Treatment Issues: Newsletter of Current Issues in HIV/AIDS - Volume 19, Number 1 & 2, January / February 2005
Daniel Raymond

It's official: Superbug fatigue has set in. Nobody held a press conference, but the case report that launched a thousand news articles, watercooler conversations, and heated e-mail exchanges has passed from the acute phase into the chronic fate of overhyped AIDS stories: after a shiver of anxiety, a collective shrug of indifference.

Intensive media coverage failed to ignite mass hysteria; gut reactions seemed to run a short gamut from "So what else is new?" to "This just proves what I've been saying all along!" But the fact that everyone was talking suggested that this "superbug," whatever its merits as a clinical phenomenon, clearly represented a potent meme, or unit of cultural information. Memes are to culture what genes are to biology.

The superbug meme adapted itself to a remarkably broad range of hosts — it evolved into strains tailored to support virtually everyone's agendas. We saw public-health officials fretting and prominent researchers bickering over the significance of the case, while press releases from the HIV/AIDS community provided healthy doses of skepticism and context embedded in well-rehearsed calls for more funding and better prevention policy, while conservative commentators drafted Patient X into their war on hedonism and moral decay.

But the novelty of the superbug meme quickly dissolved into a mix of now-familiar cultural struggles around promiscuous gay sex and illicit drugs. The superbug may not be spreading, but it briefly illuminated a landscape of out-of-bounds bodies and the pleasures they seek.

The persistent cultural fascination with a rampant, renegade version of gay male sexuality may seem anachronistic after a domesticated decade of Will & Grace and gay marriage debates. Political pressure forced a retreat from creative HIV prevention campaigns and threatens to stifle research into the highways and byways of sex on the margins of society. Even current discussions of the prevention of sexual transmission of HIV between men (under the anodyne acronym MSM) increasingly seem to focus on tepid, unsexy themes like self-esteem and responsibility.

But the last several years also generated a steady diet of new incarnations of the sexual outlaw at regular one to two year intervals: barebacking, "bug chasers" and "gift givers," surging syphilis rates and internet-enabled anonymous sex, men "on the down low," and crystal meth-fueled sex fiends, to name a few.

The current focus on crystal meth brings a new twist, linking sexual deviance to a long-standing tradition of moral panic around drugs. From a harm reduction perspective, the recent anticrystal campaigns are a familiar remix of reefer madness and "just say no" style demonizations of a drug and, by extension, the people who use it. The relentless coupling of crystal meth and HIV in some "educational" materials would lead one to think that on crystal, unsafe sex and resultant HIV infection are all but inevitable. I've taken to joking that I want to start a counteradvocacy group of people who've used crystal and never got HIV. Not a pro-crystal group, per se, but a pro-reality group, to break through misleading and ultimately counterproductive rhetoric.

At the height of the AIDS epidemic in the United States, some people were committed to telling the truth about sexuality to power — and each other. I still remember the sense of liberation in the early '90s from reading certain 'zines — Scott O'Hara's sexy yet matter-of-fact "How I Got AIDS: Memoirs of a Working Boy," serialized in Diseased Pariah News, or Pat Califia's essay in Frighten the Horses about the struggles and contradictions of safer sex, and how and why we slip. These sex radicals pushed buttons and boundaries, all while maintaining a politically engaged commitment to exploring and documenting the messy, murky, contradictory truths of desire. Radical AIDS activism and queer cultural politics blended and fed each other in new fusions and recombinations resembling nothing so much as sex itself.

We need that energy now — the response of the HIV community to the superbug Sargasso betrayed a bankruptcy of new ideas, new strategies, new narratives. Nobody even attempted to defend Patient X, much less understand or identify with him. Advocates used the case to press for more prevention dollars, without any explanation of how current programs could have prevented this infection if adequately resourced and freed from political constraints. HIV prevention is in a silent state of crisis — we're not doing any better now, and we've ceded our power and knowledge to the CDC, just as communities — or, more accurately, social networks and subcultures — have conceded the responsibility for prevention to AIDS service organizations.

Perhaps we could start by breaking down the boundaries between people who work on preventing sexual transmission and people who work on preventing transmission in injection drug users (IDUs). It's increasingly clear that alcohol and drugs play a role in a lot of HIV infections through sex and that a lot of IDUs actually get HIV from sex rather than needles. Both camps have different conversations, different agendas, and different struggles. But maybe that provides fertile ground for the kinds of fusions and recombinations that could reignite HIV prevention as a movement, not just an institution.

Daniel Raymond is the hepatitis C policy analyst for the Harm Reduction Coalition.

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