"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, this runs seemingly contradictory to Sontag's assessment of the cultural treatment of the AIDS epidemic as outlined in AIDS and its Metaphors; there, she outlines her belief that the generalizations and myths that go into those who have AIDS - Pisani plays directly into this perception of stereotypes with often caustic, straight-talk prose that frames sufferers of AIDS as being mostly restricted to promiscuous gay men who "pick up that cute boy who works behind the Prego" (p. 163). Despite her claims of objective truth based in evidence, it is difficult to separate her own projections and judgments of those who have AIDS from Sontag's attitude that these kinds of depictions discourage treatment and provide further shame and stigma to those who do have the disease.
In Sontag's work, the author seeks to examine and explore the AIDS conversation in many different ways. In essence, she 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.
Pisani takes a fairly cynical approach to AIDS prevention compared to Sontag's - she minces no words regarding what she thinks about the kind of people she believes contract AIDS more frequently. According to Pisani, "We've inherited a lot of sacred cows from the admirable godfathers of activism, and we have rarely dared to question whether we really want or need them" (Pisani 161). These 'sacred cows' are arguably the kind of metaphors Sontag's talking about - what Pisani would call sugarcoating for the sake of liberal mindsets, and the need to not offend anyone by using distasteful language, Sontag would call reframing the intellectual approaches to discussion of AIDS to reduce anxiety and stress (not to mention fatalism) for those who have it. While Sontag wishes to make sure those infected with AIDS are treated with respect, Pisani sardonically paints a picture of a world where men who are receiving AIDS treatment to reduce their infectability collapse into a world of casual sex and drug use.
One of the main issues of contention between Pisani and Sontag is how to address the characterization of people who have AIDS; because her focus is on prevention, Pisani emphasizes the groups most at risk - promiscuous gay men: "People get sloppy about prevention partly because they're thinking: 'Well, if he's got AIDS, he's probably on treatment, so he won't be that infectious.' (p. 165). This is, according to her presumptions, the mindset that goes into diminished condom use and increase in the spread of HIV - essentially, more AIDS-positive people are healthy and sexually active because of treatments, which means the number of sexually active HIV-positive people increases. Putting this into the framework of promiscuous gay men, Pisani implies that the treatment gives people license to be sleep with whoever they like. This kind of discussion plays into the kind of stigmatization that Sontag talks about; Pisani's remarks directly link to the perception of AIDS patients as participating in "indulgence, delinquency – addictions to chemicals that are illegal and to sex regarded as deviant" (Sontag).
One point that puts Sontag's methods into question, admittedly, is Pisani's focus on practical applications for her usually blunt approach; she does not mince words, and her prose is fairly abrasive, but her work is focused on prevention. She wants to make sure condom use is adhered to, and she wants to find the reasons behind its apparent drop in frequency in the past ten years. Her solution is not to lower the ability for HIV-positive people to get treatment, but have a greater emphasis on prevention; with the current overemphasis on treatment, "Drugs must be provided for everyone who is already taking them, plus the people who develop AIDS this year and next, plus, eventually, all the people who got infected this year because we were working so hard to increase access to drugs that we forgot about prevention" (p. 163). Compared to Pisani's practical desires, Sontag does not even seem particularly concerned about actually preventing the disease - she opposes the notion that there is something degrading or dehumanizing about having AIDS, and believes that this stigma occurs because the disease in particular hits young people in their prime, affecting their physical attributes at a time when it is most important to them. It is an "esthetic" concern that is on young people's minds because of its psychological effect, but they should not be stigmatized for it (Sontag). Essentially, Sontag believes that AIDS is bad enough; those who have it should not have to undergo unnecessary and arbitrary social stigmas and characterizations because of it. That only adds further psychological damage and contributes to the pain of the victim.
Pisani could not care less about sparing the victim's feelings, conversely; she is focused on straight talk that gets to the core of emphasizing prevention. The author believes that the emphasis on political correctness and the humanity of the AIDS victim in society is what contributes to the spread of the disease: "Treatment is popular - voters smile on compassionate politicians who give out life-saving drugs, while frowning on politicians who give out condoms or clean needles that would make those drugs unnecessary" (p. 166). Her approach is decidedly practical; when talking about the objections people have to involuntary testing and treatment for fear of being outed as having AIDS, she responds simply that "untreated AIDS has a way of outing people anyway, so you get the stigma and the avoidably early death" (p. 171). Her perspective seems to be that Sontag's view of emotionally coddling potential AIDS victims by sparing their feelings, instead of taking a hard-talk approach and just getting them tested, is what needs to be done.
In conclusion, 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. She truly believes, and will not mince words in saying so, that treatment simply spreads the disease due to people 'chasing waterfalls' (as TLC would put it). 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. The question remains as to whether Sontag's emphasis on metaphors is helpful; Pisani's approach is certainly more practical, but there may perhaps be another way to address the issue of prevention without creating those aforementioned stereotypes.

Works Cited

Etheridge, M., Lopes, L, Wade, R., Murray, P., and P. Brown. Lyrics. "Waterfalls." CrazySexyCool. CD. LaFace Records, 1994. Album.
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.