Pariah among Pariahs:
Images of the IV Drug User in the Context of AIDS

Americana: The Journal of American Popular Culture (1900 - present), Spring 2002, Volume 1, Issue 2
http://www.americanpopularculture.com/journal/articles/fall_2002/lensing.htm

Dennis Lensing
University of New Mexico

The instant the camera cuts to a close-up of a spoon, we know what's coming. A dash of powder, white (usually) or brown, a spray of water, a match-head bursting into flame. Powder dissolves in boiling water. Water is soaked up in a tiny wad of cotton. Cotton is sucked dry by a needle. We wince as the needle finds the vein and blood blossoms into the barrel of the syringe. Down goes the plunger, and the camera relents, pulling back to show our antihero's eyes roll back into his (rarely her) head, blissfully, as if to confirm Brian Johnson's assertion that "[s]imulating substance abuse has become a kind of pornography" (par. 7). As a recurring and familiar landmark on the protagonist's journey into addiction, the eroticized image of use stands in stark counterpoint to the dehumanized image of user.

"The Ritual," as many films refer to it, is presented so compulsively and uniformly in filmic depictions of addiction's woes that images of the IV drug user's paraphernalia and the process of fixing have become staples of the drug-movie genre; the art of "works" has entered the age of mechanical reproduction. The Ritual sequence appears, for example, in Sid & Nancy (1986), Drugstore Cowboy (1989), Rush (1991), The Basketball Diaries (1995), Trainspotting (1996), and Requiem for a Dream (2000), just a few of the numerous addiction films of the past three decades. All participate to a greater or lesser degree in what Jonathan White has called "the Addiction Narrative," in which the protagonist "falls" into poverty and desperation as a result of addiction. The story is told over and over; indeed, so common and popular is this particular narrative that we might be tempted now to agree with a commentator in a 1916 edition of Variety when The Devil's Needle was released: "The drug story has been so often sheeted [screened] that there's nothing left to it" (qtd. in von Busack par. 1). Of course, nearly a century has passed since that weary proclamation, and drug use, like everything else, has changed much over the decades. Since the 1960s, the variety of pharmaceuticals available for injection has exploded, as has the range of pleasurable sensations and ill effects they can cause. Perhaps most notably, today's IV drug user (IVDU) has, on top of addiction, withdrawal sickness, impurities, and overdose, the threat of HIV transmission to worry about. In light of this, one of the most remarkable aspects of recent movies featuring IV drug use is the almost complete absence of mention of HIV and AIDS, as though to focus on the addict means necessarily to forget about the person with AIDS.

Of course, many of these films are set in the decades just prior to the AIDS epidemic. However, even those which could address the dangers of HIV avoid mention of the virus. In Requiem for a Dream, for example, almost everything imaginable happens to the four characters as a result of drug use except AIDS: Harry's (Jared Leto) arm is infected and amputated, his mother (Ellen Burstyn) becomes psychotic and undergoes electroshock therapy, Tyrone (Marlon Wayans) is imprisoned, and Marion (Jennifer Connelly) becomes a sex worker to support her coke habit. In a movie obsessed with addiction, abjection, and loss, the absence of HIV is remarkable. In fact, of all recent mainstream drug films, only Trainspotting mentions AIDS at all, and then only in a simplistic manner, in reference to a rather minor character. While Renton (Ewan McGregor), Sick Boy (Jonny Lee Miller), Spud (Ewen Bremner), and Allison (Susan Vidler) all shoot up heroin on a regular basis, and without much visible attention to precautions, they all manage to avoid HIV. Their straight-laced friend Tommy (Kevin McKidd), however, contracts HIV almost immediately upon trying heroin when his engagement falls apart; he proceeds to full-blown AIDS and death with remarkable speed, almost entirely offscreen. In effect, his story serves as a cautionary tale that "good boys" should not dabble; "real users," like the main characters, need not worry — not, at least, about AIDS.

However, it would be a mistake to think that the drug film genre is exceptional in its limited and simplistic portrayal of AIDS. Rather, these movies participate in a system of representation whose remarkable uniformity transcends genre, operating in news reports, scientific studies, activist writings, and novels pertaining to IV drug use and AIDS. Whereas movies dealing with IV drug use consistently elide the realities of HIV, discourse focused on HIV consistently elides or demonizes the IV drug user; these discursive moves are two facets of a single system of marginalization. The AIDS epidemic has been with us now for decades and continues to take a disproportionate toll on gay men, ethnic minorities, and intravenous drug users (IVDUs): meanwhile, media representations have moved far from the first panicky articles and newsclips attempting to get a handle on the "new Black Plague" in the 1980s. The fevered search for a cure and heated exchanges on how best to deal with this new disease have been largely replaced by calm reports of newer, more promising regimens for controlling the syndrome once HIV has been contracted. But from this steady murmur of reassuring news occasionally bursts forth something deemed newsworthy enough to merit more than a few column inches of technical jargon. Unfortunately, these hot stories are reminiscent of earlier times in more than tone; they remind us that, however far we may have come in the treatment of AIDS, we have barely progressed at all in our representations of the disease, or in our popular understanding of how to live in a world with AIDS. The astonishing announcement by Jesse Helms in March 2002 is a case in point. What could be more newsworthy than archconservative Jesse Helms, never afraid to go on record that gay men or IV drug users with AIDS deserved what they got, suddenly proclaiming his shame at not having done more to combat AIDS over the last twenty years? Reading the specifics of this newfound shame, however, one finds that this newsflash is really just the same old story.

Helms's call for government assistance to help stop the spread of AIDS is really quite specific. As has been spelled out in his editorial "We Cannot Turn Away," Helms's shame derives specifically from not helping to combat the transmission of HIV from mothers to infants in Africa. For all his rhetoric of shame and regret, and despite his closing statement that "we cannot turn away when we see our fellow man in need," Helms continues to turn his back on the realities of AIDS and to refuse to see the epidemic in terms of health rather than of morality (Helms par. 10). His new stance on AIDS shows that the same old "us/them" categories are in use, and that some "risk groups" are more deserving than others. In this particular case, African women and babies are posited as the ultimate "innocent victims," while African men, gay men in general, and IV drug users are all consigned to oblivion, presumably because they are in some way to blame for their HIV+ status. In short, Helms's epiphany has much to tell us about how far we have not come in developing our understanding of AIDS. Helms's "conversion" serves as a call for us to reflect upon present realities of AIDS, and upon the roots of the pernicious representations which have helped foster the spread of AIDS.

When attempting to get "the facts about AIDS," one cannot help but encounter the phrase "risk groups," an ubiquitous though misleading phrase, which is at once essential to the understanding of the way AIDS works in the United States and harmful to the understanding of the way HIV works in the human body. Time and again, in article after article, the litany of such "risk groups" has played itself out, naming all those "others" who are deemed likely to be infected: "gay men, Haitians, drug abusers, hemophiliacs, addicts' female sexual partners and their babies" (Shilts 429). That the category "gay man" is invoked first is hardly accidental, since AIDS has from the start been associated with the so-called "gay community," the social group hardest hit by AIDS and most able to respond. As Cindy Patton points out, "It was largely the groups based in gay community traditions which formed the basis of what was to become an AIDS service industry" (12). Other groups, such as sex workers' rights organizations and the National Hemophilia Foundation, later mobilized to represent their communities in various conflicts and crises regarding AIDS, which are often as much about representation as about "reality," as much about images as about resources.

Only one of these "risk groups" has not to any great degree entered the fray: intravenous drug users (IVDUs). As a result, discourse regarding AIDS issues relevant to IVDUs has largely been controlled by members of other groups and has been denied thorough and serious consideration. Although as of March 2002, 57% of all AIDS cases among women and 31% of cases among men have been attributed to injection drug use or sex with partners who inject drugs, it is virtually impossible to locate information specifically about or directed specifically towards IVDUs (CDC par. 4). Rather, a few pages in any given work will mention IVDUs in passing, usually in a series or phrases such as "women, IVDUs, and others with lower incomes" (Christensen 11), "other risk groups such as intravenous drug users or Haitians" (Shilts 232), and so on. In both "fictional" and "nonfictional" discourses of AIDS, IVDUs have been defined and characterized by and for others, with little attention paid to the actual situations and needs of IVDUs themselves.

Before addressing the unpleasant social realities and inaccurate representations of life as an HIV+ IVDU, one must recognize that identity as an IVDU is no more clearcut than identity based on social constructs such as race or sexual orientation. The idea that shooting up once makes one a "junky" is no less absurd than the notion that any man who has had a sexual experience with another man suddenly "is" (or "reveals himself to be") gay. The myth of either/or categorization regarding drug use has been fostered by decades of the "War on Drugs" and its propaganda, often assisted by popular culture representations of addiction, and it grossly distorts the realities of drug use and addiction, erasing all distinctions between the various drugs and between habitual and non-habitual use. Although studies of "risk groups" and how they function to control discourse about AIDS are essential, it is necessary at the same time to keep in mind the fictional, oversimplifying nature of all such "identities" and "communities" based on race, gender, sexual orientation, IV drug use, and so on.

Realities

The realities of life as an HIV+ IVDU reveal just how deleterious identification as a "community" from the outside-that is, "diagnosis" in Patton's sense (127) — can be. As Edith Campbell of the Methadone Maintenance Program states:

IVDUs are a population that until now has not even been acknowledged as existing in terms of being entitled to any attention from the rest of society. Suddenly, because there's a threat coming through AIDS, everyone wants to know what's going on. (qtd. in Carlomusto and Juhasz)

IVDUs are thus "scapegoated as vectors of transmission," "receiving attention only insofar as non-IV drug using populations are threatened" (Saalfield 124). IVDUs are among the "guilty victims" who transmit the virus to their "innocent" lovers and children. Randy Shilts, whose 1988 book And the Band Played On set the terms of most subsequent AIDS discourse, puts it thus: "Intravenous drug users would be wiped out in astounding numbers, taking with them their sexual partners and infant children" (460). Although Shilts predicts the effects of the epidemic on gay men, hemophiliacs, and equatorial Africans in the same paragraph, only IVDUs are portrayed as vindictive murderers of innocents. The Centers for Disease Control and Prevention to this day also adhere to this policy of worrying more about the effect of the IVDU on others than about the effect of HIV on the IVDU him- or herself. The CDC website delineates nine "Populations at Risk." The descriptions of these populations begin similarly for the most part, stating the impact that HIV has had on the group in question. The one exception comes in the first sentence of the description of HIV among IVDUs, which reads as follows: "Sharing syringes and other equipment for drug injection is a well known route of HIV transmission, yet injection drug use contributes to the epidemic's spread far beyond the circle of those who inject" (CDC par. 1). Concern moves away from the IVDU halfway through the very first sentence of the informational site devoted to the spreading of HIV via intravenous drug use.

Feeding the fires of public outrage against the criminally irresponsible junkies are the fears engendered by the associations linking IVDUs with sex workers, both construed as, and only as, "link[s] between high- and low-risk groups," vectors first and victims second if at all (Harcourt and Philpot 155). Although this association, as will be shown, does have some basis in reality, its prevalence in AIDS discourse is also driven by a logic that is purely representational. Knowledge about AIDS in the United States has from the very beginning been predicated on the dichotomy self/other. This has been articulated in a multitude of ways: "homosexual and heterosexual," "normal and abnormal," "guilty and innocent," and "United States and Africa" (Treichler 63-4). The heterosexual "general public" of the United States has consistently projected the possibility of "non-gay AIDS" onto Africa, imaginatively containing the danger within the borders of the Dark Continent. Once the statistics came to prove all too well that heterosexual transmission does, in fact, occur in the United States too, another means of denial was required, and a new fiction was generated: "Heterosexual AIDS in the U.S. is related to drug use, while 'African AIDS' will be related to (African) heterosexual practices" (Patton 66). And, since prostitutes have played such an important role in understanding the spread of AIDS in Africa, many of the fantasies about IVDUs in the United States are played out on the bodies of sex workers. Thus, the peculiar logic of displacement and projection generated the portrait of one of the more vile demons of the epidemic: the junky whore. Shilts again proves reliable in uncritically articulating popular myth, referring to New York City's "drug-shooting hookers" as "legion," an openly demonizing characterization (513).

The interweaving of discourse about IVDUs and about prostitutes reflects the complexity of the overlapping of categories in real life, despite the efforts of sex workers' rights groups to distance themselves from the issue of IV drug use. For example, in 1988, Carol Leigh, a member of COYOTE (Call Off Your Old Tired Ethics), claimed that "seropositivity in prostitutes is confined to IV drug users, who comprise only ten percent of prostitutes" (180, emphasis added). This absurdly extreme generalization is telling; the stigma of IV drug use is the last thing the already beleaguered community of sex workers can afford to shoulder. Once again, IVDUs are treated as "other," even by those stigmatized by the general population, and are condescended to as "victims" whose primary need is "drug treatment programs…designed to meet the needs of IV drug using prostitutes" (Leigh 180). This ubiquitous and misguided attention to "treatment programs" as a necessary good for drug users, as well as the characterization of such institutions as representative of the "IVDU community" will be examined and problematized later in this paper.

Perhaps another cause of such vehement assertions that IVDUs and prostitutes are mutually distinct categories having little to do with one another is the constituency of such groups as COYOTE and US Pros; the very existence and effectiveness of these organizations attests to a higher degree of awareness and power than sex workers not affiliated with such advocacy groups can be expected to have. Many studies undertaken regarding sex workers and IVDUs have, in fact, discovered a hierarchy, with "the highest levels of intravenous drug use…found among street prostitutes" (Harcourt and Philpot 149). Higher-class prostitutes and "call men" were discovered to have lower rates of IV drug use, resulting in skewed data, since "most studies have been conducted among street prostitutes" (Venema and Visser 52). Recognizing such studies as skewed, and wishing to avoid the additional stigmatization of association with IV drug use, spokeswomen for sex workers' organizations distance themselves from the issue of drug use, contributing to the silences and misrepresentations surrounding the issue.

Fiction

The myths which masquerade as knowledge about IVDUs in such "factual" discourses as the theoretical and scientific works cited thus far are by no means confined to those modes of representation. In the fiction of AIDS (I include Shilts's purportedly factual work in this category as well, due to its narrative structure and rhetorical style), the "twin threats of oblivion and diagnosis" are played out again and again (Patton 127). In those works which do not entirely elide the IVDU, a certain characterization arises: the IVDU is threatening, irresponsible, even animalistic, and invariably doomed to continued addiction until death comes, which never takes very long.

Although mentioned repeatedly in Shilts's And the Band Played On, IVDUs are almost never considered in and of themselves, but only as one group in a litany of "risk groups" as shown above, or as an important "similar mystery" in the days of Gay-Related Immune Deficiency (GRID) (56). Only once in the course of 621 pages is there an actual representation of an IVDU, who is, predictably, a prostitute. The portrait of Silvana Strangis that emerges in the three pages he devotes to her is less the portrait of an individual than the construction of a stereotype. Silvana is not "that different from the other prostitutes who worked the Tenderloin" (508). She is strung out, irresponsible, and ignorant enough to go along with the suggestion of the police that she get tested; it takes "a reporter to tell…about her profession…and her urgent need for AIDS screening" and the head nurse to worry "about issues like confidentiality and civil rights" (509). Shilts's statement that "years of heroin addiction had undone whatever Silvana Strangis had learned of discretion" so that she readily talks about her boyfriend's HIV status to the police who have just arrested her is about as implausible as fiction can be. The notion that heroin addiction leads one to be more confiding in police officers about anything, much less about something so sensitive, is an absurd extension of the mythic stupidity of the junky. Although Silvana tries to go straight by getting into a methadone program, seeming "repentant and eager for a new life," she, of course, fulfills the demands of the stereotype, in which addiction automatically equals doom (512). Her boyfriend Tony, "with a terminal diagnosis" and "little incentive to quit drugs," drags Silvana down with him (515). The myth articulated by Silvana is completed: "It's like what they say on TV. You get in but you can't get out" (510). And as if the function of Silvana's grim tale within Shilts's larger narrative were not already painfully clear, he spells out the moral of the story: It is "emblematic of the complicated problems that intravenous drug users presented in the AIDS epidemic. These people weren't optimistic gay men who would spend their last days doing white-light meditation with their Shanti Project volunteer; they were addicts" (515, emphasis added). Rather than having a problem in the AIDS epidemic, IVDUs present a problem in Shilts's representation; it sounds almost as though he expects an apology.

In People in Trouble, Sarah Schulman's popular 1990 novel, IVDUs receive similarly stereotypical treatment. Often, they are utterly dehumanized, used as scenery — as are homeless people-throughout the work. During the scene which takes place in the "hellhole" of the Bellvue emergency room, the litany of horrors Molly and Fabian witness includes, but only in passing, "many, many drug overdoses" among the myriad "street people," prisoners, and criminals (211-2). This infernal scene is reminiscent of one earlier in the book, in which Peter passes "a line of street people not being too rowdy…waiting to get into a soup kitchen" (134). Again, in the midst of the list of outcasts arises the death's head of addiction: "that junky/crackhead zombie look with sunken or distracted eyes and missing teeth" (135).

Only three times in this novel do IVDUs gain any semblance of humanity, in the persons of the unnamed man with the bandaged hand, Charlie, and Sam. In the first two instances, the IVDU is the stereotypical junky: the deceitful, exploitative black man. In the case of the injured man, even the "green tinge" of his hand and his "wrinkled prescription" are not enough to stop Peter and Molly from treating him like a subhuman parasite (139). Peter wonders "if the guy was just laying it on thick, trying to get some money out of him," while Molly asks him, in an accusatory tone, "Do you need a painkiller?" (139-40). Even the suspicion of drug abuse is grounds for condescension and accusation. In the case of Charlie, who is without any doubt an addict, always "looking hungry and wanting to get high," the rhetoric of blame is even clearer (172). In fact, Molly even provides a working definition of the drug addict, in case the reader is not sure what stance should be taken:

…while drug addicts are real people in that they get hungry and cold and sick and die, there is a big hunk missing from them somehow. And for that reason they couldn't be treated as fully human because they would just rip you off and exploit you every chance they got. (172-3)

Charlie, in fact, cannot even be trusted "to not pocket the waitress' tip" (173). The dehumanization of IVDUs (who are human only in getting sick and dying), as well as the racist coding of the "junky," are here completely overt.

Sam, the cowgirl who becomes Molly's lover, comes closest to escaping the junky stereotype, perhaps because, in this novel, there is no such thing as a bad lesbian. Rather than being a "junky," Sam is a person who is "a good liar and a smooth operator and a real drinker with a few secrets," one of which is IV drug use (179). Both Sam and Daisy, the latter of whom is briefly mentioned as having done drugs in the past, to explain her seropositivity while maintaining her lesbianism intact, are differentiated from the stereotypical junky by their ability to stop. "Real junkies" being less than human and doomed to die addicted, it is essential that Schulman tell the reader that Sam "got off drugs" (226). Here, the distinction between the IVDU and the junky is created; even when the IVDU is treated as human, the junky must be retained as the subhuman "other." Even so, the IVDU is represented as self-absorbed, with little if any social consciousness. Sam wants to "get stoned" on the day Justice plans its credit card strike (195). Molly has to convince her to go, insisting, "It's real" (195). Shilts's optimistic gay man vs. depraved addict dichotomy is inscribed here; IV drug use is incompatible with social responsibility. Even in its most sympathetic IVDU character, People in Trouble perpetuates the myth that IVDUs are hard pressed to care about anything but themselves and their next fix, and that they, therefore, must be led by more socially conscious groups.

One might expect that mainstream ideas would be reproduced in mainstream publications like And the Band Played On and People in Trouble, turning to "fringe" or "underground" writing to challenge these characterizations of drug use and drug users. However, many of the pieces anthologized in High Risk, presented on its opening page as "uncompromisingly truthful," also reproduce these common stereotypes of the addict. IVDUs are reduced to scenery again in Cooper's "Wrong": "Times Square was spooky; too many junkies out, pissed eyes way back in their heads" (117). Kathy Acker, in "A Young Girl," denies IVDUs even the quality of life: "On the New York City streets, children play with used needles. Therefore, it's the dead who determine how the living act" (145). Pat Califia's "Heroin" is rather better, in that it does represent the actual act of shooting up, which is as absent from most AIDS writings as is the act of sex in governmental "safe sex" pamphlets. However, she does lean towards the idea that shooting up just once can result in a loss of free will: "of course I am not addicted but I am going to make sure I can get my hands on some more of this" (64). This slippery-slope mentality and the image of "the ancient reptile in me," which inscribes animalism in IV drug use, play into the old stereotypes, despite the straightforward descriptions of the experience that came before. That such dogmatic and stereotypical representations of the IVDU are present in the same collection as William S. Burroughs's "Just Say No to Drug Hysteria" is ironic, to say the least.

In light of the oppressive mass of stigmatizing, marginalizing, oversimplifying representations of IVDUs, of which the works discussed thus far form only a small sample, any work which runs counter in any way to the dominant images is surprising and noteworthy. In the realm of fiction, David Wojnarowicz proves an exception to the condescending, accusatory tone which is the rule. His collection of lyrical and polemical essays, Close to the Knives, problematizes the presumptions of dominant discourses regarding the IVDU.

Wojnarowicz is exceptional from the start among AIDS writers in that he writes as (among other things) a drug user himself. In Close to the Knives, he describes his experiences with a number of drugs: alcohol, marijuana, speed, mushrooms, peyote, ecstasy, and heroin. He seems to be virtually alone in his willingness to admit that "there is nothing worse to [him] than witnessing a friend's addiction to dope accelerate" without regarding addicts as voiceless subhumans (208). He can even go so far as to state, referring to Dakota, an IVDU, that "I learned so much from him spiritually — he pulled me up from the bottom of the ladder," a far cry from the dead eyes, zombie looks, and larcenous souls found elsewhere (208). Without shying away from the destructive, dehumanizing effects of chemical dependency in the United States, Wojnarowicz manages to portray IVDUs as complex human beings, not victims who must be condescended to in order to save them from themselves. In his own life, too, he explodes the mythical binary opposition addict/non-user. His description of "flirting with heroin" escapes such binary logic, falling somewhere between the idea of the junky and the idea of the "normal" person. Such complexity in IV drug use representation is exceptional, very nearly unique. And very sorely needed, to contradict the simplistic characterizations and condemnations of the IVDU that have been dominant now for well over a decade.

Consequences

Among theoretical and scientific discourses of IVDUs and AIDS, the stereotype of the self-destructive, irresponsible, subhuman junky has perpetuated an oversimplified, uncritical focus on "rehabilitation programs" as the means by which the spread of AIDS can be checked. Even those bold enough to depart from "Just Say No" rhetoric to espouse the expansion of treatment programs tend to invoke these programs as a simple, straightforward panacea. Only a very few works go beyond the invocation of the phrase, and actually examine the nature of these programs as they are usually proposed and implemented.

While Catherine Saalfield is correct in asserting that "an IVDU who is HIV+ must have access to treatment for her or his HIV infection as well as her or his addiction," this statement fails to consider that the types of treatment available at present, even if the usual waiting period of many weeks were eliminated, are hardly ideal (125). Essentially, three types of cure exist for chemical dependency: individualized abstinence programs like Narcotics Anonymous, drug substitution programs like methadone maintenance, and "alternative" cures such as apomorphine and acupuncture. At present, only the first two are widely available, although their rates of success are far from admirable. Programs like Narcotics Anonymous, which require that one submit to a "power greater than oneself" and view "addiction as the primary disease in an HIV-infected 'addict'" are hardly adequate (Patton 11). As Patton points out, this method causes the IVDU to rewrite "her/his social identity (as 'irresponsible addict') as a medical identity or as sufferer from the disease of addiction" (12). Such programs, aside from being offensive in their insistence that the addict accept some form of religious belief, are certainly less effective than therapies that take into account the user's actual social contexts. That Patton lists Narcotics Anonymous among her AIDS Service Organizations, raising it to the level of the Gay Men's Health Crisis, for example, is problematic. By analogy, one could expect from the inclusion of these two groups on the same list that an efficient means of stopping the spread of AIDS would be to institute a twelve-step program in which gay men submit themselves to a higher power, admitting themselves to be "irresponsible homosexuals" and seeking the strength to become straight. Such groups do exist, in the Catholic Church, for example, but they are hardly considered admirable or even tolerable by most gays and lesbians. The essential problem with the twelve-step approach is that it misses the point: HIV is spread by unsafe sex and by dirty needles, not by gay sex or IV drug use per se.

More widespread than these self-help programs are methadone maintenance programs. While referred to as "rehabilitation," methadone maintenance is in actuality merely the substitution of one addiction for another, the only difference being that methadone is not pleasurable, only serving to forestall withdrawal pains, and that it is subsidized and provided by the government, thus preventing the accidental overdose, dangerous impurities, and financial hardships associated with heroin use. IVDUs get a prescription each week, which may or may not gradually be reduced. In the United States, it generally is reduced over time; in this case, as in the case of Narcotics Anonymous, "the treatment is old-fashioned withdrawal, with a very high incidence of relapse" (Burroughs 79). That methadone is just as addictive as heroin is made clear by "recovered addict" Jan Wessels: "I've been taking it for half a year now, it's far out. They can take anything from me…my beer, my wife…so long as they keep their hands off my injectable methadone" (Kools 5).

Apomorphine and acupuncture therapies, on the other hand, operate by supplementing the body's own supply of endorphins or by stimulating the body's manufacture of its own endorphins, in order to lessen the pains of withdrawal. Such treatments, although mentioned in passing by Catherine Saalfield in her essay "Intravenous Drug Use, Women, and HIV" (126) and vehemently championed by Burroughs in numerous essays, are hardly ever mentioned as means of rehabilitation, though they could hardly be less promising than "old-fashioned withdrawal." The cursory and superficial attention given to the real issues of IV drug use and AIDS by writers whose only knowledge of IVDUs comes from popular stereotypes prevents the realization that "treatment" can mean many different things, not all of them terribly worthwhile. Thus, calls for "treatment programs," when not specific and substantive, often amount to little more than a plaintive cry to "do something about these people."

Some few voices have managed to break through the propaganda surrounding IVDUs and see more clearly that IVDUs are indeed human, that IV drug use does not automatically mean depravity or irresponsibility or an inability to think beyond the next fix. Some have realized that injectable drugs do not cause AIDS any more than does sex. It is the sharing of needles or of bodily fluids that transmits HIV from one body to another. Studies have shown that the primary reason for sharing needles is that "many states have paraphernalia laws that have been used by police against addicts and other IVDUs for years" (Waldorf and Murphy 118). Such laws discourage users from carrying their own works and actually serve to foster such institutions as the shooting gallery, which provide drugs, (previously used) works, and a place to inject. In response to such unsafe practices, needle exchange programs have been established. Government-sponsored programs are rare, but illegal street-based programs have been organized effectively in many United States cities, San Francisco's Prevention Point Needle Exchange being one highly successful example, in operation since November 1988. Such programs are sorely needed, not only to make clean works available, but also to challenge the public perception of the IVDU as irresponsible and the assumption that drug use is essentially connected to AIDS. Speaking from her experience with PPNE, Patricia Case challenges the myth of the irresponsible junky, saying, "substance abusers are receptive to exchange programs: They are interested in preventing HIV" (Saalfield 127).

Conclusion

The stigmatizing stereotypes of the "junky," which largely determine public attitudes and actions regarding IVDUs, have, unlike myths about "fags" and "whores," remained for the most part unchallenged in the vast majority of AIDS discourse. In many cases, in fact, these negative images have been fostered by other stigmatized groups, as in the voices of Randy Shilts and Carol Leigh, in an attempt to destigmatize themselves in the context of AIDS. In both fiction and nonfiction, IVDUs have been diagnosed time and time again as parasitic, self-involved, subhuman, half-dead beings, or have been condemned to oblivion, as in the Denver Principles (the Founding Statement of People with AIDS/ARC), which nowhere refer to IV drug use or chemical dependency. IVDUs have been the "other" for just about every "risk group" trying to distance itself from the social stigma attached to AIDS. Rare are the voices that talk back, telling of IVDUs who are actually human, who are not, in the end, "only junkies."

While it is true that, in the United States today, dependence on substances like heroin will almost certainly do violence to a person's livelihood and dignity, voices must be raised to challenge the one-dimensional representations of IVDUs which form the bulk of discourse concerning the issue. Until such voices gain sufficient power and number to provide audible counterpoint to the dominant simple-mindedness, IVDUs with AIDS will continue to bear the brunt of societal victim-blame, and all the progressive asides generously included by AIDS writers regarding the "treatment" and "education" of IVDUs will continue, and will do about as much good as the "Just Say No" philosophy which has been with us over two decades now. And Jesse Helms will continue to receive astonished praise for his sudden "conversion" into a caring human being, as he urges the appropriation of funds to stop the spread of AIDS in Africa — certainly laudable — while scorning and ignoring hundreds of thousands of "guilty" people with AIDS in the United States — undeniably inexcusable. Human beings will continue to die, victims of an epidemic of ignorance and blame which continues to run rampant.


Works Cited

The Basketball Diaries. Dir. Scott Kalvert. Perf. Leonardo DiCaprio and Lorraine Bracco. New Line, 1995.

Carlomusto, Jean and Alexandra Juhasz, dir. Living with AIDS: Women and AIDS. NY: Gay Men's Health Crisis, 1988.

Centers for Disease Control and Prevention. "Drug-Associated HIV Transmission Continues in United States." Divisions of HIV/AIDS Prevention. 4 April 2002. http://www.cdc.gov/hiv/pubs/facts/idu.htm. 11 April 2002.

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