Twenty-five years have passed since the Centers for Disease Control and Prevention published the first report of a mysterious disease killing homosexual men in Los Angeles. According to the CDC's Morbidity and Mortality Weekly Report, all the men had a "cellular-immune dysfunction related to a common exposure" and a "disease acquired through sexual contact." Characterized by a strange array of infections -- pneumocystis pneumonia, Kaposi's sarcoma, candidiasis, cytomegalovirus -- the disease was initially dubbed "gay cancer," then GRID (gay-related immunodeficiency disease). As federal health officials learned of similar cases involving people who were not gay, GRID was abandoned for AIDS, Acquired Immune Deficiency Syndrome.
The CDC's report appeared in June 1981, but it would be nearly two years before the virus that causes AIDS would be identified -- and two more years before the U.S. Food and Drug Administration would approve the first antibody test for HIV, the human immunodeficiency virus. Recently Newsweek magazine quite correctly observed that, in the beginning, "no one -- not the government, not the media, not the gay community itself -- reacted fast enough to head off disaster." Politicians objected to funding research of a new pathogen believed to kill mostly gay men and intravenous drug users. Mainstream media outlets largely ignored AIDS until it turned up in women, children and hemophiliacs. Even the New York Native, a gay newsmagazine, originally dismissed AIDS cases with a perfunctory headline: DISEASE RUMORS LARGELY UNFOUNDED.
During the early years, President Ronald Reagan made no public acknowledgment of AIDS -- even after a Hollywood pal, charismatic film and TV star Rock Hudson, was diagnosed and died. For many Americans, Hudson's death in 1985 was their first exposure to AIDS. Then, America's extreme political right wing and the usual pack of pseudo-Christian evangelical jackals seized the opportunity to demonize gay men. Reagan advisor Pat Buchanan proclaimed, "The poor homosexuals -- they have declared war against nature, and now nature is exacting an awful retribution." In the absence of any prudent, discerning national leadership on the subject, people living with HIV or AIDS were routinely divided into two categories: "innocent victims" and "people who deserve to get AIDS." Hostility towards those in the latter group was palpable. People were routinely fired from jobs, evicted from their homes and denied access to healthcare.
Some gay men went into denial, refused testing and mourned closed bathhouses, but many others mobilized, creating advocacy groups and AIDS service organizations such as ACT UP and Gay Men's Health Crisis (GMHC). In those early days, the deaths were unrelenting, the losses made all the more painful by our nation's indifference and propensity for tasteless jokes. During a 1986 rededication ceremony for one of America's greatest monuments, beloved comedian Bob Hope quipped: "I just heard the Statue of Liberty has AIDS. Nobody knows if she got it from the mouth of the Hudson or the Staten Island Fairy."
It would soon be hard for Americans to ignore AIDS or revile all its sufferers. Entertainers, from actors to musicians, would succumb. Artists, fashion designers, athletes and porn stars would perish. Grandmothers, brothers, school children and college students would be diagnosed and die. As early as 1983, rational voices warned of an epidemic, even predicting that AIDS could be the public health threat of the century. And while Americans are capable of profound compassion from time to time, we truly excel at fear, ignorance and hysteria. With a collective shudder, the nation lurched forward, abandoning the myopic "AIDS is a gay disease" scenario for one even more fallacious and loathsome: AIDS is a gay disease that's spreading to the population at large!
How did AIDS bring out the worst in us as a nation? In 1986, the Pentagon began testing new military recruits for HIV, rejecting those who tested positive -- an obvious effort to expose homosexuals. That same year, HIV-positive Indiana teenager Ryan White was barred from attending public school. By 1987, the United States had added HIV to the immigration-exclusion list (that policy remains intact). Later that year, Congress adopted the Helms Amendment, legislation banning the use of federal funds for HIV prevention and educational materials that "promote or encourage, directly or indirectly, homosexual activities" -- it would not be declared unconstitutional until 1993. Throughout the 1980s, anxious voices advocated everything from compulsory testing of all hospital patients, prison inmates and marriage license applicants to the quarantining and tattooing of people with AIDS.
How did our government fail? It would be fully seven years after the first cases of AIDS were reported before the CDC would distribute information about HIV and the behaviors that can lead to its transmission. In May 1988, 107 million American households were mailed a copy of "Understanding AIDS," a brochure put together by U.S. Surgeon General C. Everett Koop, but never publicly acknowledged or endorsed by then President Reagan. Nine years passed before the United States government introduced a federal program or legislation -- 1990's Ryan White CARE Act and the Americans With Disabilities Act -- to improve the quality of care for and prohibit discrimination against people affected by HIV and AIDS. None of that, however, can be attributed to any particular effort on the part of Reagan's successor, the first George Bush, a man who can most charitably be summed up as oblivious. And by 1992, AIDS had become the No. 1 cause of death for American men aged 25-44.
You may want to believe President Bill Clinton genuinely "felt your pain" during his two presidential terms in the 1990s. After all, he championed reauthorization of the Ryan White CARE Act, created the Presidential Advisory Council on HIV and AIDS and appointed the first "AIDS czar." Unfortunately, it was also his administration that launched federally funded abstinence-until-marriage programs for America's youth in 1996, a misbegotten initiative that appeases the nation's prudes, but tends to create the kind of dumbed-down teenager who will insist that oral sex isn't real sex.
Clinton and his predecessors would be dramatically upstaged by HAART (highly active antiretroviral therapy) in 1996. This combination of pharmaceutical drugs known as protease inhibitors and reverse transcriptase inhibitors would prove to be powerful medicine despite its ludicrous marketing as an "AIDS cocktail." Barely a year later, the revolutionary treatment was credited with drastically reducing the AIDS death rate and bringing scores of men and women back from the brink of death -- a so-called "Lazarus Effect," named for the biblical figure who was raised from the dead. But HAART -- an expensive, lifelong commitment distinguished by grim side effects -- is not the answer, a panacea or cure; it's a bitter pill.
A quarter century of AIDS and a decade of HAART behind us, where are we? According to a recent national survey (May 2006) conducted by the Kaiser Family Foundation, significant percentages of Americans still mistakenly believe HIV might be spread through kissing (37%), sharing a drinking glass (22%), and touching a toilet seat (16%). More than half of all Americans do not know that a pregnant woman with HIV can take drugs to reduce the risk of her baby being infected (55%), or that having another sexually transmitted disease may increase a person's risk of getting HIV (56%). Maybe Americans don't know any better because the Centers for Disease Control and Prevention has, under pressure from tight-assed congressional ultraconservatives, de-funded explicit prevention efforts over the past ten years.
Apparently the CDC needs reminding that prevention is not simply part of its name, it's their responsibility. Serious, explicit, fundamental prevention education has been thwarted, abandoned in favor of vague initiatives about testing and linking positive people to treatment -- period. Does it really make any sense to gut comprehensive sex education in schools and strip funding for proven, straightforward prevention programs when we live in a country that spends an estimated $10 billion a year on adult entertainment? We can handle the truth. It's time for the rest of us to tell our government -- especially its most insufferable legislators, like Tom Coburn, Bill Frist and Mark Souder -- to get over its squeamishness about sex and acknowledge, once and for all, that politicians have no right whatsoever to hold the entire American population to a rigid puritanical sexual standard that begins and ends within the context of a monogamous heterosexual marriage. Hey, Uncle Sam, grow the hell up!
What else? Well, let's acknowledge that safer sex was a great idea. Yes, it's sounds soooo 1989, but it works. We hear a lot about how it's an "old paradigm" -- a fancy way of saying it's a tired model -- but the truth is we've gotten lazy and bored. So then, what if we dropped the language and moved on? Everyone, including people with HIV and AIDS, is entitled to a full and satisfying sexual and emotional life. Start having conscious sex. You know, try being fully aware that sex always has consequences -- from pleasure and intimacy to pregnancy and sexually transmitted diseases. Common sense, candid conversation and condoms = conscious sex.
For the gay guys: Listen, something is definitely wrong when "Will & Grace," a sitcom featuring two sexually active gay men, can run eight freakin' years wringing laughs from homophobia, infidelity, gay parenting, single motherhood, addiction and death, but fails to find even one single amusing way to send those boys to the clinic for an HIV test. Looking for positive role models? Forget TV. Maybe gay men could just start caring about one another again like we did when AIDS was ravaging our communities and the preachers were telling us it was God's wrath and the politicians could not have cared less. Where are love, courage and compassion today? Are they awakened only by crisis? Maybe you don't think HIV is a big deal anymore; the meds make it chronic and manageable just like diabetes or heart disease, right? Please wake up and smell the scented candle. If you think a life of pricey, toxic meds, bizarre side effects, disclosure and discrimination is acceptable, then you need your head examined. And by the way, please avoid crystal meth; it's rots your teeth and makes you stupid.
So it's been 25 years since those first AIDS cases. What needs to happen for us to move forward as a nation? First, the United States government and the CDC should apologize immediately for mistakenly suggesting a link between homosexuality and AIDS. Worldwide, over 40 million people are infected with HIV and half of those are women. HIV is not a gay virus and AIDS is not a gay disease. The president of the United States should say that in a televised address to the nation and the CDC should mail that information to every American household. Next, we should have a national day of mourning; an opportunity to grieve and acknowledge that AIDS has killed more Americans than every military conflict from World War II through Iraq. And finally, pharmaceutical companies -- the world's most wildly profitable businesses -- should quit squabbling over patents and generics, stop buying off Congress and the FDA, and refrain from irresponsible marketing practices and price gouging. In other words, try something ethical for a change.
Yes, the urgency that once surrounded HIV and AIDS in the United States has ebbed. Many Americans think the epidemic is under control here and the problem now exists over there. Our government cunningly deflects attention away from the growing American HIV social-services crisis and disproportionately high rates of infection and death in our communities of color by constantly dwelling on the plight of poverty-stricken Africans. It's bad over there; we get it. But poor and disenfranchised Americans don't have it much better. And our government-sanctioned complacency is leading to rising infections among women, teenagers and even the AARP generation. Make no mistake: The problem has not been solved; America is still struggling with this virus.
David Salyer is an HIV-positive journalist, educator and activist living in Atlanta, Georgia. He leads Conscious Sex presentations for men and women and has facilitated workshops for people living with HIV since 1994. firstname.lastname@example.org.