Let me tell you three stories.
First story. One of my best friends, a middle-age man with whom I worked on AIDS issues in the 1980s, sent me an e-mail several months ago saying that he had recently tested positive for HIV. He acknowledged that he was extremely embarrassed to be confessing this fact: The message we had all promoted then-as now-was to have only "safe sex" and to use "a condom every time." "I must have neglected to use a condom," he said simply.
Second story. I was at my local grocery store during the late summer when I ran into a casual friend I've known from the bars, a man somewhere in his late 40s, I'd guess, and we stopped to chat. He said he recently found out that he was HIV-positive, which he confessed surprised him. "I thought I was safe because I was exclusively a top," he said. "But apparently not." I gathered that he was already taking an antiviral combination, which suggested that his T-cell count was low, so he may have been infected some time ago.
Third story. A good friend, an older man, told me that early this fall he had his first HIV test in several years and was surprised to learn that he was HIV-positive. Not only that but his T-cell count had sunk to the 100-150 range, clearly qualifying for an AIDS diagnosis. "I did what I considered 'safe sex' and assumed I was uninfected. I never had any symptoms that I recognized as being HIV-related," he told me. "But then I noticed that I was getting tired easily and wanted to take naps throughout the day. I thought that was just a function of getting older, but evidently not."
These men are all Americans, fellow Chicagoans. And, most of all, friends. World AIDS Day will be observed on December 1. Do I care about AIDS among people I do not know and will never see or meet? Only marginally. What I do care about is gay men in the U.S., in my city, in my neighborhood. In short, I care about my friends, present and potential. Anyone who cares as much about total strangers in foreign lands as he does his friends and people in his own community has a strange idea about the value of personal relationships.
I lived through the first wave of AIDS, 1981-1996. I lost a lot of friends during that time. Suddenly it feels as if I am beginning to live through a second wave of AIDS infections-not necessarily resulting in deaths this time, at least in the medium term, but decisively altering people's lives.
When people's T-cell levels decline to a certain point, they have to begin an anti-viral drug regimen that involves taking one to four drugs every day at the same time every day. If they travel, they have to pack their drugs and make sure nothing interferes with their drug regimen. They have to do this for the rest of their lives. And some of the drugs have inconvenient side effects, from nausea or wooziness to diarrhea to unpleasant dreams. But taking the drugs is better than not taking them.
It seems vitally important to remind people that AIDS is still a threatening presence in the gay community. I have read estimates that 20 percent of those infected do not know it. I have seen no statistical support for that estimate and I am sure the number is far higher-40 percent? 50 percent? Recall that the Centers for Disease Control acknowledged not many months ago that for years it had underestimated the number of people annually infected with HIV by more than 40 percent.
Every year, every day, young gay men come out and begin engaging in sex. They may think they are invulnerable, they may be heedless, or they may never see a safe-sex message or have had the term "safe sex" spelled out for them. When I have visited bathhouses or back-room bars, I have seen people of all ages and ethnicities engaging in unprotected sex. Clearly safe-sex messages have lost their impact or are not reaching them in a persuasive fashion.
Many people seem to care more about AIDS abroad than in the U.S. President Bush has sponsored billions of dollars in funding to prevent AIDS in third-world countries, but said little abut AIDS in the U.S. Some evangelical churches are involved in helping to combat AIDS abroad, but show no interest in AIDS in the U.S. It seems clear that they are interested in helping heterosexuals abroad, but want nothing to do with homosexuals in the U.S.
So it continues to be up to us.