Research Note:  A Brief Reflection on Researching the Social Construction of HIV/AIDS in Taiwan June Yi-chun WANG 王宜君©版權所有 　 As a sociology student studying in England and working on a phenomenon as recent as HIV/AIDS, I am destined to be submerged in floods of discourses produced in western academia, to which I have an ambivalent feeling. Possible (and may be preferable) as it is to embrace the elegant, sharp, historically-based analyses put forward by cultural studies, I cannot rest my conscience but to suspect the appropriateness of frameworks being referred to. For example, while biomedicine in Taiwan is no doubt an import, does this fact alone make it unproblematic to adopt the commentaries made by its critics (Treichler 1988a, 1988b, 1992; Crimp, 1988; Patton, 1990b; Haraway, 1993)? On the other hand, whereas anti-homosexual sentiment invoked in AIDS crises has different cultural embeddedness in different countries (notably, between Judo-Christian cultures and non-Christian others), does it therefore weaken the legitimacy of borrowing gay rights voices to criticize social apathy and prejudice? These intriguing questions cannot be answered solely in disinterested, "scientific" terms. Obviously, with dissimilar historical backgrounds, many aspects of these scholarly constructions can only be regarded as tentative theories. The following quote from Giddens (1984: xxxiv-xxxv) attests my point in a parallel sense: [W]hy do some social theories retain their freshness long after the conditions that helped produce them are past? Why, now that we are familiar with the concept and the reality of state sovereignty, do seventeenth-century theories of the state retain a relevance to social or political reflection today? Surely exactly because they have contributed to constituting the social world we now live in. It is the fact that they are reflections upon a social reality which they also help to constitute and which both has a distance from, yet remains part of, our social world that engages our attention. In other words, for me, the premise for grafting western insights on the subject of HIV/AIDS onto Taiwanese realities hinges on a reminiscence more relevant to the similarities of issues raised and institutions established. Crudely put, as a descendent of hybrid-copycat, I cannot claim any undisputed inheritance of any "unsullied" territory. By spelling out the epistemological conditions, I hope my thesis can properly reflect the uncertain areas of ethics and political alignment - which I constantly negotiate with. Although I have to admit that at times, reservation as such may have functioned like a self-imposed censorship, and it may not always be duly justified. It is possible to catalogue the publications I came across in very different ways. For instance, since the existing literature on HIV/AIDS registers a variety of angles to approach this subject, one option of presenting an organized front is to distinguish these pages by the authors' disciplines, as typically, a sociologist's concerns and styles differ from that of a historian's. Another plausible principle to sort out the juggernaut comes from the model of area studies, in whose domain categorizing the titles by nation-states seems to offer a "natural" solution. However, as the subject matter demonstrates a tendency for interdisciplinary inquiry, I chose not to follow a strict distinction between academic spheres. On the other hand, because I have not been able to get hold of a significant number of in-depth case studies, adopting such a strategy would inadvertently induce a facade of a comprehensive, world-wide review, which at the moment, would be the opposite to the reality. As Plummer (1988) and Weeks (1989) both indicate, in contrast with medical, impersonal formulation of AIDS, multifarious respects of social life have been both affecting and affected by this new entry of human world. Like other epidemics, AIDS can be seen as "constitut[ing] a transverse section through society, reflecting in that cross-sectional perspective a particular configuration of institutional forms and cultural assumptions." (Rosenberg, 1989: 2) My concern is mainly about the macro structuring forces affecting the responses to the virus/syndrome in Taiwan, hence temporarily, I arrange the review under following topics: public health policy and the medical profession; sexuality; social representation; (global) mobilization and activism. In order to confine my discussion within the limit of length set by the editor, the ensuing sections will exclude literature on the subject of policy-making and professional community. It should also be noted that I take the existing academic works produced against non-Taiwanese backdrops as a starting point which provides me with valuable sensitizing ideas, not a convenient, unproblematic source of reference. Sexuality In the wake of HIV/AIDS epidemic, many critics in the West worried about the prospect of losing the hard-won wars against state regulation on sexuality. For a while, re-medicalization and other forms regulation on homosexuality looked a looming consequence of the rampancy of HIV/AIDS. Well before such fear becoming materialized, the fruit of gay liberation movement from 1960s onwards provided a timely cushion for the challenging tasks in western democracies (Altman, 1986: 102-9, 1994: ch.2; Bayer, 1989), though not without fighting numerous battles with the New Right, both nationally and locally (Patton, 1985: ch.7, 1993; Altman, 1986: 65-70; Bayer, 1989 [esp. pp.147-53]; Smith, 1994: chs.1 & 5). In such a context, from their first-hand experience, it was gay men who devised the earliest safe sex messages and made the most contribution to promote the awareness of AIDS in community settings (Altman, 1986: ch.5; Patton, 1989: 237-9). Offering their expertise and networks, gay organizations earned their entry (if only a limited one) to participate in policy-making, especially in the first years of the epidemic (Bayer, 1989; Meldrum, 1990: 86-8; Watney, 1991; Berridge, 1992). The pros and cons of "gaying" (taking on the subject on a full scale) and "de-gaying" (preventing overt association between gay men and the syndrome) AIDS had been fiercely contested (Jones, 1992: 460-62; King, 1993: chs. 5 & 7; Altman, 1994: ch.6; van der Vliet, 1996: ch.3). Nevertheless, there is no dispute that the epidemic has, in many places of the world, spurred an openness to academic and lay discussion about sexuality (Altman, 1993), although the effects may not all be very liberating (Alcorn, 1988), nor the research methods in the state of the art (Bolton, 1992). Indeed, the break of silence on matters of tabooed sexualities means no less than a revolution, particularly when state apparatuses are still in use to curb sexual expressions as such (Ballard, 1993). While in certain context, the emergence of AIDS may signal a red light for engaging with stigmatized or unorthodox sexual identities (Seidman, 1997: ch.8; Watney, 1997: ch.1, 2000: ch.5) in others, this is an opportunity for "legitimation through disaster" (Altman, 1988; Roberts, 1994; Watney, 1995). Even the seeming non-identity of Men Who Have Sex with Men (MSM) can trigger the opening-up of unforeseen spaces for sexual minorities. Here, suffice it to say that the extent to which "health from below" projects can be crystallized remains a function interacting with many other conditions. From mid-1980s, articles linking AIDS and homosexuality started to appear in Taiwanese print media. As can be expected, one short essay published in a humanist/left-wing magazine attempted to clear the name of homosexuals by pointing the finger at the triumph of capitalism (Wang/王菲林, 1987), while a popular counseling journal justified its foray into the topic with a self-proclaimed "sociological" interest (Chong/鍾文良 and Chen/程開昔, 1987). In the latter, the authors repeated the oft-cited causes, types of homosexuality, and offered tips to avoid its happening. Metaphor of war was invoked to stress the severity of the AIDS problem. Eventually, it became rather difficult to tell the real intention of the article - to prevent homosexual relations or AIDS? However, it seems reasonable to posit that with media frenzy about the fatal syndrome, some Taiwanese writers felt obliged to introduce the outdated psychological theories on homosexuality to clueless readers, and therefore reinforce the misleading association (Wu/吳銅坤, 1990: ch.8); or by contrast but with similar effects, other writers contextualized their inquiries of homosexuality with AIDS as a pretext (Cheng/鄭先仁, 1985; Shen/沈楚文, 1986). 　 In the case of Taiwan, government-initiated health campaigns invariably carry an overtone of moralism, and it is in its one-sided emphasis on the benefits of monogamy many local critics found unbearable, especially from heterosexual women's experiences. The administration tightly guarded its moral agenda by lavishing callous insults on "the deserved", apparently unaware of the contradictions between such an attitude and the official desire to be seen as caring about the welfare of the infected. Harsh words disseminating in health promotion leaflets then became the easy target for criticism (Gay Chat, 1993; Chang/張小虹, 1994; Liu/劉淑華, 1994; Ni/倪家珍, 1994; Wang/王作方, 1996: 75; Shiao/`蕭佳華, 1996: 64, 70; Shi/施侒玓, 1997). Yet AIDS struck at a time when the shadow of martial law was anything but the bygone, when affirmative discourse on non-procreative sexualities was scant and awaited for articulation. Without a strong presence of gay/lesbian communities well-versed in political mobilization, the near absence of opposition in the public arena ensured the official messages to be all the more powerful in molding public opinions. Despite a sea change in recent years, where Taiwanese tongzhi (同志) have been able to win support from more liberal sections of the society, the deeply-seated stigma of AIDS remains a territory less ventured. For instance, among the papers presented at the sexual liberation landmark, the annual Conference on Sexuality Education, Sexology, Gender and LesBiGay Studies since 1996, only two of them tackled AIDS-related issues. Social Representations We rely on language to symbolically pin down the ever changing world. In so many language games, we are warned by Wittgenstein that the normative, routine understandings of events sustain only on an ad hoc basis. Nevertheless, uncannily, as critics point out, social representation of HIV/AIDS seem to repeat themselves along some fixed lines. So what have been the constant of various trajectories of AIDS storylines? Thankfully, race card may no longer become an acceptable tactics by today's standard in party politics. However, in the pursuit of truth, no political correctness should be allowed to stand on the way of scientists, especially at a time when the origin of the virus allegedly cause the development of AIDS was anyone's guess. Chirimuuta and Chirimuuta (1989: ch.12) found scientists' inclination to imagine that it was Africans who first spread HIV to the white world something hard to digest (also Patton, 1997). Meanwhile, they documented the complicity committed by western gays, who attempted to shift the blame to the black (1989: 5-7). Later the distinction of "AIDS" and "African AIDS" was invented by western scientists and media on the grounds of different transmission patterns and the virus variants (Patton, 1992). Such a construction, conditioned by "post-colonial powers over their former or current client states" leveled out diversities in the continent while creating an Euro-American fantasy about the sexualities of "the other". According to Patton, heterosexual normality then comes into play to impose the ideals of bourgeois family as the universal bulwark against AIDS. Hence, from the interpretive diagnosis to prescription, developing nations have "no opportunity to affect the theoretical framework of Western science nor plead for a better place in the economic plan in which that science operates." (Patton, 1990a: 86) Eventually, against the wish of Susan Sontag (1988/1989), nothing really can escape the "contamination" of language and metaphors (Grover,1989) . The "hard sciences" such as biomedicine is not immune from the epidemic of signification (Treichler, 1988a, 1988b; Patton, 1990b; Haraway, 1993; Waldby, 1996), when the health status of the body has long been implicated in that of the society (McGrath, 1990: 144). To get health promotion messages across to the public, further codification of the content seems ineluctable (Patton, 1990b). Who gets the safe sex education and how? At its birthplace, as a lifeline and a symbol of collective empowerment, safe sex campaigns initiated by gay men aimed to achieve both sexual liberation and sexual health at a community level (Patton, 1989). But once AIDS was perceived to be a deadly and overwhelming threat, the preservation of self integrity and immunity then became the paramount concern of the public. The intimate relevancy of such knowledge can easily induce emotional responses (Markova and Power, 1992). A defensive social representation collaborated by the messengers and recipients is thus needed to quell the shock of the new and the uncertain (Joffe, 1995). Analyzing the Taiwanese media representation of AIDS consists of a significant input made by specialists in journalism and communication. These studies focus on the ways how the audience receive health promotion messages (Hsu/徐美苓, 2000), how reporters go about the agenda-setting and source-tracking (Hsu/徐美苓, 1999), their narrative strategies (Lin/林文淇, 1996; Hu/胡紹嘉, 2000), and the implicit or explicit moral judgment loaded in the materials (Lin/林文淇, 1996). Overall, though their research may not be entirely innovative, so far, it embodies the most critical perspectives on AIDS produced by the local academia. (Global) Mobilization and Activism AIDS activism has been seen as a ramification of gay rights movement, which social theorists in the West tend to regard as part of the middle-class-based, new social movements. Resisting the colonization of the life-world, one of the sources of the participants' impetus comes from an attempt to re-define the meanings of the private and the public (Habermas, 1981). The newly politicized, activated civil society demands action on the part of the state to institutionalize the hitherto unprotected arenas like a basic criterion of living environment, abortion rights, and legal recognition of unmarried partnership (Offe, 1985; Melucci, 1996: part II). For the civil society itself, the mobilization also involves deepened questioning of the ways the immediate habitat is composed; notably, distrust of the managing experts is widely expressed and the meaning of the institutional knowledge contested (Bayer, 1981; Melucci, 1996: ch.10; Epstein, 1996). In the mobilizations around AIDS, palpably, a knowledgeable, well-organized army of gay men equipped with their cultural capital and insider's information hugely boost the chance of success (Epstein, 1991: 51). However, when the professionalization of AIDS service organizations grow sophisticated, there are visible risks of being co-opted by the state and the pharmaceutical companies, which results in alienating the grassroots they claim to represent (Cain, 1993; Adam, 1997: 28). By asking "who's the enemy", the many campaigns launched by ACT-UP (the AIDS Coalition To Unleash Power) cross national borders signify, for many, a renewed momentum for radical citizenship and democracy (Brown, 1997; Dowsett, 1998). Moreover, the direct intervention made by Persons Living with HIV/AIDS (PLWHAs) defies the stereotype of their passive death. Via the global media, the very existence of such a group and their tactics can inspire similar actions worldwide; but it should be noted that the epidemic, as well as its socio-cultural embeddedness is not the same in any two countries (Watney, 1995: 56). After the first international Conference on AIDS in Atlanta, WHO has been taking positive initiatives in devising related programmes, recommendations and guidelines. In 1987, WHO set up its Special Programme on AIDS, later renamed the Global Programme on AIDS (GPA). One of the first principles firmly established under the leadership of Jonathan Mann is to prioritize the protection of human rights. Such a resolution then became incorporated into international human rights apparatuses. Yet precisely because the United Nation system has been one of the toothless mechanisms with symbolic sanctioning power rarely utilized, in many countries, the human rights abuse on the basis of HIV seropositive status has never been seriously treated by relevant authorities. By contrast, the San Francisco-based International Gay and Lesbian Human Rights Commission (IGLHRC) seems much more ready to take on nation-states. All in all, I take great pleasure in asking some intriguing questions: Are the officials and NGO representatives at international arena accountable delegates to the functioning of localized democracy? In the global trend of modern state system, where, as Adam (1997: 27) summarizes, the manipulating strategy of is "to convert political problems into administrative ones, to reduce civil society to media management, to limit politics to elections, and to convert citizens into welfare clients", where is the hope for forging a minimum consensus on such a marginalized issue as AIDS? In places where the disastrous consequences of AIDS have so far been perceived merely as a problem of the few, how would the global lessons be possibly learned? In the case of Taiwan, where governing bodies seem to have little hesitation preaching what officials believe to be morally right, how should local activists intervene effectively? After the transient attention of each year's World AIDS Day, does the feeling of being united really save a soul? Note on author: June Yi-chun WANG: PhD student at Dept. of Sociology, Univ. of Essex. I'm currently organizing a study group Asia-Unbounded at Essex University, hoping to bring out different visions of social studies to western academy. For details, check the website http://www.essex.ac.uk/sociology/quickframes/reading_groups.htm My e-mail: ywangd@essex.ac.uk; inverness@mail2000.com.tw