The state, public policy, and AIDS discourse

Contemporary Crises 13:1-14 (1989) © Kluwer Academic Publishers, Dordrecht - Printed in the Netherlands The state, public policy, and AIDS discourse B A R R Y D. A D A M Dept. of Sociology and Anthropology, Universityof Windsor, Windsor, Ontario, CanadaN9B 3P4 Abstract. The paper probes the "deep structure" of perceptions of AIDS and the ensuing public policy trends. AIDS has become the latest symbol indexing 20th century conflicts over the Iamily and sexuality and recapitulates some features of early debates over contraception and the control of sexually transmitted diseases. From 1981 to 1983, public talk about AIDS was virtually taboo. Since 1983, the massive proliferation of AIDS discourse has led to the development of an "official story" common in the press and clear in the presumptions underlying recent state policies in the United States, Canada, and the United Kingdom. These policies have favored state control of sexual speech and education, as weil as control of people "blamed" for HIV infection, while community-based groups have sought to empower people to affirm their sexuality while avoiding vital transmission. AIDS is something of a "pure case" in the social construction of disease, having arrived as an unknown and unanticipated phenomenon at the site of some of the deepest anxieties of western civilization, namely sex and death. It was not long before this entirely novel entity was being encoded by highly charged rhetorics ready made by traditional debates over disease, sexual control, and homosexuality. Indeed, to make sense of the public debate over AIDS control policy in the 1980s requires a determined "unpacking" of the AIDS languages that have formed since 1981 and a concerted probing into the deeper political forces which have generated conflicting discourses on the issue. The socio-historical milieu AIDS arrived into a highly developed political and ideological arena which gave it meaning and a "place" on the historical stage. The late 1970s and 1980s, at least in the United States, the United Kingdom, and Canada, has been a period of conflict over the (dis)establishment of the nuclear family and the rights of people to take up new domestic and sexual arrangements outside the purview of patriarchal authority (Adam 1987). This might be understood in the broad historical sweep as an element in a larger process which has been underway for several centuries where the toleration of religious and political diversity has developed in opposition to church and state orthodoxies. Sexual debates are inheritors of older struggles which eventually disestablished state religions by redefining religious beliefs and practices as personal or private confessions. As weil, they are the beneficiaries of the historical development of public and secular worlds supportive of norms of freedom of conscience, speech, and political pluralism. The erotic and intimate realms now seem to be the contested terrain of disputes between church- and state-sanctioned orthodoxies and the toleration or, even celebration, of single or multiple parenthood, gay and lesbian households, and fertility controlled by women. In this view, AIDS "dropped into" the latest frontier of a profound historical change and so quickly came to bear a cosmological significance which other diseases escape. Against any liberal, progressivist reading of these trends may be set the caveats presented by the work of Michel Foucault. A core theme in his work, not only in The History of Sexuality, but perhaps even moreso in The Birth of the Clinic and Discipline and Punish, is how "dark continents" of existence have been brought forward, massaged, shaped, and ultimately controlled by their articulation in discourse. In The History of Sexuality, Foucault (1978:11) wants "to define the regime of power-knowledge-pleasure that sustains the discourse on human sexuality in our part of the world" and questions why sex is made to speak in the modern era and how it is carved into taxonomies of ostensibly discrete categories of perversity and normality. Talk about sexuality has always been much more than a simple contest between "liberation" and "control", for the contest itself rises out of a deeper political play which constructs, produces, and disciplines the parameters of the debate and the use and meaning of sexuality. In Discipline and Punish, he notes how liberal reform movements participated in the larger disciplinary trends of the early nineteenth century where they ultimately "set up a new 'economy' of power to p u n i s h . . , so that it should be distributed in homogeneous circuits capable of operating everywhere, in a continuous way, down to the finest grain of the social body" (Foucault 1979:80). The result has been the panoptic eye of the efficient jailer which both suppresses and "produces domains of objects and rituals of truth (Foucault 1979:194; 1980). It is probably fair to say that no one objects to the control and eradication of the causative agent(s) of AIDS, but AIDS control policy has always been much more and has inevitably raised the question of the supervision and regulation of sexuality. AIDS has ushered in a further development of sexual speech which cannot but partake of the larger twentieth-century "obsession" with sexuality and its colonization by the professions, the media, and the state. Moving beyond Foucault's parameters, conflicts over the "ownership" of the issue of AIDS raise again fundamental questions of feminism and gay liberation, in particular, who controls whose bodies? 3 Joseph Gusfield's classic study of Prohibition pointed out that social issues such as drinking are rarely fought out on their practical or intrinsic merits whatever they may be - but as symbols of much larger and more difficult social changes. Gusfield showed that temperance debates were fueled by the much bigger concerns which the antagonists perceived to be at stake. "Armed with the response of indignation at their declining social position, the adherents of Temperance sought a symbolic victory through legislation which, even if it failed to regulate drinking, did indicate whose morality was publicly dominant" (Gusfield 1963:111). In particular, Gusfield identifies the status anxiety of the small-town, American Protestants faced with increasing numbers of immigrants, Catholics, and minorities as the motor behind Prohibition. The AIDS control debates, too, are indecipherable without recognition of their symbolic value for certain social constituencies. AIDS recapitulates aspects of other twentieth-century campaigns and debates around family, sex, and gender. Like earlier struggles over contraception, and more recent ones over abortion, the Equal Rights Amendment, and gay rights, many read AIDS control policy as a sign of the direction of larger historical forces. As Dennis Altman (1986:28) points out, AIDS appeared at a particular moment in a particular society and these contingencies have shaped the career of the syndrome. It was first identified in the one western nation without universal health care during a government administration determined to cut spending on social programs. It appeared among homosexual men, Haitians, and drug users during an official retreat from the policy of protecting the rights of minorities. And AIDS appeared when the Christian right was ascendant with a program of traditional moralism and an ideological mold which had had a "dry run" with herpes and was easily adaptable to the new affliction. Adventures of the discourse To cite Gusfield (1981:53) again from an entirely different context, AIDS is very much the story of how "uncertain, inconsistent, and inaccurate" knowledge is "fashioned into a public system of certain and consistent knowledge in ways which heighten its believability and its dramatic impact." AIDS has been made to fit the contours of the sexual politics of the 1980s and has been channelled into ready-made ideological ruts which have resulted in a "public system of certain and consistent" categories impelling public policy. In the short history of the syndrome may be discerned three stages in the institutionalization of the "strange virus of unknown origin". From 1981 to 1983, AIDS was guarded in silence by taboos which forbade talk about sex, especially about the "exotic" sex practices of gay men and about the stigmatized people it afflicted - again homosexuals, but also intravenous drug users and Haitians, who for the most part, are poor black people. Only a few medical researchers and gay people, seeing their friends and neighbors rapidly waste away until death anxiously discussed the new disease, but weil outside the mainstream press. AIDS was made to speak from 1983 with the identification of higher status, more "respectable" and "innocent" victims of the disease, namely, children, people who had received blood transfusions, and in 1985, the popular Hollywood actor, Rock Hudson (Adam 1987). The breaking of the silence around AIDS punctured a logjam which led to an inundation of speculation, terror, "facts," and "experts." Still, there remained important repressions and silences around AIDS; the parameters of the spoken and the unspoken had shifted with new patterns of elision and separation encoding the new phenomenon. It is this AIDS discourse which occupies this section of the article. The "third stage" emerging in the mid-1980s of state financial and legislative control of AIDS issues will take up the next section. There is much to be learned from the history of contraception for understanding AIDS discourse. The most direct parallel involves conflicts over the implications of the use of condoms, but both issues raise again questions over the separation of sex from reproduction and of the right of people such as women, youth, and homosexuals to make their own sexual choices. As Linda Gordon points out, both suffragists and their opponents, and both the political left and the right, agreed on the immorality of condoms through much of the nineteenth century. But in the first decades of the twentieth century, the popular interest in contraception overcame the suffragist opposition to it, which rested on the "fear of the other women - 'fallen women' - who might undermine husbands' fidelity" (Gordon 1976:98). The women's movement along with progressives of the day, swung around to the view that contraception was a fundamental right of women to control their bodies and their fertility. By the 1970s and 1980s, contraception had few effective opponents. The debate had relocated onto abortion. For traditionalists, abortion, like contraception before it, was yet another sign of the decline of the nuclear family because it allowed the escape of sex from family control, it released women from the obligations of motherhood and into the labor market, it permitted men to have sex while avoiding the responsibilities of family, and it let sex "leak away" from the family to youth and to people who might stay unmarried, become "loose" or "bad" women, or prefer homosexual relationships. The conservative position, then, has typically resisted contraceptive technology and abortion in order to conscript sex for the family, naming abstinence as the only acceptable alternative. This framework was employed during the 1910s and 1920s when public authorities in the United States became alarmed by the rising rates of sexually transmitted diseases (STDs) especially among soldiers (Brandt 1985). Public health authorities expended a great deal of energy and money attempting to counsel men to remain chaste and in closing down "red light" districts across the United States. The results were ever-increasing rates of syphilis and gonorrhea. Infection rates were not brought down until the implementation of quite another policy by the federal government in the 1930s - and this was accomplished in the days before penicillin. The new policy abandoned the daunting task of trying to make sex unpopular in favor of a more practical approach of making condoms readily available and instructing men in their use. By separating the issue of infection (basically a question of placing a barrier between oneself and the infectious agent) from the question of sexuality, significant headway was made in controlling disease. It is noteworthy that in the United States and Canada, prophylactic means were given only to men and not to army women, that anti-STD campaigns were conceived solely from the male viewpoint complete with warning posters identifying women of bad morals as the source of disease, and the "clean-up" campaigns arrested women of "bad character" such as prostitutes and not male soldiers who were apparently held blameless in their spread (Gordon 1976:358; Kinsman 1987:110). This "democratization" of sexual information and technique from the educated classes to heterosexual men in general has yet to extend rauch farther and many of the sharpest debates today center around the distribution of information and technique to gay men and lesbians, youth, and to a lesser extent, women. Prohibitions against contraceptive information, which largely gave way in the postwar period, have been displaced by a censorship regime applied to safe sex (examined further below). The upshot today is an AIDS discourse which recapitulates many of the themes and linkages of contraception, abortion, and STD policies. What has emerged is a closed rhetorical system which might be typified by the following suppositions: - AIDS is an invariably fatal disease caused by the AIDS virus. - AIDS can be contracted by having sex with an AIDS carrier. - AIDS control, then, means finding out who the AIDS carriers are and stopping their irresponsible sexual behavior. Limiting sex to the traditional family is the most effective means of limiting the spread of AIDS. From these articles of faith follow a number of moral and policy positions which Simon Watney (1987:124) has called the "discourse of punitive fidelity". The media and the state frequently repose the "chastity-or-family" choice (sometimes qualified by "if you must, use condoms") with obituaries on the putative "sexual revolution" of the 1960s and claims of a "return to family values". In reviewing some very expensive television advertisements funded by the Canadian government and produced the by Canadian Public Health Association, Guy Poirier (1987:8) remarked that the ads presented: - straight white y u p p i e s . . , featuring a heterosexual couple and their children flaunting their supposed monogamy as the best protection against AIDS . . . [The ads have] less to do with AIDS prevention t h a n . . , with the re-hegemonization of the monogamous heterosexual nuclear family as the only acceptable model for survival in the 1980s. Educational materials have persistently advised first gay men and now the "general public" to avoid "promiscuity" and "reduce the number of sex partners" as the first line of defense against AIDS. From here, it is a short step to a "wages of sin" argument, which has been articulated publicly primarily by the Reagan administration and fundamentalist preachers, where AIDS sufferers are held responsible for their own plight despite the fact that the greatest proportion of them were infected before AIDS was discovered and during the first "silent" years of its history (Bayer 1985:589). Gordon's (1976:171) observations of medical attitudes to contraception in the 1920s ring eerily today: Injuries supposedly caused by contraception, such as venereal disease, were just punishments for s i n . . , condoms degraded love and produced les i o n s , . . . 'God's little allies' in promoting chastity. It was almost as if doctors felt a subconscious satisfaction, a justification, when their patients developed infections. Even when dealt with "sympathetically" by the British media, people with AIDS have been presented as the victims of rejection by gay friends, lovers, and family (and not by governments, hospitals, and employers) and have been made to speak as guilty victims of past misdeeds (Watney 1987:124). James Jones' (1987:188) study of United States television drama notes how "sympathetic" portrayals reinforce traditional scenarios: By placing the character within this largely heterosexual situation, the TV dramas create a discourse in which the character becomes the victim. The vietim testifies as to the tragedy set upon him by forces beyond his control. He pleads for understanding and for a c c e p t a n c e . . , hoping for a sympathetic ear. But the position of supplicant reinforces the status quo which maintains a separation between the heterosexual and the homosexual. Jones (1987:196) observes that in stage plays, where gay writers have had some access, "the gay person retains his individual humanity as weil as his membership in the gay community a realm which remains beyond the television screen." In addition to this sex-family complex, AIDS discourse is thoroughly riven 7 by a fundamental structural opposition between guilt and innocence, a signification inextricably connected with self and other, and with power and powerlessness. 1 As Jonathan Elford (1987:545) writes, and has been widely noted elsewhere (Altman 1986:25; Watney 1987:33; Herdt 1987:1), "disease transmission was orten described as being from the culpable (gay men) to the blameless (women, haemophiliacs, recipients of blood transfusions) a n d . . . scant attention was paid to the plight of those gay men with the disease." Mapped over this deep structure is a moral/sexual hierarchy, identified by Gayle Rubin (1984:281), which ranges sexual activities and persons on a scale of virtue and vice. This symbolic system is further overlaid by a domino theory of contagion which postulates the disease progressing from the right-side categories to the left (Table 1). The "risk groups" named by the United States Centers for Disease Control (CDC) have been inevitably interpreted against this semiological system. While the risk groups (homosexual men, IV drug users, Haitians, their sexual partners, recipients of blood products) came about as an initial orientation to the early data when the nature of AIDS was entirely unknown, the categories have lived on, even after the epidemiological evidence has provided a clear Table 1. Symbolic substructure of AIDS. Symbolic systems Categories Domino theory Heterosexual men Good women Children Rubin's hierarchy Heterosexual Married Monogamous Procreative Free Coupled In relationship Same generation At home No pornography Bodies only Vanilla Homosexual In sin Promiscuous Nonprocreative For money Alone or in groups Casual Cross-generational In the park Pornography With manufactured objeets SM Deep structure Innocence Self Power Guilt Other Poweflessness Bisexuals Prostitutes Loose women Homosexuals Drug users Africans Haitians 8 profile of a transmissible agent, probably Human Immunodeficiency Virus (HIV), which is semen- and blood-borne. By postulating types of persons instead of routes of transmission, the CDC has given rise to a set of popular ideas which have been purveyed in the media from time to time and repeated back to AIDS information workers. These ideas include: Only homosexuals get AIDS, or Anal sex causes AIDS. (This also has given rise to an odd set of writing on the "strong vagina" and the "weak anus.") The postulation of a Haitian risk group, in particular, masked a largely heterosexual transmission route, and the numbers of heterosexual people with AIDS jumped suddenly when the CDC abolished the Haitian category as a result of protests from Haiti and from Haitians in the United States. This set of symbolic associations has also tended to anchor AIDS perceptions in the "gay plague" complex, where the symbolic constructions of drugs and race have contributed little to the AIDS image and people with AIDS from the nongay risk groups have, in turn, tended to be rendered invisible to both their antagonists and to service agencies who would offer support. With the mid-1980s comparative decline of AIDS among gay men and rise among other groups which include disproportionate numbers of black and hispanic peoples both inside the United States and in the third world, it is an open question whether racial issues will shift the meaning of the syndrome in the future. This discursive system controls and conceals a number of ambiguities, complexities, and alternative interpretations: - AIDS is the name given to the most extreme manifestation of a wide range of immunodeficiency disorders. Weil over ninety-five percent of people who test positive for the HIV-antibody (HIV+) have relatively minor symptoms called AIDS-Related Complex (ARC) or no symptoms at all. Medical debates today turn on the question of whether this pattern is a function of a long incubation period or of variable reactions to the infectious agent. Predictions of how many people who test HIV+ will acquire AIDS range from less than one percent to thirty-five percent to one hundred percent. Despite a clear pattern of transmission established from epidemiological research, there remains a possibility that HIV is not the "cause" of AIDS, at least not the only cause, but is orte of several factors (Duesberg 1987). This casts further doubt on the use of the HIV antibody test as an "AIDS test". - AIDS control, then, is a question of avoiding contact between your bloodstream and the blood or semen of another person, and means providing people with the informational and technical means of doing so. Various options remain open to people. Besides avoiding sex altogether, a range of "safe" or "safer" sex practices remain. Condoms properly used can - - make vaginal and anal sex "safer sex". Research into sexuality and public health suggests that the traditional "family-or-chastity" choice is ineffective in disease control. Besides Brandt's study, rates of teenage and unwanted pregnancy, and rates of marital infidelity point to the ineffectiveness of a policy which has been promoted, after all, for centuries. The stress on monogamy is misleading in that an infected person entering a monogamous relationship will not reduce his or her risk and may endanger the other person. Conversely, safe sex practised with multiple partners should pose little or no risk of infection. These propositions rupture the conflation of sex with STDs and deconstruct sex itself into a range of pleasurable practices thereby separating AIDS out from the grand moral schemes. Taboos against naming and thus acknowledging erotic variation enforce the chastity-or-family choice and guard against migration from sexual orthodoxy by installing a fear of the unknown at the site of the unspoken sensualities. The refusal to speak about safer sex establishes a secure terrain for blanket moralism. The dissemination of sexual how-to information risks disrupting the sex-STD elision by offering people the means to express their own particular sexualities. To draw another analogy from the history of contraception, we might replace the "refusal of motherhood" with the "pursuit of homoeroticism" to see how prepackaged scripts about sex and gender can be revived to do new service for AIDS. In characterizing the position of the opponents to contraception, Gordon (1976:149) remarks: In refusal of motherhood, it seems personal and ideological feminism were joined: women's unnatural and false yearning were threatening the entire race. The state and public policy AIDS thought then has flowed into pre-existing channels structured by a taken-for-granted symbolic universe. Increasingly the practical deconstructionists who would chip away or even upset the discursive edifice have found themselves at the peripheries of a world-view in the process of hegemonization by the state. The strength of AIDS language is not due to imminence, reason, or inevitability, but to concrete political forces. In the mid-1980s, legislative bodies in the United Stares, the United Kingdom, and Canada have been moving to guarantee a particular AIDS story through formal regimes of censorship and through funding the educational agencies which would promote the official story. 10 Most notable in this trend is the 14 October 1987 United Stares congressional ban on the "use of federal funds for educational projects or materials that promote or encourage, directly or indirectly, homosexual sexual activity" (Bul11987:1). That this law is intended to prevent safer-sex information which assesses the danger or safety of various sexual activities, is clear from the debate where Republican congressmen brandished (privately funded) leaflets produced by community-based AIDS organizations and declared them "obscene." In February 1988, the British parliament moved to ban the "promotion" or teaching of the "acceptability of homosexuality as a pretended family relationship" and rescinded the right of rnunicipalities to fund gay-related organizations or projects (Pincus 1988:1). Its own public service announcements stressed AIDS fear and the "just-so" story where family life is the antidote to disease (Watney 1987: epilogue). Pending before the Canadian parliament is a bill which would prevent health educators from: counseling the use of condoms during anal intercourse since all "encouragement" of anal sex is forbidden, whether safe or unsafe; mentioning that masturbation or ejaculation upon a person are safe-sex practices as both are forbidden; pointing out that the use of erotica/pornography is itself a no-risk expression of sexuality as it is banned altogether. The bill forces the accused to establish that any "matter" has "an educational, scientific or medical purpose" thereby potentially subjecting AIDS education organizations to have to justify every publication, communication, and seminar while the courts strike a "balance of probabilities" among the "erotic," "pornographic," "artistic," "educational," and "scientific" aspects of each item. The bill also denies absolutely the educational/scientific/medical defense to sex education material directed to those under the age of eighteen. At the same time, school curricula have been prepared which decry "promiscuity" while remaining mute on safer-sex and which stress the safety of monogamy and the fallibility of condoms (Kinsman 1987:4). British and Canadian Customs have also been inclusive in their interpretation of obscenity: - - - Safe sex guidelines and letters about safe sex experiences are routinely censored from magazines aimed at gay men. Even advertisements for condoms are somehow construed to be depictions of anal intercourse and are therefore blanked out of Canadian editions of some magazines. (Armstrong 1986: 1-2) While censors have consistently suppressed popular and explicit talk about sex in favor of clinical descriptions, AIDS educators strongly suspect that the former literature is rar more widely distributed, more easily understood, and 11 infiuential. They have sought to use it to popularize the safer sex message. Research done by Michael Quadlund and associates (1987) have shown that men shown erotic films featuring safer-sex activities made the greatest changes in their sexual behavior compared to men exposed to other educational techniques. The state, at the same time, suppresses popular forms and texts which disrupt the official story. With the traditionalist script in place, the HIV antibody tes t presents an almost irresistibly attractive technological fix to the AIDS problem. By reconstructing the procedure as an "AIDS test," mandatory HIV-antibody testing and quarantine arise as central tools in AIDS control. The United States president, in his only public address on AIDS, called in 1987 for "mandatory HIV testing for federal prisoners, potential immigrants and possibly for patients in Veterans Administration hospitals." Reagan also suggested that states consider routine testing for "marriage license applicants and state and local prisoners" (Westheimer 1987:1). The United States military was by then already testing all of its members. Colorado authorized quarantine for those who fail to "'cease and desist' [in] behavior believed to be 'dangerous' by public health officials" (Poggi 1987:1). Illinois mandated quarantine of HIV+ people through a court order, as weil as marriage testing, required testing of those convicted of sex and drug offenses, mandatory reporting of HIV+ children to school superintendents, and safe-sex education limited to "preaching abstinence until marriage" (Botkin 1987:3). Minnesota required "forcible testing and quarantine of people who show a 'careless disregard' for the transmission of AIDS" (Halfhil11987:1) and a HIV+ prisoner in that state was convicted of "assault with a deadly weapon" for biting a guard. British Columbia authorized quarantine by order of a medical officer of health (Kinsman 1988:4). In Ottawa, city police issued to the press the name, address, and photograph of a man who came to their attention as HIV+ following a blood donation. He was immediately evicted from his apartment and dismissed from his job. 2 Similar bills have been introduced in other state and provincial legislatures across the United States and Canada. On democracy and social control The major constituency for alternative discourses on AIDS is the communitybased organizations devoted to offering personal and practical support to people with AIDS and to disseminating safer-sex information and techniques. Most of the community groups in North America and the United Kingdom originated in the periods of silence and hysteria about AIDS, and have evolved into alliances of gay and nongay members as increasing numbers of women, blacks, and hispanics have joined, as weil as people with backgrounds in 12 volunteer, medical, and social service work. The community organizations have generally involved a great many people lacking the luxury of believing themselves beyond infection and who, therefore, have found no place for themselves in the traditional discourse which assigns AIDS to the guilty Other. Though by no means unitary in their approaches, the community groups have been central in generating practical and emancipatory understandings of empowering themselvez to resist AIDS. Governments have displayed considerable ambivalence when faced with the community groups. Especially conservative governments, such as British Columbia and Queensland, have denied any public money to community work. Texas preferred having the Houston Institute for Immunological Disorders close, rather than offer it support once its AIDS patients ran out of money for medical care. In other cases, community groups have received "soft money" through government grants, though the sums pale in comparison to funding granted specifically for AIDS to the established public health and social welfare sector which became interested in AIDS with the appearance of government money. Government funding poses new problems for community groups. Safer-sex information must be typically financed from local fundraising and apart from government money. Like the contraception movement before it, AIDS groups experience a "pull" toward the official version of AIDS and face the possibility of redirection. While many early contraception activists went to jail in the early part of the century for distributing how-to information, the movement eventually made a transformation to respectability by shifting focus from "birth control" to "family planning" and by withdrawing information to unmarried people (Gordon 1976:365). Like other community groups before them when faced with the prospect of state funding, AIDS organizations are subject to internal dissension and problems of patronage and cronyism in allocating money. There is no lack of precedent for social and health reformers being displaced or converted into social control agents doing the work of the state. In several major cities, new activist groups in 1987 and 1988 have sprung up to confront public officials on slow drug testing and quarantine legislation. The fundamental issue underlying the AIDS debates of the 1980s is: who has the right to make sexual choices? Traditional conservative forces, whether based in the church, state, or "patriarchy," seem more than a little reluctant to cede the power to be sexual (including homosexual) to the masses, but would rather have it done surreptitiously and have its practitioners "suffer the consequences." The psycho-scenario is familiar to analysts of unwanted pregnancy. Contraception is not used when "it is easier to deal with guilt about sex by viewing one's adventures as one-time-only slips, promptly repented- over and over (Gordon 1976:407). The issue has been run through once in the closing of bathhouses in major cities. While community AIDS groups orten (but not 13 always) saw bathhouses as vehicles for offering safer-sex information and condoms, empowering gay men to make sexual decisions which avoid AIDS transmission, local authorities saw bathhouses as sites of uncontrollable sex and contagion (see Collier 1985). Much of the educational issue has been not just one of talking about sex but also of providing the means for individuals to take control of their sexuality by being able to separate it from reproduction and disease. Framing it in ethical terms, Ronald Bayer, Carol Levine, and Susan Wolf (1986:1769) postulate that "individuals be treated as autonomous agents who have the right to control their own destinies." For community organizations, whose participants are closest to the affliction itself, AIDS control is a question of the most pragmatic and effective means of preserving themselves, their friends, and their community from rapid death without sacrificing erotic bonding. 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