At the World AIDS Conference:
Where hope is a financial principle

by Cliff Bostock
(Originally published in the "Paradigms" column of Creative Loafing, Atlanta, July 25, 1998

By a cruel irony, I learned, checking my e-mail in a cyber café in Geneva before filing this column, that my old friend Ted Pickering died a few days ago. Ted was a "long-term survivor" of AIDS, having maintained a high T-cell count up until the time of his death from pneumocystis. His death, an anomaly, demonstrates that AIDS is still often a fatal disease and that HIV itself seems to have an intelligence of its own -- able to kill when it shouldn't be able to, according to the best guesses of physicians.

The theme of the 12th World AIDS Conference in Geneva is "bridging the gap," a phrase that only hints at the enormous chasms that describe nearly every aspect of a disease that has killed 11.7 million people worldwide. While the disease remains mythologized in the American media as one that primarily attacks white gay men, it is anything but.

In actuality, in our own country, 57 percent of the infected are African-American -- 63 percent if you limit the count to those between the ages of 13 and 24. The treatment gap is just as vast as the infection gap. In the Third World, the often effective and always expensive "cocktail" of protease inhibitors isn't even available. And, of course, its cost in our own country makes it unavailable to the majority who suffer.

AIDS infection and treatment are true examples of the way health functions as an expression of economy and politics -- specifically of capitalism. At the conference this year, a representative of the World Bank informed representatives of Third World countries they were going to have to make some "difficult decisions" about whether to invest their limited resources in treatment or prevention. The grisly fact of life throughout the world remains that most people with AIDS are sacrificed to early death.

It is astonishing that in 17 years these inequities should not be treated with more indignity than their reduction to the warm-and-fuzzy plea of "bridging the gap" scrawled as the conference logo across a heart on a rainbow. Those of us old enough to recall the onset of the epidemic and its first wave of rapid death cannot forget the monstrous indifference of Ronald Reagan, who would not even utter the disease's name until Rock Hudson succumbed.

The torrent of blood eventually reached every American in some personal way -- a dead co-worker, an infected nephew -- so that the apocalyptic potentialities of the epidemic became evident. Research began and, although medicine remained impotent for more than the first decade of the epidemic, real advances have been made in treatment in the last few years.

Indeed, at the Vancouver conference two years ago, people even began uttering the word "cure" because of the success of combination therapies with protease inhibitors. Many reported that the virus had been eradicated from patients. But anyone who looked at the actual science -- only six months of data tracking the new therapies -- could see there was more hope than substance to any talk of cures. And that is not even commenting on the fact that the treatment is affordable to only a tiny percentage of the sick.

There have been no bombshells dropped in Geneva this year. The combination therapies or "cocktails" continue to be very effective for those who can afford them but the street talk is that they most definitely do not represent a cure. The virus is not eradicated by them. Anthony Faucci of the National Institutes of Health reported that in HIV patients who tested having "undetectable" levels of the virus, he was always able to detect the virus with a newly developed, more sensitive test.

Moreover, side effects and failures seem to be increasing, although the hope is that new therapies will develop as the virus continues to mutate into more resistant forms.

That word "hope" is bandied about everywhere here. It even creeps into the theme of this conference's official art exhibit: AIDS Worlds: Between Resignation and Hope. Although the exhibit, staged at the Centre d'Art Contemporain, is many times better than the Vancouver show, its own effort to comment intelligently on AIDS gets sucked into the very attitude it should be fighting.

For one has to ask: Resignation to what? The answer, of course, is death. And the hope is for a cure, or life. Between the two extremes, says all of the literature for the show, are people on combination therapies, no longer sure they will die but not sure they will live either.

But hope does not seem to me to be a very useful way of approaching AIDS, or anything else, for that matter. It is hope, not death, that causes suffering. It is the continual expectation that things be different than they are when we are unable to control them. Hope's opposite is indeed resignation -- the despair that arises when hope, which is always a fantasy, is dashed. Living in hope always invites despair, for the end of any life is death and the seasons of the psyche oscillate between melancholy and happiness, no matter how distant our fate. When we are in hope, we are actually preoccupied with our pending loss.

The actual work in the AIDS World show seems mainly objective to me on this score. One shock of the show, before you even get well into it, is to suddenly realize that nobody is much making art about AIDS anymore. Indeed much of the work in this show could be about any condition that gives rise to considerations of life's grand themes: love, death, sexuality, despair, remembrance.

And the second thing you do notice is that the suffering body has been subtracted from most of the work here. I don't recall seeing a single deathbed image, or any other impressions of people in the end stage of AIDS, in this show. Although you could argue that this abstracts the disease, it seems to me to reverse a cliché that in reality is now misrepresentative. On the other hand, you don't see any propaganda-like images of gay boys made muscular by protease inhibitors and steroids, either (except in a couple of parodies of drug company ads). Many combine the erotic and the melancholic, reminding us -- whether we are HIV-positive or not -- that sex and death are related initiations into the mysteries of life.

One section of the exhibit, titled "The Garden/The Wicked Garden," actually seeks to almost completely abstract the disease. It is a disturbing reminder of how objects in life carry all kinds of emotional resonances. Even though the human form is absent from most of the work here, you feel yourself drenched in melancholy and nostalgia -- looking at an enormous faux-emerald necklace that reminds you of a drag queen's jewelry or, perhaps, something your mother wore when you were a child, dazzling and huge to your young eyes. There is a quilt stitched together from photographs of flowers, reminding you of the AIDS quilt, but, again, of the close relationship between death and the rejuvenant.

The most remarkable and political work in the show, actually the product of a performance piece, is by Fernando Arias. It features the words "Happy Hour" rendered in white neon. The words are laid on opposite sides of one of those three-level platforms on which Olympic winners stand. On one side is a cocktail glass full of sperm sealed into a silver cup, so that it looks like a pill. On the opposite is an identical construction containing blood. In the center, in the winner's place, is a silver cocktail shaker. A device ticks menacingly nearby, and somewhere out of the darkness, the song "Happy Birthday" is hummed every few moments.

It is a chilling piece, full of dark irony and visceral confrontation. Still, like the hope the exhibit attempts to simulate and stimulate, happiness is another dubious goal. Indeed, the cocktail's effectiveness for the time being may be no more than a "happy hour" that will soon end, but do we ever have more than that? I am left wondering, really, by this exhibit and the conference itself, if our desire is to truly bridge the gap to one another's suffering or to extend the sunny promise of meaningless hope. Again, hope for what? An improvement in Third World economies sufficient to buy drug therapies?

Yes, where AIDS is concerned, money really can buy a modicum of happiness. Thus, hope here is at heart a financial principle. As the governments and banks of the world are quite unprepared to finance a full assault on AIDS, it ought to be clear that hope is completely beside the point.

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