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06 Jun 2006 02:14 pm

AIDS At 25

The anniversary is American - and a little arbitrary. It was 25 years ago yesterday that the CDC reported two deaths from a form of pneumocystis that turned out to be a consequence of HIV. What has happened since cannot be summarized, because there are, in fact, dozens of HIV epidemics around the world today, each with distinctive patterns, populations, cultures, and prognoses. The world of HIV even within the gay male Western world is complex enough, which is why prevention efforts and drug regimens now have to be carefully recallibrated all the time to deal with a constantly moving target. One thing we can say, though. There was a turning point in 1996, when a critical mass of treatments turned the plague in America into something else. I wrote the first big essay celebrating and analyzing this - and nothing I have ever written prompted more hostility or anger from my gay brothers. It's the first chapter in my book, "Love Undetectable," my own attempt to absorb what plague had taught. Now, the 1996 Rubicon is taken as a premise of most AIDS journalism. From a subtle and truthful account in the NYT today:

Twenty-five years ago, treading water in that black sea of untreatable illness, we had only one answer to give. Only a lunatic would look back to those days with nostalgia, but certain parts of them have, inevitably, taken on that glow tricks of memory can sometimes confer on the terrible past. With no possibility of saving our patients, life was sadder but far simpler. The big war was already lost, so we could concentrate on small victories instead.

Now, a complete rundown of all the news from the front would take hours. Risk of death from AIDS: way down. Risk of death from other things: going up. Risk of drug reaction: depends. Risk of fatal drug reaction: low but not zero. Risk of drug resistance: gets higher every year. The statistics change almost hourly as new treatments appear. It is all too cold, too mathematical, too scary to dump on the head of a sick, frightened person. So we simplify. "We have good treatments now," we say. "You should do fine."

Most do. My last bloodwork came back with undetectable levels of virus, and an immune system stronger than at any time in the thirteen years I have lived with HIV. It is both great news that this has occurred for me and so many others, but it makes the tragedy of continuing death and suffering in the developing world more poignant and terrible. We are making progress in many ways. But the path toward brighter years is strewn with pockets of deep darkness. The demonized drug companies did a lot of this work, and have never received their fair share of praise; the Bush administration too has done much more than its critics will ever concede; the private charitable sector - you only have to think of Bill Gates' work - has been astonishing; the efforts of gay men, lesbians and countless heterosexuals as well have made lives with HIV easier, better, more hopeful.

And yet AIDS exhaustion is also real. The first words of my book are the following: "First, the resistance to memory." I knew I would one day want to block it out, that one day, I would forget most of it, especially the terror of it, and so I made myself write it out at the time. Now I find myself with little new to say, or, rather, nothing to say, except the obvious. I survived. Others I loved didn't. There was no fairness in this. None. Countless more are dying - and surviving - with the same senseless randomness. In this sense, AIDS and HIV are just more intense experiences of life itself. Except death, once encountered, becomes always more real; and life never again resumes the ease and oblivion it once contained. HIV is a crash-course in being human. And everyone passes.

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