RETURNING TO THE STREETS

Ethnography has become an important research method in social scientific efforts to understand AIDS. The relationship between ethnography and AIDS has had numerous consequences on the conduct of ethnographic work: (a) the influx of large-scale government funding; (b) the bureaucratization of the ethnographic team; (c) the need for sophisticated, computerized data management systems; (d) the use of ethnography as a mechanism for empowerment; (e) the movement from viewing the research collaborator as "subject" to "client"; (f) the reduction in the stigma traditionally attached to research on homosexual phenomena; (g) increased cooperation between qualitative and quantitative researchers; and (h) the opportunity to conduct a wide range of innovative ethnographic studies. Although the relationship between ethnography and AIDS can inform current academic debates on the ethnographic enterprise, the ultimate value of our research lies in our ability to elegantly describe the everyday lives of people who are coping with or simply trying to make sense of AIDS

FOR THOSE OF US who have been involved in social science research on AIDS, it is difficult to believe that the epidemic has been with us, at least officially, for nearly 10 years. In 1981, the Centers for Disease Control (CDC) began tracking a new disease syndrome that mysteriously struck young, male homosexuals and left them vulnerable to otherwise rare forms of pneumonia and cancer (CDC 1981). Since then, many events have transpired around the AIDS Phenomenon, including (a) the growing awareness that AIDS is not identity related (i.e., "a gay disease"), but activity related; (b) pharmacological research, although it has yet to discover a cure or vaccine for HIV, nurtures hope by the development of treatments such as AZT; (c) the Quilt; and (d) safer sex. Yet it seems that we have only begun to understand the complex sociocultural profiles of those who (a) contract the disease, (b) are at risk of contracting the disease, (c) attempt to avoid contracting the disease, and (d) simply try to make sense of the disease.

The five articles in this special issue represent a benchmark in social science research on AIDS because they are all ethnographically based. Of the major social and medical problems to appear in the past 1 0 years, including abortion rights, homelessness, the environment, and crime, AIDS more than any other issue occasioned the application of ethnographic strategies to both policy and basic research. The study of AIDS not only demonstrates ethnography's particular ability to describe in elegant detail the ways by which people make sense of and cope with everyday life and its problems, but provides the occasion for refining ethnographic techniques and technologies.

Yet the bond between ethnography and AIDS has also emerged in the midst of an intellectual climate of crisis that has marked the ethnographic enterprise for the past 1 0 years or so. Ethnography, especially within anthropology but also to a lesser degree in sociology, has lost some of its faith in itself. Some ethnographers now claim that they can no longer claim authority over their particular view of the world. Other ethnographers feel that their work is sexist since it sees the world through the patriarchal framework of male-dominated science. Still other ethnographers confess that their work may not be much more than mere fiction that depends more on the rhetoric of the writer than that of the subject (Clifford and Marcus 1986).

Although these epistemological issues reflect a healthy, reflective angst over the intellectual legitimacy of our artform, ethnographers of AIDS have had to suspend or ignore the academic issues surrounding their method in order to respond quickly to a pressing public health problem. Thus the issue of whether ethnography can arrive at the "truth" about people's everyday ways of life (e.g., Price 1983) has largely been waived in favor of the practical goal of achieving the particular kinds of truths needed to establish programs to save people's lives. I am reminded of the following anecdote from Clifford and Marcus's (I 986) discussion of contemporary ethnography:

Ethnographers are more and more like the Cree hunter who (the story goes) came to Montreal to testify in court concerning the fate of his hunting lands in the new James Bay hydroelectric scheme. He would describe his way of life. But when administered the oath he hesitated: "I'm not sure I can tell the truth.... I can only tell what I know." (p. 8).

The articles presented here testify to the variety and impor tance of the partial truths about AIDS investigated ethnograph ically. This special issue, though, provides us the occasion to reflect on the significant accomplishments already made in this research.

First, at the onset of the AIDS epidemic, ethnographers demonstrated their ability to organize research strategies, penetrate the field, and generate high-quality research quickly and efficiently. As early as 1982, ethnographers were examining settings and activities that public health officials speculated were relevant to the transmission of the HIV. Des Jarlais, Friedman, and Strug (1986) described the social organization of "shooting galleries" In New York City, where intravenous drug users (IVDUs) could pay a fee to use a relatively safe place to shoot and to rent "works," the equipment used to inject drugs. Although public health officials were aware that IVDUs were highly at risk of contracting AIDS, Des Jarlais et al., discovered the actual interactional mechanisms conducive - to contagion, such as the fight bond between "shooting buddies" that makes. needle sharing an essential element of friendship.

Although some early ethnography was federally funded, much of this work was conducted by researchers who were simply curious about the social scientific implications of this unprecedented public health problem. My early work with Norris Lang (Kotarba and Lang 1986), for example, explored the impact of AIDS on gay male life-styles in Houston, Texas, in 1984 and 1985. With a team composed of several graduate and undergraduate students and a shoestring budget (i.e., a small grant from the university), we discovered a range of behavioral responses to AIDS among this population, which illustrated the tremendous difficufty In translating abstract beliefs and fears about AIDS into actual preventive behaviors (e.g., "safer sex").

Second, ethnography became a methodology of choice when the federal government eventually got involved in the largescale funding of AIDS intervention.[1] The best example of this development has been the National AIDS Demonstration Research Project (the NADR Project) established by the National Institute on Drug Abuse (NIDA) in September 1987 (NIDA 1989). Briefly, NIDA awarded comprehensive community outreach and AIDS intervention research grants to six cities (New York, Chicago, Miami, San Francisco, Philadelphia, and Houston). These grants enabled local groups to design and implement education, intervention and referral services for three populations at risk of AIDS: IVDUs not in formal drug treatment programs, sexual partners of IVDUs, and prostitutes. Each local program was also responsible for both mapping the prevalence of at-risk individuals in the targeted communities, as well as evaluating the innovative services provided. Persons were recrufted into the program by indigenous outreach workers, largely through personal contact in the "streets" and other locations where potential clientele either live, work, or play. After initial contact and screening for eligibility, the client was administered a formal questionnaire by a trained interviewer, offered pre-HIV test counseling and the HIV blood test, offered both condoms and a supply of bleach to clean needles, and given remuneration of usually $10 to $15.

Ethnography has been a central feature of the NADR project from the beginning, and Rs value to this type of AIDS Intervention has been well established (e.g., see Broadhead and Fox's and Margolis's articles in this special issue). At first, project managers decided that ethnographers should be hired to help locate clients who are not always visible, given their deviant social status. Over time, though, ethnography was Increasingly seen as a practical method for generating more basic social scientific data on a range of related topics. Put differently, AIDS has provided the occasion for ethnographic exploration of social phenomena, largely ignored in the Past by social scientists, of both policy and theoretical interest. For example, the ethnographic team in Houston conducted studies of our clients' everyday health care activities, with particular emphasis on late adolescents and women (Kotarba and Williams 1989, 1990). Outside of institutional and clinical studies, there is very little research in the literature on the ways by which adolescent IVDUs, especially runaways and throwaways, and prostitutes of both genders take care of illness and Injury. The practical import of our research in this area has been to suggest strategies for conducting AIDS intervention through existing, indigenous health care systems available to and used by at-risk persons. The theoretical import of our research lies in the development of the concept of safety net-work, which describes the often intricate systems of health care resources that at-risk persons maintain for use, as last resorts, during episodes of severe or debilitating illness (e.g., "friends" or "sugar daddies" for adolescent, male prostitutes).

Another example is our study of the importance that rock music holds for the everyday lives of adolescent IVDUs, specifically heavy metal rock among White and Hispanic youth and rap music among Black youth (Kotarba forthcoming, Kotarba, Johnson, and Williams forthcoming). In policy terms, we are interested in establishing these media as conduits for AIDS messages that will be relevant to the cultural tastes and languages of at-risk youth. In theoretical terms, we are examining these media as everyday sources of meaning for those adolescents who may not have access to more culturally acceptable sources of meaning (e.g., church, viable nuclear family, school, or "friends from nice families").

There are now 41 NADR Programs operating in over 60 sites in the United States, in addition to several ethnographic programs supported by other federal agencies, such as the Centers for Disease Control (Inciardi 1990). The massive federal AIDS mandate has not only legitimated ethnography as a research method but has deeply affected the very structure of the ethnographic enterprise. First of all, ethnographers suddenly found themselves in demand, and therefore in short supply. Among NADR administrators, principal investigators, and others, there has been constant talk regarding the difficulty of locating doctorally trained ethnographers for their outreach projects. Second, many ethnographers suddenly realized that they had many more material resources than ever before. They were now able to hire trained staffs, contract for computer services, and otherwise increase the scope of their work from the traditional "lone ranger" approach to field research in sociology and the traditional dependence on students for help in the field (cf. Douglas 1976).

Suddenly available resources are also helping mechanize ethnographic procedures. The management and analysis of the large and complex data sets being generated by these ethnographers are greatly enhanced by microcomputer applications, sophisticated software, and ethnographic staff members trained to use them (Pfaffenberger 1988). In the Houston project, for example, we have established a bank of microcomputers and appropriate software to enable efficient entry of conversational and observational data by the team member who collects the data. This, in turn, enhances both the validity of the data and feeling for the nuances of field experiences that could readily be lost in a traditional process of formal transcription by office staff (Johnson, Williams, and Kotarba 1990).

Large-scale AIDS intervention and research have occasioned a shift in the organizational identity of ethnographers. The senior ethnographer commonly serves as a manager as well as a researcher. The ethnographer may not only find himor herself in charge of a number of ethnographic workers but also of formal interviewers, phlebotomists, HIV counselors, Quanttitative data managers, computer technicians, and a host of other personnel (Weibel 1989). In the Houston NADR project, for example, the ethnographic team was composed of a senior ethnographer, a qualitative data manager, several staff research assistants, University of Houston student intems, and clerical support personnel. The management of this team followed the corporate model more than the academic model in terms of style of meetings (e.g., agenda and report driven), task assignment, worker accountability, and so on (Kotarba 1990). In general, funded AIDS ethnography requires an interdisciplinary orientation. Jay Johnson's article on ethnopharmacology in this issue is a good illustration of how otherwise disparate disciplines have been brought together in response to the AIDS crisis.

Whether or not this "bureaucratization" of ethnography increases the overall applicability and quality of our data, available resources have clearly occasioned experimentation with creative research techniques. Eric Margolis's article in this issue is a good example. He uses both photography to enhance the description of everyday life in the Tenderloin district of San Francisco and computer graphics to construct clear and illustrative charts and maps.

As mentioned earlier, many ethnographers studying AIDS have had to conduct their research without the luxury of contemplating the relevance of trendy epistemological issues. However, I would argue that this work addresses some of the major concerns of the critics within and outside of ethnography, although only implicitly in most cases. One of these concerns is the claim that traditional ethnography is an autocratic endeavor in which the lives of persons are described from the limited, distant, masculine perspective of elitist ethnographers (Clifford 1988, 46; Denzin forthcoming). Minorities and women in particular are not readily given a voice in the descriptions of their own lives and experiences (Bertaux 1981; Richardson forthcoming). In response, Lang (1989) has argued that AIDS has already provided gays with the opportunity to speak for and about themselves since AIDS has made homosexuality a legitimate topic of research. Yet perhaps the greatest advancement in this area has come from the ways by which various groups of women and minorities have learned collective empowerment through the process of learning how to protect themselves from AIDS. There are two examples of this from the NADR project.

First, several local programs such as those in Hartford (Connecticut), Philadelphia, Puerto Rico, and Los Angeles organize outreach to women with the understanding that these women need to take control of all aspects of their lives before they can address specific problems like AIDS. These programs counsel female IVDU sexual partners and prostitutes on how to protect themselves from abusive relationships, how to locate social services for themselves and their children, and how to increase their sense of self-worth. Ethnographically, it Is important to understand how the everyday culture of women at-risk of AIDS dfffers from that of men in order to construct effective outreach programs. For example, the female sexual partners unit of the San Francisco NADR project discovered that streetbased strategies to locate male clients did not work with female clients because these women did not hang out in the "streets"! Instead, they were most likely to be at home much of the time taking care of children and other domestic responsibilities. In light of the great importance placed on the notion of 'home,' outreach workers rented a room at a local hotel and turned it into a safe and comfortable center where (a) female values prevailed, (b) clients could bring their children, and (c) various services could be administered in an atmosphere of trust (Romero 1989).

Second, several NADR programs have actually attempted to empower IVDUs through self-organized and activist peer groups. In New York City, for example, self-organized groups that are self-sustaining, messianic, and in contact with related service delivery groups are quite successful (Friedman 1989). In effect, these IVDUs serve as coauthors of the ethnographic description of themselves and their involvement with AIDS intervention.

These examples of AIDS intervention and empowerment relate to another Issue in contemporary ethnography: the analytical relationship between the ethnographer and his or her "other."2 Traditionally, ethnographers across disciplines have attempted to define the other as "subject," that is, a person to be studied and written about from an analytical if not social distance. Recent critics have opposed this stance as being nothing more than the cultural creation of the subject that is likely to distort the real experiences of the people we study. Ethnography turns out to be less a window to culture than a canvas for a portrait of culture (e.g., Rabinow 1986). Apologists have countered that ethnography can, in fact$ adequately describe the subject but, of course, must take Into consideration the subject's own description of self (e.g., Geertz 1988). Still other commentators have argued for an active involvement in the Subject's world through a politically driven praxis (Fabian 1983).

AIDS research has defused this largely academic debate in a very pragmatic way. Due more to the urgency of the AIDS epidemic than to any calculated methodological reflection, the ethnographer's role and identity in this arena have become qufte holistic. Especially in intervention projects like the NADR, the ethnographer is likely to respond to, talk with, and write about the client in several ways. In the Houston project, our ethnographers often found themselves engaged in additional activities while out in the field under the formal pretext of conducting interviews or logging 'hanging around" observational time. These additional activities included instructing clients on HIV infection prevention, helping the phlebotomist locate a usable vein in a client's arm from which to draw blood, referring clients to social service agencies, driving clients to social service agencies, taking clients to lunch, helping clients resolve domestic disputes, filling little plastic bottles with bleach, distributing bleach, distributing condoms, and demonstrating how to use condoms. The ironic point is that AIDS has helped take urban ethnography out of the academy and put it back into the streets. The ontological status of the "subject" Is largely a moot issue, since ethnographers are increasingly conceptualizing their research collaborators as "clients," that is, the recipients of services rather than the object of mere definition. Given the prospect that AIDS will be with us indefinitely, we should be training the next generation of ethnographers to adapt to the increasingly holistic configuration of their work (Kotarba, 1990).

In Spite of all the changes occurring in ethnography since AIDS--changes in our resources, our technologies, our job descriptions, our employability, and our legitimacy--the ultimate value of our work aesthetically, organizationally, and epistemologically lies in our elegant, yet detailed descriptions of our research collaborators' everyday ways of life, descriptions that help us feel their cultures as well as see them. Large-scale funding is neither a necessary nor sufficient guarantee of quality. Ethnography still -depends on the skill and creativity of the ethnographer as observer and writer. In this issue, Kent Sandstrom's glimpse into the very seff of the person with AIDS and Tiffani Mari and Raymond Schmitt's chronicle of one community's efforts to make collective sense of AIDS by dealing with one particular boy's infection are effective because they successfully introduce the reader to new feelings, new communities, and new cultures.

There are numerous other consequence--mostly positive--of the relationship between ethnography and the AIDS epidemic. The five articles included here testify to the most obvious and important consequences of this relationship: knowledge of the social and cultural dynamics of living with AIDS and preventing AIDS that, hopefully, contributes to the management and alleviation of suffering. This is but the first stage of the relationship. The second stage will be the confirmation of ethnography's increased status and legitimacy through a scholarly examination of relevant epistemological issues. Some of these Issues were raised in this article. Others will include the ways that Al DS research has largely removed the stigma and doubt traditionally attached to heterosexual social scientists who study homosexual phenomena; the architecture of an emerging, activist ethnography; and the ways by which AIDS research has occasioned cooperation, if not mutual dependency, among qualitative and quantitative researchers. Many of the issues raised by the critics of ethnography are legitimate concerns that require self-correcting debate. Nevertheless, we cannot lot this debate immobilize ourwork, especially now that the AIDS phenomenon has shown us just how much we can learn and help.

EDITOR'S NOTE: Support for the preparation of this special issue was provided by a grant from the National Institute on Drug Abuse (#SRI 8TAO5156) to Affiliated -Systems Corporation. The editor would like to thank the following reviewers for their helpful comments: Diane Beeson, Janet Chafetz, Russell Curtis, Gary Dworkin, Jacqueline Hagan, Thomas M. Johnson, Mark Kowalowski, Rose Weitz, and Juniper Wiley. Special thanks to Isaac Montoya and Mark L. Williams for their encouragement.

NOTES

1. Inciardi (1990) provided a concise, yet useful summary of the history of federal efforts to control AIDS. Shilts (1987) offered what is still considered the most influential account of the politics of AIDS.

2. Adler and Adler (1987) surveyed the range of researcher/other relationships in field research in terms of the degree of researcher membership in the groups or sociocultural phenomena being studied.

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By JOSEPH A. KOTARBA

JOSEPH A. KOTARBA is Associate Professor of Sociology at the University of Houston. He teaches undergraduate and graduate courses in social theory, qualitative research methods, popular culture, and the sociology of health and won the university's first Innovative Teaching Award for his course on the sociology of AIDS. He also serves as Director of Ethnographic Research for the National AIDS Demonstration Research Project in Houston. His latest book is Managing the Field Research Team (Sage, forthcoming).