I heard the crying before I saw who it was. Walking down the quiet corridor, my footsteps echoing on the tiles, the only other sound was the rhythmic sobbing. It was a strange sound for an office building at midnight. Walking toward my lab, the sound increased, and I could finally tell from which office it was coming. As I drew abreast of his door, which was open, I looked to the left and saw the burly, heavily muscled man dressed in leather, and although his nearly shaved head was bent down and turned away from me, I knew immediately who it was. Guy was a licensed clinical social worker whose therapy practice was limited exclusively to gay men mostly in the S-M community.
He heard me pass and looked over with a wan smile, tears streaming down his face. “Didn't know anyone else was still here,” he said.
“Do you want to talk about it?”
“Look at this,” he said gesturing to the large notebook I could see was his appointment schedule, which lay open in his lap.
“Thirty two, Stephan. Thirty two. That's how many I have buried. I feel like I practice on a battlefield, and my clients are disappearing in death, one by one.”
We sat that night in his therapy room and talked for several hours about AIDS and its impact on his world and the American gay community. Had anyone else been there to see us, we would surely have been an odd couple. But we had become friends months before, when Guy first moved into the small complex where I had my lab, and we met by chance in the parking lot. We liked each other immediately, and he liked my wife, Hayden, and I liked Wayne, his lover and life partner, similarly muscled and leather clad, an organist specializing in Bach. We all shared a taste for Japanese food and the classical music that Wayne played for his straight largely conservative Republican congregations—I often wondered what they told themselves about their brilliant organist. From Guy I got a window into the gay world, and its S-M subset, a world that would have otherwise been hermetically sealed to me. I heard from the inside how AIDS, just emerging in the public's consciousness, had already begun to sweep through the Los Angeles gay population, apparently randomly striking down many of its best and brightest. Killing them in a long, lingering, torturous embrace that went on for months.
That was in 1983, and over the years that have followed I have moved to Virginia and lost contact with Guy and Wayne. But they came back to me as strongly as if we had seen one another yesterday, when after a quarter century, the World Health Organization's epidemiologist Dr Kevin de Cock, head of the HIV/AIDS Department of WHO, said the threat posed by the virus had changed. “It is very unlikely there will be a heterosexual epidemic” in the sense of a planet-wide pandemic.1 It was now recognized, he explained, that outside sub-Saharan Africa, AIDS is largely confined to high-risk groups, including men who have sex with men, injecting drug users, and sex workers and their clients.
In no way do I want to make light of what is happening in the sub-Saharan nations. There, AIDS remains a nightmare. According to the recent United Nation's AIDS summary, “In 2007, this sub-region accounted for almost a third (32%) of all new HIV infections and AIDS-related deaths globally, with national adult HIV prevalence exceeding 15% in eight countries in 2005. Nowhere else has national adult HIV prevalence reached such levels.”2, 3 South Africa, alone, has an estimated 5.5 million people with AIDS. Since the epidemic began, 1.8 million South Africans have died of AIDs and its related diseases. More than three quarters of all AIDS deaths globally in 2007 occurred in sub-Saharan Africa.
Even though two million people are on the antiretroviral drug program, some 2.1 million people died of AIDS last year. Untold millions—33 million people worldwide—have the HIV infection, and as a result, weakened immune systems. These individuals are up to 50 times more likely to develop tuberculosis. “We cannot separate the fight against HIV/AIDS from the fight against TB,” UN General Assembly President Srgjan Kerim has made clear.4
But Africa excepted, where “Ten years ago a lot of people were saying there would be a generalised epidemic in Asia, and China was the big worry with its huge population, that doesn't look likely,” says de Cock, although “There could be small outbreaks in some areas.”1 Of Russia, which was once also considered at high risk, de Cock says, “I think it is unlikely there will be extensive heterosexual spread in Russia. But clearly there will be some spread.”1
It doesn't help that the current American administration continues to obsess on abstinence programs, which in study after study have been shown not to work as was trumpeted, or that, bowing to the religious right, the United States continues to block condom distribution.
The truth is, though, that critics now question whether the money continuing to be spent on virtually universal planet-wide training in AIDS prevention is now being largely misspent. Certainly some of it could be reallocated to solving one of the biggest mysteries about AIDS in Africa. As de Cock points out, no one yet understands why the disease spreads amongst the heterosexual populations in the nations of sub-Saharan Africa quite differently than elsewhere.
“Sexual behavior is obviously important but it doesn't seem to explain [all] the differences between populations. Even if the total number of sexual partners [in sub-Saharan Africa] is no greater than in the UK, there seems to be a higher frequency of overlapping sexual partnerships creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection,” de Cock notes.1
And it would also be worth putting some time and money into figuring out what it would take to make the homosexual community in the developing world, often a highly repressed population, much more careful in their sexual practices. “It is astonishing how badly we have done with men who have sex with men. It is something that is going to have to be discussed much more rigorously,” de Cock says.1
One thing seems clear to me looking back across the decades, and thinking about Africa. We in the heterosexual community of the West owe gay men a great debt of gratitude. It was only a random act of destiny that AIDs first appeared with gay men. If the person who brought it to our shores had been straight, given the multiyear delay between exposure and disease manifestation, it would have swept across America killing millions before therapies could be researched and developed. In that far away historical outlier time, after the Pill and before AIDS, when those of us in our 20s, 30s, and 40s saw casual sex as just that—casual—it would have taken hold with a vengeance that can hardly be imagined.
We were unbelievably lucky as a nation that it began with gays, who were, at the time, a cohort tightly organized to push its civil rights. They quickly organized and cooperated with the medical community, and served as shock troops. Thousands volunteered for drugs trials. They bought America time by sacrificing themselves. They gave researchers a chance to develop the drug cocktails that have made AIDS more a chronic disease here than the pandemic it could easily have become. One that could have overwhelmed our culture. My daughters have been spared what might have been, because young gay men died like soldiers in a battle to save them from unwitting exposure. And the same could probably be said of me as well. And, perhaps, it could be said of you. They are the largely forgotten—but not unknown—soldiers in one of history's great medical world wars. No less than the Marines who stormed Guadalcanal, they saved our world.
FULL TEXT