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Dilip K. Das
Teaching
AIDS
The Cultural Politics of HIV Disease in
India
Teaching AIDS
Dilip K. Das
Teaching AIDS
The Cultural Politics of HIV Disease in India
Dilip K. Das
Department of Cultural Studies
English and Foreign Languages University
Hyderabad, Telangana, India
ISBN 978-981-13-6119-7 ISBN 978-981-13-6120-3 (eBook)

https://doi.org/10.1007/978-981-13-6120-3
Library of Congress Control Number: 2018968595
© Springer Nature Singapore Pte Ltd. 2019

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
This book is dedicated to the memory of my
father, Professor Sadhu Charan Das, whose
passion for learning I have always tried to
emulate, and my mother, Mrs. Annapurna
Das, who always supported me in the effort.
I also dedicate this book to my teacher,
Professor Prafulla C. Kar, and to Mrs.
Mokshada Kar, who have constantly inspired
me in my life and academic career.
Acknowledgments
The idea of working on the cultural politics of HIV/AIDS first came to me in 1998,
when Professor Prafulla Kar asked me to review Thomas Yingling’s AIDS and the
National Body for the Journal of Contemporary Thought. I owe to him the inspira-
tion for this book.
My work on the AIDS epidemic was enabled by a year’s sabbatical that I spent at
the University of Illinois, Urbana-Champaign, in 2002–2003, as a Fulbright post-
doctoral fellow. I am grateful to Professor Paula Treichler and the Institute of Culture
and Communication, UIUC, for hosting me and providing all facilities. I also thank
the United States Educational Foundation in India and the Fulbright Foundation for
sponsoring my sabbatical. In 2005, I received a South Asia Regional Fellowship
from the Social Science Research Council, New York, to work on the subject. I thank
SSRC and Itty Abraham, program director for South Asia fellowships, for their sup-
port. I am grateful to my former institution, Berhampur University, for granting
leave on both occasions. I am also grateful to my present institution, the English and
Foreign Languages University, Hyderabad, for giving me two 1-year sabbatical
terms, in 2009–2010 and 2017–2018, which enabled me to write this book.
Professor D. Venkat Rao read Chap. 7 of this book and offered many insights and
suggestions that I have incorporated. Professor Kar, also read Chaps. 4, 5 and 6, and
his comments helped me revise the chapters. I am indebted to them for the pains they
took when they were themselves overburdened with work.
I am grateful to the anonymous reviewers of Springer for their valuable feedback
on the book. I also thank Shinjini Chatterjee, then executive editor for human sci-
ences at Springer India, who constantly encouraged me to complete the book, and
Priya Vyas of the editorial team, who followed it up subsequently.
The research for this book would not have been possible without the help I got
from many individuals and organizations. H.N. Girish discussed in detail the AIDS
Amma project that he initiated and shared with me his photographs, while
S. Gangadhar translated for me on my field trip to the shrine. I could not have
undertaken the trip to Menasikyathanahalli without the help I got from Professor
A.R. Moosvi. Sinchana, who was then my Ph.D. student at EFLU, translated the
AIDS Amma messages for me. I gratefully acknowledge their support.
vii
viii Acknowledgments
My thanks are also due to the National AIDS Control Organization, especially
Director General Sanjeeva Kumar and Dr. Rajesh Rana, Rajeev Varma of the World
Health Organization, Nandini Kapoor of UNAIDS, and officials of ActionAid India
and the State AIDS Control Societies of Orissa, West Bengal and Kerala, for provid-
ing me with material essential for my research.
Finally, I must thank Mrs. Mokshada Kar, who is Nani to me, my wife Sumitra
and son Kartik. Without their persistent goading and encouragement, I would not
have been able to complete this book. Their support especially in these last few
months has been invaluable.
Contents
1 AIDS Awareness and Behaviour Change:

An Interdisciplinary Perspective�� 1
References�� 16
2 Pedagogy, Power and the Subject of Disease Control�� 19
2.1 Pedagogy, Ideology, Subjectivity: Freire and Althusser �� 21
2.2 Pedagogy and the Disciplining of Embodied
Subjects: Foucault�� 28
2.3 Representing Disease: The Social Construction of Reality�� 33
2.4 Language and the Body in Pain�� 36
2.5 Conclusion�� 41
References�� 45
3 Incipient Pedagogy I: AIDS in the National Media�� 49
3.1 Discursive Construction of AIDS in the Indian Media �� 51
3.2 Theory of Foreign Origin�� 53
3.3 Ordering Disorder: Profiling the Nation’s “Other”�� 57
3.4 Imag(in)ing the “AIDS Victim”�� 63
References�� 70
4 Incipient Pedagogy (II): AIDS Narratives �� 73
4.1 Disease Versus Illness �� 74
4.2 Representing Disease and Illness�� 76
4.3 The Disease Travelogue: Sex, Lies and AIDS
and Positive Lives�� 77
4.4 AIDS Sutra: Living with the Virus�� 87
4.5 Narrative and the System of Norms�� 93
4.6 “Innocent Victims”: A Dove in Desert, Nidaan,
Ek Alag Mausam �� 96
ix
x Contents
4.7 Disease as Culpability: Phir Milenge and

My Brother… Nikhil�� 103
References�� 108
5 AIDS and the Enigma of Law �� 113
5.1 Structure and Process in Law�� 114
5.2 Law and the Enigma of Biopolitics�� 117
5.3 Segregating the Diseased: Lucy D’Souza V. State of Goa�� 121
5.4 Suspended Rights: Mr. X V. Hospital Z �� 124
5.5 Disease as Contagion: Dhirendra Pandua V. State of Orissa�� 127
5.6 Interpretation and Indeterminacy in Law�� 132
5.7 The Enigma of Corporeal Justice: M. Vijaya V. Chairman
and Managing Director, Singareni Collieries�� 136
6 AIDS Awareness Campaigns: Pedagogy as Strategy�� 149
6.1 Paradigms of Public Health�� 150
6.2 Health Education, Expert Knowledge and the Shaping
of Subjectivity �� 156
6.3 NACO and the Nationalization of AIDS�� 158
6.4 NACO and the Nationalization of Pedagogy�� 162
6.5 The Pedagogy of Risk: Mehr-un-Nisa
and Let’s Talk About AIDS�� 170
6.6 Teaching Lifestyle Management: Saavdhaan
and Handbook on AIDS Home Care �� 178
7 AIDS Amma Shrine: Pedagogy as Tactics �� 189
7.1 Genealogical Descent�� 194
7.2 Ritual Structure �� 201
7.3 Epistemological Implications�� 214
7.4 Tactical Pedagogy �� 216
8 Conclusion: Towards a Critical Medical Humanities�� 223
About the Author
Dilip K. Das is Professor of Cultural Studies in the School of Interdisciplinary

Studies at the English and Foreign Languages University, Hyderabad. He is a recipi-
ent of a Fulbright Postdoctoral Fellowship at the University of Illinois, Urbana-
Champaign, USA, and a South Asia Regional Fellowship from the Social Science
Research Council, New York. His research area is interdisciplinary body studies,
and he has published essays on the social dimensions of disease.
xi
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Chapter 1
AIDS Awareness and Behaviour Change:
An Interdisciplinary Perspective
Abstract In the absence of vaccine or cure, teaching how to avoid infection seems
to be the only strategy for epidemic control. Declining figures of new infection sug-
gest that pedagogic efforts have had a modest success. To enhance its effectiveness,
the assumptions underlying pedagogic interventions and their effects must be exam-
ined. Given the multiple contexts of the epidemic, it is necessary to examine AIDS
pedagogy from an interdisciplinary perspective, and the humanities can be a valu-
able critical resource in this effort.
Keywords AIDS pedagogy · Interdisciplinarity · Critical medical humanities
Against the urgency of people dying in the streets, what in God’s name is the point of cul-
tural studies? (Hall 1992, p. 284)
The HIV/AIDS epidemic, which began in the United States and Western Europe in
1980, is now three-and-a-half decades old. Since then, an estimated 77.3 million
people have been infected globally, with 35.4 million succumbing to AIDS-related
illnesses. UNAIDS estimates for 2017 indicate 1.8 million new cases and about 1
million deaths in that year alone. However, the number of new infections acquired
annually has declined by 47% since 1996, when it had reached a peak of 3.4 million,
while AIDS-related deaths have reduced by 51% against the 2004 figure of 1.9 mil-
lion (UNAIDS 2018a). Based on the achievements of three decades, it appears pos-
sible “to end the AIDS epidemic as a public health threat by 2030” (UNAIDS 2018b,
p. 8). While these figures are reassuring, suggesting that the epidemic may be on the
decline, there is as yet no vaccine, and health education may be the only way to
bring down the spread of AIDS. Initially, it was assumed that merely providing
information about HIV transmission and prevention would motivate individuals to
take precautions. Subsequently, when this did not have the desired effect, more
proactive strategies were designed to change sexual and intravenous drug-use
behaviours of individuals or groups who were at risk of infection because of their
profession, lifestyle and inadequate understanding of the disease. “Gaps in knowl-
edge, attitudes, and behaviours among a target audience can be identified, and
© Springer Nature Singapore Pte Ltd. 2019 1

D. K. Das, Teaching AIDS, https://doi.org/10.1007/978-981-13-6120-3_1
2 1 AIDS Awareness and Behaviour Change: An Interdisciplinary Perspective
communication interventions are then targeted to addressing these deficiencies at

the individual level” (Singhal and Rogers 2003). Information-based awareness cre-
ation and behaviour change communication have been the two main props of edu-
cational projects in epidemic control.
Teaching AIDS is about pedagogic interventions in India, which it examines in
the context of public discourses about AIDS- and HIV-positive people. It attempts
to locate these interventions within shifting constructions of the epidemic in media
reports, narratives and court decisions about people with disease. It also attempts to
understand the wider cultural politics of representing, understanding and respond-
ing to disease and persons with disease and the effects these have on the governance
of public health. It needs to be stated at the outset that this book is not polemical: it
does not seek to discredit AIDS pedagogic interventions in India, which do seem to
have played a role in bringing down new infections by 66% since 2000, against a
global average of 35% (NACO 2015, p. 5; NACO 2017, p. 340). Rather, it tries to
understand how AIDS pedagogy functions as a mode of governing the conduct of
people, an exercise of power that seeks to empower and not constrain those it gov-
erns, how it constructs the “truth” of AIDS and of the experience of AIDS and what
resonances it has with the wider public discourse. In a lecture given to the French
Society of Philosophy in May 1978, Michel Foucault explained that the task of
critique is to find out not “what is true or false, founded or unfounded, real or illu-
sory, scientific or ideological, legitimate or abusive” but the links between the exer-
cise of power and elements of knowledge (Foucault 1997/2007, p. 59). Teaching
AIDS is written in the spirit of such inquiry.
The first cases of what later came to be called AIDS were discovered in 1979–
1980, among gay men in New York, California, and a number of cities in Western
Europe. Since most of the cases were diagnosed with two rare diseases associated
with low immunity, Pneumocystis carinii pneumonia and Kaposi’s sarcoma, it was
initially understood as a PCP/KS complex and informally referred to as gay-related
immunodeficiency (GRID) because of the population in which it predominantly
occurred. In 1982, by when there were a number of heterosexual cases, the Centers
for Disease Control and Prevention (CDC) adopted the term acquired immunodefi-
ciency syndrome (AIDS). During the same period, a number of cases of heterosexu-
ally transmitted HIV infection were reported from countries in sub-Saharan Africa
such as Uganda, Congo, Rwanda and Tanzania (Shilts 1987, pp. 138, 171). In 1985,
when the first international conference on AIDS was jointly organized by the CDC
and World Health Organization (WHO) in Atlanta, 17,000 cases had been reported
worldwide, with more than 80% from the United States. It was officially recognized
as an epidemic on a global scale in 1988 when the United Nations, in response to
the mounting number of cases reported from various countries, launched the Global
Programme on AIDS, the triple objective of which was “to prevent HIV infection,
reduce the personal and social impact of HIV infection and mobilize and unify
national and international efforts against AIDS” (UNAIDS 2008, p. 15). When
UNAIDS was established in 1994, it was estimated that by then there were about 13
million HIV-positive cases worldwide, of whom more than half a million died of
AIDS-related opportunistic illnesses. By 1996, when UNAIDS started compiling
1 AIDS Awareness and Behaviour Change: An Interdisciplinary Perspective 3
global data, the epidemic had spread to most parts of the world, with 15.4 million
reported cases in sub-Saharan Africa, 1.8 million in Asia, 1.5 million in North
America and Western and Central Europe, more than 1 million in Latin America and
the Caribbean, 300,000 in North Africa and the Middle East and 80,000 in Eastern
Europe and Central Asia. Further, it appeared as a complex of multiple and differ-
entiated regional epidemics, based on transmission modes, rates of spread, geo-
graphical foci, HIV subtypes and socio-economic and behavioural characteristics of
the populations most affected (UNAIDS 2008). In 2000, at the start of the new
millennium, UNAIDS reported a total of 34.3 million people living with HIV/
AIDS, with 5.4 million new infections in 1999 and 2.8 million deaths. India alone
accounted for 3.7 million people living with HIV, though the average prevalence
rate in the population was only 7 per 1000. The epidemic in India was very diverse,
with some states reporting almost nil prevalence while others reported 2% or more
(UNAIDS 2000).
The first cases of HIV infection in India were detected in 1986, about 5 years
after the epidemic emerged in the United States, Europe and sub-Saharan Africa.
The initial governmental and public response to this was to deny that it could spread
in India, because of strong moral traditions. But the Indian press recycled deeply
negative stereotypes of HIV disease and HIV-positive people taken from the Western
media, and there was intense moral panic about the disease. In 1992, with the help
of a World Bank loan, the government established the National AIDS Control
Organization (NACO) as the nodal agency to deal with the epidemic, and a central-
ized regulatory framework called the National AIDS Control Policy (NACP) was
formulated in five phases. At the time, there were only 5879 reported cases of HIV
infection and 96 cases diagnosed as AIDS. “Seeking a World Bank loan for HIV/
AIDS made no sense. But circumstances were compelling. Media reports of dis-
crimination and social boycott of HIV patients, denial of treatment by hospitals,
suicides driven by fear and shame, abandoned dead bodies with no one willing to
cremate them, and the handcuffing and jailing of drug addicts in Manipur created
panic and disbelief” (Rao 2017, p. 202). Data collection, however, was not done on
a large scale, and it was only after the formation of NACO, in the first phase of
NACP, that the HIV Sentinel Surveillance (HSS) was instituted, based on seropreva-
lence figures from antenatal clinics and STD clinics. By 1998, which marked the
end of NACP I, there were 3.5 million people living with HIV in India, with 2,85,000
new infections in that year alone (NACO 2004, p.16; NACO 2015, p. 4). In 2005, at
the end of NACP II, the number of new infections had dropped to 1,53,000, or
almost half the 1998 figure. In 2012, at the end of NACP III, the figure was 96,000,
and in 2015 it was 86,000 or a 65.7% decline on the figure for 2000 and 32.3%
decline on the figure for 2007 (1,27,000), which was taken as a baseline for NACP
IV (NACO 2015, p. 4).
Annual new infection figures are an index of how effectively disease control
measures have worked. The significant decrease in the number of new infections
during NACP III and NACP IV can be attributed to a number of factors. The first
was a multifold increase in the number of sentinel surveillance sites and improved
reporting, which made people aware of their HIV status so that they could take pre-
cautions against getting infected or, if infected, against transmitting it to others.

Second was improved blood safety, which had started from the very first phase of
NACP. Third was increased condom distribution through social marketing and
needle-exchange facilities for injection drug users; fourth, prevention of
parent-to-child transmission; and fifth, free supply of antiretroviral therapy for per-
sons living with HIV that reduced viral loads and consequently transmission of
disease. But all these strategies depend upon peoples’ knowledge of the facilities
available and their willingness to access them, and that is where pedagogy plays a
crucial role. Since the decision to test for HIV and sexually transmitted infections,
use condoms or uncontaminated needles and syringes, insist on HIV-free blood for
transfusion and avail of antiretroviral therapy for therapeutic and prophylactic (in
case of parent-to-child transmission) purposes – since the decision in such cases
cannot be mandated by law or coerced in any other way – it is only through peda-
gogic interventions that people can be persuaded to follow the precautions. There
may be, therefore, a correlation between the drop in new infections and the shift in
pedagogic techniques from a singular focus on informational formats, listing the
“facts” and “myths” of AIDS, to a mix of information and behaviour change com-
munication designed specifically for discrete risk groups, in what came to be called
“targeted interventions”.1 In this context, it becomes imperative to understand what
pedagogy involves as a form of governing peoples’ conduct, how it functions and
what kind of subjective effects it achieves in those whom it targets. Pedagogy, like
all social processes, never exists in isolation but is embedded within larger struc-
tures of meaning-making that organize and constitute our knowledge of ourselves
and the world; and to understand it effectively, we need to locate it within these
structures and the discourses as well as practices they generate. That, in effect, sums
up the approach and concerns of Teaching AIDS.
Let me now trace the trajectory of arguments developed in the six main chapters
of the book. In outline, the chapters are organized on the following themes: concep-
tual framework and tools of analysis, media accounts and narratives of AIDS as
“incipient” pedagogic sources, court decisions that construct the epidemic as a
problem for the law, formal pedagogic initiatives formulated by the state and imple-
mented by a range of agencies on behalf of the state and a local popular initiative
that combines the knowledge disseminated in official pedagogies with the reinven-
tion of a long-standing ritual tradition.
Chapter 2, titled “Pedagogy, Power and the Subject of Disease Control,” explains
the key concepts that are used in the book, as tools of analysis. It begins with the
concept of pedagogy and its relation to power in the work of Louis Althusser, Paulo
Freire and Michel Foucault. Althusser’s account of education in his ISA essay
brings out its role in sustaining and legitimating social power structures through
ideology. Its function is not simply to disseminate knowledge but to do so in ways
that make people more amenable to authority. The most telling example of this is the
lesson in civic citizenship and moral science, which is a core component in school
1
The term was introduced in NACP III, though the strategy had been adopted in the previous
phase.
curricula. One may also add lessons on hygiene, which began to be introduced in
schools in the late nineteenth century. Freire, too, holds a critical view of education
as a tool of political domination, especially in the countries of the global south, but
unlike Althusser he also advances a form of liberatory education that is dialogical
and problem-oriented rather than providing information. Despite their philosophical
differences, Althusser subscribing to an anti-humanist and Freire to a humanist
Marxist standpoint, both see education as essentially political, either in the service
of power or opposed to it. Foucault’s approach to education, however, is radically
different, though he too emphasizes its links to power relations. For Foucault, edu-
cation’s chief role is not to promote an ideology but to shape subjectivities. Unlike
the Marxists, he views power not as negative, working through ideological false
consciousness, but as productive and enabling. As he puts it in Society Must Be
Defended, the task of political analysis must be to show not how and why people
agree to be subjugated (which is the question for ideology critique) but “how actual
relations of subjugation manufacture subjects” (Foucault 2003, p. 45).
The role of pedagogy in subject formation is crucial to all three thinkers. For
Althusser ideology produces subjects who bear an illusion of autonomy and agency,
in the act of self-constitution that he calls “interpellation”. For Freire, mainstream
pedagogic practices work similarly on the learners, to ensure their continued domi-
nation through ideology and the illusion of freedom. An “education for critical con-
sciousness” opposes it and, through such opposition, produces empowered subjects.
In Freire, then, the subject is not only one who is subjected but equally one with a
capacity for autonomy and agential action. Foucault’s view of the subject resembles
to some extent this idea but without its liberatory overtones. For Foucault, free sub-
jectivity is not an ideological illusion, but neither does it exist and function outside
the field of power relations. The exercise of power, in its specifically modern form
that he calls “governmentality”, enables individuals to choose their course of life,
but from options outlined in advance by power. The subject, thus, is produced in a
socio-political space that is both enabling and constraining, in a paradoxical relation
to power that Foucault terms “subjectivation”. While the subject’s freedom is the
essential condition for this politics, it is not absolute. This should be clear from the
way modern systems of law both guarantee freedom and place what are called
“exceptions” or “reasonable restrictions” in the name of a higher good that is social.
Foucault’s emphasis, however, is not on law but disciplinary controls, which are
most prominent in the field of pedagogic practice. In its approach to subjectivity in
the context of pedagogy, the book’s conceptual framework draws on both Althusser’s
theory of interpellation and Foucault’s theory of subjectivation.
Chapter 2 also explains the concepts of norm and normativity, as the regulatory
schema within which subjects are produced. It draws on the work of a number of
authors, including Mary Douglas, Susan Sontag, Cindy Patton, Sander Gilman, and
Thomas Yingling, to understand how normative ideas are discursively produced and
legitimated in the context of health and disease, and the social effects of such pro-
duction. If discourse is one instance of normativity, embodied practice as the perfor-
mance of norms is the other. The chapter explains the concept of embodiment in
Thomas J. Csordas and Judith Butler, the former from a phenomenological and the
latter from a post-structuralist perspective, and theories of social practice in Pierre

Bourdieu and Victor Turner. Finally, the chapter explains Foucault’s concept of
“biopolitics”, or the politicization of life in modern societies. This concept is crucial
in understanding public health governance as one of the main activities of the state,
through which it ensures the life and well-being of its subjects. It briefly takes up the
negative inflection of biopolitics in Giorgio Agamben and Roberto Exposito, which
is explained in greater detail in Chapter 5.
Chapters 3 and 4 deal with what I call “incipient pedagogies”, that is, texts that
do not take up teaching about AIDS as their objective but which shape opinion
about the disease and how it can be comprehended. Some of these texts, especially
those discussed in Chapter 4, are in passing overtly pedagogic and are also associ-
ated with pedagogic initiatives undertaken by agencies of public health.
Chapter 3, “Incipient Pedagogy I: AIDS in the National Media”, is about early
media responses to the epidemic. When AIDS first appeared in India in 1986, there
was a lot of confusion about its modes of transmission and prevention, the people
most vulnerable to it and the kind of problem it posed for society. In the absence of
any Indian experience of the disease, the media turned to reports in the Western
press which were to a great extent homophobic and stigmatizing. Since transmis-
sion of the disease at this time was understood to be predominantly heterosexual,
the Indian media did not take up the homophobic perspective but re-articulated the
stigma in other ways. First, they stressed that AIDS was of “foreign origin”, in a
denial of disease that, as Susan Sontag has argued, is xenophobic. Disease always
belongs to the outside, the space of the other onto whom it must be projected. Inside
the nation, the media produced an othering of spaces like brothels, slums and high-
ways and those who inhabited them, from which it discursively insulated the
middle-class home. The reports attributed the spread of disease to prostitutes,
migrant workers and truck drivers, who were identified in public health discourse as
the “risk groups”. In public health parlance, the term meant people at risk of con-
tracting infection: through a slippage in the meaning of risk, the media translated
this as groups that posed a danger to others. Subsequently, when a significant num-
ber of housewives started testing positive for HIV, media accounts constructed a
“victimology” of AIDS founded on the binarism of the “innocent victim” and the
“guilty”. India Today devoted a cover story to the issue, titled “AIDS: Striking
Home”, with texts and illustrations that established the binary as fact and intensified
moral panic. These early media representations played a significant role in shaping
both popular and pedagogic understandings of AIDS and influenced social response
to the epidemic and the people affected by it.
The chapter discusses how media accounts constructed the epidemic as simulta-
neously a medical and moral catastrophe, a construction that was to have a signifi-
cant impact on the National AIDS Control Organization’s pedagogic initiatives in
its early phase. While the media also documented instances of human rights viola-
tions, especially the unlawful custodial detention of sex workers and injection drug
users, it tended to justify this as warranted by the severity of the crisis. This was also
the view reflected in a number of court cases concerning the rights of HIV-positive
people. One of the positive things that the media did, however, was to draw attention
to the contamination of blood supply, because of which ensuring blood safety

became a priority for the National AIDS Control Policy in its first phase.
By the late 1990s, when AIDS had already “struck home” in a big way, it was no
longer possible to believe that it concerned solely the marginal risk groups. It was
only then that it became a subject for narratives, of sufficient interest to the literate
middle class to warrant their publication. Besides, much of the panic had decreased,
making it a topic that one could talk about and not anxiously deny, especially after
the availability of antiretroviral therapy made it possible to see AIDS as a fatal but
manageable illness. Chapter 4, titled “Incipient Pedagogy II: AIDS Narratives”, is
about the way the HIV/AIDS epidemic has been recounted in factual and fictional
texts, including cinema. The narratives of AIDS that were published at the turn of
the century emerge from this conjuncture of events. We note a number of important
shifts in the way these narratives construct the epidemic.
First, AIDS comes to be seen as a social rather than biomedical issue, both in
terms of the stigma that it generates and the structural factors like gender and eco-
nomic inequalities that make people vulnerable to infection. Secondly, pedagogy
comes to be understood as the only means of controlling the epidemic by inducing
disease-preventive and risk-avoidance behaviour, especially since there is no vac-
cine available. Many of the narratives examined in this chapter are associated with
pedagogic projects, either commissioned or subsequently sponsored by them, and
all include a pedagogic component. In some narratives, like Sex, Lies and AIDS,
Nidaan and A Dove in Desert, the pedagogic function is overt, while in others it is
less obvious. Third, there is a shift from a macrosocial perspective, mapping the
extent and scale of disease incidence, to a micro-social one that focuses on the indi-
viduals affected. In terms of narrative mode, the epidemic comes to be constructed
through two forms of writing, the travelogue and the life narrative, with the empha-
sis gradually shifting to the latter. Fourth, with the emergence of life narratives,
AIDS comes to be understood more as illness than disease – that is, a condition that
involves the whole person rather than the body as an entity separate from the self,
thus emphasizing the subjective experience of illness rather than the objective
pathologies described by biomedicine. Accompanying this is a concern with heal-
ing, as the process of developing a sense of emotional and spiritual well-being
despite the presence of disease. Some of the narratives express the theme of human
vulnerability and the need to overcome it through establishing bonds of community
and support systems. This theme coincides with a major development in the epi-
demic when Positive People networks are formed to counter stigma, self-abjection
and isolation, through the embodied affiliations that Paul Rabinow calls “biosocial-
ity”. In the context of the epidemic, biosociality bears an inverse relation to stigma:
both involve the body, but while stigma devalues it as diseased and therefore to be
isolated, biosociality invests it with a new value as a foundation for community. The
shift to biosocial affiliation in turn corresponds with the emergence of two new
conceptualizations of embodiment in the epidemic: the use of the term “Person
Living with HIV/AIDS” (PLWHA), with its emphasis on living with AIDS instead
of dying of it, and the transformation of “positive” from a sign of disease in the
diagnosis of AIDS to a sign of self-affirmation in “Positive People”. These discur-
sive articulations constituted a meaning of AIDS opposed to that assigned to it in the
first decade of the epidemic. Finally, with Phir Milenge and My Brother … Nikhil,
we note a shift in the understanding of AIDS from a socio-economic problem to a
problem that law must address, in protecting the rights of the HIV-positive. The
epidemic thus comes to be complexly constructed and represented as simultane-
ously a medical, economic, social and juridical phenomenon.
An important aspect of these narratives is that they are all produced by and
addressed to people who are not themselves infected, and there is a tendency to repre-
sent and distance the HIV-positive as objects of compassion. This is more pronounced
in the early texts, both factual and fictional, in narrating the life stories of people who
have acquired the infection not through “promiscuity” but “innocently”, that is, either
through blood transfusion or from their spouses. By reproducing the guilt/innocence
binary, they unwittingly reinforce the stigma that they seek to counter. In this context,
Phir Milenge and My Brother … Nikhil, which focus more on the subjective experi-
ence of illness than on objective conditions of disease, are exceptions.
Chapter 5, “AIDS and the Enigma of Law”, examines three court judgments
pertaining to HIV disease and one to leprosy, which deal with the constitutional
validity of statutes that curtail the fundamental rights of persons with disease on the
ground that they pose a risk to the public. Lucy D’Souza v. State of Goa (1989) is
about a provision of the Goa, Daman and Diu Public Health Act, 1985, which allows
the state to isolate persons with HIV/AIDS in the interest of epidemic control.
Under this provision, Dominic D’Souza was kept in custody in an abandoned TB
sanatorium for 61 days, till a bench of the Bombay High Court ordered his release.
In Lucy D’Souza, the court ruled that the statute does not contradict the constitu-
tional rights to life, liberty and freedom of movement. Mr. X. v. Hospital Z (1998) is
about the action of a hospital that had violated the right to privacy and confidential-
ity of a Nagaland doctor who was HIV-positive, by informing others of his serosta-
tus and causing him severe social ostracism and loss of his job. The court held that
the hospital had acted in the interest of the woman he had proposed to marry, thus
saving her from disease and death, and was therefore justified in its action. It further
ruled that HIV-positive persons should not be allowed to have sex and their right to
marry be treated as a “suspended right”. Dhirendra Pandua v. State of Orissa (2008),
which concerned a provision of the Orissa Municipal Act, 1950, that disqualified
persons with leprosy from holding public office, similarly ruled that there was no
constitutional infirmity in the provision, even as it suggested that the state legisla-
ture may consider removing it. The paradox of a law that must protect the right to
life and liberty of its subjects by withdrawing the same right from those who are
diseased forms the central argument of M. Vijaya v. Chairman and Managing
Director Singareni Collieries (2001), which is the only judgment that explicitly
foregrounds this enigma. But Vijaya too, like the other judgments, resolves it in
favour of public interest and justifies the exclusion of diseased persons.
The chapter attempts to bring out the contradictions and inconsistencies underly-
ing such exclusion of persons with disease in the name of the public good. The
contradictions, it argues, do not become manifest in the structure of the legal system
but in the process by which the system is used in the maintenance of law. The
dichotomy of structure and process is one that has concerned the study of culture
and society since the 1970s. On the one hand, it is necessary to have a sense of the
structures by which order is maintained, whether it is the ordering of meaning in
language or the ordering of people’s conduct in law. But, on the other hand, this
abstract structure of ordering does not account for what actually happens. Social
reality cannot easily be determined by the rules that law and custom impose on it.
When the gap between this reality and the structure of rules becomes insuperable,
indeterminacies emerge that compel a rethinking and transformation of the rules.
Thus, structure is what both constrains process and is in turn transformed by it, in a
dialectical relation that Anthony Giddens calls the “duality of structure”. The pro-
cess central to the legal system is the adjudication of a case, and the judgment is its
quintessential inscription. The judgment not only matches acts to statutes, to deter-
mine whether they are licit, and prescribe penalties if they are not, but it also explains
in the process the rationality of law. Contradictions and inconsistencies, when they
appear in specific judgments, undermine that rationality and its attempt to deter-
mine the conditions of social existence. Such contradictions and inconsistencies, it
is argued, must not be viewed as the errors of an individual judgment but, given the
enchainment of judgments through precedents and procedures, the outcome of
deeper instabilities in the system of law itself.
The chapter links law to medicine in the form of governance that Foucault calls
biopolitics, or the politicization of life. One of the imperatives of the modern state as
it emerged in eighteenth-century Europe was to ensure that the subjects are provided
with all conditions necessary for health and well-being, which was mainly how it
differed from the rule of the sovereign. The rationale behind this was that the strength
and prosperity of the state depended on the productive capacity of its subjects, which
in turn depended on their health and well-being. In this form of governance, both
law and medicine worked to ensure the disciplining of individuals and the regulation
of populations in a double exercise of authority that was positive and productive.
However, in the case of individuals who were understood to pose a threat to the
social order, the medicolegal order functioned negatively, to exclude them from
society, and medicine provided the justifications for the sanctions that law imposed.
Legal psychiatry came up with the concept of the “dangerous individual”, whose
rights could be curtailed on the grounds not of what he did but what he was likely to
do given his character or condition of disease. This was a major paradigm shift in
law, when it turned from actions that must be proscribed to persons who must be
socially eliminated. This can explain why persons with disease are treated as a “dan-
ger”, whose rights may therefore be justifiably suspended to protect the right to life
of others. In the case of diseased individuals, thus, the biopolitics that is ordinarily
positive and empowers subjects to be productive inverts itself, acquires a negative
declension and sacrifices the very life it seeks to nurture and protect.
The chapter argues for a transformation in law’s understanding of the diseased
person, from one that objectifies them as source of social danger to one that is more
responsive to the social vulnerabilities that they themselves suffer under stigma and
ostracism. It ends with a discussion of the AIDS Prevention and Control Act, 2017,
which was the product of just such a transformation, with one significant
shortcoming. While it prohibits any form of discrimination against HIV-positive
individuals, it fails to address the discriminations implicit in legal provisions for

segregating the diseased and curtailing some of their fundamental rights.
Chapters 6 and 7 are about the main theme of the book: AIDS pedagogy. Chapter
6, “AIDS Awareness Campaigns: Pedagogy as Strategy”, discusses what I term
“official” or “national” pedagogies, which draw on large-scale plans and strategies
for governing the conduct of people. Using a distinction that I borrow from Michel
de Certeau, I call them “strategic” pedagogies. Chapter 7, “AIDS Amma Shrine:
Pedagogy as Tactics”, examines a popular initiative undertaken by the governed,
which I call, following de Certeau again, “tactical”. In order to understand how the
national AIDS pedagogy works, Chapter 6 places it in the larger context of public
health strategies, health education and nationalization of epidemic disease.
Historically, there have been three major paradigms of public health: quarantine/
vaccination, sanitation/personal hygiene and risk surveillance/lifestyle manage-
ment. In each of these couples, one element targets populations and the places they
inhabit, while the other targets individuals, in the double strategy of modern gover-
nance that Foucault characterizes as “an anatomo-politics of the human body” and
“a biopolitics of the population” (Foucault 1978, p. 139, italics in original). These
paradigms are not mutually exclusive, with one supplanting the other, but draw upon
techniques used earlier in re-articulated forms. Thus, the current public health para-
digm of risk surveillance/lifestyle management, instituted in the second half of the
twentieth century, includes techniques of quarantine and personal hygiene oriented
through the notion of risk group and risk practice in dealing with epidemic disease.
Public health pedagogy as a technique of acting upon individuals to follow
health-promoting practices emerged with the sanitation/personal hygiene paradigm,
in the second half of the nineteenth century, and has continued since then. It was
both disseminated among the general public, especially those populations held to be
most vulnerable because of illiteracy and poverty, and incorporated into school cur-
ricula in the form of primers, so as to raise levels of disease awareness in society.
Public health pedagogy as a strategy for governing people has followed a top-down
approach, with its experts drawn from medicine, sociology and social work, psy-
chology and communication. At present, it links good health no longer to morality
as the old hygienist paradigm did but to lifestyle factors that decrease risk of dis-
ease. However, moral norms are often recycled in the form of scientific wisdom
especially in the context of infectious sexual disease. This is because public health
governance has been since its inception a way of regulating the conduct of its sub-
jects, in a social hygiene that it performs alongside law and discipline. With its
emphasis on lifestyle, health education targets the subjectivities of the people it
addresses through techniques of interpellation and subjectivation, in producing ped-
agogic subjects who learn to value health above pleasure and are instilled with a
sense of responsible and rational conduct.
The chapter then examines the role of NACO in formulating and instituting
AIDS education in India. When the first cases of HIV disease were detected in1986,
the Indian government’s response was to deny its presence and to try and seal the
boundaries of the country in what Alison Bashford describes as imagining the “geo-
body” of the nation (Bashford 2004, p. 115). But when it could no longer be denied
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as a disease of foreigners, governmental response focused more on the interiors of the

nation rather than its borders. NACO was the product of this shift. With the formation
of NACO in 1992 and the formulation of the National AIDS Control Policy, the epi-
demic came to be nationalized primarily in two forms, through a cartographic map-
ping of spaces of disease and a demographic mapping of populations at risk. In
successive phases of the NACP, this strategy came to be scaled up in extending both
the reach and the depth of AIDS governance. With regard to pedagogy, nationaliza-
tion took the dual form of policy centralization by NACO and decentralized imple-
mentation by NGOs and community-based organizations, thus opening up multiple
sites of governmentality (NACO 2011, p. ix). Pedagogy adopted a technique of dou-
ble address, aimed at the general population through awareness creation and the risk
groups through what came to be called “targeted interventions”. Emphasis also
shifted from providing information about HIV/AIDS to facilitating behaviour change.
The major implication of this shift was the fashioning of the pedagogic subject in
policy and practice, deploying techniques of both interpellation and subjectivation.
In conformity with the new public health paradigm, the production of this subject
involved the teaching of risk and safety on the one hand and of managing lifestyles
on the other. In epidemiological discourse, risk is understood as the degree of one’s
vulnerability to disease, but in lay language, it is usually construed as danger to the
public. Given this semantic uncertainty, AIDS policy formulations and pedagogic
texts, though intended to address the epidemic in value-neutral terms and without
prejudice to risk groups, are often undermined by the slippage of meaning between
risk as vulnerability and risk as danger. The chapter uses a number of texts to dem-
onstrate this. With regard to the pedagogy of lifestyle management, it shows how it
is founded on an ideology of free and self-responsible subjectivity, which is the
mainstay of liberal or neo-liberal public health governance. There are, however,
fundamental contradictions in this ideological conception of subjectivity, the most
crucial being the way actual power relations are disguised in the form of an exper-
tise of enablement. The chapter attempts to bring out this contradiction by analyzing
two texts that are about teaching individuals to make responsible and health-
promoting choices.
The pedagogic construction of HIV/AIDS as a national problem is not insulated
from the constructions of the epidemic in the media, narratives and the law. It was
the panic about AIDS in the media that led to the creation of NACO and the priori-
tization of AIDS as public health issue, and not actual morbidity and mortality fig-
ures. There are many points on which official AIDS pedagogy either converged with
popular understandings of the disease in the media and narratives, especially with
regard to moral norms and family values, or opposed them with regard to stigma. As
for the juridical construction of AIDS, one of the important issues that pedagogy has
addressed is the violation of the human rights of HIV-positive people. For instance,
a booklet titled HIV/AIDS: Stand Up for Human Rights was produced jointly by the
office of the UN High Commissioner for Human Rights, WHO and UNAIDS and
circulated as a pedagogic text for the general population. More significantly, in a
Delhi High Court case in 2009 regarding the constitutional validity of Section 377
IPC, NACO became impleaded as a respondent. NACO’s stand, in support of the
petition filed by Naz Foundation, was that the statute, by criminalizing adult same-
sex relationships, drove underground gay men, bisexuals and hijras, making it very
difficult for pedagogic interventions to reach them. NACO’s stand on Section 377
IPC in Naz Foundation v Government of NCT of Delhi (2009), together with its sup-
port for targeted interventions among men who have sex with men, shows how
AIDS pedagogy has responded to the juridical construction of AIDS.
Chapter 7 is about an initiative undertaken not at the official level but by the
people acting independently of the official domain. Following de Certeau’s distinc-
tion between strategy and tactic, the chapter discusses this initiative, the worship of
a new “disease goddess” that the people call AIDS Amma, as a tactical response to
a local contingency.
The AIDS Amma shrine at Menasikyathanahalli was set up in 1998 by Girish,
science teacher in the local government school, to teach people about modes of
transmission of HIV/AIDS. Incidence of disease in the rural community led to panic
and stigma against HIV-positive people. Girish started the campaign to allay fear,
when he learnt that in the previous year an HIV-positive couple had committed sui-
cide due to stigma and their neighbours had cremated their bodies without following
ritual traditions. The maintenance of the shrine was subsequently taken up by the
community, who conducted weekly worship and organized an annual jatra or festi-
val on World AIDS Day. It was entirely a popular initiative, without support from
the government or non-governmental organizations. As such, it is an instance of
pedagogic efforts that are not part of public health governance and do not use the
form and logic of awareness campaigns conducted under the auspices of the state.
The initiative differs from official pedagogies in its use of religion to communi-
cate biomedical information about HIV. Taking his cue from a Mariamma temple on
the village outskirts, Girish thought of this method when his attempts in the usual
format of official pedagogy had received poor response. In most parts of India, there
is a long-standing tradition of the worship of disease goddesses, especially in times
of epidemic. Most of these goddesses are associated with smallpox and cholera,
epidemics of which were regular occurrences in the past and which took a heavy toll
of lives. A few temples had also been set up for a goddess associated with plague
after epidemics broke out at the end of the nineteenth century. The most popular of
these goddesses are Sitala in the north of India and Mariamma in the south, both
associated with smallpox. It is mostly believed that the goddess, who is benign, does
not cause the disease but protects her devotees from it, though sometimes she is also
imagined as malignant if she is displeased because people neglect her worship.
There are certain common features of disease goddess worship. It is ordinarily a
local affair, the goddess being a gramadevata or village deity, though the belief in
disease goddesses is itself more or less pan-Indian. The goddess is often attributed
with wide-ranging powers, most of which are associated with the prevention of dis-
ease and natural calamities: the tradition of goddess worship, thus, is an i maginative
way of resolving crises caused by chance events, when the resources of the com-
munity to reduce distress are felt to be inadequate. Weekly pujas are held at the
shrine of the goddess, normally situated at the entrance to the village, and a day is
fixed in the ritual calendar for her annual worship and jatra. Worship of the goddess
is most often a public affair, with the entire village community participating in it,
though domestic worship is not prohibited. Localization, collective participation
and attribution to the goddess of the power of ensuring well-being of both individu-
als and the community are the forms in which disease goddess worship becomes a
part of the everyday lives of the people, their ways of being. By linking the AIDS
Amma initiative with this long tradition, Girish could ensure acceptance of the
information he sought to communicate. But this itself was possible because the tra-
dition was available as a resource, in precisely the same context of epidemic disease
crisis that presented itself in Menasikyathanahalli, providing the conditions neces-
sary for Girish’s “invention” of AIDS Amma. By looking at the AIDS Amma initia-
tive from this perspective, one understands how its meaning and effects derive not
from the logic that Girish intended but the structural intentionality of the tradition.
Acceptance of the pedagogy was ensured by the ritual structure that framed it.
Theories of ritual emphasize its performative dimension, meaning not only that ritu-
als need to be performed but equally that their acceptance, meaning and efficacy are
an outcome of this performance. The authority that ritual has over the conduct of
one’s life is the effect of its performative structure, just as its authority ensures its
continued performance. By framing the pedagogic content in the ritual of goddess
worship, the initiative invested it with the authority of a popular and valued tradition.
Further, ritualization linked this authority to the idea of the sacred, thereby separat-
ing the pedagogic content from the practico-discursive field of public health com-
munication to which the local community had initially failed to respond. It is the
process of ritualization that makes sacred acts that would otherwise be secular or
profane, as seen in the way smallpox variolation or tika became an integral part of
Sitala worship. In this way the acts both gain authority and link the sacred to the
everyday life of the practitioners. Thirdly, as embodied activity, ritualization is an
important way in which South Asian societies have preserved cultural knowledge
and the shared sense of belonging to a collectivity. The perspective of embodiment
does not distinguish between mind and body as polarities of existence but assumes
their mutual implication in what Scheper-Hughes and Lock call the “mindful body”.
What this meant in the case of AIDS Amma was that the biomedical ideas could be
incorporated into existing ways of knowing and responding to epidemic crisis
through the embodied act of offering puja and celebrating the annual jatra. Memory,
consciousness and the body function as a complex in constituting knowledge of dis-
ease and integrating it with ideas of personhood in the cosmological order. Acceptance
of the pedagogic function of AIDS Amma was ensured by this complex.
The framing of biomedical knowledge in religious ritual, however, leads to cer-
tain epistemological effects that appear paradoxical and self-contradictory. It is
marked by a series of juxtapositions that bring together otherwise incompatible ele-
ments. Thus, AIDS Amma worship assumes divergent explanations of disease, per-
sonalistic and naturalistic. It assumes a magico-naturalistic conception in which the
body is understood as both open to external supernatural influence and constituted
by internal organic processes that follow natural law. It also involves contrary ways
of knowing, one performative and embodied and the other discursive and cognitive.
These juxtapositions, however, do not affect either the acceptance of the pedagogy
or its effectiveness in eliciting popular response. While the epistemology of AIDS

Amma may appear paradoxical from a theoretical perspective, the logic of expedi-
ency and symbolic assimilation of meaning in practice makes it otherwise in the
minds of its practitioners. The objective of the AIDS Amma initiative is pedagogic,
to teach the community about HIV/AIDS and the need to destigmatize it, but it
seeks to achieve this in a way that differs from conventional AIDS education and
behaviour change communication. Insofar as this is concerned, it is a tactical
response both to the crisis of epidemic disease and the strategies of public health
governance on which it draws. If the activity of governance is located in the position
of those who govern, this is an activity that belongs to the governed, without support
from though with reference to the former. It thus constitutes an agentiality not
dependent on governmental relations of power but on a popular will exercised
within the structures of a popular tradition. The significance of the AIDS Amma
initiative can only be understood in such a context. To see it merely as AIDS com-
munication or, corollarily, as an artificial ritual is to reduce this significance to its
most literal meaning. It then appears to be trivial, an improper innovation beset by
contradictions between what it seeks to do and how it does it.
Teaching AIDS, as stated above, approaches the HIV/AIDS epidemic in India
from an interdisciplinary cultural studies perspective. Here, I wish to make a dis-
tinction between interdisciplinarity and multidisciplinarity. What is crucial to a dis-
cipline is the demarcation and defining of its proper object of study. The conceptual
and analytic procedures that are specific to disciplines are both defined by and in
turn delimit this object. A discipline, in other words, is both an area of study and a
form of training that follows the rules appropriate to its object: the questions that
may be asked of it, the conclusions drawn and the perspective that bears legitimately
on the object. Multidisciplinarity expands the range of questions, answers and per-
spectives, without putting at risk the boundaries of the disciplines that it brings into
convergence. The object is what is crucial, remaining the same even as it passes
through the lens of different but compatible disciplines. Interdisciplinarity, in con-
trast, is concerned not with objects but contexts: what new insights emerge when the
object proper to a specific discipline is contextualized in another discipline incom-
patible with it? For example, what insights can be gained by placing public health
strategies, the object proper to medicine, in the context of a political inquiry or by
examining court decisions regarding the rights of the HIV-positive as texts that con-
struct and deconstruct the meanings they advance as authoritative? Rustom Bharucha
has made a similar distinction between multiculturalism and interculturalism: mul-
ticulturalism “is concerned with the cohabitation of different cultural and ethnic
groups negotiating an ostensibly common framework of citizenship”, while inter-
culturalism offers “a greater flexibility in exploring – and subverting – different
modes of citizenship across different national contexts, through subjectivities that
are less mediated by the agencies of the state” (Bharucha 2001, pp. 41–42).
Disciplines, in other words, rigorously establish sameness, multidisciplinarity nego-
tiates differences to articulate a common objective, and interdisciplinarity prolifer-
ates difference by contextually transforming both objects of inquiry and objectives.
Like Bharucha’s intercultural practice, it is subversive and indisciplined, with no
respect for the “proper”: “the savage impropriety of object choice that would seem
so thoroughly to outrage disciplinarity” (Nelson and Gaonkar 1996, p. 4). This does
not mean that interdisciplinarity is nihilistic: on the contrary, it is a critical practice
that explores new ways of looking at objects that both disciplinarity and multidisci-
plinarity ideologically foreclose. Its objective is not restricted to the production of
academic knowledge but to inquire into the politics of knowledge itself, the interests
that drive it to establish something as the “truth”. It is not, to use a distinction from
Michel de Certeau that we have already referred to, “strategic” but “tactical” in its
deployment of theories, concepts and tools of analysis. In an essay on cultural stud-
ies as interdisciplinary practice, Lawrence Grossberg writes:
To say that its object of study is contextual is to say that the context is the real object of study.
Its questions are not defined by theoretical and disciplinary concerns, but are posed, as it
were, by the context. The particular theory it deploys will vary with the context and the
problem, and it will be judged as a resource and measured by its ability to say something new
about the context which can open up new strategic understandings. (Grossberg 1996, p. 143)
Teaching AIDS draws upon the methods – and not the methodology2 – of interdisci-
plinary cultural studies, varying the resources it uses according to the context in
which its object of study, the HIV/AIDS epidemic in India, appears. As such, there-
fore, it does not use a singular methodology, but whatever methods are appropriate
for the specific context of each chapter. Thus, Chapter 3, which is on early media
responses to the epidemic, uses the methods of textual analysis and ideology cri-
tique to show how the media constructed HIV/AIDS. It focuses specifically on early
media responses because these predated the emergence of pedagogy in the 1990s
and influenced its forms and meanings. The chapter on narratives, Chapter 4, uses
narratological analysis along with a historicization of disease narratives, to examine
a number of texts selected not on the ground that they are representative but because
they are symptomatic of the shifting paradigms of how the disease was understood.
Chapter 5, which is on AIDS and the law, draws on critiques of jurisprudence in
philosophy and legal studies, and it selects for textual analysis a number of Supreme
Court and High Court judgments that were important for the medicolegal construc-
tion of AIDS. Chapter 6 contextualizes AIDS pedagogy in the history of public
health governance and health education and draws on a range of social theories and
methods of discursive analysis to examine AIDS intervention efforts undertaken at
the official level. Chapter 7, which is on the worship of AIDS Amma in a village
community in Karnataka, draws on arguments from the anthropology of religion in
India and ritual theory, reworked from the perspective of epistemological critique.
Thus, the method followed by the book as a whole is syncretic, drawing on the
approach most appropriate for the specific context of analysis. Overall, however,
Teaching AIDS tries to develop its arguments from resources in the humanities,
which it argues can help overcome the strong objectivist bias of the biomedical and
social scientific approaches that dominate the field of medical humanities.
Humanities, wherever it has figured in the field of medicine, has usually served a
2
Interdisciplinarity has no methodology, that is, no overarching framework of procedures and rules
of analysis, and no logos that grounds it in a singular animating principle.
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CHAPTER LVII
Whether I should go East or West suddenly became a question

with me. I had the feeling that I might do better in Detroit or some
point west of Chicago, only the nearness of such cities as Cleveland,
Buffalo, Pittsburgh and those farther east deterred me; the cost of
reaching them was small, and all the while I should be moving
toward my brother in New York. And so, after making inquiry at the
office of the Bee for a possible opening and finding none, and
learning from several newspaper men that Detroit was not
considered a live journalistic town, I decided to travel eastward, and
bought a ticket to Cleveland.
Riding in sight of the tumbling waves of Lake Erie, I was taken
back in thought to my days in Chicago and all those who had already
dropped out of my life forever. What a queer, haphazard,
disconnected thing this living was! Where should I be tomorrow,
what doing—the next year—the year after that? Should I ever have
any money, any standing, any friends? So I tortured myself. Arriving
in Cleveland at the close of a smoky gray afternoon, I left my bag at
the station and sought a room, then walked out to see what I should
see. I knew no one. Not a friend anywhere within five hundred
miles. My sole resource my little skill as a newspaper worker. Buying
the afternoon and morning papers, I examined them with care,
copying down their editorial room addresses, then betook me to a
small beanery for food.
The next morning I was up early, determined to see as much as I
could, to visit the offices of the afternoon papers before noon, then
to look in upon the city editors of the two or three morning papers.
The latter proved not very friendly and there appeared to be no
opening anywhere. But I determined to remain here for a few days
studying the city as a city and visiting the same editors each day or
as often as they would endure me. If nothing came of it within a
week, and no telegram came from my friend H—— in Toledo calling
me back, I proposed to move on; to which city I had not as yet
made up my mind.
The thing that interested me most about Cleveland then was that
it was so raw, dark, dirty, smoky, and yet possessed of one thing:
force, raucous, clattering, semi-intelligent force. America was then
so new industrially, in the furnace stage of its existence. Everything
was in the making: fortunes, art, social and commercial life. The
most impressive things were its rich men, their homes, factories,
clubs, office buildings and institutions of commerce and pleasure
generally; and this was as true of Cleveland as of any other city in
America.
Indeed the thing which held my attention, after I had been in
Cleveland a day or two and had established myself in a somber room
in a somber neighborhood once occupied by the very rich, were
those great and new residences in Euclid Avenue, with wide lawns
and iron or stone statues of stags and dogs and deer, which were
occupied by such rich men as John D. Rockefeller, Tom Johnson, and
Henry M. Flagler. Rockefeller only a year or two before had given
millions to revivify the almost defunct University of Chicago, then a
small Baptist college, and was accordingly being hailed as one of the
richest men of America. He and his satellites and confreres were
already casting a luster over Cleveland. They were all living here in
Euclid Avenue, and I was interested to look up their homes, envying
them their wealth of course and wishing that I were famous or a
member of a wealthy family, and that I might some day meet one of
the beautiful girls I thought must be here and have her fall in love
with and make me rich. Physically or artistically or materially, there
was nothing to see but business: a few large hotels, like those of
every American city, and these few great houses. Add a few theaters
and commonplace churches. All American cities and all the
inhabitants were busy with but one thing: commerce. They ate,
drank and slept trade. In my wanderings I found a huge steel works
and a world of low, smoky, pathetic little hovels about it. Although I
was not as yet given to reasoning about the profound delusion of
equality under democracy, this evidence of the little brain toiling for
the big one struck me with great force and produced a good deal of
speculative thought later on.
The paper with which I was eventually connected was the
Cleveland Leader, which represented all that was conservative in the
local life. Wandering into its office on the second or third day of my
stay, I was met at the desk of the city editor by a small, boyish-
looking person of a ferret-like countenance, who wanted to know
what I was after. I told him, and he said there was nothing, but on
hearing of the papers with which I had been connected and the
nature of the work I had done he suggested that possibly I might be
able to do something for the Sunday edition. The Sunday editor
proved to be a tall, melancholy man with sad eyes, a sallow face,
sunken cheeks, narrow shoulders and a general air of weariness and
depression.
“What is it, now, you want?” he asked slowly, looking up from his
musty roll-top desk.
“Your city editor suggested that possibly you might have some
Sunday work for me to do. I’ve had experience in this line in Chicago
and St. Louis.”
“Yes,” he said not asking me to sit down. “Well, now, what do you
think you could write about?”
This was a poser. Being new to the city I had not thought of any
particular thing, and could not at this moment. I told him this.
“There’s one thing you might write about if you could. Did you
ever hear of a new-style grain-boat they are putting on the Lakes
called——”
“Turtle-back?” I interrupted.
“Turtle-back?” went on the editor indifferently. “Well, there’s one
here now in the harbor. It’s the first one to come here. Do you think
you could get up something on that?”
“I’m sure I could. I’d like to try. Do you use pictures?”
“You might get a photo or two; we could have drawings made
from them.”
I started for the door, eager to be about this, when he said: “We
don’t pay very much: three dollars a column.”
That was discouraging, but I was filled with the joy of doing
something. On my way out I stopped at the business office and
bought a copy of the last Sunday issue, which proved to be a poor
makeshift composed of a half dozen articles on local enterprises and
illustrated with a few crude drawings. I read one or two of them,
and then looked up my waterfront boat. I found it tied up at a dock
adjoining an immense railroad yard and near an imposing grain
elevator. Finding nobody about, I nosed out the bookkeeper of the
grain elevator, who told me that the captain of the boat had gone to
the company’s local office in a nearby street. I hastened to the
place, and there found a bluff old lake captain in blue, short, stout,
ruddy, coarse, who volunteered, almost with a “Heigh!” and a “Ho!”
to tell me something about it.
“I think I ought to know a little something about ’em—I sailed the
first one that was ever sailed out of the port of Chicago.”
I listened with open ears. I caught a disjointed story of plans and
specifications, Sault Ste. Marie, the pine woods of Northern
Michigan, the vast grain business of Chicago and other lake ports,
early navigation on the lakes, the theory of a bilge keel and a turtle-
back top, and all strung together with numerous “y’sees” and “so
nows.” I made notes, on backs of envelopes, scraps of paper, and
finally on a pad furnished me by the generous bookkeeper. I carried
my notes back to the paper.
The Sunday editor was out. I waited patiently until half-past four,
and then, the light fading, gave up the idea of going with a
photographer to the boat. I went to a faded green baize-covered
table and began to write my story. I had no sooner done a
paragraph or two than the Sunday editor returned, bringing with him
an atmosphere of lassitude and indifference. I went to him to
explain what I had done.
“Well, write it up, write it up. We’ll see,” and he turned away to his
papers.
I labored hard at my story, and by seven or eight o’clock had
ground out two thousand words of description which had more of
the bluff old captain in it than of the boat. The Sunday editor took it
when I was through, and shoved it into a pigeon-hole, telling me to
call in a day or two and he would let me know. I thought this
strange. It seemed to me that if I were working for a Sunday paper I
should work every day. I called the next day, but Mr. Loomis had not
read it. The next day he said the story was well enough written,
though very long. “You don’t want to write so loosely. Stick to your
facts closer.”
This day I suggested a subject of my own, “the beauty of some of
the new suburbs,” but he frowned at this as offering a lot of free
advertising to real estate men who ought to be made to pay. Then I
proposed an article on the magnificence of Euclid Avenue, which was
turned down as old. I then spoke of a great steel works which was
but then coming into the city, but as this offered great opportunity to
all the papers he thought poorly of it. He compromised a day or two
later by allowing me to write up a chicken-farm which lay outside the
city.
Of course this made a poor showing for me at the cashier’s desk.
At the end of the second week I was allowed to put in a bill for
seven dollars and a half. I had not realized that I was wasting so
much time. I appealed to all the editors again for a regular staff
position, but was told there was no opening. It began to look as if I
should have to leave Cleveland soon, and I wondered where I
should go next—Buffalo or Pittsburgh, both equally near.
CHAPTER LVIII
Finding Cleveland hopeless for me, I one day picked up and left.
Then came Buffalo, which I reached toward the end of March. Aside
from the Falls I found it a little tame, no especial snap to it—not as
much as I had felt to be characteristic of Cleveland. What interest
there was for me I provided myself, wandering about in odd drear
neighborhoods, about grain elevators and soap factories and railroad
yards and manufacturing districts. Here, as in Cleveland, I could not
help but see that in spite of our boasted democracy and equality of
opportunity there was as much misery and squalor and as little
decent balancing of opportunity against energy as anywhere else in
the world. The little homes, the poor, shabby, colorless, drear, drab
little homes with their grassless “yards,” their unpaved streets, their
uncollected garbage, their fluttering, thin-flamed gas-lamps, the
crowds of ragged, dirty, ill-cared-for children! Near at hand was
always the inevitable and wretched saloon, not satisfying a need for
pleasure in a decent way but pandering to the lowest and most
conniving and most destroying instincts of the lowest politicians and
heelers and grafters and crooks, while the huge financial and
manufacturing magnates at the top with their lust for power and
authority used the very flesh of the weaker elements for purposes of
their own. It was the saloon, not liquor, which brought about the
prohibition folly. I used to listen, as a part of my reportorial duties,
to the blatherings of thin-minded, thin-blooded, thin-experienced
religionists as well as to those of kept editorial writers, about the
merits and blessings and opportunities of our noble and bounteous
land; but whenever I encountered such regions as this I knew well
enough that there was something wrong with their noble
maunderings. Shout as they might, there was here displayed before
my very eyes ample evidence that somewhere there was a screw
loose in the “Fatherhood of Man—Brotherhood of God” machinery.
After I had placed myself in a commonplace neighborhood near
the business center, I canvassed the newspaper offices and their
editors. Although I had in my pocket that letter from the publisher of
the St. Louis Republic extolling my virtues as a reporter and
correspondent, so truly vagrom was my mood and practical
judgment that I did not present it to any one. Instead I merely
mooned into one office after another (there were only four papers
here), convinced before entering that I should not get anything—and
I did not. One young city editor, seeming to take at least an interest
in me, assured me that if I would remain in Buffalo for six weeks he
could place me; but since I had not enough money to sustain myself
so long I decided not to wait. Ten days spent in reconnoitering these
offices daily, and I concluded that it was useless to remain longer.
Yet before I went I determined to see at least one thing more: the
Falls.
Therefore one day I traveled by trolley to Niagara and looked at
that tumbling flood, then not chained or drained by turbine water-
power sluices. I was impressed, but not quite so much as I had
thought I should be. Standing out on a rock near the greatest
volume of water under a gray sky, I was awed by the downpour and
then became dizzy and felt as though I were being carried along
whether I would or not. Farther upstream I stared at the water as it
gathered force and speed, wondering how I should feel if I were in a
small canoe and fighting it for my life. Behind the falls were great
stalagmites and stalactites of ice and snow still standing from the
cold of weeks before. I recalled that Blondel, a famous French
swimmer of his day, had ten years before swum these fierce and
angry waters below the Falls. I wondered how he had done it, so
wildly did they leap, huge wheels of water going round and round
and whitecaps leaping and spitting and striking at each other.
When I returned to Buffalo I congratulated myself that if I had got
nothing else out of my visit to Buffalo, at least I had gained this.
CHAPTER LIX
I now decided that Pittsburgh would be as good a field as any, and

one morning seeing a sign outside a cut-rate ticket-broker’s window
reading “Pittsburgh, $5.75,” I bought a ticket, returned to my small
room to pack my bag, and departed. I arrived at Pittsburgh at six or
seven that same evening.
Of all the cities in which I ever worked or lived Pittsburgh was the
most agreeable. Perhaps it was due to the fact that my stay included
only spring, summer and fall, or that I found a peculiarly easy
newspaper atmosphere, or that the city was so different physically
from any I had thus far seen; but whether owing to one thing or
another certainly no other newspaper work I ever did seemed so
pleasant, no other city more interesting. What a city for a realist to
work and dream in! The wonder to me is that it has not produced a
score of writers, poets, painters and sculptors, instead of—well, how
many? And who are they?
I came down to it through the brown-blue mountains of Western
Pennsylvania, and all day long we had been winding at the base of
one or another of them, following the bed of a stream or turning out
into a broad smooth valley, crossing directly at the center of it, or
climbing some low ridge with a puff-puff-puff and then clattering
almost recklessly down the other slope. I had never before seen any
mountains. The sight of sooty-faced miners at certain places, their
little oil and tow tin lamps fastened to their hats, their tin dinner-
pails on their arms, impressed me as something new and faintly
reminiscent of the one or two small coal mines about Sullivan,
Indiana, where I had lived when I was a boy of seven. Along the
way I saw a heavy-faced and heavy-bodied type of peasant woman,
with a black or brown or blue or green skirt and a waist of a
contrasting color, a headcloth or neckerchief of still another, trailed
by a few children of equally solid proportions, hanging up clothes or
doing something else about their miserable places. These were the
much-maligned hunkies just then being imported by the large
manufacturing and mining and steel-making industries of the
country to take the place of the restless and less docile American
working man and woman. I marveled at their appearance and
number, and assumed, American-fashion, that in their far-off and
unhappy lands they had heard of the wonderful American
Constitution, its guaranty of life, liberty and the pursuit of happiness,
as well as of the bounteous opportunities afforded by this great land,
and that they had forsaken their miseries to come all this distance to
enjoy these greater blessings.
I did not then know of the manufacturers’ foreign labor agent with
his lying propaganda among ignorant and often fairly contented
peasants, painting America as a country rolling in wealth and
opportunity, and then bringing them here to take the places of more
restless and greatly underpaid foreigners who, having been brought
over by the same gay pictures, were becoming irritated and
demanded more pay. I did not then know of the padrone, the labor
spy, the company store, five cents an hour for breaker children, the
company stockade, all in full operation at this time. All I knew was
that there had been a great steel strike in Pittsburgh recently, that
Andrew Carnegie, as well as other steel manufacturers (the Olivers,
for one), had built fences and strung them with electrified barbed
wire in order to protect themselves against the “lawless” attacks of
“lawless” workingmen.
I also knew that a large number of State or county or city paid
deputy sheriffs and mounted police and city policemen had been
sworn in and set to guarding the company’s property and that H. C.
Frick, a leading steel manager for Mr. Carnegie, had been slightly
wounded by a desperado named Alexander Berkman, who was
inflaming these workingmen, all foreigners of course, lawless and
unappreciative of the great and prosperous steel company which
was paying them reasonable wages and against which they had no
honest complaint.
Our mid-Western papers, up to the day of Cleveland’s election in
1892 and for some time after, had been full of the merits of this
labor dispute, with long and didactic editorials, intended in the main
to prove that the workingman was not so greatly underpaid,
considering the type of labor he performed and the intelligence he
brought to his task; that the public was not in the main vastly
interested in labor disputes, both parties to the dispute being unduly
selfish; that it would be a severe blow to the prosperity of the
country if labor disputes were too long continued; that unless labor
was reasonable in its demands capital would become disheartened
and leave the country. I had not made up my mind that the
argument was all on one side, although I knew that the average
man in America, despite its great and boundless opportunities, was
about as much put upon and kicked about and underpaid as any
other. This growing labor problem or the general American
dissatisfaction with poor returns upon efforts made crystallized three
years later in the Free Silver campaign and the “gold parades.” The
“full dinner-pail” was then invented as a slogan to counteract the
vast economic unrest, and the threat to close down and so bring
misery to the entire country unless William McKinley was elected was
also freely posted. Henry George, Father McGlynn, Herr Most, Emma
Goldman, and a score of others were abroad voicing the woes of
hundreds of thousands who were supposed to have no woes.
At that time, as I see it now, America was just entering upon the
most lurid phase of that vast, splendid, most lawless and most
savage period in which the great financiers were plotting and
conniving at the enslavement of the people and belaboring each
other. Those crude parvenu dynasties which now sit enthroned in
our democracy, threatening its very life with their pretensions and
assumptions, were then in their very beginning. John D. Rockefeller
was still in Cleveland; Flagler, William Rockefeller, H. H. Rogers, were
still comparatively young and secret agents; Carnegie was still in
Pittsburgh, an iron master, and of all his brood of powerful children
only Frick had appeared; William H. Vanderbilt and Jay Gould had
only recently died; Cleveland was President, and Mark Hanna was an
unknown business man in Cleveland. The great struggles of the
railroads, the coal companies, the gas companies, to overawe and
tax the people were still in abeyance, or just being born. The multi-
millionaire had arrived, it is true, but not the billionaire. On every
hand were giants plotting, fighting, dreaming; and yet in Pittsburgh
there was still something of a singing spirit.
When I arrived here and came out of the railway station, which
was directly across the Monongahela River from the business center,
I was impressed by the huge walls of hills that arose on every hand,
a great black sheer ridge rising to a height of five or six hundred feet
to my right and enclosing this river, on the bosom of which lay
steamboats of good size. From the station a pleasingly designed
bridge of fair size led to the city beyond, and across it trundled in
unbroken lines street-cars and wagons and buggies of all sizes and
descriptions. The city itself was already smartly outlined by lights, a
galaxy climbing the hills in every direction, and below me as I
walked out upon this bridge was an agate stream reflecting the
lights from either shore. Below this was another bridge, and
upstream another. The whole river for a mile or more was suddenly
lit to a rosy glow, a glow which, as I saw upon turning, came from
the tops of some forty or fifty stacks belching a deep orange-red
flame. At the same time an enormous pounding and crackling came
from somewhere, as though titans were at work upon subterranean
anvils. I stared and admired. I felt that I was truly adventuring into a
new and strange world. I was glad now that I had not found work in
Toledo or Cleveland or Buffalo.
The city beyond the river proved as interesting as the river cliffs
and forges about the station. As I walked along I discovered the
name of the street (Smithfield), which began at the bridge’s end and
was lined with buildings of not more than three or four stories
although it was one of the principal streets of the business center. At
the bridge-head on the city side stood a large smoke-colored stone
building, which later I discovered was the principal hotel, the
Monongahela, and beyond that was a most attractive and unusual
postoffice building. I came to a cross street finally (Fifth Avenue),
brightly lighted and carrying unusual traffic, and turned into it. I
found this central region to be most puzzlingly laid out, and did not
attempt to solve its mysteries. Instead, I entered a modest
restaurant in a side street. Later I hunted up a small hotel, where I
paid a dollar for a room for the night. I retired, speculating as to
how I should make out here. Something about the city drew me
intensely. I wished I might remain for a time. The next morning I
was up bright and early to look up the morning papers and find out
the names of the afternoon papers. I found that there were four: the
Dispatch and Times, morning papers, and the Gazette-Telegraph and
Leader, afternoon. I thought them most interesting and different
from those of other cities in which I had worked.
“Andy Pastor had his right hand lacerated while at work in the 23-inch
mill yesterday.”
“John Kristoff had his right wrist sprained while at work in the 140-inch
mill yesterday.”
“Joseph Novic is suffering from contused wounds of the left wrist
received while at work in the 23-inch mill yesterday.”
“A train of hot metal, being hauled from a mixing-house to open hearth
No. 2, was side-swiped by a yard engine near the 48-inch mill. The
impact tilted the ladles of some of the cars and the hot metal spilled in a
pool of water along the track. Antony Brosak, Constantine Czernik and
Kafros Maskar were seriously wounded by the exploding metal.”
Such items arrested my attention at once; and then such names

as Squirrel Hill, Sawmill Run, Moon Run, Hazelwood, Wind Gap
Road, Braddock, McKeesport, Homestead, Swissvale, somehow
made me wish to know more of this region.
The Dispatch was Republican, the Times Democratic. Both were
evidently edited with much conservatism as to local news. I made
haste to visit the afternoon newspaper offices, only to discover that
they were fully equipped with writers. I then proceeded in search of
a room and finally found one in Wylie Avenue, a curious street that
climbed a hill to its top and then stopped. Here, almost at the top of
this hill, in an old yellow stonefront house the rear rooms of which
commanded a long and deep canyon or “run,” I took a room for a
week. The family of this house rented rooms to several others, clerks
who looked and proved to be a genial sort, holding a kind of court
on the front steps of an evening.
I now turned to the morning papers, going first to the Times,
which had its offices in a handsome building, one of the two or three
high office buildings in the city. The city editor received me
graciously but could promise nothing. At the Dispatch, which was
published in a three-story building at Smithfield and Diamond
streets, I found a man who expressed much more interest. He was a
slender, soft-spoken, one-handed man. On very short acquaintance I
found him to be shrewd and canny, gracious always, exceedingly
reticent and uncommunicative and an excellent judge of news, and
plainly holding his job not so much by reason of what he put into his
paper as by what he kept out of it. He wanted to know where I had
worked before I came to Pittsburgh, whether I had been connected
with any paper here, whether I had ever done feature stuff. I
described my experiences as nearly as I could, and finally he said
that there was nothing now but he was expecting a vacancy to occur
soon. If I could come around in the course of a week or ten days (I
drooped sadly)—well, then, in three or four days, he thought he
might do something for me. The salary would not be more than
eighteen the week. My spirits fell at that, but his manner was so
agreeable and his hope for me so keen that I felt greatly encouraged
and told him I would wait a few days anyhow. My friend in Toledo
had promised me that he would wire me at the first opening, and I
was now expecting some word from him. This I told to this city
editor, and he said: “Well, you might wait until you hear from him
anyhow.” A thought of my possible lean purse did not seem to occur
to him, and I marveled at the casual manner in which he assumed
that I could wait.
Thereafter I roamed the city and its environs, and to my delight
found it to be one of the most curious and fascinating places I had
ever seen. From a stationery store I first secured a map and figured
out the lay of the town. At a glance I saw that the greater part of it
stretched eastward along the tongue of land that was between the
Allegheny and the Monongahela, and that this was Pittsburgh proper.
Across the Allegheny, on the north side, was the city of Allegheny, an
individual municipality but so completely connected with Pittsburgh
as to be identical with it, and connected with it by many bridges.
Across the Monongahela, on the south side, were various towns: Mt.
Washington, Duquesne, Homestead. I was interested especially in
Homestead because of the long and bitter contest between the
steel-workers and the Carnegie Company, which for six months and
more in 1892 had occupied space on the front page of every
newspaper in America.
Having studied my map I explored, going first across the river into
Allegheny. Here I found a city built about the base of high granite
hills or between ridges in hollows called “gaps” or “runs” with a
street or car-line clambering and twisting directly over them. A
charming park and boulevard system had been laid out, with the city
hall, a public market and a Carnegie public library as a center. The
place had large dry-goods and business houses.
On another day I crossed to the south side and ascended by an
inclined plane, such as later I discovered to be one of the
transportation features of Pittsburgh, the hill called Mt. Washington,
from the top of which, walking along an avenue called Grand View
Boulevard which skirted the brow of the hill, I had the finest view of
a city I have ever seen. In later years I looked down upon New York
from the heights of the Palisades and the hills of Staten Island; on
Rome from the Pincian Gardens; on Florence from San Miniato; and
on Pasadena and Los Angeles from the slopes of Mt. Lowe; but
never anywhere have I seen a scene which impressed me more than
this: the rugged beauty of the mountains, which encircle the city, the
three rivers that run as threads of bright metal, dividing it into three
parts, the several cities joined as one, their clambering streets
presenting a checkered pattern emphasized here and there by the
soot-darkened spires of churches and the walls of the taller and
newer and cleaner office buildings.
As in most American cities of any size, the skyscraper was just
being introduced and being welcomed as full proof of the growth
and wealth and force of the city. No city was complete without at
least one: the more, of course, the grander.
Pittsburgh had a better claim to the skyscraper as a commercial
necessity than any other American city that I know. The tongue of
land which lies between the Allegheny and the Monongahela, very
likely not more than two or three square miles in extent, is still the
natural heart of the commercial life for fifty, a hundred miles about.
Here meet the three large rivers, all navigable. Here, again, the
natural runs and gaps of the various hills about, as well as the levels
which pursue the banks of the streams and which are the natural
vents or routes for railroad lines, street-cars and streets, come to a
common center. Whether by bridges from Allegheny, the south bank
of the Ohio or the Monongahela, or along the shores of the
Allegheny or Monongahela within the city of Pittsburgh itself, all
meet somewhere in this level tongue; and here, of necessity, is the
business center. So without the tall building, I cannot see how one-
tenth of the business which would and should be normally
transacted here would ever come about.
CHAPTER LX
Barring two or three tall buildings, the city of Pittsburgh was then
of a simple and homelike aspect. A few blackened church spires, a
small dark city hall and an old market-place, a long stretch of blast
furnaces, black as night, and the lightly constructed bridges over the
rivers, gave it all an airy grace and charm.
Since the houses up here were very simple, mostly working-men’s
cottages, and the streets back followed the crests of hills twisting
and winding as they went and providing in consequence the most
startling and effective views of green hills and mountains beyond, I
decided that should I be so fortunate as to secure work I would
move over here. It would be like living in a mountain resort, and
most inexpensively.
I descended and took a car which followed the Monongahela
upstream to Homestead, and here for the first time had a view of
that enormous steel plant which only recently (June to December,
1892) had played such a great part in the industrial drama of
America. The details of the quarrel were fairly fresh in my mind: how
the Carnegie Steel Company had planned, with the technicalities of a
wage-scale readjustment as an excuse, to break the power of the
Amalgamated Steel Workers, who were becoming too forceful and
who were best organized in their plant, and how the Amalgamated,
resenting the introduction of three hundred Pinkerton guards to
“protect” the plant, had attacked them, killing several and injuring
others, and so permitting the introduction of the State militia, which
speedily and permanently broke the power of the strikers. They
could only wait then and starve, and so they had waited and starved
for six months, when they finally returned to work, such of them as
would be received. When I reached there in April, 1894, the battle
was already fifteen months past, but the feeling was still alive. I did
not then know what it was about this town of Homestead that was
so depressing, but in the six months of my stay here I found that it
was a compound of a sense of defeat and sullen despair. The men
had not forgotten. Even then the company was busy, and had been
for months, importing Poles, Hungarians, Lithuanians, to take the
places of the ousted strikers. Whole colonies were already here,
housed under the most unsatisfactory conditions, and more were
coming. Hence the despair of those who had been defeated.
Along the river sprawled for a quarter of a mile or more the huge
low length of the furnaces, great black bottle-like affairs with rows of
stacks and long low sheds or buildings paralleling them, sheds from
which came a continuous hammering and sputtering and the glow of
red fire. The whole was shrouded by a pall of gray smoke, even in
the bright sunshine. Above the plant, on a slope which rose steeply
behind it, were a few moderately attractive dwellings grouped about
two small parks, the trees of which were languishing for want of air.
Behind and to the sides of these were the spires of several churches,
those soporifics against failure and despair. Turning up side streets
one found, invariably, uniform frame houses, closely built and dulled
by smoke and grime, and below, on the flats behind the mill, were
cluttered alleys so unsightly and unsanitary as to shock me into the
belief that I was once more witnessing the lowest phases of Chicago
slum-life, the worst I had ever seen. The streets were mere mud-
tracks. Where there were trees (and there were few) they were
dwarfed and their foliage withered by a metallic fume which was
over all. Though the sun was bright at the top of the hill, down here
it was gray, almost cloudy, at best a filtered dull gold haze.
The place held me until night. I browsed about its saloons, of
which there was a large number, most of them idle during the drift
of the afternoon. The open gates of the mill held my interest also,
for through them I could see furnaces, huge cranes, switching
engines, cars of molten iron being hauled to and fro, and mountains
of powdered iron ore and scrap iron piled here and there awaiting
the hour of new birth in the smelting vats. When the sun had gone
down, and I had watched a shift of men coming out with their
buckets and coats over their arms, and other hundreds entering in a
rush, I returned to the city with a sense of the weight and breadth
and depth of huge effort. Here bridges and rail and plate steel were
made for all the world. But of all these units that dwelt and labored
here scarce a fraction seemed even to sense a portion of the
meaning of all they did. I knew that Carnegie had become a multi-
millionaire, as had Phipps and others, and that he was beginning to
give libraries, that Phipps had already given several floral
conservatories, and that their “lobbies” in Congress were even then
bartering for the patronage of the government on their terms; but
the poor units in these hovels at Homestead—what did they know?
On another day I explored the east end of Pittsburgh, which was
the exclusive residence section of the city and a contrast to such
hovels and deprivations as I had witnessed at Homestead and
among the shacks across the Monongahela and below Mt.
Washington. Never in my life, neither before nor since, in New York,
Chicago or elsewhere, was the vast gap which divides the rich from
the poor in America so vividly and forcefully brought home to me. I
had seen on my map a park called Schenley, and thinking that it
might be interesting I made my way out a main thoroughfare called
(quite appropriately, I think) Fifth Avenue, lined with some of the
finest residences of the city. Never did the mere possession of
wealth impress me so keenly. Here were homes of the most
imposing character, huge, verandaed, tree-shaded, with immense
lawns, great stone or iron or hedge fences and formal gardens and
walks of a most ornate character. It was a region of well-curbed,
well-drained and well-paved thoroughfares. Even the street-lamps
were of a better design than elsewhere, so eager was a young and
democratic municipality to see that superior living conditions were
provided for the rich. There were avenues lined with well-cropped
trees, and at every turn one encountered expensive carriages, their
horses jingling silver or gold-gilt harness, their front seats occupied
by one or two footmen in livery, while reclining was Madam or Sir, or
both, gazing condescendingly upon the all too comfortable world
about them.
In Schenley Park was a huge and interesting arboretum or
botanical garden under glass, a most oriental affair given by Phipps
of the Carnegie Company. A large graceful library of white limestone,
perhaps four or five times the size of the one in Allegheny, given by
Andrew Carnegie, was in process of construction. And he was
another of the chief beneficiaries of Homestead, the possessor of a
great house in this region, another in New York and still another in
Scotland, a man for whom the unwitting “Pinkertons” and
contending strikers had been killed. Like huge ribbons of fire these
and other names of powerful steel men—the Olivers, Thaws, Fricks,
Thompsons—seemed to rise and band the sky. It seemed
astonishing to me that some men could thus rise and soar about the
heavens like eagles, while others, drab sparrows all, could only pick
among the offal of the hot ways below. What were these things
called democracy and equality about which men prated? Had they
any basis in fact? There was constant palaver about the equality of
opportunity which gave such men as these their chance, but I could
not help speculating as to the lack of equality of opportunity these
men created for others once their equality at the top had made
them. If equality of opportunity had been so excellent for them why
not for others, especially those in their immediate care? True, all
men had not the brains to seize upon and make use of that which
was put before them, but again, not all men of brains had the
blessing of opportunity as had these few men. Strength, as I felt,
should not be too arrogant or too forgetful of the accident or chance
by which it had arrived. It might do something for the poor—pay
them decent living wages, for instance. Were these giants planning
to subject their sons and daughters to the same “equality of
opportunity” which had confronted them at the start and which they
were so eager to recommend to the attention of others? Not at all.
In this very neighborhood I passed an exclusive private school for
girls, with great grounds and a beautiful wall—another sample of
equality of opportunity.
On the fourth day of my stay here I called again at the Dispatch
office and was given a position, but only after the arrival of a
telegram from Toledo offering me work at eighteen a week. Now I
had long since passed out of the eighteen-dollar stage of reporting,
and this was by no means a comforting message. If I could show it
to the Dispatch city editor, I reasoned, it would probably hasten his
decision to accept me, but also he might consider eighteen dollars as
a rate of pay acceptable to me and would offer no more. I decided
not to use it just then but to go first and see if anything had come
about in my favor.
“Nothing yet,” he said on seeing me. “Drop around tomorrow or
Saturday. I’m sure to know then one way or the other.”
I went out and in the doorway below stood and meditated. What
was I to do? If I delayed too long my friend in Toledo would not be
able to do anything for me, and if I showed this message it would fix
my salary at a place below that which I felt I deserved. I finally hit
upon the idea of changing the eighteen to twenty-five and went to a
telegraph office to find some girl to rewrite it for me. Not seeing a
girl I would be willing to approach, I worked over it myself, carefully
erasing and changing until the twenty-five, while a little forced and
scraggly, looked fairly natural. With this in my pocket I returned to
the Dispatch this same afternoon, and told the city editor with as
great an air of assurance as I could achieve that I had just received
this message and was a little uncertain as to what to do about it.
“The fact is,” I said, “I have started from the West to go East. New
York is my eventual goal, unless I find a good place this side of it.
But I’m up against it now and unless I can do something here I
might as well go back there for the present. I wouldn’t show you this
except that I must answer it tonight.”
He read it and looked at me uncertainly. Finally he got up, told me
to wait a minute, and went through a nearby door. In a minute or
two he returned and said: “Well, that’s all right. We can do as well
as that, anyhow, if you want to stay at that rate.”
“All right,” I replied as nonchalantly as I could. “When do I start?”
“Come around tomorrow at twelve. I may not have anything for
you, but I’ll carry you for a day or two until I have.”
I trotted down the nearby steps as fast as my feet would carry
me, anxious to get out of his sight so that I might congratulate
myself freely. I hurried to a telegraph office to reject my friend’s
offer. To celebrate my cleverness and success I indulged in a good
meal at one of the best restaurants. Here I sat, and to prepare
myself for my work examined that day’s Dispatch, as well as the
other papers, with a view to unraveling their method of treating a
feature or a striking piece of news, also to discover what they
considered a feature. By nine or ten I had solved that mystery as
well as I could, and then to quiet my excited nerves I walked about
the business section, finally crossing to Mt. Washington so as to view
the lighted city at night from this great height. It was radiantly clear
up there, and a young moon shining, and I had the pleasure of
looking down upon as wonderful a night panorama as I have ever
seen, a winking and fluttering field of diamonds that outrivaled the
sky itself. As far as the eye could see were these lamps blinking and
winking, and overhead was another glistering field of stars. Below
was that enormous group of stacks with their red tongues waving in
the wind. Far up the Monongahela, where lay Homestead and
McKeesport and Braddock and Swissvale, other glows of red fire
indicated where huge furnaces were blazing and boiling in the night.
I thought of the nest of slums I had seen at Homestead, of those
fine houses in the east end, and of Carnegie with his libraries, of
Phipps with his glass conservatories. How to get up in the world and
be somebody was my own thought now, and yet I knew that wealth
was not for me. The best I should ever do was to think and dream,
standing aloof as a spectator.
The next day I began work on the Dispatch and for six months
was a part of it, beginning with ordinary news reporting, but
gradually taking up the task of preparing original column features,
first for the daily and later for the Sunday issue. Still later, not long
before I left, I was by way of being an unpaid assistant to the
dramatic editor, and a traveling correspondent.
What impressed me most was the peculiar character of the city
and the newspaper world here, the more or less somnolent nature of
its population (apart from the steel companies and their employees)
and the genial and sociable character of the newspaper men. Never
had I encountered more intelligent or helpful or companionable
albeit cynical men than I found here. They knew the world, and their
opportunities for studying public as well as private impulses and
desires and contrasting them with public and private performances
were so great as to make them puzzled if not always accurate
judges of affairs and events. One can always talk to a newspaper
man, I think, with the full confidence that one is talking to a man
who is at least free of moralistic mush. Nearly everything in
connection with those trashy romances of justice, truth, mercy,
patriotism, public profession of all sorts, is already and forever gone
if they have been in the business for any length of time. The
religionist is seen by them for what he is: a swallower of romance or
a masquerader looking to profit and preferment. Of the politician,
they know or believe but one thing: that he is out for himself, a
trickster artfully juggling with the moods and passions and ignorance
of the public. Judges are men who have by some chance or other
secured good positions and are careful to trim their sails according
to the moods and passions of the strongest element in any
community or nation in which they chance to be. The arts are in the
main to be respected, when they are not frankly confessed to be
enigmas.
In a very little while I came to be on friendly terms with the men
of this and some other papers, men who, because of their intimate
contact with local political and social conditions, were well fitted to
enlighten me as to the exact economic and political conditions here.
Two in particular, the political and labor men of this paper were most
helpful. The former, a large, genial, commercial-drummer type, who
might also have made an excellent theatrical manager or promoter,
provided me with a clear insight into the general cleavage of local
and State politics and personalities. I liked him very much. The
other, the labor man, was a slow, silent, dark, square-shouldered
and almost square-headed youth, who drifted in and out of the
office irregularly. He it was who attended, when permitted by the
working people themselves, all labor meetings in the city or
elsewhere, as far east at times as the hard coal regions about
Wilkes-Barre and Scranton. As he himself told me, he was the
paper’s sole authority for such comments or assertions as it dared to
make in connection with the mining of coal and the manufacture of
steel. He was an intense sympathizer with labor, but not so much
with organized as with unorganized workers. He believed that labor
here had two years before lost a most important battle, one which
would show in its contests with money in the future: which was true.
He pretended to know that there was a vast movement on foot
among the moneyed elements in America to cripple if not utterly
destroy organized labor, and to that end he assured me once that all
the great steel and coal and oil magnates were in a conspiracy to
flood the country with cheap foreign labor, which they had lured or
were luring here by all sorts of dishonest devices; once here, these
immigrants were to be used to break the demand of better-paid and
more intelligent labor. He pretended to know that in the coal and
steel regions thousands had already been introduced and more were
on their way, and that all such devices as showy churches and
schools for defectives, etc., were used to keep ignorant and tame
those already here.
“But you can’t say anything about it in Pittsburgh,” he said to me.
“If I should talk I’d have to get out of here. The papers here won’t
use a thing unfavorable to the magnates in any of these fields. I
write all sorts of things, but they never get in.”
He read the Congressional Record daily, as well as various radical
papers from different parts of the country, and was constantly calling
my attention to statistics and incidents which proved that the
workingman was being most unjustly put upon and undermined; but
he never did it in any urgent or disturbed manner. Rather, he
seemed to be profoundly convinced that the cause of the workers
everywhere in America was hopeless. They hadn’t the subtlety and
the force and the innate cruelty of those who ruled them. They were
given to religious and educational illusions, the parochial school and
church paper, which left them helpless. In the course of time,
because I expressed interest in and sympathy for these people, he
took me into various mill slums in and near the city to see how they
lived.
CHAPTER LXI
I went with him first to Homestead, then to some tenements there,

later to some other mill districts nearer Pittsburgh, the name of
which I have forgotten. What astonished me, in so far as the steel
mills were concerned, was the large number of furnaces going at
once, the piles, mountains, of powdered iron ore ready to be
smelted, the long lines of cars, flat, box and coal cars, and the
nature and size and force of the machinery used to roll steel. The
work, as he or his friends the bosses showed me, was divided
between the “front” and the “back.” Those working at the front of
the furnace took care of the molten ore and slag which was being
“puddled.” The men at the back, the stock and yard men, filled huge
steel buckets or “skips” suspended from traveling cranes with ore,
fuel and limestone, all of which was piled near at hand; this material
was then trundled to a point over the mouth of the melting-vats, as
they were called, and “released” via a movable bottom. At this
particular plant I was told that the machinery for handling all this
was better than elsewhere, the company being richer and more
progressive. In some of the less progressive concerns the men filled
carts with raw material and then trundled them around to the front
of a hoist, which was at the back of the furnace, where they were
lifted and dumped into the furnaces. But in this mill all a man had to
do to fill a steel bucket with raw material was to push one of those
steel buckets suspended from a trolley under a chute and pull a rod,
when the “stock” tumbled into it. From these it was trundled, by
machinery, to a point over the furnace. The furnaces were charged
or fed constantly by feeders working in twelve-hour shifts, so that
there was little chance to rest from their labors. Their pay was not

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© Springer Nature Singapore Pte Ltd. 2019

1 AIDS Awareness and Behaviour Change:

4.7 Disease as Culpability: Phir Milenge and

Dilip K. Das is Professor of Cultural Studies in the School of Interdisciplinary

Keywords AIDS pedagogy · Interdisciplinarity · Critical medical humanities

© Springer Nature Singapore Pte Ltd. 2019 1

communication interventions are then targeted to addressing these deficiencies at

cautions against getting infected or, if infected, against transmitting it to others.

latter from a post-structuralist perspective, and theories of social practice in Pierre

to the contamination of blood supply, because of which ensuring blood safety

individuals, it fails to address the discriminations implicit in legal provisions for

as a disease of foreigners, governmental response focused more on the interiors of the

or its effectiveness in eliciting popular response. While the epistemology of AIDS

Whether I should go East or West suddenly became a question

I now decided that Pittsburgh would be as good a field as any, and

Such items arrested my attention at once; and then such names

I went with him first to Homestead, then to some tenements there,

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