M ost of us probably think that, after all those high school health classes, magazine articles, and brochures dropped into our mailboxes by various campus groups, we know how AIDS is transmitted and how to reduce our risk of contracting the virus. Peter Duesberg, an illustrious professor of molecular and cellular biology at the University of California at Berkeley, would beg to differ. The first to discover a cancer-related gene, Duesberg also claims that HIV does not lead to AIDS and that AIDS is caused differently in different groups and regions. For instance, Duesberg holds that AIDS in America and other wealthy nations results from heavy drug use, while in Africa it results from malnutrition and such indigenous dangers as intestinal parasites. In addition, since he does not believe that AIDS is infectious, Duesberg proposes that screening blood products for HIV is a useless endeavor and creates unnecessary fear among blood donors and recipients. This extraordinary and unlikely stance has sent waves of amazement and anger through scientific and non-scientific communities alike.
Duesberg brings to mind certain Christian fundamentalist groups that, despite overwhelming evidence to the contrary, still view AIDS as a specifically gay disease. His stance is reminiscent of the attitude of blood banks in the early and mid 1980s, which refused to believe that HIV could be transmitted through blood even as hemophiliacs and other transfusion recipients lay dying from AIDS. Most of all, Duesberg reminds us that, more than 15 years after the first appearance of a mysterious cluster of symptoms in gay American men, and despite the millions of dollars poured into research against the disease, denial and blame still run rampant when it comes to AIDS.
As another World AIDS day comes and goes and AIDS sinks further into the realm of "old news," we are left with a set of questions. How is it possible that despite health education and a barrage of publicity, seven Massachusetts residents are newly infected with the virus each day? How did Duesberg arrive at his fantastical claim? If we are certain about routes of HIV transmission, why has Duesberg received such extensive media coverage? Finally, why do some support the Christian fundamentalist cry that AIDS is punishment for homosexual sin, when we know that AIDS is a disease that strikes according not to an individual's character but an individual's behavior? We have the knowledge--the disease cannot thus far be cured, nor is it well understood, but neither is it the complete mystery it once was. Yet this knowledge has not served us as we would expect.
Rationally speaking, having unprotected sex without knowing a partner's sexual history is as reckless as riding a motorcycle down a highway with no helmet--luck may or may not be on our side. But in practical terms, we view the two entirely differently. Somehow, because it feels dangerous to fly along an asphalt strip in the open air, because a certain flutter in the gut reminds us that a crash could be just ahead, most people wear helmets. The thrill of danger remains, but the danger itself is vastly reduced.
Though both might be equally risky, the threat of AIDS does not induce the spine-tingling, bodily fear of an unprotected motorcycle spin. Because AIDS takes years to strike following infection, its danger lacks the immediacy of the asphalt. What's more, AIDS is not as observably horrible as diseases like the plague or smallpox, whose victims and carriers always display the ravages of their illness. The danger posed by AIDS is most often experienced only at a distance, and not at the profound, intimate level where knowledge is felt irresistibly. Instead of driving people, out of fear, to protect themselves, AIDS is rationalized and pushed away; its dangers are denied both immediacy and reality.
Furthermore, most people's knowledge of AIDS is purely intellectual: each can repeat what she has heard in class about the mechanics of AIDS' transmission. She might score a perfect 10 on a quiz, carefully circling all the correct answers. Such an understanding is somewhat akin to knowing one's multiplication tables or having memorized the periodic table of elements: while it shouldn't be dismissed, it just isn't always enough.
Remembering that a helium atom has two electrons while a hydrogen atom has only one constitutes a different sort of knowledge from the type that prompts one to bolt out of the way of an oncoming car or don a helmet while riding a motorcycle. The former endows us with the "right" answers and gets us an "A" in a class. The latter governs our day-to-day reactions and saves our lives. Our brain controls the former, our gut the latter. The problem AIDS presents is that it should fall into the "gut" category, but instead winds up being understood intellectually--at a distance. The brain repeats again and again that AIDS strikes indiscriminately, that anyone is at risk. But the gut rejects that claim, and the cycle of denial continues.
Denial is admittedly a natural response to trauma, and few would disagree that AIDS has been one of the greatest traumas of recent years. AIDS challenged blood banks that lacked a screening system which might have reduced the number of victims of tainted blood transfusions. It challenged the gay community from within and from without, and forced physicians to acknowledge that here was a disease they could not puzzle out, a disease with horrific symptoms and no foreseeable cure. AIDS revolutionized attitudes toward sex, making the "free love" of the sixties and seventies a distant memory. Each of these challenges fundamentally altered American society, and each deserves to be studied in its own right. But it suffices to say here that the types of challenges initially presented by AIDS were both extremely varied and, in many cases, unprecedented. The changes forced on America by AIDS proved too much to take in all at once. Denial set in, coupled with blame directed at groups believed responsible for spreading the virus.
These are predictable reactions--few would reject the proposition that denial can rear its head on a national as well as an individual level, and that AIDS provided prime breeding ground for such denial. Yet denial ordinarily fades and is replaced, eventually, by acceptance. Today, as promising new treatments come to the fore, as politicians talk more freely about the disease and allocate more funding to research, and as every unit of blood is tested for the virus, one would expect the years of denial to have passed. But although the World Health Organization reports that over 90% of new HIV infections are acquired through heterosexual sex, most mothers continue to worry far more about unplanned pregnancy in their daughters than about HIV. The "nice girls" mentality--"nice girls don't get AIDS"--prevails in spite of obvious evidence to the contrary. And although AIDS threatens us all, many persist in associating the disease with "risk groups" to which they do not belong. We think we know who gets AIDS. And they're not like us. The world may be unfair, we think. But it will be fair to us. While science cannot provide immunity from AIDS, a denial grounded in AIDS' invisibility, its lengthy latency period, and its assault on our most intimate relations, can. And this denial in turn generates crackpot scientific theories that explain the disease away.
Ultimately, the denial that runs rampant through middle-class homes differs little from Duesberg's fantastical claim that AIDS is not infectious and from the Christian fundamentalist's cry that AIDS is punishment for homosexual sin. Ironically, because AIDS falls into the "brain" category and not the "gut" category, it lends itself to outrageous interpretations. Brains have evolved far better denial mechanisms than guts; where a brain thinks, a gut knows. No one argues that chicken pox is not contagious--we know without needing to wonder that exposure often leads to infection. By its very nature, AIDS leaves room for interpretation. And bad interpretations, be they Duesberg's claim that AIDS is not infectious or a young woman's vague sense that she is not at risk, abound.
Although there will always be a few Duesbergs, there is a general solution to this problem of denial: AIDS must be understood on a gut level as well as on an intellectual level. We must somehow learn to react to the threat of AIDS almost as we would to a car veering toward us or to a choking child: with fear and an immediate, protective response. Naturally, the fear must be tempered with reason so we are not living in a state of constant (and unreasonable) panic. But we must feel, as well as know, that there is no guarantee that the world will be fair to us. Only by teaching this to ourselves and to others in a more human and less academic way can we begin to dissolve the wall of denial and blame that continues to shroud the AIDS epidemic.