by Nikolaas Deketelaere (Paris, France)
We are more than a year into what the American poet Paul Monette (1945-1995) called “the calamity,” referring to the viral pandemic that claimed the life of his first partner, Roger Horwitz, followed by that of his second partner, Stephen Kolzak, and ultimately his own. Only, the viral pandemic Monette referred to was AIDS, not COVID-19. Moreover, while this calamity dragged on for many years, we have developed several effective COVID-19 vaccines in much less time than it took to even identify HIV as the cause of AIDS. Indeed, the speed with which the scientific community is tackling our present crisis, which emerged only in 2019, is all the more remarkable when we consider that there is still no cure or vaccine for HIV/AIDS, a disease that was identified in 1981. Given that all of our lives are currently being held hostage by a virus that has killed over three million people, it is fortunate that scientific and technological innovations to mitigate the impact of the COVID-19 pandemic are becoming available in record time. Of course, this incredibly short scientific timeline is cold comfort for Monette, or for the 38 million people who have died of AIDS (including 690,000 in 2019). The AIDS crisis is not over, but we have reason to hope that what we are all referring to as “the pandemic” soon will be. We should think about what this means.
It is not my intention to engage in glib equivocating about human suffering or to make pronouncements about the current state of virology in comparison to the 1980s. The comparison I am setting up is intended to illustrate a single fact, the analysis of which strikes me as urgently required: like the 2020s, the 1980s were inaugurated by the emergence of a previously unknown viral agent with pandemic potential; yet, the response by societies and governments around the world was markedly different (and remains so). Why is that? Well, in the developed world at least, AIDS was the pandemic that happened only to what public health officials call certain “risk groups,” primarily gay men (though not exclusively, as intravenous drug users, haemophiliacs, and the recipients of blood transfusions were also at risk). Meanwhile, what in that same vocabulary is called “the general public” remained largely unaffected: “Straight folk seem like tourists,” Richard Goldstein observed in 1987, “oblivious to the blitz.”1 There is thus, as the queer theorist Douglas Crimp puts it, a certain “incommensurability of experiences” when it comes to the AIDS crisis: “Certain people are experiencing the AIDS crisis while society as a whole doesn’t appear to be experiencing it at all.”2 Yet, COVID-19 has “risk groups” of its own, primarily the elderly (though not exclusively, as people with certain underlying health conditions are also at risk). Nevertheless, there is no similar “incommensurability of experiences” today. Regardless of whether we fall ill ourselves, the pandemic is deeply affecting all of our lives. If anything, there is an “incommensurability” between the experiences of the respective pandemics rather than how different groups are experiencing the current one. It is the significance of this incommensurability that we should think about.
In the 1980s, “the general public” was not affected, and society as a whole therefore reacted inadequately to the emergency; in the 2020s, as all of our lives have been turned upside-down in response to the pandemic, things are fortunately different. So, if San Francisco journalist Randy Shilts’ book And the Band Played On documented the lacklustre early response to the AIDS crisis by governments, scientists, and media,3 the situation could not be more dissimilar today: the band was yanked off stage and live music venues shut down, along with restaurants and bars, schools and cinemas. This time, the band did not play on. Of course, this does not mean that the extraordinary measures taken to mitigate the current pandemic lack justification. However, it does beg the question: having now seen to what extraordinary lengths free societies are willing to go to protect public health, why were similarly drastic measures not taken and comparably generous resources not spent on tackling the AIDS crisis months after it got underway? Indeed, would society today react in a similarly dramatic way if an unknown virus were decimating a generation of mostly (but not exclusively) gay men, rather than mostly (but not exclusively) the elderly? Does society now consider it in its interest, in the general interest, to protect the health—the lives—of gay men? Are we, gay men, part of “the general public” yet?
Medical statistics and clinical evidence do not grant us insight into this question, for it is one of social attitudes: how we think and talk about illness, how we experience living through the pandemic. It is therefore worth repeating the analysis put forward by Susan Sontag’s Illness as Metaphor (1978) and continued in AIDS and Its Metaphors (1989).4 While undergoing treatment for cancer, Sontag noticed that illness is primarily discussed metaphorically: diseases are no longer suffered, they are battled; rather than a tragic inevitability, dying has become a failure of medical science. Indeed, the metaphors with which illness is discussed are often military, painting the suffering of illness as warfare. This language is not innocuous, for it brings with it a particular understanding of disease: succumbing to illness becomes a defeat in war, a capitulation, even a humiliation. This is particularly true of a viral infection, where the invader to be battled is not an anomalous growth of one’s own body, but—quite literally—a foreign agent: a virus coming from the outside, infecting me, making me sick. Sontag therefore finds it supremely unhelpful to discuss illness metaphorically: nobody is eager to go to war, we are all tempted to dodge the draft. Hence, these metaphors, she writes, “inhibit people from seeking treatment early enough, or from making a greater effort to get competent treatment. The metaphors and myths, I was convinced, kill.”5 The war metaphor explains, for example, why people might feel reluctant to have themselves tested for cancer or HIV/AIDS: having the test requires you to consider what having the disease might entail, and when its suffering is understood in terms of the horrors of war, it can become too much even to contemplate.
Yet, here we encounter an initial difference in how the respective pandemics are experienced. Unlike with HIV, there appears to be little reluctance to get tested for the virus causing COVID-19, perhaps because a positive result generally only entails an inconvenience, or because a negative result can have practical benefits. This cannot solely be due to the fact that COVID-19 is not an inevitable death sentence, for nowadays, in the developed world, neither is an HIV infection. So, in what sense is the COVID-19 pandemic experienced differently now than the AIDS pandemic was then?
The first difference between the two pandemics lies in their nature or the kind of battle that we think we are fighting. The primary experience of the current pandemic has certainly been that of war, namely collective action against a shared external enemy: together we are meant to “flatten the curve” in order to give medical professionals “on the frontline” the ability to neutralise the threat. This is markedly different from Sontag’s own, personal, battle with cancer: her cancer is presented as the enemy, and she is the one on the frontline. Indeed, our present fight is not so much with the disease, but with the virus, detached from the patients it makes sick yet itself almost anthropomorphised. In other words, the metaphoric language surrounding COVID-19 concerns public rather than personal health. This stands in rather shrill contrast with the rhetoric of officialdom surrounding AIDS in the 1980s. For example, Margaret Heckler, in charge of the US Department of Health and Human Services under Ronald Reagan, suggested there was “a very strong public interest in stopping AIDS before it spreads outside the risk groups.” Or, employing the war metaphor: “We must conquer AIDS before it affects the heterosexual population and the general population.”6 In short, stopping gay men dying of AIDS was not in itself in the “public interest” because gay men did not belong to “the general public.” Indeed, the implication is that the “public interest” is best served by protecting “the general public” from gay men. This contrast is reflected in the experience of the gay men living through the AIDS crisis in the United States during the 1980s. Monette describes the day of Horwitz’s diagnosis as “the day we began to live on the moon.”7 What he means is that life itself became alien, detached from the world and its everyday concerns precisely because these differed from, or were incommensurate with, those of people with AIDS. The same incommensurability does not seem to govern the experience of the COVID-19 pandemic: with the introduction of new terms into our everyday vocabulary—“social distancing,” “face coverings,” “reproduction number”—those two realms of concern have merged, the moon is brought closer to the earth, the interests of those personally at risk of serious disease are commensurated with the public interest. Indeed, the battle with AIDS is conceived much more along the lines of Sontag’s personal battle with cancer than our own war against COVID-19: describing Horwitz’s final hours, Monette refers to his doctor as “having fought with us in the trenches for nineteen months.”8 It is remarkable that one viral infection is conceived of in an analogous way to something as qualitatively dissimilar as cancer, while another viral infection is not.
Monette and Horwitz’s experience reinforces the argument of Simon Watney’s 1987 Policing Desire that AIDS “is not only a medical crisis on an unparalleled scale,” but “involves a crisis of representation itself.”9 He argues that AIDS was discussed in terms of how it concerned a “general public” that was artificially constructed as both uniform and heterosexual. This meant that gay men, the group of people most affected by the crisis, were both excluded from the discussion and that this discussion framed their interests as distinct from or incommensurable with those of the audience addressed. It is this difference in the way each pandemic is discussed that accounts for the incommensurability of their respective experiences: whereas Watney speaks of AIDS as a private epidemic, since it is not collectively understood to concern an artificially constructed “general public,”10 COVID-19 is arguably a public epidemic because the effort to combat it must be exerted by all of us. Otherwise put, within the developed world, the more salient metaphor for the AIDS epidemic is that of a personal struggle with disease: a generation of gay men, like Monette and Horwitz, nursing their dying friends and partners. For the COVID-19 epidemic, meanwhile, the appropriate metaphor is that of a national war with the virus: a nation “clapping for carers” or “flattening the curve.” This is the incommensurability of the experiences of the respective pandemics at issue here, which is a question of the metaphors used to discuss them.
This brings us to a second difference between the experiences of the respective pandemics. It is not a difference in their respective natures as pandemics (public or private), and therefore not a question of the metaphors by which we discuss them (national war or personal struggle), but rather in their meaning as social phenomena, and thus in what they themselves become metaphors for. When Sontag writes that “‘plague’ is the principal metaphor by which the AIDS epidemic is understood,”11 she is correct, but only because AIDS itself became a metaphor for a social phenomenon: homosexuality as the supposed perversion of gay men that is seen as threatening to a “general public” artificially constructed as uniformly heterosexual. What differentiates AIDS from COVID-19 is that the former is precisely not viewed as a contingent event, not viewed as a tragedy or natural disaster, of which the origins are always mysterious. This makes it possible to blame the people suffering from AIDS for their illness. After all, “plague” is not an epidemiological category, but a moral one: rather than designating the contingencies of the epidemic spread of an illness, it designates the necessary consequence of widespread moral pollution among particular groups, precisely to serve as a warning to “the general public” it threatens. Plagues never come first or out of nowhere; they are often foretold and remembered. Indeed, as a metaphor, plague only emerges in response to perceived moral pollution for which it serves as the punishment: hence, AIDS itself becomes a metaphor for, a way of talking about, the deviancy of gay men, against which “the general public” must be protected.
Sontag correctly observes that this identification of the group with the illness, and thus the designation of the group as the invader to be battled, is facilitated by the sexual transmission of the virus. Indeed, the means of transmission are here but a proxy for the group within which the virus spreads: the only thing gay men have in common is the fact that they have sex with other men; for an infectious disease to spread predominantly amongst gay men, it must then necessarily be sexually transmittable.12 In other words, the specific route of infection provides the opportunity for the status of invader to be ascribed, not to the disease or the virus, but to the group within which it spreads, and thus for the epidemic disease to be conceived of as a plague: the metaphor of a plague for AIDS is only appropriate insofar as the horrors of AIDS are seen as just deserts for those who engage in the behaviour that spreads the virus. Put bluntly, AIDS becomes a metaphor for the sin of homosexuality, of which gay men as a group—by definition—are guilty.
In this sense, the experience of the AIDS pandemic is markedly different from, and thus incommensurable with, that of the COVID-19 pandemic: the latter, though discussed by way of metaphors, does not itself seem to be a metaphor for anything. Here, Sontag’s analysis—over thirty years old by now—proves extraordinarily topical:
The emergence of a new catastrophic epidemic, when for several decades it had been confidently assumed that such calamities belonged to the past, would not be enough to revive the moralistic inflation of an epidemic into a ‘plague.’ It was necessary that the epidemic be one whose most common means of transmission is sexual.13
In the 2020s, we find ourselves in the exact opposite situation of the 1980s: a pandemic that does not spread sexually and which therefore cannot be understood in moral terms. Indeed, Sontag refers to the 1918-1920 Spanish flu pandemic to illustrate her point: “Influenza, which would seem more plague-like than any other epidemic in this century if loss of life were the main criterion […], was never viewed metaphorically as a plague.”14 COVID-19, like the Spanish flu, does not allow itself to be understood as a plague because it is unclear what it would be a punishment for, exactly who is being punished, and thus for what it is supposed to be a warning; it is an exclusively epidemiological phenomenon, bereft of any moral significance. Sontag therefore concludes that “it has become almost impossible to moralize about epidemics—except those which are transmitted sexually.”15 In other words, sexual transmission has the power to localise the epidemic within a particular group by confining it to an activity constitutive of that group which is disapproved of beforehand by “the general public” due to its artificial definition as distinct from that group. As Leo Bersani, in his essay “Is the Rectum a Grave?”, puts it: “There is a big secret about sex,” namely that “most people don’t like it”16—i.e., they are uneasy about it in general and want nothing to do with it when it is different from what they are used to in particular.
In short, AIDS is conceived of metaphorically as a plague because it is understood to be a moral crisis (with infections confined to a particular group as opposed to “the general public”), whereas COVID-19 is simply conceived of as a pandemic because it is understood to be a public health crisis (with severe disease confined to a particular group while infections affect “the general public”). It is the sexual element, as the means of transmission and the ground for moral condemnation, which allowed for the AIDS crisis to be conceived of metaphorically as a plague and thereby privatised as a matter of “the homosexual lifestyle.” This metaphoric privatisation of a public health crisis absolved “the general public” of their responsibility to safeguard the lives of gay men and therefore explains the inadequacy of the initial response to the crisis.17 In other words, the language we use to talk about a pandemic has very real consequences.
What are some of these consequences? The view of AIDS as an issue of morality—or, better, of mores—explains the inadequate response to the crisis by those responsible for dealing with threats to public health, namely: the scientific establishment, government, and the media. Take, for example, the issue of pharmaceutical innovations. Antiretroviral therapy has indeed proved highly effective in prolonging the life of people infected with HIV, but there is still neither a cure nor a vaccine. Consequently, in the developing world, treatment is unavailable to many due to its high cost and complexity; meanwhile, in the developed world, people living which HIV have become dependent on the continued availability and efficacy of certain medications. This is, of course, infinitely preferable to a certain and drawn-out death; however, at the same time, it is still a far cry from an ordinary life, since the necessity of life-long treatment is the source of significant medical and social complications. Where COVID-19 is concerned, however, the situation is very different: fortunately, less than a year after the virus first emerged, several safe and effective vaccines became available. In fact, the British drugmaker AstraZeneca is producing a COVID-19 vaccine developed by Oxford University that it intends to sell at cost to developing nations, ensuring that vaccines will be easily accessible all around the world. This is of course admirable, but would AstraZeneca be so generous if that same institution suddenly came up with an AIDS vaccine that could potentially save millions of lives in the developing world? Why this pandemic, but not that pandemic? Of course, such slippery slopes are commonplace in the pharmaceutical industry, where life and death decisions are constantly made on a more or less arbitrary basis. Yet, that is exactly my point: given the arbitrary nature of the basis on which circumstances are deemed to be sufficiently “exceptional,” we ought to interrogate it. Whose lives are pharmaceutical companies willing to make sacrifices for? This is a moral question, not a clinical or technological one.
So, if hurdles like the profit incentives of pharmaceutical companies can be overcome now, why was this apparently impossible then? Or, more specifically: is the fact that there are several effective vaccines available for COVID-19 roughly a year after a previously unknown virus was identified, while 40 years after the identification of HIV a vaccine is still not available for AIDS, due to inherent clinical difficulties or rather to research priorities and commercial incentives? If the answer is the latter—as it must surely be, at least partially—we should ask ourselves why this is the case: what is different in our experience of the COVID-19 pandemic compared to that of the AIDS pandemic that causes our priorities and incentives to be aligned differently? With Sontag, we may answer that, unlike AIDS, COVID-19 is not understood metaphorically as a plague: it is a public health crisis, not a moral crisis, hence the need to resolve it is felt more urgently. The crime is then structural, intellectual even: it concerns how we think and talk about the AIDS pandemic, the metaphors we use for it, since these metaphors determine what is a matter of “public health” rather than “private lifestyle” and thus decide who deserves to live or die in a pandemic. Sontag’s 1978 conviction then remains painfully acute today, namely that “metaphors and myths […] kill.”18
Of course, some might ask what the point of this analysis is. Are the shortcomings of the early response to the AIDS crisis not widely recognised, and should we not be happy that history is not repeating itself today? Monette’s answer to this question is as pressing now as it was then: “Now we know that stride could have been made in ‘82 or ‘83 if the government hadn’t been playing ostrich. Spilled milk, people tell me; you can’t undo the past. But can’t we measure the spill?”19 It is my contention that the spill gains clearer definition, that its contours come to stand out more vividly, in light of the COVID-19 pandemic, precisely because the response to both pandemics is so different and their respective experiences are therefore incommensurable. However, that contention does not let itself be fitted neatly into a conclusion, but instead comes by way of a question and a proposal. In short, the spill demands activism.
The proposal calls for a very specific action, namely to extend Sontag’s strategy of resisting metaphoric discourse even further: “to deprive something of meaning,”20 as she puts it, not just in reference to the illness which is needlessly discussed metaphorically (her analysis), nor the social phenomenon for which the illness itself becomes a metaphor (my earlier suggestion), but to extend this deprivation of meaning to the apparently successful treatment of the illness. Sontag’s reason for resisting metaphoric discourse was simple, namely that the metaphor belies the reality of the problem at hand: the metaphor might lose salience while the underlying problem it is meant to bring to words does not. Precisely that, I would suggest, has happened with HIV, the treatment for which has assumed the status of metaphor for the disease it causes: antiretroviral therapy has diminished the horror of AIDS, precisely because it has proved so successful in transforming an HIV infection from a death sentence into a manageable condition, thereby blunting the pain and suffering of the 1980s and 1990s. Of course, in no way am I suggesting that we should not be overjoyed at the extraordinary achievement these treatments represent; rather, I am merely pointing out that, at the same time, we should also be enraged by the fact that there is still no cure or vaccine: the AIDS crisis is not over, the fight is not over. In the absence of a cure or a vaccine, we must deprive these treatments’ mere existence of its meaning, precisely in light of that absence—which stands in such shrill contrast to the speed and confidence with which not one, but several COVID-19 vaccines were developed. If the rage that characterised the AIDS activism of the 1980s and 1990s was dulled by the introduction of successful therapies, then the incommensurability of the respective experiences of the AIDS and COVID-19 pandemics ought to reawaken it today.
Once we have done that, once we have scraped away another layer of metaphor in order to expose the horror of AIDS underneath, a question arises: Could this happen again? Or, rather: having now seen the extent to which society is willing to mobilise its resources, would the response be the same if the disease spread primarily (but not exclusively) amongst gay men—or any other sexual minority—instead of the artificially constructed “general public”? In other words, if HIV were to emerge for the first time today, would the ensuing crisis—like with COVID-19—be conceived of metaphorically as a national war? After all, the significance of the war metaphor, Sontag writes, is that “war-making is one of the few activities that people are not supposed to view ‘realistically’ […]. In all-out war, expenditure is all-out, unprudent—war being defined as an emergency in which no sacrifice is excessive.”21 In light of the COVID-19 pandemic, the AIDS crisis clearly was not—is not—understood metaphorically as a war: certain sacrifices, which we are apparently able to make for COVID-19, we were not and are not willing to make for AIDS.22 In short, the incommensurability at issue, the new light our response to the COVID-19 pandemic throws on the AIDS crisis, consists in a profound retrospective corroboration of Monette’s 1988 accusation: “It will be recorded,” he writes, “that the dead in the first decade of the calamity died of our indifference.”23
The incommensurability between the experience of the AIDS crisis (1980s) and that of the COVID-19 pandemic (2020s) thus goes to the heart of the very cause of gay activism (then and now): not just the acceptance of individual homosexuals, but the acceptance of homosexuality as such.24 AIDS showed, not necessarily that gay men were not accepted, but that homosexuality was not accepted: though individual patients received treatment, the disease itself was insufficiently prioritised. As Watney put it in 1987, the AIDS crisis makes evident that “gay men are officially regarded, in our entirety, as a disposable constituency.”25 Here, in our entirety is key: as individuals, white gay men often lead lives of privilege; but AIDS showed that, as a group, they were disposable, precisely because the only thing that—supposedly—unites gay men is sex (which most people do not like). Now that legal parity has been achieved in many countries, the incommensurability between the experiences of the respective pandemics can serve as a reminder, not only of what is at stake in gay activism, but also of its enduring relevance beyond these recent legal achievements: the question we must ask ourselves, as gay men, is whether “the general public” would now also “go to war” for us specifically, because we count in the same way they do generally; whether “our health” would today finally be seen as part of, or commensurate with, “public health,” because “we,” gay men as a group rather than as individuals, are included in “the general public.” The answer to this question decides whether we have achieved equality beyond mere legal parity. The incommensurability from which it arises is then perhaps best captured—rather brutally for the contemporary reader—by a line from a poem Monette wrote shortly after Horwitz’s death, which gives voice to his constant worrying about possible sources of opportunistic infections that could prove fatal to his lover: “the whole world ought to be masked,” he sighs in desperation; today, the whole world is.26
1. Richard Goldstein, “A Plague on All Our Houses,” in Village Voice (16 September 1987), quoted by Simon Watney in Policing Desire: Pornography, Aids and The Media, third edition, Minneapolis: University of Minnesota Press, 1996, 3.↑
2. Douglas Crimp in Cathy Caruth and Thomas Keenan, “‘The AIDS Crisis Is Not Over’: A Conversation with Gregg Bordowitz, Douglas Crimp, and Laura Pinsky,” in Cathy Caruth (ed.), Trauma: Explorations in Memory, Baltimore: Johns Hopkins University Press, 1995, 256-271 (256). See further Douglas Crimp, Melancholia and Moralism: Essays on AIDS and Queer Politics, Cambridge: MIT Press, 2002, 129-149.↑
3. Randy Shilts, And the Band Played On: Politics, People and the AIDS Epidemic, San Diego: St. Martin’s Press, 1987. Shilts’ book is controversial. Arguably, the account it provides should be complemented by that of David France’s How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS, New York: Knopf, 2016, as well as Sarah Schulman’s Let the Record Show: A Political History of ACT UP New York, 1987-1993, New York: Farrar, Straus and Giroux, 2021.↑
4. Susan Sontag, Illness as Metaphor, New York: Farrar, Straus and Giroux, 1978; Susan Sontag, AIDS and Its Metaphors, New York: Farrar, Straus and Giroux, 1988.↑
5. Sontag, AIDS and Its Metaphors, 14↑
6. Shilts, And the Band Played On, 554.↑
7. Paul Monette, Borrowed Time: An AIDS Memoir, San Diego: Harcourt, 1988, 2.↑
8. Monette, Borrowed Time, 341.↑
9. Watney, Policing Desire, 9.↑
10. Simon Watney, Imagine Hope: AIDS and the Gay Identity, London: Routledge, 2000, 3.↑
11. Sontag, AIDS and Its Metaphors, 44.↑
12. This is, of course, in no way a suitable definition of what it means to be a gay man. However, it is appropriate for this little exercise in discourse analysis, since that is how public discourse conceives of gay men. For an argument against the reduction of gay male identity to homosexuality, see the incredibly insightful first chapter of Walt Odets’ Out of the Shadows: Reimagining Gay Men’s Lives, New York: Farrar, Straus, and Giroux, 2019.↑
13. Sontag, AIDS and Its Metaphors, 60.↑
14. Sontag, AIDS and Its Metaphors, 56.↑
15. Sontag, AIDS and Its Metaphors, 56.↑
16. Leo Bersani, “Is the Rectum a Grave?” October, 43 (Winter 1987): AIDS—Cultural Analysis/Cultural Activism, 197-222 (197).↑
17. I do not mean to dismiss the mismanagement of the COVID-19 pandemic by some countries, which undoubtedly also caused a vast number of unnecessary deaths. However, the point I am making here is a higher order one: not simply making mistakes that cost lives, but framing an issue in such a way that lives are not seen as worth saving.↑
18. Sontag, AIDS and Its Metaphors, 14.↑
19. Monette, Borrowed Time, 119.↑
20. Sontag, AIDS and Its Metaphors, 14.↑
21. Sontag, AIDS and Its Metaphors, 14.↑
22. Insofar as I use the present tense here, I am of course referring to the fact we in the West do not appear to consider the still very much ongoing AIDS crisis in the Global South as a public health crisis that would merit an extraordinary expenditure of public resources.↑
23. Monette, Borrowed Time, 18.↑
24. A significant distinction that I borrow from Dennis Altman, The Homosexualization of America, San Diego: St. Martin’s Press, 1982, 214.↑
25. Watney, Policing Desire, 135. Writing in 2000, Watney ultimately concludes in Imagine Hope that “lesbians and gay men have come in from the cold now as a recognized social constituency” (268). My point is not that this later statement is an incorrect description of the current situation, but rather that the question I am articulating would be the test of whether it is indeed correct.↑
26. Paul Monette, Love Alone: Eighteen Elegies for Rog, San Diego: St. Martin’s Press, 1988, 11.↑