The growing numbers of women living with HIV begged a question: Why and how were women contracting HIV? Chapter 4, “Sex Bargains,” tracks the emergence of a new logic that centered heterosexual sex as the site of women’s vulnerability. Focusing in on the interpersonal negotiation before surrounding sex had a powerful effect: It obfuscated the role of structural responses to the epidemic, from housing to harm reduction, and instead focused public health interventions on individual behavior. This chapter follows an influential debate between law and economics scholars and feminist activists on the question of the sex bargain.

This concluding chapter, “Governing the Unknown: Legal–Scientific Settlements,” offers a new framework to describe the momentary stabilization of scientific facts in and through lawmaking: legal–scientific settlements. From these legal–scientific settlements emerge a range of distributional consequences that have material effects on people’s lives and shape the ability of individuals to survive and thrive despite public health crises.

Chapter 3, “Experiments in Risk: Women and Clinical Trials,” follows feminist advocates as they set out to use the law to mandate the inclusion of women in clinical trials. With the advent of HIV treatment, people with HIV began to survive longer. A new problem emerged: Women were being excluded from clinical trials due to a 1977 Food and Drug Administration (FDA) guideline concerned about the impact of experimental drugs on women’s reproduction and the fetus. Not only did this mean that women could not access experimental treatments, it also resulted in confusion around how to treat women with HIV. Feminists began to advocate for a change in the FDA guidance which was excluding women from clinical trials. In keeping with the broader demands in the feminist movement at the time, feminists asserted that women should be able to choose to enroll in trials despite potential exposure to risks. Buoyed by ideas of choice and bodily autonomy, feminist AIDS activists were able to undo the FDA’s reticence to enroll women in clinical trials altering scientific research in HIV and beyond.

This introduction lays out a core argument of the book: that social movements mobilize law and legal institutions to unsettle expert consensus and alter the distribution of material resources. This chapter describes how feminist activists concerned about women and AIDS sought to reset public health practice on surveillance, diagnosis, risk, and treatment to effectuate feminist goals, including access to public health resources and welfare benefits.

Chapter 1, “‘We Are Not Immune’: A New Branch of the Feminist Women’s Health Movement,” begins by describing the emergence of a new coalition of feminists who turned their attention to the HIV epidemic in an attempt to understand how the virus would impact women. Together they realized that HIV was killing women more often than the those in charge of the AIDS response acknowledged. The failure to recognize and respond to issues facing women with HIV was due, in part, to the Centers for Disease Control and Prevention definition of AIDS that did not include gynecological infections. The incomplete definition of AIDS resulted in a lack of data on women with HIV and impacted the Social Security Administration’s determinations of who should receive benefits. Allying with lawyers and fellow activists, feminists set out to challenge the law and science of the epidemic.

Chapter 2, “Litigating Risk: The Law and Politics of Disease in the Administrative State,” turns to the litigation and activism that resulted in the shift in the Centers for Disease Control and Prevention definition of AIDS and turned attention to women’s risk of contracting HIV. The chapter tracks how litigation and advocacy were central to the shift in the CDC definition of AIDS. Feminist success would result in many more women being diagnosed with HIV, resulting in a greater ability to access benefits. This life-changing shift would mark a major victory for the feminist women’s health movement.

As heterosexual sex became a driving explanation, feminist debates about sex and power took center stage in the AIDS response. At the heart of this feminist struggle is the question of sex work. Some feminists, carceral antitrafficking feminists, saw sex work as the objectification and exploitation of women. Others saw it as a site of agency and power. Chapter 5, “The Sex Wars Come to AIDS: Risk and Consent,” follows these debates as they moved into public health and the AIDS response. Sex workers were (and continue to be) among the hardest hit with HIV. They were also some of the most powerful advocates of harm reduction. Empowering sex worker communities would turn out to be one of the most reliable ways to slow the spread of HIV. But for feminists who saw sex work as exploitation, these public health interventions were aiding in the exploitation of women. Buoyed by political conservatives and the antitrafficking movement, carceral antitrafficking feminists successfully lobbied for restrictions on funding sex worker projects. The consequences were deadly.