What We Say About AIDS

This World AIDS Day, Paul Attinello explores perspectives on how we think and talk about HIV/AIDS, and his own thinking over the last four decades.

1 December has been World AIDS Day since 1989. AIDS was first recognized as a distinct condition in 1981 – now 41 years ago; over that time more than forty million have died, and about forty million are now living with HIV worldwide.

Expressionist image of a male torso.
Reflections of You (1988) by Jack Carroll

I am unusual in having lived with HIV for a long time – I was probably infected in the winter of 1981 in San Francisco, first watched someone I loved die in 1983, tested positive in April 1987 in Los Angeles, and have lived, been treated, and worked with and in support systems on four continents. It is statistically (and existentially) bizarre that I have lived long enough to actually retire from teaching at Newcastle University in February of this year – though I still write and teach, with HIV/AIDS as a main theme.

As I’ve crossed a number of spaces and boundaries, I want to talk about crossing epistemological spaces in relation to AIDS. Some of the ways I have written and taught for decades now look too incomplete to me, and I’m thinking about how one writes about culture in a way that is more useful – something with more flexibility, more life.

A lot of my postgraduate work in musicology and aesthetics in the 1990s was linked to Adorno, who was ideal for me because he understood more about music than most. He was a source for much of the contemporary practice of ‘cultural criticism’ – the idea that one could analyse cultural materials and interpret their implicit meanings, which included post-Marxist assumptions about uncovering unacceptable ways of understanding the world. That was fine for a long time but, these days, I’ve become impatient with that approach. Adorno’s bitter dismissals are inadequate to an increasingly dense, varied world; it is now some years since I started having students read Kosofsky Sedgwick’s (2003) analysis of paranoid thinking as an antidote. She points to problems with the way we use Marx, Freud, and others to dismiss much of what we are. I don’t think it is an accident that this major shift in Kosofsky Sedgwick’s theoretical approach occurred after she was diagnosed with breast cancer – when we are faced with certain realities, ideological concerns start to look a bit beside the point, as it were.

‘Paranoid’ dismissals can be exasperating enough in music, but in relation to HIV/AIDS they can be appalling. My books on HIV/AIDS at home cover four three-foot shelves – plus CDs, DVDs, and oversized materials elsewhere in the house; perhaps a quarter of all those things might be called ‘critique’, but I find it increasingly difficult to engage with the dismissals, the repeated arguments that texts or works are politically unacceptable. I reached a saturation point with a 2001 book about AIDS in cultural works; it was a good book – intelligent, well-written, a fine example of the kind of thing we teach in cultural studies. The only problem is, the author spent many pages tearing into AIDS memorials as insufficiently political, insufficiently radical: and at that point, I thought…

Well, I thought: illness and death are real. Treating them as culturally constructed, as created through political or social arguments, can be a kind of nonsense. If forty million people have died, then – any responses that they have to their suffering and deaths are all of value, all to be taken seriously and understood.


This perceived inadequacy has become even more important in what is now my second career, and third life: in the 2010s I spent time in Zürich, studying to be a Jungian psychoanalyst, which I now do professionally. When Newcastle colleagues ask if I’m bored since retirement, I look at them with a slightly patronizing pride, because I am *still* working – but fortunately on my own schedule, with analysands, with the stuff of their lives (and without departmental meetings, which means the work is very different indeed).

I am therefore in a position to take responses to difficult situations more seriously, not only on a personal basis, but on a professional basis. It would be ludicrous to criticize someone going through therapy because they seemed too anxious or sad, and not sufficiently politically aware, in relation to their own physical suffering or the prospect of dying.

So, the first major change in my thinking is: in interpreting materials around HIV/AIDS, I’m uninterested in demanding any political or forward-thinking aspects. Human responses to illness, fear, death, are valid, are meaningful.

And so I look for different kinds of connections, or groupings of ideas and feelings… which brings us back to psychoanalysis, in its Jungian form: I am looking for complexes, in their cultural form.

When Adorno, or later cultural theorists, talk about cultural complexes, they are generally looking for ways that people have been foolishly deceived by one ideology or another. That’s fine for sociopolitical thinking; but it’s ridiculous in the face of death. Death isn’t political. Indeed, at this point in my life, I’ve accepted that any interpretation I use to understand death is, inevitably, incomplete – I now think that any psychological, philosophical, or religious framing of death is limited, partial, and will at some point show cracks; death is unknown, and whatever seems to lay around or beyond it is endlessly incommensurable.

I don’t mind if any of my analysands, or for that matter if I, generate ways of relating to death – but it is obvious that, at some point in whatever we go through near the end, most of us lose certainty. Our ideas and beliefs are hardly ever quite enough; and that’s not tragic or frightening, it is simply how things are.

So: let’s say, number one – complexes are, complexes exist. We spend a lot of time in psychoanalysis trying to reduce/dissolve certain problematic complexes, but we obviously leave most complexes alone – so that you remember where your home is, so that you know that it is your face in the mirror, so that you continue to love your partner and your cat. The Adornoesque/neo-Marxist impulse to attack all complexes needs to be restrained; and, pace Kosofsky Sedgwick, it is really too paranoid to be central to our work these days, in any case.


So, what are things that I want to talk about, in the world of HIV/AIDS?

I’ve talked and written about: infection as a learned complex; fear and anxiety in the body, fear and anxiety of other persons; different ways the sick body is experienced – the various pains and damage of advanced, untreated AIDS, though most of you will never see them, were terrible to see, and most of my friends who are also PWAs still tend to focus anxiously on the odd and trivial symptoms of aging, trying to decide whether they are merely signs of time, or of something worse. I’ve just finished a chapter on afterlives – and have felt a bit disoriented to realize how much of my imagination lived for years in hopes of some possible afterlife, some transcendent rescue at the edge of death. I wrote another article about the projective anxiety that shows up in analytic case studies before 1996, when many analysts were overwhelmed by the terror of what their analysands are going through.…

Those are just examples, of course. What I want is to look at this entire world of complexes, the network of projections and images and feelings and responses that form a large, shared structure that we have arranged around HIV/AIDS. Some of those things are irrational, some are cruel or unacceptable, in the classic Marxist sense – but they are real in the mind, and they need to be seen. One cannot suggest to an analysand, or to a PWA, or that matter to anyone, that they should rationally contain their fear, grief, sadness, around the prospect of their own bodily suffering and ending.

Of course, many of those feelings around suffering and ending have reappeared in the world of COVID. In the spring of 2020, members of my HIV support groups were irritated, a bit sarcastic – did all these people who weren’t HIV+ actually think they would never be threatened with illness and death? Arguments against vaccines, the fantasy that those (disorientingly invisible) microorganisms didn’t really exist, or they were created by a government, the hope that someone somewhere had designed this (biologically, perfectly understandable) crisis – all of those illusions were absolutely familiar to us. And so, one can treat COVID in the same way, and we must think: what is it to fear all of the patterns I mentioned above – plus respirators, plus more unpredictable outcomes…


This World AIDS Day has been a long one for me, about a month of various projects and writing. It hasn’t been easy. Most people will hear that and think: oh, it’s not easy because you are grieving, because it is so terrible. But that’s not it. The hard part is that it is so dense. Memory, feeling – so many people and places, so many things have happened, or are not happening again. I am realizing this month how much has changed over the years, and how many facets there are to every part of it…

So, perhaps there is a metaphorical relationship among all these things: my memories and experiences are parts of me, I want to see them all. And the things that so many have thought and felt and said over the past forty-one years – I want to see all of those, too: they are not split between good and bad, between reason and its shadow. They are all, absolutely all, what we are.


Kosofsky Sedgwick, Eve. 2003. ‘Paranoid Reading and Reparative Reading, or, You’re So Paranoid, You Probably Think This Essay is About You’ in: Touching Feeling: Affect, Pedagogy, Performativity. Durham, NC: Duke.


About the author

Paul Attinello is an analyst in private practice, recently retired as a senior lecturer from Newcastle University, who has also taught at the University of Hong Kong and as a guest professor at UCLA. He received his PhD from UCLA and diploma as a psychoanalyst from the C. G. Jung-Institut in Zürich. He has lived and worked on four continents and been involved in HIV groups and programs, as well as numerous academic and creative events and projects. He is published in essay collections, journals, and reference works, including the groundbreaking Queering the Pitch: The New Lesbian & Gay Musicology. He has written on contemporary musics, the culture of AIDS, and psychological and philosophical topics.

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