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
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
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.
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
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
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
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.
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
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
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
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
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.
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
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
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).
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.
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