"Don’t go chasing waterfalls, please stick to the rivers / And the lakes that you’re used to."
(TLC, "Waterfalls") In the immortal words of TLC in their song "Waterfalls," they describe the dangers of unsafe sex - the boy chasing 'waterfalls', because of his "natural obsession for temptation," finds himself paying the price for his dangerous behavior - "His health is fading and he doesn't know why / 3 letters took him to his final resting place" (Etheridge et al., 1994). The three letters are undoubtedly "HIV," and this attitude about HIV and AIDS is one focused on with particular relish by Elizabeth Pisani in her essay "Sacred Cows." In essence, just like TLC's focus on AIDS as being prevented by avoiding bad behavior and unsafe sex, Pisani's perspective is that the focus on AIDS research and treatment has actually increased the recklessness by which people with AIDS treat themselves.
However, there is another perspective that is comparatively even more dangerous with regards to AIDS treatment - that of the HIV/AIDS denier. In Seth Kalichman's chapter "Denialist Journalism and Conspiracy Theories," there is an entire fringe movement that exists which seeks to debunk and deny the connection of HIV to AIDS, in order to achieve their own political ends (Kalichman 91). These conspiracy theorists use the Internet and their own skewed sense of journalism to create passionate, targeted media meant to make people question the convictions of the scientific community (Kalichman 92). The result is a concerted movement to cast doubt on the things that have been scientifically proven regarding AIDS, which can actually negatively affect people's opinions of otherwise productive ways to fight the AIDS epidemic. When information is obscured and denied in this way, it gets in the way of actually helping people, which makes this phenomenon extremely dangerous. The fact that there are people who actually deny the presence of AIDS, therefore, becomes a much more important argument than the issues of methods in addressing the phenomenon of AIDS (as per Pisani's and Sontag's arguments).
Pisani directly opposes Sontag's peaceful, laissez faire approach to the sociological discussion of AIDS in society in her work; unlike Sontag's plea to restrict stereotypes and prevent anxiety for the patient, Pisani believes we are mistaken in dealing with how to keep alive those who are infected in lieu of preventing others from getting sick. As Pisani says, "We are so focused on trying to increase the number of HIV-infected people on antiretroviral treatment that we tend to let people who test negative go away with nothing more than a handful of condoms and a little lecture about staying safe" (p. 173). Pisani thinks more hard talk is needed; Sontag represents exactly the kind of ideological hand-wringer that (according to her) prevents people from actually allocating resources to prevention. In many ways, Pisani's approach is not dissimilar to AIDS deniers, strictly in that both wish to de-emphasize the retroviral drug approach - however, while Pisani still believes AIDS is caused by HIV and thinks retroviruses simply lead to people increasing their risk of reinfection, AIDS deniers think that retroviral drugs are a manufactured answer to a manufactured problem, and think 'Big Pharma' is attempting to control people.
Take a look at this AIDS denial video meant to discredit the scientific consensus on AIDS and HIV treatment:
"The Shocking Truth About HIV and AIDS"
Here, several tactics are used by denial journalists to achieve their ends: creative editing of man-on-the-street interviews make it seem as though people are ill-informed "sheep" only capable of believing something if the scientific establishment tells them. This is meant to discredit those who would reject AIDS denialism, and throw suspicion on the scientific establishment (which allows conspiracy theorists to feel as though they are special and have uncovered something dramatic few know about). HIV testing procedures are framed as skewed and unnecessary, with the editing of those scenes creating the implication that the tester lies to those being tested about the necessity of the interview questions. The entire presentation is coordinated to generate suspicion, with filmmaking techniques making AIDS deniers seem like brave crusaders against a totalitarian and Draconian medical establishment. There are no definitive claims made within the video; vague statements such as "HIV in America is different than HIV in Uganda," etc., are meant to entice doubt without actually revealing their claims. Videos like these are used by AIDS deniers to create enough of a question to draw in supporters. Sontag believes that the metaphors and discussions of AIDS need to be changed to destigmatize the ailment; however, AIDS deniers contribute to that stigmatization by generating doubt in their claims.
Dramatic slogans and simplistic cynicism are the AIDS denier's stock in trade; instead of providing scientific evidence or skepticism about the connection of HIV to AIDS, the deniers simply reframe it as a political and economic conspiracy to take people's money and control them - the above banners make claims of "drugging Africa," "funding the drug companies," and "spreading lies and misinformation." All of these sound like bad things, and so people are more willing to react to such strong language; however, this also presumes that a) drug companies are inherently bad, b) giving Africa drugs is unequivocally bad, and c) the current information on AIDS and HIV is false. No proof of these claims are offered, but the statements themselves are emotionally charged enough to provoke a response in the kind of people receptive to AIDS denialism: those suspicious of the government and scientific establishments, as Kulichman mentioned earlier. Pisani's argument of focusing on prevention rather than destigmatization, when viewed in this outside lens (and the framework of the AIDS denier) comes across as splitting hairs - when people are having problems with the fundamental nature of AIDS as a disease, then the conversation should still be a major focus.
(The Washington Post, 1999)
Connecting this with the current discourse in discussion of AIDS, deniers completely write off the notion of plagues and epidemics as overwrought propaganda meant to sell drugs. Conversely, in Sontag's work, the author believes that ''one cannot think without metaphors,'' thus making it important to discern which metaphors are the best ones to use when talking about the issue. For example, she prefers to refer to the disease as an epidemic instead of a plague: "The plague metaphor is an essential vehicle of the most pessimistic reading of the epidemiological prospects. From classic fiction to the latest journalism, the standard plague story is of inexorability, inescapability" (Sontag).
The emphasis of Sontag's work is not prevention or treatment, but discussion of the issues at hand, and ways to change society in order to make the lives of those with the disease lighter on discrimination and anxiety. These kinds of discussions are completely anathema to the AIDS denier: "for denialist deconstructionists, not understanding the basic pathology of HIV and failing to see the logic in how HIV causes AIDS is the basis of their doubt" (Kalichman 98). Because they do not even see the cause of AIDS to be HIV, they would see no point in continuing these discussions; the HIV/AIDS connection is simply a smokescreen concocted to make people spend money on retroviral drugs they do not need.
(The Economist, 2002)
Despite the realities of HIV and AIDS infection and their correlation, AIDS deniers have remained a vocal minority in AIDS discourse. While Pisani and Sontag discuss notions of how the AIDS problem is to be addressed, AIDS deniers believe that there is no problem at all; their lack of understanding of "the basic science of AIDS" leads them to find answers elsewhere, in a framework that validates their cynicism and doubt - this is found through the Internet, the freelance blogging community, and the work of other denialist activists. As a result, Pisani's arguments become comparatively unimportant, as Sontag's and Kulichman's mention of the issues of stigmatization of AIDS sufferers and the fight to treat them (whether done through metaphors or AIDS denialism) prevents people from even getting the treatment they need, to say nothing of focusing on cures.
Etheridge, M., Lopes, L, Wade, R., Murray, P., and P. Brown. Lyrics. "Waterfalls." CrazySexyCool. CD. LaFace Records, 1994. Album.
Kalichman, Seth. C. "Denialist Journalism and Conspiracy Theories." in Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy. Springer, 2009.
Pisani, Elizabeth. "Sacred Cows." in The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS. Granta Books, 2008. Print.
Sontag, Susan. AIDS and its Metaphors. Farrar, Straus and Giroux, 1989. Print.