Panel: Death, Memory, and Transformation

Adriana Garriga López

This paper will examine the intersections and manifestations in American media of a social imaginary of hypodermic needles as a basis for discussion of the place and location of needles, IV drug use, AIDS, and racism in depictions of infected and/or diseased bodies. Although most of my search for the documentation of an "originary" moment at which the use of hypodermic needles and syringes became a common and regular medical practice yielded ambiguous information, most biographical records of Edward Jenner’s development of the smallpox vaccine trace his first use of inoculation to 1796.

Jenner’s vaccination (named after the Latin Vacca, meaning cow,) his developments, and others’ subsequent successes with the technique, established and popularized a medical practice of invasion of the patient’s body through the use of surgical "lancets," needles, and syringes. Needles, spawned by the medical industry and later codified as objects of vice and instruments of destructive identity through their connection to drug use, resist categorization as life saving implements in the struggle to overcome AIDS infection and HIV spread. This is because they are too closely bound up within the criminalization and stigmatization of drug use, and because HIV is incorporated into the space of a social imaginary of territories of addiction, (as though it belongs there, as though it has always been there). As such this paper is also concerned with the development of the hypodermic needle as medical implement and how it comes to be appropriated for other uses and significations.

The classed, gendered and racialized position of AIDS positive bodies is the central theme of this paper, yet it is the construction and representation of an imagined infectious identity through the metaphors of disease, illness, and death which are the main concerns. Representations of "African AIDS," for example, are discussed as containers for a dynamic narrative racism that depicts disease, foregoing accountability, and casts the dying body as disruptive element of the body politic. The medical gaze is intrinsic here in its orchestrated performance of violence. The Western toolbox for measuring, assessing and quantifying the epidemic in Africa casually ignores the circumstances of poverty and lack of resources and information which leads to the spread of HIV, and in which the rest of the world is implicated.

During the 18^th century, medicine was practiced on the basis of an understanding of the sick body as a system out of balance. Susan Sontag argues, in her influential book Illness as Metaphor (1978) that

Metaphors of the body’s interiority were all that was available for the 18^th century medical practitioner. In many ways, metaphors of that same interiority are the basis of modern medicine. They are simply based on more compartmentalized constructions of the body that portray disease through the use of imaging technology and other ways of representing an internal space which has become the primary indicator of health. Without the intrusions to the interiors of sick bodies we are so accustomed to today in American culture, the physician had to decipher the treatment needed by eliciting proof from the inside of the body. Rosenberg’s (1987) description of medicine in the 18^th century describes a system that relied upon an understanding of the body as a system for the negotiation of balance amongst its multiple elements. In his book, The Care of Strangers: The Rise of America’s Hospital System, Rosenberg states:

The attending physician would observe the patient and take notice of the appearance of the tongue, the excretion of blood or other bodily fluids, the relative state of heat or lack of heat of the body, and the qualities of the blood pulse. Allen Feldman (1991) suggests that torture is likewise a forced truth telling inflicted through the extraction of bodily evidence and performed through violence. According to Edith Wharton’s book The Touchstone (1991) the confession or testimony extracted through the torture of domestic employees of an accused person in ancient Greek culture was considered proof enough to condemn them. These violent extractions of an interior truth locate the source of knowledge within the body; a hidden reserve of existential veracity. Foucault (1978) further specifies this type of truth-telling through his drawing of a metaphoric diagram of the confessional in which the confessor provides entry into his/her sinful self and through which the truth of human sin is then revealed in order to gain absolution.

Early 14^th century French medical treatises indicate the use of needles to suture open skin wounds, much in the same way they are still used today. Yet, in the pre-hypodermic age cutting into the sick body was painful, extremely dangerous without the existence of anti-septics, and considered unnecessary in all but the most desperate of medical cases. Observable manifestations of disease within the body were not yet the chief modality of interpreting disease and illness. In fact, the very notion of a "diagnosis" or identification of a specific "disease" or pathogenic agent only appears after the laboratory and post-mortem analysis of sick bodies becomes routine protocol. Then the penetration of the medical gaze into the interior of the patient allows for the identification of specific relationships between symptoms exhibited or expressed by the patient, and the physically identifiable manifestations of disease within the human body (Rosenberg 1987). In any case, I am interested in these developing historic understandings of the hypodermic needle for how they might prove significant in the development of a professional and social imaginary of needles and their usage as medical instruments in the United States.

Hypodermic needles are interesting because they come to function as the gatekeepers of the human body for a medicine subservient to its spatial boundaries, and a developing medical practice which looks to insert itself inside the body, under the skin, in order to localize the illness. Most people in the contemporary American health industry (practitioners and patients alike) have come to see this access to the bodily interior as a necessary institutionalized gaze, one that must reach inside the sick body in the interest of medical recognition and the treatment of the diagnosed disease. Before the age of sterile biomedicine this would have seemed dangerous to the point of being futile in the face of the probabilities for infection and of mortality. Contemporary biomedicine considers the technologies of blood testing, surgery, vaccination, and x-ray photography (to name a few) as integral to the identification of disease, and the recomposition of a healthy body. The development of sterile surgical practices and instrument sterilization became then the impetus behind the popularization of the hypodermic needle, making it the foremost tool for the analysis of blood and the preferred mode of manipulation of subcutaneous mass.

The above advertisement, paid for by the organization Partnership for a Drug Free America, features a woman with white skin, downcast eyes, and torn clothing. The text informs us that she is "positive" for the HIV virus, and that she was once, both, an entrepreneur, and a heroin addict. This appears to be an advertisement directed at a young (mid 20's to mid 30's) audience, preoccupied with material security and a healthy body. Its message seeks to warn them of the dangers of heroin use, yet the descriptive text instills that warning via the positioning of "Stacy's" body as a diseased one. An HIV positive body dependent on heroin.

Why would this work as an anti-drug advertisement? What is it about this image, and its captions, which the people at the publicity department of the Partnership for a Drug Free America think will help steer people away from the use of heroin? How do the circumstances or presence of prejudice, racism, and classism inform the consideration of this advertisement as a successful tool for drug use prevention and/or intervention?

These questions are based on a reading of the woman's ("Stacy's") body as a metaphor for the intersections of cultural discourses on drug use, AIDS, and HIV. We, (members of an assumed HIV negative audience,) are supposed to look upon that body as a text that narrates for us its arrival to an HIV-positive status. Then, we must interpret its meaning as an HIV positive body as an admonition to stay away from heroin. The advertisement’s textual argument is couched in the cultural mytho-historical libretto of "Dismantled Dreams." The story of a good, young, healthy entrepreneur who falls in with the wrong crowd and gets addicted to heroin, subsequently becoming infected with the HIV virus. It is a cultural narrative we are quite familiar with. But, what are the implications of this narrative when it becomes displaced and estranged from the reality of HIV transmission by the practice of sharing needles? How is it then projected upon the image of the drug user as failed citizen, as disruptive element of the body politic, and as polluted and polluting body? And, how is AIDS incorporated into the ability of heroin to "let you escape"?

This last point in particular seems somewhat confused within the context of the advertisement. Particularly with the use of the phrase "heroin lets you escape" in conjunction to the altered sense of normalcy which "Stacy" describes as part of the heroin addiction. Here the relevance of AIDS to heroin use is not that heroin use can directly cause us to become HIV positive, but that transgressing upon the limits of acceptable social behavior, (for example, using heroin), guarantees a deviation from our assumed moral positioning in the dominant social logic. The relevance of infection is that, as heroin user, one becomes susceptible to the social influences of AIDS, and enters into the liminal space of drugs and addiction. Before heroin, when we were 'clean', we were removed from the possibility of infection by our positionality as a non-addict or non-user within the moral economy of American culture. The connection between "Stacy's" HIV status, and the purported "escape" which heroin supposedly facilitates, lies perhaps in a moral transgression of and imaginary remove from a social norm. Her body, having moved away from 'normalcy', from its productivity as "entrepreneur," through the use of heroin, enters now into a pathologic space of disease controlled by addiction and mediated through the needle and the syringe. Once her body has been absolved through rehabilitation it is appropriated as the tool with which the Partnership for a Drug Free America will relay its message to the Sunday New York Times readership. But the presence of the pathogen has not disappeared. Her body remains marked and scarred (and now publicly displayed,) as a reminder to those of "us" still "healthy" and drug-free that we should stay that way, lest we find our dreams shattered and our bodies polluted by our participation in heroin's moral escapism.

Images of HIV positive and AIDS infected bodies in American media are always presented within a logic of accusation and moral condemnation. Whether they seek to disrupt the notion of the "dying" AIDS patient, in favor of representations that show the person living with AIDS as thriving and happy, or not, images of AIDS are necessarily interpreted by the historical consciousness within the context of its 'original' identifications and its socio-medical history. Homosexuals and intravenous drug users are consistently posited as those at highest risk of infection, although current information clearly shows that heterosexual women of color are instead the occupants of that statistical category. In this way, representations of AIDS infected bodies, and those of gay male bodies, have become conflated in their reference to a diseased identity which, if not already infected with AIDS, is always potentially soon-to-be-infected and dying. This may provide some clues as to the violent potential of AIDS imagery, of its interpretations, and of its use. In a story published in The Rutgers Daily Targum on September 28^th of 1998 ("Model to sue for being made AIDS poster boy"), Paul V. Facchina explains that he is suing the Mutual Benefits Corporation for their use of his image in advertisements geared towards the marketing of life insurance policies (providing to and buying insurance death benefits from) gay men with AIDS. His attorneys state that Mr. Facchina:

This emphatic assertion of homosexuality as not within the scope of possibility for the young Italian model is based on the rationalization of stereotypical notions of gender and ethnic identity, as well as the conflation of homosexuality and HIV positive status. His defense assumes that it is common knowledge that gay men, should they exist at all, are not accepted within Italian families, and much less would there be any HIV positive gay Italian males! This ‘impossibility’ is in turn naturalized so as to justify the legal claim of the model on the use of his image. In this case, it is not only gender identity, but also racial and ethnic identity, which is used as an authorizing claim to a Self which is not pathological, and which precludes the possibility of HIV infection.

Facchina's claim is that his image was placed in an untruthful context; in a space where his "clean" identity was compromised by the purpose for which his image was used. Facchina is suing the company because he claims that his image was published without his consent in various media geared towards gay men, and that the ad "implied he was a gay man dying of AIDS." This would presume that there exists a particular context within which the image of his body could be placed so that it would be "read" as pathological, and/or diseased. In effect, what Mr. Facchina's moral indignation at the potential readings of his body as pathological show is the very prejudice and stigmatization which he claims to be avoiding. It is not HIS prejudice to counter with. And yet, the experience of being casually cast into that stigmatized identity has not allowed him to view gay men, much less gay men living with AIDS, from a positive perspective which includes a diversity of experience and identity. On the contrary, his reaction is one of desperate moral panic. He must get the company to formally concede that his identity has been misconstrued by the removal of his image from its normative context, and its subsequent insertion into a pathogenic space. The model's self image was then (according to him) assaulted by the violence of the misrepresentation, which then results in his attempt at reclaiming his heterosexual HIV negative identity through a legitimization of it by the judicial system. In this case, the courtroom becomes the arena where boundaries are re-drawn and difference is re-established in order to produce and re-assert identity. And yet, the Other is within. It is has been allowed access to the metaphoric body through a diseased contextualization.

The Other as virus and the virus as Other have entered into the image of the body, even if the body has removed or attempts to remove itself from the infectious spaces. For instance, Stacy's body, in its identity as "recovering" from the addiction, makes for an appropriate medium through which to market abstinence from drugs. It is now useful as a strategic signifier bought by financial conglomerates that threaten us with the certainty of becoming pathological subjects should we be deviant enough to inject heroin. Should we defy this logic of accusation we will face the inevitable consequence of the marking of our bodies and social personalities as polluted and as Other.

There is an apparent particularity with heroin, however, which sets it apart from other drugs and addictions. Although nearly all addictions are at least in part the result of some process of alteration of the body's functioning, heroin, whose dark mystique and allure has been celebrated in the media by films such as Trainspotting, Sid and Nancy, and Pulp Fiction, is that drug imagined to be the most invasive to the corporal topography of "health". Other drugs taken intravenously are capable of garnering the same perception of the body as mutilated, invaded, corrupted, and/or ruptured, but it is heroin, along with the economic, political, and social characterizations of its users, which instills the most terror and provokes a moral outrage.

Injection is a violence done unto the body which begins at the surface of the skin, and which gains us access to the bloodstream from the outside of the body. It is a widely used and extremely common practice for doctors, nurses, and other state sanctioned medical technicians whose purpose it is to regulate the sick or disruptive body and re-assimilate it to "health" and to the proper functioning of its elements and processes. Needles, as well as the act of injection, do not carry a negative connotation for the body of the recipient within this medical context. Yet, in the landscape of addiction, needles are instruments for the corrosion of the civilized body, and they metamorphose the contours of the injected body into a space on which morality is wasted, where there is no high ground for the imperatives of moral citizenship.

Public and political positions on needle exchange programs for drug users reflect the dichotomous semantic personality of needles. In an article in The Daily Targum on October 9^th of 1998 ("AIDS panel supports needle exchange"), the Governor of New Jersey, Christine Todd Whitman, is quoted as saying that:

It seems absurd that a strategy which has proved effective elsewhere in the prevention and containment of the spread of HIV (needle exchange programs) is deemed unlawful on the grounds of the "message" it may send to "New Jersey's children." The tactical invocation of children as the prototypical "innocent" receptors of culture and society legitimizes the negation of life saving measures for a growing sector of the population. It is no accident that this stubborn moralist reaction serves to undermine the well-being of disruptive bodies.

Everyone knows heroin users are all poor, urban, Black or Latino, and lacking in moral strength. So why should we give our kids the message that injecting drugs is okay in order to save the lives of these misfits? Of course, the problem with this attitude is that it negates the suffering of those "children of New Jersey" whose lives are very deeply affected by the presence of HIV and AIDS in their communities. These children are rarely spoken of or invoked when moral imperatives against needle exchange programs are used because they are inhabitants of criminalized culture-spaces, as well as containers of pathogenic identity. This diseased identity places them at a socio-political disadvantage vis-à-vis the innocent faces of white suburban middle class children. Their social location, then, is an agent of their stigmatization. The rhetoric of those who oppose needle exchange programs, like Gov. Whitman, seeks to protect the lives of "normal" people; people whose realities are barely affected by things such as drug addiction and/or AIDS. These untainted realities must be protected from the invasion of immorality and disease that the drug user and the HIV positive person represent for a cultural economy of morality and health. Would these "normal" people, and their children in particular, be any more likely to use intravenous drugs in their lifetime if needle exchange programs were legalized? The ''wrong message" defense presumes that, should this happen, an entire generation would rush out into the streets in search of hypodermics and drugs. The irony is that those children deemed to be within this categorical normalcy are part of the fastest growing sector in heroin addiction statistics. More white, middle class, suburban kids use heroin today than was ever imagined probable.

Needles, codified as objects of vice and instruments of destructive identity, resist categorization as life saving implements in the struggle to overcome AIDS infection and HIV spread. AIDS then becomes normalized in its representation as a "natural" presence within these "high risk" areas. The people living within these would-be endemic environments for AIDS are then marked as being responsible for their own pollution, as though the immorality of their spatial and cultural identity had induced the presence of the disease. In turn, this posits an opposite category of "Us", an always removed and ambiguous "We" who are thus not responsible for providing cures or prevention alternatives.

Throughout its various representations in American media, AIDS brings to the forefront a mixture of issues that have to do with notions of pollution and polluted identities. The violence, psychic, emotional, or even physical done unto HIV positive bodies is a matter of course in the everyday representations of HIV and AIDS. It is imagery that is used to serve the purposes of all sort of initiatives that are always bound up within the racial, gendered, and classed frameworks of American identity formation.