Black Hole’s depiction of the social perception of illness resonates with the historical weaponization of illnesses to reinforce social biases and police behavior. Central to Burns’s novel is the bias against sexual activity; that the Bug is perceived to be a sexually transmitted infection contributes to the stigmatization of the characters who have it. As the novel progresses, it becomes clear that the Bug’s symptoms are largely superficial. There is never any significant threat to the health of those who contract the Bug, yet people without the illness treat those who do have it with fear and revulsion. In one case, the public exposure of Chris’s illness highlights a double standard in her peer community’s gender dynamics, as her peers stigmatize her for having the illness while showing no disapproval toward her male peer, Rick Ames, who stripped naked just moments before Chris did without any fear of reproach or judgment. The visceral disgust that the Bug evokes thus echoes the perception of sex as something “dirty,” particularly for women.

There are several real-world precedents for the novel’s depiction of the stigmatization of illness. The novel’s setting in the 1970s and initial publication run in the 1990s bookend the decade in which the global HIV/AIDS pandemic began. Throughout the 1980s, the disproportionate impact of AIDS on gay men reinforced an antigay bias throughout the United States. Randy Shilts’s And the Band Played On suggests that this contributed to a slow public health response from the Reagan administration, which exacerbated the spread of the illness and drove the wrongful perception that AIDS exclusively affected gay people and other marginalized groups deemed morally suspect (e.g., people who used intravenous drugs). Another precedent is the global spread of tuberculosis, which American author John Green argues is the clearest evidence that social perception and public health are inextricably linked with one another. In his book Everything is Tuberculosis, Green traces how historical shifts in the understanding of the causes of tuberculosis influenced its romanticization among privileged classes and its stigmatization among marginalized communities, especially Black and Indigenous populations in the United States. More recently, the COVID-19 pandemic saw a sharp increase in incidents of anti-Asian discrimination around the world as the first reports of the illness in Wuhan, China, were weaponized to foster distrust against people of East Asian and Southeast Asian descent. In the United States, a New York University study revealed that the pandemic encouraged people who already held anti-Asian biases to act on their discriminatory beliefs (Daniels C., DiMaggio P., Mora G.C., Shepherd H. “Does Pandemic Threat Stoke Xenophobia?” New York University College of Arts & Science, 2023). Thousands of incidents of racist violence against Asian Americans were consequently reported in the online forum, “Stop AAPI Hate.”

Burns himself has said that the Bug is meant to represent the experience of adolescence, externalizing the terrifying changes that people feel as they transition from childhood to adulthood. However, the novel also shows the different ways that people use the illness to justify their biases against others. In an early chapter, for instance, Dee and Todd destroy the tent of a former schoolmate named “Rick the Dick” Halstrom, who went into self-exile after experiencing the Bug. Rick and his friend Dave are later revealed to have experienced bullying before they contracted the Bug, suggesting that the illness merely served as a pretext for ongoing abuse.