Is There Still an AIDS Crisis in the U.S.? It Depends on Who You Are

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victory-deferred.jpg As three decades of AIDS were marked in 2011, it was startling to see the degree to which Americans' notoriously short memories had already begun to airbrush away the experience of their gay countrymen's devastation and defiance in the plague years. Used by now to thinking of the "face" of AIDS as that of an impoverished, dark-skinned African woman or baby, even the nation's best-educated young people seem not to be aware of the plague's impact here in their own homeland, beginning in the very decade when many of them were born.

"The de-gaying thing really worked," said author and Dartmouth College professor Michael Bronski. "For better or worse, we did our jobs." As evidence, Bronski described a class about AIDS he taught, called "Plagues and Politics." He said his students couldn't understand why he spoke of AIDS as a "gay disease." Even a lesbian student told him, "I thought it was a little weird you were talking so much about 'gay.'" She believed AIDS "was Africa and inner-city drug users, but mostly Africa." Another student said, "I was wondering how you were going to bring in the U.S. part."

Young gay men can be forgiven for not knowing the details of their community's recent travails. They didn't live through the nightmare, after all. At the start of the millennium, the New York Times noted that a generation of young gay men had by then already come of age without seeing their peers suffer and die from the horrific and disfiguring effects of HIV before Highly Active Antiretroviral Therapy (HAART) brought such dramatic change for many of those living with the virus.

Older gay men, many having lost lovers and friends and possibly living with HIV themselves, seem to prefer more pleasant subjects than the horrors we lived through. It's understandable, to an extent. Like returning war vets, the grief and shock sustained by our wounded warriors keeps so many of us silent.

Unfortunately, our silence means our younger brothers are far less likely to learn about the bravery, courage, and creativity with which our people faced the fight of our lives, for our lives. "Gay men in their forties and fifties don't want to talk about AIDS," said long-time activist and former National Gay and Lesbian Task Force director Urvashi Vaid. Hundreds of men in that very age group streamed by as we talked on a brilliant August Saturday outside Joe, the Provincetown coffeehouse. They looked festive, if grayer and a bit less slender than when we partied in our 20s at the Boatslip's daily tea dance. "We all have PTSD [post-traumatic stress disorder]," said Vaid.

Our silence means the organizations we created to care for our sick and dying friends and neighbors are struggling to raise funds as they continue to care for people with HIV. In Miami, Rick Siclari, the chief executive officer of Care Resource, said, "White gay men are not giving as much today." Now the agency is hoping its new clients, many of them black and Latino, will participate in fundraising by giving them the chance to make smaller donations in the five to ten dollar range.

HIV infection has steadily increased among gay men in the U.S. since the early '90s, even as it has decreased among heterosexuals and injection drug users.

It's as if we haven't learned one of the most important lessons that we ourselves taught the world: "Silence = Death," as ACT UP famously put it. It would seem that silence is inexcusable when gay and bisexual men of all races continue to bear the overwhelming brunt of the American AIDS epidemic. Extraordinary numbers of us continue to become infected with HIV. And thousands of our brothers each year are still dying from AIDS because they don't know their HIV status until it's too late. They likely don't have the means to access life-saving medical treatment or the stable life needed (including housing) to use it properly, or else their bodies simply don't respond to the medication.

In 2010, the Centers for Disease Control (CDC) released figures showing that, although the agency estimates gay and bisexual men to account for only two percent of the U.S. population over age 13, we are 60 times more likely than heterosexual men and 54 times more likely than women to be diagnosed with HIV. We account for 48 percent of the more than one million people living with HIV in the United States, an estimated 532,000 men. We comprise nearly half (48 percent) of all new HIV infections in the U.S., an estimated 28,700 new infections a year. In 21 major U.S. cities, one in five gay men is HIV-positive. Of 8,153 gay and bisexual men tested in the cities, 1,562 were positive. In Baltimore, 38 percent were positive; 29 percent in New York City; 26 percent each in Dallas and Houston; Miami, 25 percent; 23 percent in San Francisco; and 21 percent in New Orleans.

HIV infection has steadily increased among gay and bisexual men in the United States since the early '90s, even as it has decreased among heterosexuals and injection drug users. Most new infections among black and Hispanic gay/bi men are among young men between the ages of 13 and 29. Young black MSM (men who have sex with men) are twice as likely as their white and Hispanic peers to get HIV. White gay/bi men are mostly being diagnosed in their 30s and 40s. Half of all infected gay/bi men don't know they are HIV-positive. More than two-thirds of infected black men, and nearly 80 percent of HIV-positive young men aged 18 to 24, are unaware they have the virus. And there is still the death toll of AIDS, in spite of medical advances that have allowed many to live well with HIV rather than die in short order from AIDS. By the end of 2007, AIDS had killed an estimated 282,542 gay and bisexual men in America, most in the prime of life.

Long-time Los Angeles gay activist David Mixner in August 2010 called it the best and worst moment in the plague's three decades. "The good news is indeed reason to celebrate," he said. "Real progress is being made in fighting this disease." As for the bad news, Mixner said the recessionary economy was "wrecking havoc with HIV/AIDS budgets, international funds to fight HIV, research and treatment and care." In particular, Mixner noted that the federal AIDS Drug Assistance Program (ADAP) has either cut back or frozen in place. "Unless this situation is totally corrected," said Mixner, "it could mean a death sentence for some people with HIV/AIDS."

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The author of Victory Deferred, John-Manuel Andriote has specialized in HIV/AIDS reporting since 1986. His research materials, correspondence, and recorded interviews are part of a special collection curated by the Smithsonian.

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