l4
t"
rO
is the only way to get noticed. In a calmer industry rather than patients. They raged vein, the London AIDS activist Simon that a billion dollars spent on AIDS research Watney described the "inspiration" of the had resulted in the availability of only one challenge to complacency which ACT UP drug, AZT (zidovudine)-and that drug had offered. "They said we won't accept a logic not even been discovered by this costly which says everyone with HIV will get AIDS research programme. None of these allegations was questioned and will die....- We must make interventions into medical politics, into research politics." by the programme's makers or interviewees. Certainly, if patients believe that a diag- But this was a programme about being angry Channel 4's homosexual magazine nosis of being HIV positive is a death sentence not about being fair. In truth there is much to programme, Out, moved away they may walk out of the surgery without any be angry about. The New York group Queer from its usual fare of soft focus scenes incentive to care about their own health or Nation was formed after a bomb attack on of gay life and presented a documentary any personal reason to practise safe sex. This a gay club. Physical assault in public is a account of AIDS activism by director Stuart is the positive message AIDS activism offers: commonplace of homosexual life. The frusMarshall. Much of it showed the politics of a restored self respect and hope for the future tration of those in the gay community is born of watching their friends die one after the AIDS in the United States through the for people with AIDS and HIV infection. Whether because there is less AIDS, less other while society around them continues activities of three militant organisations: open homosexuality, or just less exuberance, as if-nothing is happening, or blames the ACT UP, Outrage, and Queer Nation. In the United States health care system British AIDS demonstrations are not so victims, or celebrates the disaster. No wonder patients see themselves as consumers who aggressive as the American variety. Holding grief expresses itself in political action. -JAD will complain vociferously if they are not a "kiss in" at Piccadilly Circus to challenge ADAMS, writer and television producer supplied with the services they require. the ban on homosexuals showing affection in The most dramatic scenes in this film public and to demonstrate that AIDS cannot showed demonstrators being dragged out of be contracted through kissing is a rather Company Sex, Desire and Him St Patrick's Cathedral in New York, where more restrained form of activism than casting August they had been disrupting the service because oneself in front of an ecclesiastical procession. The American activists are also abrasive the Catholic Archdiocese was not devoting adequate funding to AIDS in its health care critics of the research programme. The film programme despite, it was claimed, receiving showed a raid on the headqtuarters of the National Institutes of Health and demonAIDS money from the state. In another scene a determined woman strations in Washington and Atlanta accom- T his month Company magazine has launched into unfamiliar territory explained that, legally, all the decisions were panied by songs and slogans. Rap music with a supplemnent on male sexuality. made not by the doctor but by the patient lyrics protested, for example, that the opon the advice of the doctor. Patients must portunistic infections of women are not Intended for women from 18 to 30 it opens therefore be better informed so they are included in the diagnostic guidelines for with a sexual tourist's guide to men's bodies, better able to make their own choices. The AIDS. "The Centres for Disease Control urging the kissing of nape and nipples and principle is hardly objectionable, but the down there/Were defining AIDS like they suddenly plunging to the feet, a sort of John O'Groats to Lands End approach. A "now we tone in which it was expressed was vitupera- didn't care." A range of activists, including many from have naming of parts" portrays the penis in tive. No American AIDS activist expressed any reservations about the notion that the the largely ignored Latin American com- all its aspects. Thirty six full frontals of the medical profession was a conspiracy against munity, claimed that a mafia of five people at non-erect member, taken from the video the patients or suggested that each might the top of the hierarchy of the National Dick, adorn the page. Colour, size, whether Institutes of Health was making all the circumcised or not, testicles, and erections learn from the other. In the rather shrill society ofNorth America decisions and ensuring AIDS research was are considered, as are men's anxieties-too perhaps the defiant, non-negotiable demand based on the needs of the pharmaceutical small, too out of control, "never erect when I want to impress"-and fear that it might be an object of feminine derision. When confronted with a non-erection our modern girl is assured it is not because he does not fancy her, often quite the opposite, he is dying to please, but possibly suffering from the "woman on a pedestal" syndrome. Fatigue, stress at work, alcohol are all demons for male sexual response. If professional help i becomes necessary, Dr Alan Riley explains who men should go to, and what treatment . T'15' will be offered; all very helpful information for nervous men and concerned women. A good fantasy life is an adjunct to an active sex drive and can include fantasies never intended to be acted out. We are advised to watch for boredom. Varying the position, the time, and the place can liven things up without varying the partner. Finally comes the question "Is your potential male disease free?" Readers are warned that it is often not possible to tell if a man is infected even when he is naked, and they are advised to use condoms. HIV and AIDS are, AIDS activism can mean restored self respect and hopefor the future however, given scanty attention. Surely
Channel 4 Out "Over Our Dead Bodies" 7 August
Angry about AIDS
Demystifying men
1370
3 BMJ VOLUME 303
10 AUGUST 1991
in today's climate a woman should try to ascertain the risks of HIV infection. Has the man had many partners? Is he bisexual? Does he use drugs? Has he shared needles? No mention is made of anal intercourse and the precautions, such as using specially AS
1X
Letter from Yugoslavia Lynne Jones W hen Dr Jovan Bamburac, deputy professor of psychiatry at Zagreb University, stood up in the front row of a lecture theatre at the Institute of Public Health in Zagreb and said that as a "Serb with Croatians at his back" he did not feel attacked, the remark had more significance than the usual medical meeting jest.
". . . boundaries change continuously. States come and go. " Recently a letter was written in the name of the Zagreb group analytical society, cancelling the First Congress of Group Analysts of Yugoslavia, a congress prophetically entitled "The Group in Social Culture, East and West, Encounter or Conflict." In the letter it was argued that Serbians were "projecting" their own aggression on to Sloyenes and Croats and that "archaic and cannibalistic instincts within the large groups of Serbians" were "leading them into a deep regression to the schizoparanoid position." Serbian psychiatrists in particular were accused of "destructive narcissism." These are not easy times for doctors in Yugoslavia. It is not simply the horror of the mounting death toll. And please do not ask for accurate figures -the news is fragmented and always partial. Nightly I flick from news channel to news channel trying to get an overall view. What stays in my mind is not the figures (80 dead in the worst weekend of fighting, Zagreb TV; 180 dead, Belgrade news) but the faces: an old Serbian woman in a deserted village street, her family with small bundles around her; the horror on a doctor's face as he stands by a truckload of bodies covered with plastic sheeting-some of the limbs visible are clearly those of children; the grim earnestness of the Serbian paramilitaries as they stand shoulder to shoulder, fist clenched against breast, taking an oath of loyalty. All this is terrible enough. What adds to the distress of my medical friends is the sight of respected colleagues becoming parties to the conflict. The pressures to do so are very great. At the beginning of July, Dr Branko Krivokuca, director of the health centre at Vojnik, in BMJ
VOLUME
303
10 AUGUST 1991
strengthened condoms, that should be taken. Some may feel that this direct approach takes the mystery out of sex, but one should never confuse mystery with ignorance. Many cultures supplied "bridal roles" or "pillow books" which contained explicit sexual - - - -4- , R4
ig:z\X
Croatia, was driving to his daughter's school. He carried, as always, two bags of medicines in the boot of the car. Stopped by the Croatian police, he was arrested on suspicion of giving medical aid to Serbian terrorists and is currently in prison in Zagreb. In Vinkovci, eastern Croatia, where some of the heaviest fighting has occurred, the Croatian chief of staff at the local hospital is under pressure from the local population to throw out three injured Serbian paramilitaries. He has not done so. However, Serbian forensic pathologists have refused to join a team of Croatian pathologists to examine the bodies of a group of Croatian villagers alleged to have been tortured and killed in a massacre. The point of the suggestion was to increase impartiality, but the Serbians felt that their participation in such joint work could be "misunderstood." It was in order to rise above such misunderstandings that some 40 Serbian and Croatian physicians met in an uncomfortable lecture theatre in Zagreb last Saturday to share their ideas and experiences. This was the second meeting of the newly founded Physicians Against War. The inaugural meeting, with a similar number of participants, had been held in Belgrade the week before. The group was founded by two young physicians, Dr Vuk Stambolovic from Belgrade and Dr Milan Kosuta from Zagreb. "Our initial stand is not to blame anyone," Dr Stambolovic explained; "the need is for understanding, not blame." "We are misunderstanding each other more and more," Dr Bamburac continued in his own speech, "projecting on to the opposite nation. The question is how to confront these processes. Are we going to be passive and wait hidden behind our profession for the patient to come? How is that possible when you read in the papers of 30000 people displaced?" Dr Slobodan Lang, former minister of health in Zagreb and deputy professor at the Institute of Public Health, did not mince his words: "95% of the physicians in this country obviously do not know the definition of health given by the World Health Organisation." The group has embarked on a number of practical initiatives: a letter to European Community ministers emphasising the seriousness of the situation, arguing that what is happening is not simply ethnic strife in the Balkans but a European war in which outside mediation is essential. Pressure will be put on the medical faculties and the medical associations of Serbia and Croatia to make joint statements condemning the war. A meeting between Serbian and Croatian group analysts was suggested, and a meeting is planned with Serbian physician members of parliament. The group intends to extend
instruction for newlyweds. Considering the long waiting lists at most psychosexual clinics, I feel that publications like this fulfil a necessary role for the public.- R E GOODMAN, specialist in psychosexual medicine, Hope Hospital, Salford
~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~--~--~-~------------------------membership to doctors from other republics. Perhaps most important is that the doctors themselves are looking at how they can facilitate the long process of social reconciliation at community level. The idea is to identify those wanting to rebuild connections through contacts with local doctors and clergy and to support them in this process. The group offers no political solutions, arguing only that nothing can be achieved by war. What was striking, as we sat drinking coffee afterwards, was how wide the spectrum of opinion was and how easy it was for people to argue without animosity. Dr Lang thinks Yugoslavia has to be allowed to dissolve "because currently it is an instrument of hate. People can live more harmoniously if it breaks down; dissolving Yugoslavia you can at the same time integrate it. No one has explained to me why I should feel more strongly about Macedonians than Bulgarians or Slovenes than Slovaks." Dr Zoran Milivojevic did not agree, arguing that unity was needed to confront the problem of Serbian communist leader Milosevic and the federal army. Later still, Dr Lang insisted on showing me two collections at his home. One is of rocks. They are neatly labelled and laid out as any scientific collection should be. But the specimens themselves are unusual: pyrites from the mines in Kosovo where Dr Lang joined striking Albanian miners; a piece of twisted metal from Slovenia: "tank," he remarked shortly; and a pale porous specimen, full of holes: "Croatia." In the next
... news is fragmented and always partial. room there were maps: half a dozen prints over one wall and all of the same region, the Balkans, only in each print the pattern of little coloured areas was quite different. "I wanted my son to grow up realising that boundaries change continuously. States come and go," Dr Lang explained. In some way, hard to define, the fragments of rock arranged on the table and the shifting borders outlined on the wall encapsulated the idiocy, futility, and misery of this war in a way no media image has done. If Slobodan Lang's son is to grow up understanding that there are more important things to life than his ethnic origin, the group of Physicians Against War, to which his father belongs, needs encouragement and support. -LYNNE JONES is a psychiatn'st and writer Dr Krivokuca was released on 1 August.
371
t"
rO
is the only way to get noticed. In a calmer industry rather than patients. They raged vein, the London AIDS activist Simon that a billion dollars spent on AIDS research Watney described the "inspiration" of the had resulted in the availability of only one challenge to complacency which ACT UP drug, AZT (zidovudine)-and that drug had offered. "They said we won't accept a logic not even been discovered by this costly which says everyone with HIV will get AIDS research programme. None of these allegations was questioned and will die....- We must make interventions into medical politics, into research politics." by the programme's makers or interviewees. Certainly, if patients believe that a diag- But this was a programme about being angry Channel 4's homosexual magazine nosis of being HIV positive is a death sentence not about being fair. In truth there is much to programme, Out, moved away they may walk out of the surgery without any be angry about. The New York group Queer from its usual fare of soft focus scenes incentive to care about their own health or Nation was formed after a bomb attack on of gay life and presented a documentary any personal reason to practise safe sex. This a gay club. Physical assault in public is a account of AIDS activism by director Stuart is the positive message AIDS activism offers: commonplace of homosexual life. The frusMarshall. Much of it showed the politics of a restored self respect and hope for the future tration of those in the gay community is born of watching their friends die one after the AIDS in the United States through the for people with AIDS and HIV infection. Whether because there is less AIDS, less other while society around them continues activities of three militant organisations: open homosexuality, or just less exuberance, as if-nothing is happening, or blames the ACT UP, Outrage, and Queer Nation. In the United States health care system British AIDS demonstrations are not so victims, or celebrates the disaster. No wonder patients see themselves as consumers who aggressive as the American variety. Holding grief expresses itself in political action. -JAD will complain vociferously if they are not a "kiss in" at Piccadilly Circus to challenge ADAMS, writer and television producer supplied with the services they require. the ban on homosexuals showing affection in The most dramatic scenes in this film public and to demonstrate that AIDS cannot showed demonstrators being dragged out of be contracted through kissing is a rather Company Sex, Desire and Him St Patrick's Cathedral in New York, where more restrained form of activism than casting August they had been disrupting the service because oneself in front of an ecclesiastical procession. The American activists are also abrasive the Catholic Archdiocese was not devoting adequate funding to AIDS in its health care critics of the research programme. The film programme despite, it was claimed, receiving showed a raid on the headqtuarters of the National Institutes of Health and demonAIDS money from the state. In another scene a determined woman strations in Washington and Atlanta accom- T his month Company magazine has launched into unfamiliar territory explained that, legally, all the decisions were panied by songs and slogans. Rap music with a supplemnent on male sexuality. made not by the doctor but by the patient lyrics protested, for example, that the opon the advice of the doctor. Patients must portunistic infections of women are not Intended for women from 18 to 30 it opens therefore be better informed so they are included in the diagnostic guidelines for with a sexual tourist's guide to men's bodies, better able to make their own choices. The AIDS. "The Centres for Disease Control urging the kissing of nape and nipples and principle is hardly objectionable, but the down there/Were defining AIDS like they suddenly plunging to the feet, a sort of John O'Groats to Lands End approach. A "now we tone in which it was expressed was vitupera- didn't care." A range of activists, including many from have naming of parts" portrays the penis in tive. No American AIDS activist expressed any reservations about the notion that the the largely ignored Latin American com- all its aspects. Thirty six full frontals of the medical profession was a conspiracy against munity, claimed that a mafia of five people at non-erect member, taken from the video the patients or suggested that each might the top of the hierarchy of the National Dick, adorn the page. Colour, size, whether Institutes of Health was making all the circumcised or not, testicles, and erections learn from the other. In the rather shrill society ofNorth America decisions and ensuring AIDS research was are considered, as are men's anxieties-too perhaps the defiant, non-negotiable demand based on the needs of the pharmaceutical small, too out of control, "never erect when I want to impress"-and fear that it might be an object of feminine derision. When confronted with a non-erection our modern girl is assured it is not because he does not fancy her, often quite the opposite, he is dying to please, but possibly suffering from the "woman on a pedestal" syndrome. Fatigue, stress at work, alcohol are all demons for male sexual response. If professional help i becomes necessary, Dr Alan Riley explains who men should go to, and what treatment . T'15' will be offered; all very helpful information for nervous men and concerned women. A good fantasy life is an adjunct to an active sex drive and can include fantasies never intended to be acted out. We are advised to watch for boredom. Varying the position, the time, and the place can liven things up without varying the partner. Finally comes the question "Is your potential male disease free?" Readers are warned that it is often not possible to tell if a man is infected even when he is naked, and they are advised to use condoms. HIV and AIDS are, AIDS activism can mean restored self respect and hopefor the future however, given scanty attention. Surely
Channel 4 Out "Over Our Dead Bodies" 7 August
Angry about AIDS
Demystifying men
1370
3 BMJ VOLUME 303
10 AUGUST 1991
in today's climate a woman should try to ascertain the risks of HIV infection. Has the man had many partners? Is he bisexual? Does he use drugs? Has he shared needles? No mention is made of anal intercourse and the precautions, such as using specially AS
1X
Letter from Yugoslavia Lynne Jones W hen Dr Jovan Bamburac, deputy professor of psychiatry at Zagreb University, stood up in the front row of a lecture theatre at the Institute of Public Health in Zagreb and said that as a "Serb with Croatians at his back" he did not feel attacked, the remark had more significance than the usual medical meeting jest.
". . . boundaries change continuously. States come and go. " Recently a letter was written in the name of the Zagreb group analytical society, cancelling the First Congress of Group Analysts of Yugoslavia, a congress prophetically entitled "The Group in Social Culture, East and West, Encounter or Conflict." In the letter it was argued that Serbians were "projecting" their own aggression on to Sloyenes and Croats and that "archaic and cannibalistic instincts within the large groups of Serbians" were "leading them into a deep regression to the schizoparanoid position." Serbian psychiatrists in particular were accused of "destructive narcissism." These are not easy times for doctors in Yugoslavia. It is not simply the horror of the mounting death toll. And please do not ask for accurate figures -the news is fragmented and always partial. Nightly I flick from news channel to news channel trying to get an overall view. What stays in my mind is not the figures (80 dead in the worst weekend of fighting, Zagreb TV; 180 dead, Belgrade news) but the faces: an old Serbian woman in a deserted village street, her family with small bundles around her; the horror on a doctor's face as he stands by a truckload of bodies covered with plastic sheeting-some of the limbs visible are clearly those of children; the grim earnestness of the Serbian paramilitaries as they stand shoulder to shoulder, fist clenched against breast, taking an oath of loyalty. All this is terrible enough. What adds to the distress of my medical friends is the sight of respected colleagues becoming parties to the conflict. The pressures to do so are very great. At the beginning of July, Dr Branko Krivokuca, director of the health centre at Vojnik, in BMJ
VOLUME
303
10 AUGUST 1991
strengthened condoms, that should be taken. Some may feel that this direct approach takes the mystery out of sex, but one should never confuse mystery with ignorance. Many cultures supplied "bridal roles" or "pillow books" which contained explicit sexual - - - -4- , R4
ig:z\X
Croatia, was driving to his daughter's school. He carried, as always, two bags of medicines in the boot of the car. Stopped by the Croatian police, he was arrested on suspicion of giving medical aid to Serbian terrorists and is currently in prison in Zagreb. In Vinkovci, eastern Croatia, where some of the heaviest fighting has occurred, the Croatian chief of staff at the local hospital is under pressure from the local population to throw out three injured Serbian paramilitaries. He has not done so. However, Serbian forensic pathologists have refused to join a team of Croatian pathologists to examine the bodies of a group of Croatian villagers alleged to have been tortured and killed in a massacre. The point of the suggestion was to increase impartiality, but the Serbians felt that their participation in such joint work could be "misunderstood." It was in order to rise above such misunderstandings that some 40 Serbian and Croatian physicians met in an uncomfortable lecture theatre in Zagreb last Saturday to share their ideas and experiences. This was the second meeting of the newly founded Physicians Against War. The inaugural meeting, with a similar number of participants, had been held in Belgrade the week before. The group was founded by two young physicians, Dr Vuk Stambolovic from Belgrade and Dr Milan Kosuta from Zagreb. "Our initial stand is not to blame anyone," Dr Stambolovic explained; "the need is for understanding, not blame." "We are misunderstanding each other more and more," Dr Bamburac continued in his own speech, "projecting on to the opposite nation. The question is how to confront these processes. Are we going to be passive and wait hidden behind our profession for the patient to come? How is that possible when you read in the papers of 30000 people displaced?" Dr Slobodan Lang, former minister of health in Zagreb and deputy professor at the Institute of Public Health, did not mince his words: "95% of the physicians in this country obviously do not know the definition of health given by the World Health Organisation." The group has embarked on a number of practical initiatives: a letter to European Community ministers emphasising the seriousness of the situation, arguing that what is happening is not simply ethnic strife in the Balkans but a European war in which outside mediation is essential. Pressure will be put on the medical faculties and the medical associations of Serbia and Croatia to make joint statements condemning the war. A meeting between Serbian and Croatian group analysts was suggested, and a meeting is planned with Serbian physician members of parliament. The group intends to extend
instruction for newlyweds. Considering the long waiting lists at most psychosexual clinics, I feel that publications like this fulfil a necessary role for the public.- R E GOODMAN, specialist in psychosexual medicine, Hope Hospital, Salford
~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~--~--~-~------------------------membership to doctors from other republics. Perhaps most important is that the doctors themselves are looking at how they can facilitate the long process of social reconciliation at community level. The idea is to identify those wanting to rebuild connections through contacts with local doctors and clergy and to support them in this process. The group offers no political solutions, arguing only that nothing can be achieved by war. What was striking, as we sat drinking coffee afterwards, was how wide the spectrum of opinion was and how easy it was for people to argue without animosity. Dr Lang thinks Yugoslavia has to be allowed to dissolve "because currently it is an instrument of hate. People can live more harmoniously if it breaks down; dissolving Yugoslavia you can at the same time integrate it. No one has explained to me why I should feel more strongly about Macedonians than Bulgarians or Slovenes than Slovaks." Dr Zoran Milivojevic did not agree, arguing that unity was needed to confront the problem of Serbian communist leader Milosevic and the federal army. Later still, Dr Lang insisted on showing me two collections at his home. One is of rocks. They are neatly labelled and laid out as any scientific collection should be. But the specimens themselves are unusual: pyrites from the mines in Kosovo where Dr Lang joined striking Albanian miners; a piece of twisted metal from Slovenia: "tank," he remarked shortly; and a pale porous specimen, full of holes: "Croatia." In the next
... news is fragmented and always partial. room there were maps: half a dozen prints over one wall and all of the same region, the Balkans, only in each print the pattern of little coloured areas was quite different. "I wanted my son to grow up realising that boundaries change continuously. States come and go," Dr Lang explained. In some way, hard to define, the fragments of rock arranged on the table and the shifting borders outlined on the wall encapsulated the idiocy, futility, and misery of this war in a way no media image has done. If Slobodan Lang's son is to grow up understanding that there are more important things to life than his ethnic origin, the group of Physicians Against War, to which his father belongs, needs encouragement and support. -LYNNE JONES is a psychiatn'st and writer Dr Krivokuca was released on 1 August.
371
