Living with the ‘Enemy’: HIV and Inter-species Relating

Introduction and Theoretical Background

The crisis of humanism – and the notable move to question the constitutive nature of the human subject – resulting from the critiques of structuralism and post-structuralism has meant that social theorists have recognised the need to move beyond the human and with this address the question of the animal as Other. Wolfe (2003) further argues that, combined with these theoretical advances, the massive growth in ethology and ecology have led to serious questions about the anthropocentrism that is at the heart of the humanist project. Instead, there is now a new and sustained interest in:

… what Emerson called the ‘Not-Me’ (the environment, from the bacterial to the ecosystemic, our various technical and electronic prothesis, and so on) … for the theoretical reason that the ‘human’, we now know, is not now, and never was, itself. (Wolfe, 2003: xiii)

This article locates itself on the boundaries of this developing area, seeking to ground theory in the empirical, first and foremost through the human in relation (to the animal as Other), whilst recognising the danger that this might simply serve to re-situate the human as the site constitutive of meaning. The Other in this particular case is the Human Immunodeficiency Virus (HIV) and in this article we draw on and extend Haraway’s (2003, 2008) work on inter-species relating to explore the impact of (ostensibly) antagonistic species relating, through the body of one particular human being living with this virus. The tension in attempting to ground the ‘Not-Me’ in the empirical is acknowledged and taken seriously by critically examining the interplay between human and non-human animal, albeit articulated through the body of the human. Our aim in this article is both to develop theory on inter-species relating and also to better understand what it means to coexist with a viral-Other and how such a coexistence might be most effectively realised. In other words, we seek to explore additional aspects of distributed human subjectivity and the impact of this on the experience of living with HIV.

Of particular theoretical interest here is the work of Haraway (2003, 2008), who moved her attention from human-machine interaction (through the trope of the cyborg) to human-other animal relating (in particular, companion species animals). Whilst resisting any call to the ‘post-human’, Haraway convincingly argues that, through a gradual co-evolution, humans and companion animals have become inextricably linked and in the process ‘open up’ the world for each other. That is, the material-semiotic presence of companion species allows for an ‘a ha’ moment for the human in which more of the world is revealed and therefore more of humanity becomes known. Noting the fact that human genomes can be found in only 10 per cent of all cells in the human body with the other 90 per cent inhabited by genomes of bacteria, fungi and so on, she comments that ‘to be one is always to become with many’ (2008: 4). This symbiotic relationship is extended outwards to consider the relationship between human and animal-Other, challenging the long-held belief of human exceptionalism, of the divide between human and all others.

Haraway (2008) concentrates primarily on the relationship between companion species, notably ‘man’s [sic] best friend’, the dog. Recognising the difficulties inherent in delineating a firm line between species, she identifies the companion as that which we might consort or keep company with and the species as that which we might seek to see or behold in search of an ‘autre-mondialisation’ founded on the inevitable knots that bind us. In the process, Haraway takes issue with both Derrida (2002) and Deleuze and Guattari (1987) for failing to recognise the way in which inter-species communication can occur through meeting the gaze of non-human animals by taking up the invitation to work or play with them. She contrasts this with the work of notable biologists, such as Barbara Smuts, who saw communication as the key to understanding the animal-Other and in the process ourselves in relation. This becomes the focus of Haraway’s discussion, as she sniffs out vivid examples of the coming together of human and companion animal, through work, laboratory experimentation, dog breeding and training and the spectacle of understanding ‘naturecultures’.

What Haraway (2008) touches on but fails to consider in any depth, however, are other forms of inter-species relating, forms which are more obviously problematic but nonetheless important. This is understandable, of course, given Haraway’s primary concern with companionate species but it does leave a lacuna with regard to other more problematic forms of inter-species relating. Of importance here is antagonistic species relating, of the kind that may co-evolve from the coming together of human and virus. Is this simply a case of ‘aggressive’ antagonism or might there be more to these relationships than that? Can a more productive relationship be developed between human and virus and can this lead to a more tolerable life found in relation with rather than in conflict with the animal-Other? That is, can this and does this relationship reveal more of what it means to be human and also open up the possibility for new ways of coping with the challenges of living long term with HIV?

The Viral-Other

Viruses occupy a liminal space between the living and non-living; described as ‘organisms on the edge of life’ they possess genes and evolve by natural selection but do not have their own metabolism and require a host cell to survive (Rybicki, 1990). Viruses have a very small number of genes and, due to their peculiar way of reproducing, it seemed highly unlikely that they would be able to gain many more, as they are susceptible to lethal mutations (Zimmer, 2011). For many biologists, the low number of genes in viruses and the resultant inability to carry genes to let them eat, grow or expel waste, combined with the fact that they cannot reproduce by splitting in two, leads to them being categorised as non-living, with the International Committee on Taxonomy of Viruses declaring in 2000 that viruses are not living organisms. However, there was no consensus on this matter with many scientists rejecting the declaration outright. The recent discovery of mimiviruses, with very large numbers of genes and a cell-like structure that can itself be infected by a virus, in particular has challenged the categorisation of viruses as non-living (Zimmer, 2011).

For the purposes of this article these arguments are to some extent incidental, as the focus here is on the way in which two organisms, of whatever kind, coexist and how the human partner in this relationship understands the viral-Other as antagonistic or companionate. When thinking through Haraway’s (2008) arguments, the viral-Other presents itself as a bastard version of the companion animal-Other at the heart of her thesis. They trouble the very notion of the animal-Other, not only through their status as living or not but also through the complex ways in which they coexist in harmony or conflict, as the harbinger of life or death. We cannot live without viruses: they are necessary for reproduction, the production of a proportion of the oxygen we breathe, amongst many other things. They not only lead to bodily illness but also play a necessary role in bodily survival. As Zimmer (2011) argues, the key is not to engage in problematic boundary wars about what constitutes life but rather to see viruses existing on a continuum at the opposite end of life to ourselves but nonetheless important for the totality of life itself.

The presence of viruses within the human host is complex, only becoming the focus of embodied consciousness when they act to disrupt the ‘body passed by in silence’ (Sartre, 1969[1943]), when they trouble our everyday way of embodied living through ill-health. That is, as Toombs (1993: 70–1) explains: ‘Illness engenders a shift of attention. The disruption of the lived body causes the patient explicitly to attend to his or her body … The body thus becomes transformed from lived body to object-body.’ There is no simple opportunity to see the animal-Other here, no chance of mutual gaze and understanding (cf. Haraway, 2008). However, perhaps there is an opportunity to find a way to relate – as our bodies come to our attention through illness – that recognises the way in which they inevitably form part of our embodied being-in-the-world-in-relation to an animal-Other.

The Challenge of Living with HIV

Large numbers of people are now living long term with HIV, and other viruses such as Hepatitis C, as a result of the considerable advances in medical treatment in the last 20 years. Whilst a considerable amount of research has examined experiences of people living with HIV there has been relatively little work examining the long-term impact of living with a virus on people’s understandings of embodied subjectivity. Issues of embodied subjectivity are clearly crucially important amongst people living with HIV as the illness and drug treatment regimes have a significant impact on the physical appearance of the body (alongside a person’s lived experience of his/her body).

In addition, the person and virus may come to be seen as one by the medical profession, by friends and family and, most importantly, by the person living with HIV him- or herself. One example of this concerns the language used to describe infection. There is a growing frequency in the use of the phrase ‘I am HIV’ rather than ‘I have HIV’ amongst people diagnosed. Whether this is simply a linguistic shortcut or something more profound is not known but if we contrast this to self-descriptions from people with other diseases then it raises important questions about understandings of selfhood (in relation to others). To hear someone state ‘I am flu’, ‘I am TB’ or ‘I am cancer’, when describing what is ostensibly the same state of disease, would be astonishing but is somehow acceptable with HIV. Flowers and Davis (2012) address this issue when considering the obstinate nature of essentialism in gay men’s understandings of both sexual identity and HIV. It appears that HIV status jostles or intertwines with sexual identity as a key marker of selfhood within the context of biomedicalisation. This particular linguistic move speaks to the sense of a viral takeover, at least in psychosocial terms, leaving space only for the self to seek sanctuary in the mind, conceived as separate to the body. How is the relationship between person and virus maintained in these circumstances? Is there the possibility of embracing or regaining a sense of embodied subjectivity? Is there a productive relationality between person and virus, some accommodation between the two, or a constant ongoing battle, with the person resisting and policing his/her body in the face of an unwanted aggressor? Most importantly, what is the impact of different strategies in relating to the virus for the experience of living long term with such diseases? Are some strategies more successful in ameliorating psychological difficulties than others? Finally, and of significance for social theory, what does living with say about humanity in the face of the Otherness of the non-human, specifically that which has been traditionally understood as an antagonistic Other.

One of the key challenges of managing HIV is that, as a retrovirus, the genetic information of the virus actually becomes integrated within the host. The ‘normal’ translation of genetic information from DNA to RNA is essentially and literally corrupted and completely inverted through the process of reverse transcription, which means the virus effectively becomes a core part of the host’s DNA. Effective treatments can now control the virus within the body and reduce damage to the immune system. Treatments reduce levels of the virus within blood to the limits of detectability. However, HIV remains in certain tissues within the body, described as ‘sanctuary sites’ or ‘viral reservoirs’. These sites include ‘Lymph nodes and lymphatic tissue; the gastrointestinal tract, from the tonsils to the rectum; the central nervous system; the thymus, where T-cells are educated, mature and multiply; and the testicles’ (Bernard, 2006). Thus the virus is oddly obdurate and can be thought of as fundamentally integrated within the person living with HIV. Furthermore, HIV acts as ‘gatekeeper’ of the apparent truce with other potentially pernicious viruses – once infected and the immune system compromised a whole host of viral cease fires (for instance with cytomegalovirus) are out of the window. Infection thus leads not only to the challenge of living with the Human Immunodeficiency Virus, but also potentially with many other viruses that we might otherwise be less likely to encounter.

For people infected with HIV, one paradox of effective treatment is that the anti-viral medication rather than the virus itself is increasingly the cause of ‘problematic’ symptoms. For instance, the body may become visibly marked out through lipodystrophy or lipoatrophy, with the anti-retroviral treatment literally etched on the body of the patient. Equally, uncertainties remain concerning the long-term effects of anti-retroviral treatment in terms of risks for cancers, coronary heart disease and diabetes. One of the challenges of supporting adherence (which must remain at around 98%) is the blurring of symptom aetiology (the elision of the effects of the virus within the tangible effects of the treatments). For participant-led accounts of these dilemmas see Flowers, 2010, or for a review of interventions to ameliorate them see Harding et al., 2011.

Sam – Learning to Live with the Viral-Other

In the following section we draw on the experience of one man living with HIV – Sam. Sam was diagnosed with HIV in 1994 and so has been living with the virus for over 20 years. His story comes from a study of gay men living with HIV in Scotland and their reactions to diagnosis, explored through a phenomenological study of their experience. Data were collected through one-to-one interviews. The interview style consisted of a dynamic of reflection, followed by further questioning relating to what the participant had just said. Throughout the interview, the talk flowed from a general account of experience, to a very detailed, retrospective account of specific thoughts and feelings. For specific details of the study design and methodology see Flowers et al. (2011). Of the 14 HIV-positive participants within that study, Sam was unique in his ability to describe his changing relationship with HIV. This unique perspective is invaluable in providing an alternative understanding of the possibility of how one may learn to live with a viral-Other differently. In contrast to the interviews conducted with other participants he was the only participant to draw upon diaries and his own poetry as key ways of sharing the experience of living with HIV within the interview itself. Two interviews were also necessary in this case (around one month apart) due to the length of the interviews and need for Sam to go to another appointment during the first interview.

Throughout the following analysis, we draw primarily on Haraway’s (2008) arguments about inter-species relating alongside ideas from the sociology of science and technology (Callon, 1986a, 1986b; Latour, 1991). Central to this approach is the idea that all actants in a network of relations may contribute to the production of the particular world-in-process being considered. No a priori assumptions are made about the importance of particular entities, whether human, viral or medico-technical, accepting that the primary source of data in this study is a human account. This account is not privileged for offering insight into a particular human psyche but instead is understood to provide the most readily accessible and pertinent route into an understanding of the assembly of relations concerning the meaning and potential involved in living long term with a viral-Other.

Sam’s process of learning to live with the virus is, in his own words, ‘transformative’ as his world is opened up in relation to this ostensibly antagonistic Other. His understanding of what it means for him to live with HIV has shifted over the years through a gradual rapprochement between human and virus. This is not simple acceptance of diagnosis and then a continuing battle to deal with the effects of the interloper but something much more significant, a recognition of a ‘fusion of bodily horizons’ (Langdridge, 2005), not between two people but between human and non-human, to touch and be touched by the animal-Other. His ability to be affected by the viral-Other and move towards a companionate relationship is a beautiful example of Latour’s notion of articulation (2004). Here, the virus elicits different behaviours from Sam with him learning to be affected by the Other, not simply through some western individualist and intrapsychic act of selfhood but rather through the – medico-technologically mediated – relationship with a viral-Other. The notion of articulation is significant here for the way in which it allows for us to take on board both the artificial and material aspects of embodiment and relationality. Such articulation only becomes possible through biomedical intervention, through the coming to awareness of the presence of the viral-Other that results from HIV testing. Indeed, it is the test itself that affects Sam and thus mediates the encounter between human and viral-Other. The microscopic nature of HIV precludes a face-to-face encounter, which is not to say that such an encounter is any the less important, and thus requires a relationship between, at the very least, ‘patient’, ‘doctor’ and ‘HIV test’ to make it manifest in consciousness.

His first encounter with HIV is, however, relatively mundane though not inarticulate since the presence of the viral-Other still profoundly affects him, as his diary entry reveals. His account of diagnosis describes his fight against HIV, shock, fear and anxiety but also relief at getting a diagnosis and reducing the uncertainty around being HIV positive. Even here, whilst issues of being-towards-death (Heidegger, 1962[1927]) were now figure rather than ground in his world, Sam was determined to ‘make this bastard thing work for me’. His determination is fuelled by anger and a willingness to engage in a knock-down fight with this viral interloper.

I know I’m still in shock, it’s very strange. I watched old people today and thought about not growing to that age, about not actually wanting to, knowing that I’ve, I’m positive has in fact lifted a strain off me, I had not realised that, I had not realised I was, the uncertainty caused me a great deal of stress. I slept last night without much trouble, something I’d not done for a while, I’m going to make this bastard thing work for me, I’m going to learn to do what I want, I am important, I have a more concentrated life now, it must be of great value, I will learn to drive, I will travel more, I will be more creative, I will write, I will be remembered. [sound of page turning] I do not know at this point, I do not at this point fear death, I don’t suppose to die that soon, there’s too much to do, I’m glad that I can face this with [name 3] and with [name of partner]’s help I would like him to have … and with [name of partner]’s help… . And so I think that that, in fact I’m sure that that probably, I think I had probably been a positive a hell of a lot longer before then, [yeah] and I think that probably I kept myself alive, through that time. Un un un wittingly kept myself alive through that time, [yeah yeah] just because I had a this attitude of wanting to fight this thing.

Sam, his friends and loved ones resisted being subsumed within a medical model of health and ill-health and instead sought to live out their lives with hedonistic abandon. This was not bodily neglect but a refusal to enter the domain of the ill, a refusal to shift their embodied subjectivities from their present sense of selfhood to that of the biomedical. Humour and ‘self abandon’ through pleasure enabled a distance to be maintained between self and viral-Other, acknowledging their practical health needs and the challenge of living with a ‘monster’ whilst not embracing an identity as ill. Hedonism acted as both a continuation of a particular lifestyle but also a counter to illness, enabling Sam and his friends to neatly side-step the dangers of being subsumed within a biomedical world of ill-health and an emptying out of the lived body by technology. Sam’s sense of embodiment may have shifted from ‘a body passed by in silence’ (Sartre, 1969[1943]) to a human-viral body, whilst the move to medico-technical body, with its consequent requirements for continual health surveillance, at least within everyday living, was actively refused.

You know he was just he was just actually that sort of you know sort of, you know and we were, we were, we would almost make jokes about it. Um er … And not see it as as some – well it was a great monster, but er it didn’t we weren’t allowing it to frighten us out of our lives you know, because we we had very vibrant fun filled lives … I think perhaps it what it, what it was was … a non conf … non confirmation to a lifestyle which you might have seen as a change, you know: you’re ill now, so you’re going to have to, you’re going to have to get yourself together, that’s that’s where the self abandon comes in. ‘No I’m not going to,’ you know ‘I’m not going to change anything.’ That’s the sort of self abandon I’m talking about, so maybe it’s not quite such a self abandoning as I, as actually in the background, is the process of of actually keeping yourself together. So it seems like self abandoning, but in fact what you’re doing is is that you’re not letting it stop you being yourself, funnily enough, so it’s quite the opposite!

Soon after diagnosis it was a diary that came to occupy the role of medical repository, with Sam splitting off this aspect of living with HIV from his experience of everyday living and other diary writing activities. The impact of medical surveillance (through CD4 counts, bodily self-inspection, etc.) became ground rather than figure in Sam’s life through their representation in a medico-technological diary. Whilst Sam was diagnosed before the current regime of drug treatments he was still subject to medico-technological interventions (regular testing, drug trials, and medical examination). Rather than allowing the medico-technological body to subsume the body living with the virus, Sam relegated this aspect of embodied selfhood to a specific diary, separate from his other diary. Here, it could be acknowledged and recorded with a reciprocal relationship between the human, virus, and medical technology (embodied through the HIV medical professional) manifest in paper form, enabling Sam to live with the viral-Other less affected by the ‘mundanity’ of medico-technological surveillance than might otherwise have been possible.

I started a separate ‘HIV and me’ diary, sort of separate from my other life time … it was getting in the way of the flow of this diary in that I was describing mundane things like CD4 cell counts … every boil that my body got and every rash … I’d actually found it boring.

A Process of ‘Transformation’ and Rapprochement

With the passing of time, the relationship between Sam and virus evolves and through this evolutionary process his worldview begins to change. He highlights the way in which HIV has changed him for the better, led to a more compassionate, more human sense of subjectivity alongside his belief that there is no place for regret. The temporal nature of existence (cf. Heidegger, 1962[1927]) is also emphasised as his HIV diagnosis and the threat of death, brought to conscious awareness through the loss of friends and loved ones to AIDS, leads to him living much more in the present, rejecting his former tendency to put things off for the future:

… we’ll probably come to that later when I when I’ll start talking perhaps about the ways, ways in which I’m thankful for being HIV positive, um because I see that in fact it’s it changed my, the way I am, it’s change changed my character for the better, so so … I have no, I might even read you another poem about um having no regrets about being HIV positive, because I know at the time of my diagnosis, I was having a good time, so should have a regrets about having a good [yeah] time? No so you know, it’s it’s just it’s attitude, it’s to do with attitude towards what’s happening to you, [aye] and my attitude at that time point in time, well what if life still goes on here? … Live life in the moment, this is the moment, this is the moment and I might, I might not be able to do it tomorrow, I might, you know we don’t know where we’re going here, and just that the the why put off till till tomorrow what you can do today, so that that that whole sort of just …

With time Sam’s understanding of HIV being the ‘monster’ or ‘alien’ intruder is transformed upon the twin recognition that ‘making a friend’ of your enemy dissipates its power and that rather than fight this ‘enemy’ a better strategy might be to nurture his body. Resistance to the threat engendered by this particular animal-Other gradually made less sense as he came to recognise the way in which his own embodied subjectivity was inflected by that of the virus. This led to a more caring and compassionate relationship to his own selfhood. The relationship experienced is closer than we see in Haraway (2008), though even when describing the closeness to her doggy companions she notes the exchange of saliva (and hence bacteria) that may be manifest through a loving lick. Here we see the relationship between human and animal-Other move to an enfolding of ‘flesh’ within ‘flesh’ (cf. Merleau-Ponty, 1968[1964]) that is more ontologically profound, more bodily significant and more emotionally affecting. The intertwining of self and Other, realised through the medico-technical realisation of the presence of the viral-Other, offers Sam an opportunity to become more human, to develop his sense of selfhood through the most profound of ‘a ha’ events.

You’ve got to, you’ve you’ve got, you know, if you make a friend of your enemy, he’s not your enemy anymore … not even, actually, no because not long after that moment, I realised that in fact, it was part of me, I did realise that it was part of me, so how could I, how could, could … yes so I did start off with this idea of this this thing being something to be resisted, um … and I’m not sure exactly when the change came, I couldn’t really put a, or you know there wasn’t a defining, a defining moment as to when it changed that I I then started to think about it as being part of me, as opposed to um, but I think it might have had something to do with my belief that one way in which I thought I could attack the HIV – and it’s a total fantasy this, was I used to lie, I I it would be really nice sunny days, and I’d go for walks by myself, and I would sit in the sun and I would meditate in in the sun, not sun bathe, it’s not … it wasn’t some sort of strange er way to get a tan, and I used to think that the energy of the sun, not not the, not its heat, but just the energy of the sun, um … could could change me, could heal my body. I think that’s probably what it was, so I had this meditation where I would allow the energy of the sun to heal my body, um and that might have had something to do with it, that the idea that it starts, it’s a nurturing process that’s going on. So what I wasn’t doing, I wasn’t fighting HIV, I was nurturing my body, and it’s some somewhere in in that process, um the two things became the same thing. The fighting and nurturing were the same thing …

This is further nuanced by his realisation that he must not only nurture himself but also resist hatred as the fight against HIV involves a fight against his own embodied subjectivity. Sam understands the anger that is at the heart of conflict as a negative response to something that is now a part of his own body, part of himself. The metaphor of war shifts to a ‘symbiotic dance’ between human and virus. Dualisms, whether this is mind-body, oneself-another or human-animal, are rejected and a new connectedness is emphasised between all aspects of his world. There is the beginning of the possibility of ‘breaking-bread with’ the companion Other (from the Latin root of companion: com - panis), acknowledging them, not through the visual connection between the eyes of human and canine (Haraway, 2008), but rather through the medico-technical manifestation of the viral-Other within the human as a result of HIV diagnosis. It is the viral-Other, manifest through the medical technology of HIV testing, that induces new articulations through an opening-up of selfhood through a sense of distributed subjectivity. In Despret’s (2004: 114) terms, we might argue that the virus ‘embodied the chance to explore other ways by which human and non-human bodies become more sensitive to each other’.

You’re right, ok um … [So that …] what what changed was the realisation was that was that this is well wait a minute, wait a minute, I think that what’s changed is that I can’t hate myself, you know I can’t I can’t hate something that’s inside me, how can you hate something that’s inside you? I mean that just logically that doesn’t sound right from from the start you know. If you, if if the whole nature of conflict, and conflict revolution, er er resolution, is about negotiation, so there you are that’s that’s the, let’s let’s negotiate how we live together, and ok so we that that’s not the same as being, you’re saying, you see where do I see the divide? It’s like the old er er problem of a Cartesian problem about mind and … So how can you, how can it, how can you hate something: alright that’s your body, [yeah] you’re not your body, [yeah] and then you have you have, that’s a … You see, but there is it’s a symbiotic dance you see, is that these things are so, they’re so um … er, it’s not, it’s not two separate things, it’s the one same thing, going back to Buddhism again, you know it’s that it … the same thing, the mind, it’s all connected, [yeah] it’s there’s you know, being apart … it’s it’s all …

DNA becomes the ultimate marker of biological selfhood with Sam moving to finally recognise his relationship to HIV through an acknowledgement that it is part of his biological foundations. He seemingly accepts a foundational, potentially reductionist, understanding of biology and subjectivity through the course of his emerging understanding of his relationship to this virus. Such a reductionist discourse does not involve a simple erasure of key distinctions between human and virus but represents a very clear understanding of the biological reality of this particular and rather peculiar relationship.

Right, how is HIV part of me, [yep] um … it is, it is part of my DNA … love me, love my HIV that was the sort of thing that was going on there I guess, that em, um … Well there you are that’s just, you know, what you can’t you can’t pick and mix your options when it comes to having to truly relate wholesomely with people; you can’t say: oh well you know, I like you but I’m not so keen on your HIV. Um I think I’ve said to you before, you know, it’s the nature it, is it’s er, it’s in our DNA, it’s in our RNA, it’s you know …

There is a profound intertwining between human and animal-Other at the heart of Sam’s rapprochement between human and virus. There is increasing awareness of what it means to be human, of living in the present and a process in which his world is opened up. We witness an example of intercorporeal being emerging, the realisation of flesh in Merleau-Ponty’s (1968[1964]) terms as human and animal-Other are connected through a double belongingness. Sam and HIV perceive and touch each other with world and body, human and animal-Other inextricably intertwined in a chiasm. The relationality demonstrated here is of the same order, though subtly transformed, as that described by Haraway (2008) and the relationship between human and companion animal. Much as we might see in pregnancy (Young, 1985: 30), this relationship ‘challenges the integration of my body experience by rendering fluid the boundary between what is within, myself, and what is outside, separate.’ Merleau-Ponty (1968[1964]) uses the example of touch to highlight the reversibility of flesh but this ontological point implies a fundamental enfolding or invagination beyond this one mode of perception. As Young (1985: 30) points out with pregnancy and we can extend here with human viral-Other relating, flesh may actually become enfolded with an-Other, in a way that becomes companionate but is still asymmetrical. The virus does not have conscious awareness of the relationship – the relationship is only in principle reversible – and, in Merleau-Ponty’s terms, the viral-Other is a mirror of Sam’s conscious awareness of living with HIV, conditioning Sam’s understanding of embodied selfhood itself. The viral-Other assumes less Otherness, less of a sense of threat and the possibility of it further mutating into a ‘docile’ companion is realised in Sam’s imagination:

It’s now something, it’s it’s it’s it’s a a a it’s a … [exhales] given that we’re we’re surviving on drugs, I would hope that then in fact, you know I – that’s fine that’s just the way it is, um … would I rather it was out of me? Yes, but that’s not to say, that’s not to say that you’d want to kill it, you would just want it for, for it to transform into something else, and er and er, it might do that, I mean I don’t know. None of us know where we’re going with HIV, it might well be that one cure for HIV, is to let it be, is just to to actually um protect our bodies, so as our bodies can function … and that and if we leave it long enough, what will happen to the HIV? What will it mutate into? It might mutate into something, a a docile, you know we don’t we don’t know. If we don’t attack it, it might not attack us, you know it’s … I don’t know. [aye] Um …

But this is neither a simple passive acceptance of HIV nor a giving of oneself over to the virus, as Sam, of course, wishes that he did not have to be in relation with HIV but does not see the answer as a fight, as an aggressive antagonism. Instead, he seeks a genuine rapprochement in which the viral-Other is also transformed into a docile companion. Sam also notably refuses to take up the label ‘I am HIV’ that is introduced by the interviewer, a phrase commonly heard from people living with the virus to describe their status and identity, in which an essentialist identity of ‘being HIV’ appears to assume a dominant status (Flowers and Davis, 2012).

His thoughtful and considered understanding includes a sense of relationality with the virus without loss of selfhood or the adoption of an identity label of ‘being HIV’. His verb choice (‘to have’ rather than ‘to be’, implied through the inclusion of ‘positive’ in his self-description) is notable (cf. Flowers and Davis, 2012) and contrasts markedly with the expressions of many other gay men living with HIV. As Flowers and Davis highlight, the status of HIV as an illness entails many consequences, particularly for gay men. They become bound up in an assembly of relations between self, medical profession, biotechnology (and biotechnological surveillance), the still stigmatising social world, supportive community relations, friendships and much else besides, in which it necessarily becomes a central part of their identity. Sam does not escape or avoid this, of course, but his identity remains that of Sam, not the Human Immunodeficiency Virus or medico-technological object, whilst accepting his HIV positive status, inextricably bound up in an embodied relation with this particular animal-Other.

Conclusions

Sam’s story is exceptional and through this we can – perhaps – identify new possibilities for how we might better face the challenge of living with HIV, as well as how we might best encounter those other viral and bacterial ‘mess-mates’ that are intrinsic to life. The continued biomedical struggle to separate us permanently from this viral interloper must, of course, continue, but until the time when separation becomes a reality there is a need to understand how we might live together, how we might cope better with this particularly troubling animal-Other. It is the medico-technological that makes the relationship with a viral-Other manifest but in this case there is not an emptying out of the lived body through medical technology. The medico-technological body is relegated to a diary and instead it is the body in relation with the virus that takes centre stage. Sam’s story offers a particular resolution with human and viral-Other learning to find some sense of accommodation, a stance that may better equip us humans to live long term with HIV and allow for an opening up of the world rather than its closing down. Flesh is conditioned by the viral-Other, with this particular human consciousness articulated more fully as a result. It is clearly a very human story, of struggle and survival, but it is also much more than that. It is a remarkable story of human-animal relating, of a coming together, or enfolding, involving the coexistence of species that – at this moment in history – must meet and resolve their differences, one way or another.

Haraway (2008) rightly focused her attention on the relationship between human and companion animal, recognising the way in which these vital relationships lead to humans becoming more worldly, becoming more than they were before their encounter. What we argue here is that this idea of human and animal-Other might also usefully be extended to account for animal-Others beyond the companionate, beyond those that already coexist in normally caring relationships. In addition, we also provide an extension to Merleau-Ponty’s notion of flesh. Flesh is enfolded here not simply with an object of consciousness or element of one’s own body, but with a material Other, an-Other of a different species and one which has traditionally been understood as antagonistic. Living with an antagonistic other, one on the edge of life itself, has traditionally been understood as a battle, a war in which the animal-Other must be fought and destroyed. Sam’s story alerts us to a new possibility, that of a coming together between human and viral-Other and an imaginary possibility of these two creatures becoming more companionate. There is a real sense of the intertwining of human embodied subjectivity with that of the animal-Other and wider social world. This relationship is fundamentally mediated by the medico-technological, for it is only with the intervention of testing that the virus is made manifest in human consciousness, with its continuing presence further mediated through drug regimes and continual medical surveillance. Whilst efforts to find a biomedical solution must undoubtedly continue, in the mean time an extension of Haraway’s ideas might be valuable in developing an understanding of relationality that, whilst complex and troubled, is fundamentally human, demonstrated through the desire to nurture a positive and constructive relationship with the world that we inhabit and all those ‘mess-mates’ that we might encounter therein.

Whilst this article has focused on a case study of one man and his virus it is worth considering the resonance of his story and our analysis with a range of other conditions. Other blood-borne viruses, for example, such as hepatitis, present obvious corollaries. The herpes viruses also merit distinct investigation with their far higher prevalence and the concomitant challenging demands of living well with the virus (to avoid stress-related outbreaks of symptoms in which the virus leaves the central nervous system and sheds particles within the outside world). Equally, Sam’s particular relationship to HIV speaks to many cancer stories and the similar challenges of maintaining embodied subjectivity when the body is understood to have attacked itself.

Together these possibilities speak to the theoretical and potentially therapeutic implications of attending closely to the relational aspects between human and animal-Other. In contrast to the common discourses framed around a model of jeopardy, in terms of conceptualising relationality between human and animal/viral-Other through the tropes of survivor, remission, and outbreak, or the dichotomous dynamics suggested by biomedical understandings of infectious disease, here we have highlighted a more radical alternative. This alternative involves the possibility of a gradual rapprochement between human and animal-Other, such that there is both a greater possibility of embodied subjectivity and also potential for a more articulated, more fundamentally human, sense of selfhood within the context of the challenge of ‘illness’ that we all must face.