprehensive continuum of care for all people with HIV who need it.  In this regard, at a minimum, we call for the immediate implementation of the World Health Organization goal to ensure antiretroviral (ARV) treatment for at least three million people in the developing world by 2005.  Together with our international allies, we will hold governments, international agencies, donors and the private sector accountable to meet this target.

We represent activists and organisations from 21 African countries that met in Cape Town, South Africa, 22-24 August 2002, and launched a Pan-African HIV/AIDS Treatment Access Movement dedicated to mobilising our communities and our continent to ensure access to HIV/AIDS treatment for all people who need it.

We have heard reports on the state of HIV/AIDS treatment and prevention interventions throughout the continent.  Remarkable achievements have been registered in every region resulting in some countries significantly reducing new infections and improving care for individuals, families and communities affected by HIV and AIDS.  However, there was a consensus that current efforts are insufficient.  The AIDS epidemic has exposed many of the problems facing Africa, including poverty, socio-economic and gender inequality, inadequate health-care infrastructures and poor governance.  We insist that access to ARV therapy is not only an ethical imperative, but will also strengthen prevention efforts, increase uptake of voluntary counselling and testing, reduce the incidence of opportunistic infections, and reduce the burden of HIV/AIDS – including the number of orphans – on families, communities and economies.

The recognition of the human rights to life, dignity, equality, freedom and equal access to public goods including health care are the fundamental principles of a successful response to the epidemic.  In this regard, we reaffirm the Universal Declaration of Human Rights and the African Charter on Human and Peoples’ Rights.  Furthermore, we recognize that the rights of women, children and youth are particularly vulnerable in Africa.  Treatment and prevention strategies for HIV/AIDS must consider their particular needs.  Critically, the rights of people with HIV/AIDS (PLWAs) must be protected, including equal access to social services and to medical insurance plans.  Discrimination and stigmatisation threaten our dignity and hamper efforts to address the epidemic.  Our experience as African PLWAs has been that of token involvement, not meaningful participation, in decision-making processes.  It is only through active involvement of PLWAs in all policy and implementation decisions related to HIV/AIDS that we will achieve our goals.

Alleviating the effects of the AIDS epidemic will require political leadership and greater accountability from national governments, international organisations, the private sector, especially the pharmaceutical industry, and wealthy countries, particularly the United States and European Union.  We are faced with enormous barriers:  national governments do not prioritise HIV/AIDS treatment; donor countries refuse to fulfill commitments to mobilise necessary resources; pharmaceutical companies deny access to essential medicines and diagnostics by charging exorbitant prices; structural adjustment programmes, driven by the World Bank and the International Monetary Fund, destroy public health-care systems; and debt to rich countries hampers financing of vital social services, including health care.  Community mobilisation and civil society action are essential for forcing action and ensuring greater accountability from all these institutions.

Health is a prerequisite for sustainable development.  The AIDS epidemic presents an immense challenge to health care systems in Africa.  Sustainable economic development can only be possible through the implementation of sound social security policies that target the poor and include HIV/AIDS treatment and prevention programmes….

We know that this is an immense challenge.  Millions of lives are at stake.  We must succeed.

 

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“Cc…: CCC,” part 2

Dear Gregg, John, Jack and Kendall,

I hope this message finds each of you well, wherever and whenever it reaches you.  I hope, too, that it will serve to initiate an e-mail exchange about the virus and the pandemic that will appear at the conclusion of my recently completed The Brevity of Life:  What AIDS Makes Legible.  The manuscript, parts of which some of you may already have had a chance to read, and others surely not as yet, includes as the volume’s proposed frontispiece a photograph of Felix Gonzalez-Torres’ “Untitled” (Perfect Lovers), dated 1987-1990, an installation that features two apparently identical clocks hung side by side, barely touching one another, and synchronized such that both read “2:43:58” (or “14:43:58”).

 

My hope was that Gonzalez-Torres’ work, photographed in situ, would resonate with a citation I was considering as an epigraph for the book:  Peter Piot, Executive Director of the Joint United Nations Program on HIV/AIDS (UNAIDS), writing in his “Foreword” to the Encyclopedia of AIDS that “the worldwide AIDS epidemic has become a permanent challenge to human integrity and solidarity.  Given the scale of suffering, given the proven effectiveness of several approaches, and given the prospect of furthering other human goals through the fight against AIDS, an expanded response makes ethical and practical sense.  Instead of letting AIDS turn back the clock, let us use our response to the epidemic to turn humanity’s clock ahead.”

Now John, who was kind enough to take the time recently to read the manuscript and to respond with characteristic generosity and insight, wondered in an e-mail to me whether Piot’s language in this instance set a tone in keeping with the chapters that follow.  I take the liberty of citing from John’s message:  “Peter Piot [citation]:  for me it set the wrong tone, starting your book like that – I’m sure I’m carrying around too much baggage vis a vis UNAIDS and that very mainstream don’t really rock the boat agenda…. Couldn’t you start with Seneca – maybe juxtaposed with Ben and his phone card?” **

John’s thoughtful and wide-ranging response reached me on July 15, as I was reading the Report on the global epidemic  just released by UNAIDS.  Writing in the report’s preface, Piot notes that “In 2001, the world marked 20 years of AIDS.  It was an occasion to lament the fact that the epidemic has turned out to be far worse than predicted, saying ‘if only we knew then what we know now.’  But we do know now.  We know that the epidemic is still in its early stages, that effective responses are possible but only when they are politically backed and full-scale, and that unless more is done today and tomorrow, the epidemic will continue to grow….  The time has come to put all the pieces together.  Plans have been made.  Needs are clear.  Solutions are available.  Now act!”

With your permission, I would like to take Piot’s language in the preface to the UNAIDS report as a provisional point of departure for our exchange.  In what context or contexts do you place this brief exercise in historiography on Piot’s part?  More specifically, perhaps, how do you read and respond to its concluding imperative?

With my thanks in advance, and warm regards,

Deborah

** John here alludes to one of the epigraphs to the prologue, which cites Ben, a long-time seropositive man who tells the New York Times that he feels like someone with a phone card who knows that at some point he will hear the inevitable “you have two minutes left.”

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“Cc…: CCC,” part 1

As I wind down the project of making most of the manuscript of The Brevity of Life public in the form of a series of blog posts, in preparation for some research and writing in a different vein, I feel compelled to add to the chapters already reproduced a final postscript of sorts, which is arguably the most valuable part of the book in its historiographic function.  It takes the form of an e-mail exchange that took place between July and September of 2002, initiated by me and made possible by Gregg Bordowitz, John Greyson, Jack Lewis and Kendall Thomas, who generously agreed to take part.  I will record it in this and the next several posts, under the title “Cc…:  CCC.”  The “Cc” is self-evidently grounded in the structure and operation of a group e-mail exchange.  “CCC” is an acronym for “complex continuing care,” the parlance commonly used in North American tertiary care centers to designate a relative level of medical intervention (relative to “acute care,” for example, or “sub-acute care”).  The process of designating such levels of care involves “RIW,” short for “relative intensity weighting,” and is intimately associated with resource allocation.  In the Canadian public health care system, level-of-care designations derive from an assessment of the clinical and medical supports required to treat a particular “case mix.”

The archive has always been a pledge, and like every pledge, a token of the future.    

 Jacques Derrida, Archive Fever:  A Freudian Impression, 1995, 18

Chiefly on the basis of the five exemplary instances they analyze [Felix Gonzalez-Torres, Derek Jarman, Herve Guibert, Aaron Shurin and Stephen Andrews], the foregoing posts make the case that in order to read what HIV/AIDS makes legible we must first of all and among other things recognize the differential temporalities inscribed in the virus and the epidemic-turned-pandemic, and likewise in their artifactual remains.  The wager that underwrites The Brevity of Life is that only a labour of reading attentive to the multiple specific structures and operations of time enables a responsible reconsideration, now and henceforth, of the grave challenges with which the global crisis persists in confronting us.

In making public the exchange transcribed in the following posts, the participants ask the reader to take account of the complex temporalities that traverse it.  Derek Jarman’s reflections on the difficulty of translating HIV/AIDS, whether in autobiographical or more broadly historiographical terms, onto film may help make legible here a fundamental incommensurability between the multiple temporalities of a pandemic that continues to outstrip our best efforts to make sense of what is occurring today (and what it may portend for the future) and a mode of production – in this case, electronic mail – whose impact over time remains, for us, an open question.  As Derrida observes in Archive Fever,

Electronic mail today, even more than the fax, is on the way to transforming the entire public and private space of humanity, and first of all the limit between the private, the secret (private or public), and the public or the phenomenal.  It is not only a technique, in the ordinary and limited sense of the term:  at an unprecedented rhythm, in quasi-instantaneous fashion, this instrumental possibility of production, of printing, of conservation, and of destruction of the archive must inevitably be accompanied by juridical and thus political transformations.  [17]

With much at stake – psychically, socially, politically – the participants in this exchange accepted the risks entailed in the terms of a tacit contract struck first of all among themselves, but in effect with their eventual readers as well.  The willingness of Gregg Bordowitz, John Greyson, Jack Lewis and Kendall Thomas to take part, in the knowledge that these virtual communications circulated initially among a handful of trusted friends and comrades in the spirit of a conversation would be transcribed and subsequently consigned to the public sphere bespeaks an extraordinary generosity, a readiness to assume the attendant burdens (among them, perhaps,a sense of vulnerability, an unaccustomed hesitancy, an unanticipated resistance to the format) for the sake of the matter at hand.

“I wonder if any of this will be remembered; probably not.”  Jarman’s musing in the journal entry that serves as the epigraph to “Archive of Devastation (Derek Jarman’s Blue, Part 1), brought to bear on e-mail communications, might translate as a kind of optimism according to which we typically assume that the electronic script on which we are increasingly reliant is invariably ephemeral, short-lived, impermanent, never fully realized – indeed, that it is bound to disappear, sooner rather than later, that it is in the process of disappearing even as we hit “Send.”  Our utilization of a postal technology that seems to court oblivion opens up a certain freedom to muse, to hypothesize, to risk the kinds of formulations that may or may not stand the test of time, and do not pretend otherwise.

The participants can only hope, then, that readers of their exchange will respect the terms of the contract on which it rests, however uneasily:  that the latter will assume responsibility for discerning and seeking to negotiate the variable temporalities and rhythms involved, and honour the spirit in which this joint venture was undertaken.

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“the x factor” (“The West Wing,” part 4)

In both instances [the New York Times editorial and the Boston Globe report], a journalistic appeal to progress in the form of late-breaking bio-medical developments (“The newest AIDS medications,” “recent advances”) operates in effect to overlook, if not to excuse, the unmistakable racism inscribed in language that may or may not simple imitate TV.  (In the scene from “In this White House,” the audible irony in Toby’s response to the question “What’s the problem?” – “They don’t own wristwatches.  They can’t tell time” – has the thinly-veiled racism of the fictional pharmaceutical executives as its target.)  The promising advances signaled by the new treatment regimens (which effectively date this episode of The West Wing, relegating it with dispatch to the cultural archive) may indeed reduce the burden on those who have access to these therapies, whatever their circumstances.  And what such “progress” may mean (and portend) for the millions presently living with HIV/AIDS is difficult to overestimate.  What it emphatically does not mean (as this series of posts attempts to make plain) is that “there is no need to tell time.”

On the contrary, the need – the unavoidable imperative – to tell time has perhaps never been more urgent.  Part and parcel of the work of correlating the order of events and the order of language in the face of the interminability of AIDS, telling time is itself at least a twofold task, as the archive of the pandemic instructs us.

1.  It is first of all a matter of accounting for the multiple specific temporalities inscribed in the virus, in the epidemic-turned-pandemic and in its artifactual remains to date, among which would number not only the episode of The West Wing but also the journalistic reports that speculated on its impact on the subsequent policy debate.  In the latter cases, for example, we are obligated to recognize the time that divides the scripting of “In this White House” from its eventual broadcast, as well as the interval between the episode’s airing and the adoption of its language by American policymakers, which is partly co-extensive with the time of the “recent advances” in treatment regimens cited with the effect of side-stepping the racist overtones of the bureaucrats’ arguments.  Far more importantly, these documents from the archive of the pandemic raise the matter of the (much longer) time between drug development in the west and access to “the newest AIDS medications” in sub-Saharan Africa, and with it that of the (still longer) time between the date assigned to the official inception of HIV/AIDS in North America and any consequential attention to its global impact.  Ultimately, they summon us to reflect on the variable temporalities of what we call human lifetime and on the diversity of the times death takes.  Under the pressure of reading, they remind us that what has become a widely-accepted state of affairs, and indeed a norm – that vastly divergent lifespans can and shall co-exist, that life expectancy of, say, thirty-seven years in some parts of the world can and shall obtain alongside life expectancy of more than double that figure in others, and this for an unspecified period of time to come – is also legible as a damning indictment of a shameful history.  In these and innumerable other instances, the need to tell time translates as the imperative to discern – which is to say, to read – the time in question, the always crucial variable that is never quite the same from one reading to the next.  Only a work of reading attentive to time as the x factor can ground a responsible theoretical consideration of the temporal and historical questions with which the pandemic never ceases to confront us.

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