The End of the AIDS Crisis
In January, I wrote in The Stranger that the AIDS crisis was over. I was careful to point out that by "the end of the crisis" I did not mean the end of AIDS. People would continue to die, I wrote. But effective new treatments-protease inhibitors and triple-drug cocktails-were ending the AIDS crisis as we knew it. I pointed out that people with AIDS were responding to the new drugs-but our local AIDS, Inc. franchises weren't. In the wake of this article, I was attacked by a lot of people, the most well-known being Terry Stone of the Northwest AIDS Foundation, John Leonard of Gay City, and Dr. Robert Woods of the AIDS Prevention Project. All three thundered in unison that AIDS was not over -- if anything, things were getting worse. A few weeks later, Eric Rofes, a San Francisco-based writer, came to town and gave a speech. In that speech, he said that not only was the AIDS crisis over, but that for many gay men, in many parts of the country, the AIDS crisis never existed. Gay City's John Leonard was there, and the text of Rofes speech was published (without his permission) in the Seattle Gay News, where Stone and Woods must have seen it. A week later, I picked up a copy of the SGN and turned to the letters page, anxious to read angry tirades from Leonard, Stone, and Woods condemning my fellow apostate Eric Rofes. Surely Rofes' position was more extreme than mine: I only said the crisis was over, he came close to saying it never happened. There were no letters. "I didn't say it never happened," said Rofes, when I asked him about his speech. "I argued that many gay men involved in the community today have never experienced AIDS as a crisis. For gay men between the ages of 16 and 34, the bulk of socially active gay men, it is an expected part of life, not a crisis." And AIDS "was never the crisis in rural areas that it was in urban areas, and even in those urban areas hardest hit by AIDS, gay men over 34 have adjusted to the realities of AIDS, and have ceased experiencing it as a 'crisis.' That's what I said." Which sounds a lot like what I said-the crisis is over. Why the different responses? "Because you're a journalist and I'm an academic. You write for the press, you say things quicker, and in grabbier ways, than someone like me who writes at greater length. You simplify, reduce, exaggerate, and blow them out the water. And you get in trouble for that. And that's important, and that's valuable, but that's not what I do." What a difference six months can make. With the effectiveness of the new drug cocktails fast becoming absolutely undeniable -- too many fat 'n' happy PWAs going back to work, too few Barbra Streisand albums available at the Chicken Soup Brigade thrift stores -- Seattle's AIDS, Inc. education franchises have reluctantly started to address the new drugs. In the process, they seem to be making a concerted effort to downplay the drugs' effectiveness. Over the last four weeks, NWAF has launched an ad campaign called "AIDS is Changing -- Find Out How." One ad reads, "Éthese new treatments are responsible for vast improvements in the health of some individuals who take themÉ. Unfortunately, about one in every three people find they can't tolerate these drugs. Even for those who can, the side-effects, including diarrhea, nausea, and kidney stones, can be overwhelmingÉ." In another ad, an HIV-positive man on the drugs says he has "hardly any side-effects," but describes himself as "super lucky." His friends taking the drugs have "harsh side-effects, side-effects like kidney stones and diarrhea." Gay City recently held a forum, "The End of AIDS: Hype or Hope?" Three men with AIDS were on the panel. Two were doing well on the drugs, one could not tolerate them. The drugs were failing him. When someone in the audience asked the panel just what percentage of people taking the new drugs were doing well, no one answered the question. In the last month, there have been write-ups about the new drugs in both of Seattle's daily papers. On May 23, the Seattle Times ran a story based on a poll NWAF conducted of about half their clients-clients who have AIDS. In a story headlined, "The New AIDS Drugs Helping Some-But Not All," Times health reporter Warren King writes that NWAF survey showed that "the drugs have improved the health of many patients, but not as many as the hype would suggest." Less than half of the NWAF's respondents "said their health had improved." In the June 4 Seattle Post-Intelligencer, a story by Scott Maier, headlined "Living Longer With AIDS," stated that the new drugs were failing "an estimated third of those with AIDS." He didn't say whose estimates those were. So how many people taking the new drugs can't tolerate them? Thirty percent? Fifty percent? Try fewer than 10 percent. Dr. Peter Shallit, who has been seeing AIDS patients for the seven years, currently serves about 300 patients in all stages of HIV-disease. He won't say the AIDS crisis is over, but he will say that he is seeing a "different AIDS crisis" in his office. How are his patients doing on the new drugs? "Probably 90 percent of my patients are 'getting better.'" What about debilitating side-effects? "You can usually find a regimen that is relatively free of side-effects, but people usually have some complaints. Mild problems. The drugs are not that bad for most people." Of his 300 patients with HIV, how many have had side-effects so bad they had to go off the drugs? "Five or fewer." Dr. David Spach, who edited The HIV Manual, a guide for clinicians working with AIDS patients, was a panelist at Gay City's forum. Spach also serves about 300 patients with HIV. How many of his patients are being failed by the new drug cocktails? "I'd say 10 percent. But that includes lots of people who had really advanced HIV-disease when the drugs became available. We don't have the data yet, but if you use these triple-drug cocktails early enough, the failure rate could drop to less than five percent." The figures in the Times and P-I, and the impressions created by Gay City's forum and NWAF's recent ad campaign ("one in every three people find they can't tolerate these drugs") simply do not reflect reality. When asked how people taking the drugs are doing, AIDS, Inc. answers something like this: "Well, people with AIDS taking the drugsÉ." But not everyone who's taking the new drugs has AIDS-most of the people taking the drugs are simply HIV-positive. People who've had AIDS for longer periods are more likely to be failed by the drugs, so if you count only PWAs in your survey, you can make the drugs look less effective than they are. But the "one-third" and "less than half" figures are even inaccurate when applied to people with AIDS. Citing the only ongoing, comprehensive survey of people with advanced AIDS on the drugs, Dr. Spach notes, "Eighty-two percent are doing extremely well." That's better than four out of five. Over at NWAF, everyone who does gay men's education is leaving in the next two months, including Education Director Martin McCombs. And NWAF has zeroed out the education department's budget for media campaigns; the only thing that department will be advertising from here on out are their poorly attended men's workshops. This means that the "AIDS is Changing" campaign is over, which is a shame: while it denies the effectiveness of the new drugs, it was the only education campaign that talked to gay men at all about the new drugs. Of course, the new drugs are not a cure. And once you're on them, you're on them for good. And they're a bitch to take. And they don't work for a very small number of people. And some people do have side-effects. But they work for most people. And that changes everything. Evidence of change is everywhere. Our local chapter of the Names Project is going under for want of volunteers, and the annual AIDS memorial vigil was poorly attended. People are moving past large, politically motivated public displays of grief. The Portland-to-Seattle/ Vancouver-to-Seattle AIDS "Ride for a Reason" just canceled the Portland-to-Seattle leg for want of riders. In the last month The Advocate and The Wall Street Journal have both run stories about AIDS fundraising drying up. It's a fascinating, wrenching moment in time. The drugs work for most people with AIDS, and they're working for the vast majority of people with HIV-if they're getting treatment. As fewer people with HIV progress to full-blown AIDS, the numbers of people with AIDS is shrinking-but the number of people living with HIV is growing. The same number of people are getting infected every day. But if they get on the drugs, and don't become ill or disabled, they're not going to need the meals, hospices, case managers, and other "client services" we've constructed around what it meant to be a person living with HIV/ AIDS during the crisis. People made enormous personal, financial, and professional investments in AIDS as it was. Thank God they did, or the sick would not have been cared for, the dead would not be remembered, and the drugs would not be here. But we invested in a set of circumstances that don't exist anymore. The changes happening now in the gay community are as far-reaching as the changes that swept over the gay community between '82 and '87. People had enormous investments in what it meant to be gay before the AIDS crisis began. Letting go of those investments-closing bathhouses, learning to use condoms, caring for the sick, being sick-this too was wrenching. Eventually the gay community was transformed. And whether or not we want to admit it, it's happening again. You can feel it, if you let yourself. There are other controversies on the horizon that gay men need to start thinking about. There are renewed calls for contact tracing and mandatory HIV testing. In the past, we argued that people with HIV and AIDS faced hostility and discrimination; and more importantly, there were no drugs, no treatments, to offer people with HIV or AIDS-so what good did it do to "ruin" someone's life by telling him he had HIV, or forcing him to take the test? (Besides, of course, that it might stop him from unknowingly ruining other people's lives.) But as Chandler Burr writes in this month's Atlantic Monthly, the arguments against contact tracing and mandatory testing no longer hold water, thanks to the new drugs and the ADA-the Americans with Disabilities Act, which outlawed (but did not eradicate) discrimination against people with HIV and AIDS. The earlier someone with HIV starts on the drugs, the likelier the drugs are to work, and the fewer side-effects that person will have. Contact tracing and mandatory testing would suddenly seem to be in the best interests of people living with HIV-especially those people who are not aware they have it. If it's about saving lives, not scoring points, we'll have to revisit these issues. Another storm cloud on the horizon is the issue of so-called "morning after" treatments. When health-care workers are exposed to HIV in a medical setting, the Centers for Disease Control recommend they go on the drug cocktails for a month. There's no hard proof this actually prevents infection, but better safe than sorry. Should the drugs be made available to people exposed via consensual sexual contact? If not, why not? Would it encourage irresponsible behavior? What if the person exposed was behaving responsibly: what if they were using a condom, and it broke-what then? And if that condom broke in a bathhouse? By selling condoms to gay men for HIV/ death control, AIDS educators have set themselves up for a fall. We were told to use latex because condoms were all that stood between sexually active gay men and death. Now drugs stand between us and death, leaving condomsÉ where? Gay men still need to use condoms-we should still avoid HIV-infection-but 30 to 40 percent of gay men weren't using condoms when the wages of unprotected anal sex were death. Does anyone seriously believe that number is not going to rise now that the wages of raw buttfucking areÉ drug cocktails? Getting gay men to use condoms to avoid HIV effectively prevented the spread of other STDs. We prevented the spread of herpes, hepatitis, genital warts, syphilis, and gonorrhea among gay men by talking about HIV. Maybe we can prevent the spread of HIV by talking about herpes, hepatitis, genital warts, syphilis, and gonorrhea. Maybe what gay men need now is not AIDS education, but sex education. AIDS educators have the opportunity to broaden their mission beyond AIDS, to focus on the broader issues of gay men's sexual health. But to do that, AIDS, Inc. will have to drop the "drugs might not work/ only work for some" scare tactics. If we don't change, if we don't adjust to these new realities-whether or not we're living with HIV-we will become ridiculous, as the few surviving ACT-UP chapters already have. Still spitting out press releases, aging ACT-UPers are the gay community equivalent of old hippies. Young, out-of-touch acolytes turn up for demos, deluding aging ACT-UPers into believing they're still relevant, shielding them from the unsettling truth: tactics must change with the times. And the times have changed. If unreconstructed AIDS activists are our old hippies, then unreconstructed AIDS educators are quickly becoming our old folksingers, belting out protest songs in coffeehouses ("and it's one, two, three, what are we fighting for? We're fighting for dental dams, and other AIDS-funding scamsÉ"). Like those folk singers, AIDS educators will soon find themselves singing dated HIV-prevention messages to increasingly empty houses. But AIDS educators mean so well-and they're such nice people-that no one has the heart to tell 'em to get off the stage. You know what they say about the oft-repeated lie: it becomes the truth. Such is the case with me and condoms. After I wrote about these issues six months ago, the Seattle Gay News, NWAF, and Gay City admonished me for promoting unprotected anal sex. This wasn't what I wrote, but to them that didn't seem to be the point. In a letter to The Stranger, John Leonard worried that gay men would start "following [my] lead and throwing away their condoms." You know what they say about a person accused of a crime he didn't commit: he winds up wishing he had committed the crime. Why not be guilty of what you're being punished for? Such is the case with me and "encouraging" gay men to follow my lead and throw away their condoms. If I'm going to be accused of the crime of promoting unsafe anal sex, well by golly, I'm gonna to have the pleasure of committing it: Fucking without condoms is great. Wonderful. Super. There's a connection, an intimacy, you just don't get with condoms. And I'm sorry, coming inside your lover and leaving part of yourself in his butt-no amount of "feeling good about being safe" can compare to that. Greasy lubes, the kind you can't use with condoms, are so much better than all that gooey water-based shit. And you need so much less of it-just a dab will do ya! And when it's over, you don't have to yank the trash can liner out of your boyfriend's ass and throw it in the toilet. And because you didn't have to use a pint of lube, your lap, his butt, and your sheets aren't soaked. Fucking without condoms is great, and boys, I encourage you to throw those condoms away, but only if you're willing to follow my lead: meet someone you feel serious about-with seriousness measured in years, not weeks or months-and commit to balls-out monogamy; or if that's not doable, commit to fuck-and-suck monogamy (if you sleep with other people, jerk off only). After a year of strict monogamy, take an HIV test. If you're both negative, and you're damn sure you trust this guy, then follow my lead and throw away your condoms (you might want to wait three months and test again, just to be sure). I'm sure what I've just written will make some AIDS educators wet their beds tonight, but it's a post-AIDS-crisis HIV prevention message I believe gay men are ready to hear.