Dispatches on AIDS and COVID-19: Continuing Conversations from AIDS and the Distribution of Crises (Dispatch Two)

Today’s guest post is a part of the short series curated by the editors of AIDS and the Distribution of Crises, Jih-Fei Cheng, Assistant Professor of Feminist, Gender, and Sexuality Studies at Scripps College, Alexandra Juhasz, Alexandra Juhasz is Distinguished Professor of Film at Brooklyn College, City University of New York, and Nishant Shahani Associate Professor of Women’s, Gender, and Sexuality Studies at the Department of English at Washington State University. The contributors to AIDS and the Distribution of Crises outline the myriad ways that the AIDS pandemic exists within a network of varied historical, overlapping, and ongoing crises borne of global capitalism and colonial, racialized, and gendered violence. Last week’s post can be viewed here. The final post will be shared to the blog next week.

Dispatch Two:

Theodore (Ted) Kerr

I was going to take this time to discuss the amazing work that WHAT WOULD AN HIV DOULA DO? has done over the last few months. But instead here is a link. I have been moved by recent events to craft something new. 

I want to start by saying for many reasons this week has seemed the hardest of all since sheltering in place began.This has to do as much with the ongoing Coronavirus epidemic as with the white supremacist violence we continue to see everywhere including but not limited to Minneapolis, and Central Park; along with the limited uptake in my social circles regarding the cyclone that hit Bangladesh, the future of Hong Kong, Hungry’s national outlawing of trans lives, the fact that pre construction is still happening on Wet’suwet’en land, and so many other pressing calamities. 

This is to say nothing of the personal dramas unfolding in the lives of so many loved ones. Sick dogs, work fall outs, cancelled opportunities, break ups, the mental health of our offsprings, PTSD from surviving prison, the lingering tightness of breath from maybe surviving COVID-19, looming debt, and yet unnamable losses. 

With all that said, it has also been the week when I have been the most grateful for the internet, and the ways it can be used to build community and share hard won wisdom from our recently departed ancestors.  

Members of the RADICAL MONARCHS, an activist organization for young girls of color started a hashtag: #StaceyTaughtUs in honor of  Asian American Disability activist Stacey Park Milbern who died earlier this month. My friend Josephine attended Milbern’s online memorial last week, and later that day my friend Cory who also attended, began posting Stacy Taught Us contributions online, some of which I want to share:

Stacey taught me to pay attention to the things we do together, even when they seem so everyday, that I might not even notice. 

Stacey taught me that finding your ancestors is as much about changing the way you look for them as it is about where you look for them.

#StaceyTaughtUs how much we can change. That we can feel so certain about the rightness of our position, and then when we let people into our lives who have very different experiences than we do, that rightness and that position can change.

In honor of her work, two of Milburn’s peers created a syllabus, gathering much of the work Milburn leaves behind. It is where I came across a speech she gave last year in which she ends with the following words: 

We do this work together. With each other. Build a tribe. Let people in. Be vulnerable when it’s safe to do so and sometimes even when you are sure it’s not. Own your mistakes. Take a chance. Stand up for your friends and people who aren’t your friends. Stand up for yourself when others don’t. We all need each other. We need you. We love you. 

I sit in my tiny room fueled by Milburn’s legacy; namely the community she builds between the living and the dead, and her push towards a shared sense of positive empowerment. Leading with a love ethic, and progress rooted in interdependence is humbling, refreshing, and instructive.

Is it too much to say that Milburn –  from beyond the grave – can be seen as providing a answers to our questions today? I am not sure, but I am reminded that any lessons we take from what we may call the AIDS response are best when they include a refusal of any calcified idea of AIDS related knowledge. Milburn inspires me to ensure I am being nimble and porous when I consider notions of we, or learned

What AIDS and The Distribution of Crisis makes so clear is something I am picking up on in Milburn’s work: there is a togetherness in our seeds, and our bloom. Our past, present, and future are best experienced un-silo’d, we can messy in the best possible of ways. 

Without overlooking or dismissing our own collected, and recognized AIDS archives, we are wise to remember that our shared futures reside in the knowledge and communities of the movements HIV has long been entangled with: black liberation; anti-colonial organizing; reproductive justice; advancements in disability policy and practices; redistribution of wealth, and climate change to name a few.

In the age of COVID-19, with so many looking to what they may call AIDS for answers, I am reminded that AIDS is an assemblage and so too has always been the response. To find answers in our midst – be it related to security or structural racism or other pressing issues – we must figure out how to continue to look deep within, and always out. 

“Pre-existing Conditions”

Nishant Shahani

As I struggle to lend some coherence to scattered thoughts marked by multiple and mutual logics of crises, I am drawn to a seemingly marginal quote footnoted in Cindy Patton’s brilliant foreword to AIDS and the Distribution of Crises. Patton invokes the notion of “writing under erasure” to describe “an analytical strategy in which one marks a word that is inadequate to a concept but for which there is no better word” (xv). In a moment marked by both an intensification yet prolonged continuation of precarity, all writing can be viewed as a form of “writing under erasure,” both in its limited descriptive capacities but also, more violently, in that writing takes place under conditions of black death—or state-sanctioned killings to be more accurate. “Writing under erasure” marks a way to (inadequately?) describe the very inadequacy of words to “keep up” with the shifting contingencies of the quotidian. But such modes of accounting also require that we do justice to longer calcified histories informing events that seem exceptional and mundane at the same time.  To write in this moment about AIDS, or about COVID-19, or about police killings is both an acceptance of erasure but also a struggle against its purported inevitability. It is a way, to use Lauren Michele Jackson’s useful provocation to “metabolize race ‘happening,’ despite the fact that race is always happening.”

Throughout AIDS and the Distribution of Crises, we pay attention to this double movement that subtends the temporality of crises. The spectacular character of its pronouncements perform an intensification of “now;” but if “race is always happening,” then crises are not simply turning points as the epidemiological etymology of the word inadequately suggests. Instead, they are always marked by prolonged duration—i.e. by the pre-existing conditions around “crises in housing, access to water, migration and movement across borders, incarceration, racialized and gendered structures of wage labor” referenced in the above prompts. The relationship between AIDS and COVID-19 can be described through recursive loops rather than discrete logics of analogy conveyed through models of similarity or difference. With COVID-19, even the logics of recursivity between waves might be inadequate. The imminence of the much feared “second” wave has been an important way to foreground the longue dureé of crisis—but in fact, it might only perform the reductive work of erasing continuity through the calculus of sequence.  

I italicize the phrase “pre-existing conditions” above since it does some heavy lifting in multiple contexts of crises distribution that mark AIDS, COVID-19, and the pandemic of police killings. “Writing under erasure,” as Cindy Patton reminds us, is not simply “lacking visibility;” (xv) instead, it is a kind of replacement mechanism. The disappearance of pre-existing conditions that marks COVID-19 when seen through the scandal of a crisis “turning point” is replaced by the magnification of different “pre-existing conditions.” These are dangerous, even lethal substitutes. Within the corporate language of health insurance, “pre-existing conditions” mark certain bodies as “risky”—their putative volatility becomes a way to naturalize capitalistic logics of extraction and accumulation. As importantly, healthcare within neoliberalism becomes a matter of personal responsibility as a foil for the recalcitrance of subjects reified as “risk pools.” In this light, pre-existing conditions do not simply refer to diabetes or asthma that might pre-date coverage plans. They also become the necropolitical logics through which unruly bodies get blamed for their own failures to perform adequate care of the self. The failure to adequately conform to imperatives of “good” health indexes other “transgressions”: immigrant laborers in meat packing plants who supposedly cause spread of COVID-19 due to unsanitary “home” lives (rather than poor working conditions), queer bodies engaged in bareback sex or drug users causing spread of HIV/AIDS (rather than trans/homophobia or lack of accessible healthcare) or most recently, the supposedly inefficient hand washing abilities of people of color (rather than the lack of widespread testing and PPE equipment). 

When do “pre-existing conditions” fade away from analytical frames and when are they amplified? In the instance of George Floyd’s killing, “pre-existing conditions” were mobilized to frame him as a risky subject responsible for his own death through the language of race-based medicine. (The initial report of his murder was framed as a “medical incident.”) Subsequent charging documents referred to “underlying health conditions including coronary artery disease and hyperintensive heart disease” and “potential intoxicants in his system” as contributing to his death. In a recent essay in the Scientific American a group of physicians have offered a collective response to these reports, calling them a form of “structural gaslighting” through “the weaponization of medical language emboldened white supremacy with the authority of the white coat.” The excavation of prior history is also its foreclosure. Pre-existing conditions (Floyd’s medical history) function as a smokescreen to obscure histories of what Jackie Wang calls “carceral capitalism”—the economic and state-sanctioned technologies of punishment and dispossession that render black life disposable.

It is not coincidental that attempts to foreground pre-existing conditions of Floyd’s medical history sit in close proximity to the supposed scandal of false currency and the fatal 20-dollar bill that “necessitated” the involvement of law enforcement in the first place. If pre-existing medical conditions exonerate state-sanctioned violence, then the offense of counterfeit capitalism exists in the same vicinity as medicalized justifications, not only for the act of killing, but for the existence of policing and prisons as well. The amplification of pre-existing conditions (medical history, “fraudulent” exchange of currency) does the work of erasing other structural pre-existing conditions under the guise of context to grammars of violence. Lost from these frames are those acts of economic fraudulence committed by the state in nexus with its private investors, or the abdication of safety nets and healthcare in the service of speculative capital and debt economies.

When we talk about AIDS history, it often leads back to this moment in the early 1980s in the United States, and the urgencies of that time. But everything before this moment gets lost.

–Theodore (Ted) Kerr, “Dispatches on the Globalization of AIDS”, AIDS and the Distribution of Crises, 44.

“Everything before this moment gets lost” is a useful framing for these scattered thoughts on the erasure of pre-existing conditions (even when “erasure” assumes the form of visibility). In another context, Kerr’s statement on AIDS history and the limits of first occurrence formulations could also describe our memories of a world prior to COVID-19 that get lost, reframed, or bathed in an incredulity around time. “It feels like a lifetime ago” encapsulates the remembrance of quotidian communal activities prior to quarantining and social distancing; a shrinking of space compensated by the stretching of time. A friend who is a psychological
anthropologist
by training, describes to me an odd sensation she experiences of watching any images of people gathered in groups at concerts, sporting events, or movie theatres prior to the outbreak of COVID-19 infections. Even though these images predate our present, she still viscerally responds with anxiety and concern. How to put in words this very particular sensation of asynchronicity, or being out of temporal lockstep? Projective anachronism? The push or pull of the present on to the past? Once again, Patton’s mobilization of “writing under erasure” is instructive—words might be inadequate, but in marking their inadequacy, we articulate how impossibility serves as both placeholder and condition of possibility and meaning. 

“…perhaps this book aims to produce another kind of crisis—a crisis of meaning

–C. Riley Snorton, “On Crisis and Abolition,” Afterword to AIDS and the Distribution of Crises, 316.

In “Toward the Horizon of Abolition,” Mariame Kaba draws attention to the relationship between temporality and the limits of political imaginations in thinking about prison abolition: “…once things are actualized into the world and exist, you can’t imagine how the world functioned before it. It’s like we develop amnesia.” Pre-existing conditions (or a world without prisons) disappear from view, when policing and prisons are naturalized in our present. Abolition as an analytical and activist tool becomes a way to counter the erasures that amnesia performs in naturalizing structures of violence as the solutions to violence. Abolition might be a key tactic in impeding the spread of COVID-19—humanitarian release of prisoners could be a very pragmatic starting point. Perhaps the time has come “now” (although it has always been time) to think of abolition as a way of writing under erasure, but also as a way of acting against it. 

Baby You Can Drive My Car or The Hunger Games 

Emily Bass

“The traffic must be so much better than usual,” I say to my friend Lillian who lives outside of Kampala, where the roadways and roundabouts are perpetually snarled with cars, motorcycle and minibus taxis. “No, it’s not,” she says. “I went to the Ministry of Health yesterday and there were cars everywhere.” She laughes. Heh heh heh. Covid covert movement laughter. The nervous mischief chuckle that comes when, in April 2020, amidst lock-down in Uganda and the United States, we confess that we’ve been on the road. “I needed a sticker,” she says. “One for my vehicle so I can drive around. I called someone there. I told him that there were women living with HIV in their homes and I needed to go to them. It was essential business. He said you come right away. So I did. I got one.” 

Lillian is the Executive Director of the International Coalition of Women Living with HIV in Eastern Africa. She is one of my best friends. She recently wrote in a feminist journal about how she used our regular contact during asynchronous moments in our countries’ COVID-19 pandemics—America was weeks ahead of most African shut downs. She listened to what I was doing. She listened when I said, “Don’t be embarrassed about stocking up on groceries. Don’t worry what people think or say. It will happen soon.” She was able to buy all of the food supplies she needed for her household before the prices got jacked up. Heh heh heh

HIV-related work affords access for some people and some organizations to specific forms of power and specific types of resources. This distribution of power and resources is shaping the response to the COVID 19 epidemic in Uganda and in many other nodes of the transnational activist world whose borders are those of so-called ‘global AIDS.’ Long-standing friendships and activist alliances were geographically separate and made intimate via Zoom, Whatsapp and email long before work from home began. We have been sharing of information across the time zones of a pandemic for a long time. I speak to Lillian from the future. I hope she does not catch up. 

Lillian deploys her power in Uganda. She is one of the most prominent women living with HIV in Uganda. She knows everybody. She speaks regularly on the global stage. When she wants to speak on the radio or television, she can. She takes to the airwaves to talk about syndemics of COVID-19 and HIV. 

Her power, accrued over decades, reflects her skills, brilliance and palpable solidarity. The first network of people living with HIV in Uganda saw these things. When they had a paid position, they offered it to her. When that network got a grant from DfID, her executive director wrote a budget line in for her antiretroviral therapy. That was more than twenty years ago. 

Status earned and conferred in the context of one epidemic’s hierarchy of access and influence affects what is possible in the context of another epidemic. She can pick up the phone and get a sticker the same day. She is free now to move around. 

On the subject of movement: for most people, HIV does not cause chronic symptoms or debilitation for many years after it enters the body. People are ambulatory. The virus is not airborne. You can sit together in the same room, stand in the street, ride the same car. On weekends, Lillian used to drive around the country with the other members of the national network explaining HIV to people outside of the capital. They made their own curriculum. 

Those weekend road trips changed the Ugandan AIDS landscape and they changed her sense of how non-scientists can shape a public health response. She needed that sticker. She could not get it without HIV. She got it because of a virus she carries and another that she does not. People living with COVID-19 cannot drive around in vans and explain to other people what is happening and how to take good care. Both pathogenesis and public health containment measures make this impossible. 

On the subject of containment measures: every day in Uganda, the Ministry of Health tweets the number of confirmed cases from truck drivers, their nationalities and the number of foreign truck drivers returned to their countries of origin. The surveillance capabilities lie with the Ministry of Intelligence, as it has been explained to me. When the Ebola outbreak was underway, the military would call the CDC and tell them the name, license plate and ID for anyone who entered with a fever. They would call back when the person had been detained. Freedom of movement is illusory, perhaps one could even call it, in this case, a fever dream. Truck drivers have begun to falsify information, turn off their phones. 

The sex workers who work truck routes are easier to find. The government has arrested and threatened those working on the commercial routes. They are trying to work on those routes because they are hungry and they need food. While the President promised food supplies, that relief was slow in coming. Sex workers often did not receive them. In Lyantonde a group of sex workers went to the media because they had been removed from a list of priority recipients. A friend watched and posted about seeing a government donation truck refuse to leave supplies at guest houses where sex workers rented rooms. The official said the women didn’t cook there. In fact, they did. Sometimes the presumption of movement is the problem. The state’s interest in intimate details is selective, myopic: your temperature, your license plate; not where and how you make a home.

Many of the sex worker groups that have raised these concerns constituted themselves in the context of the AIDS response, within which hunger was and is an ongoing issue. In one of the towns I visit often, a woman with HIV told me proudly how she took her medication even when she didn’t have any food because it was what she knew she had to do. This is what is known as compliance. In his field work in Mozambique, the anthropologist Ippolytos Kalofonos heard this: “All I eat is ARVs.” Kalofonos witnessed the ways that uneven distribution of food aid vouchers among PLHIV groups created competition and distrust, how it hurt solidarity. 

The erasure of hunger from HIV programming is also an erasure of the reality that the things which people need to do to acquire food can involve proximity with HIV. This includes sex work. This includes continued cohabitation with a person who abuses you. COVID-19 reverses this erasure in the context of a network of community systems that have been weakened by the history and ongoing practice of forgetting that ARVs are not food. 

Strategies developed and used in the context of the historic and ongoing HIV epidemic are being used in the context of the COVID-19 response. These include turning to the media, working the system, sharing information across coalitions connected in virtual space. 

The richness of these resources and systems is not what it should or ought to be because of the deprioritization of specific types of services for AIDS funding. I think here of Cindy Patton’s vital reminder not to sentimentalize acts of agency in the context of the failure of the state, especially a state that we know is watching every move we make. Lillian uses her personal status to work the system. That is not a systematic response. 

In Gulu, sex workers threatened to produce a list of 35 Gulu District Administration workers who are their prominent and notable customers if they did not receive food ASAP. The district administration asked them to hold on. 

Read the introduction to AIDS and the Distribution of Crises free online and save 30% on the book with coupon code E20AIDS.

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