“It takes a certain amount of living with a phenomenon (i.e. AIDS), especially a relatively new one, before it can be understood properly…” (Dr. Herman W. Dickerson, AIDS Institute, New York Department of Health)
It would be great to be able to say that after living with AIDS in Colorado for approximately 18 months we now understand it fully. This is, unfortunately, not the case. In some respects we are better off than we were a year and a half ago however. My sense is that much of the numbing fear gripping many of us has faded into a more realistic perspective
The fear level, of course, had to abate somewhat before we could begin to understand it and incorporate the reality into our lives. Fear often decreases when one begins to understand and know something about that which is feared.
The cause (or causes) of AIDS remains unknown with the number of theories continuing to grow. It’s a fungus. It’s a mutant strain of cytomegalovirus (CMV). It’s a human T-cell leukemia virus (HTLV). It’s lymphadenopathy virus (LAV). It’s a particle riding along on the hepatitis-B virus. It’s repeated exposure to CMV. It’s repeated exposure to the immuno-suppressive of semen. It’s repeated bouts with V.D.
The early debate was single agent vs. multifactorial. The single agent proponents were saying (and some are still saying) a single exposure to a single agent (most probably viral) was all that was needed to acquire AIDS. Most people now concur that the AIDS agent(s) can be transmitted sexually among gay men. This greatly narrows the risk-free sexual options open to sexually active gay males and it appears that the sexual habits of many of us have changed dramatically. or a mutually monogamous relationship that assumes neither partner is already carrying the agent are about the only options if you buy the single agent/single contact theory. However, assuming AIDS is due to a single agent, it is likely that a large number of gay men have been exposed to this agent, but only a small percentage have so far become profoundly immunosuppressed and developed full blown AIDS. The early multifactorial theorists concentrated primarily on cyto-megalovirus and semen and their known immunosuppressive qualities. CMV is shed frequently in semen (and most other bodily secretions.) It was, and still is, believed by some that repeated exposure to CMV infection through multiple contacts, involving the sharing of bodily fluids, rendered one’s immune system incapable of off disease.
The presentation I’ve given here, of these two theoretical camps, is, of course, greatly simplified. Many researchers and students of AIDS are open to the possibility that the cause could actually be a combination of factors borrowing from both a single agent and multifactorial approach. Dr. Gallo of the National Cancer Institute says: “Current favorite theory or working hypothesis is that the disease is not primarily due to an immune deficiency state and that a retrovirus, or other agent, is not simply entering the scene opportunistically It is believed that the first event is a retroviral infection that selectively impairs a crucial component of the immune system. In most individuals it probably takes several attacks with the same retrovirus for the immune system to be sufficiently knocked out so that the victim of these multiple attacks is immunologically prey to all kinds of opportunistic insults, including cancer.” (Emphasis is mine. P.G.) I’ve presented this lengthy quote because it represents a sort of hybridization, in my mind, of the two broad theoretical camps, with a bias toward single agent theory.
An unavoidable conclusion to be reached from digesting all that is known today about AIDS, and realizing how very much is still not know, is that the “cure” or solution to the puzzle is not going to occur any time soon. It appears that the many missing pieces of the puzzle will be coming slowly but steadily. It is probably not going to happen over night. We won’t wake up some morning to read about the cause and cure on the front page of the newspapers. We need to incorporate a patient attitude and approach or we will go crazy with it all! Only in October of this year were research grants made to five cities for a study of the epidemiology of AIDS among gay men. So an answer to the question – ‘Is there something (or some things) about the gay male lifestyle that increases our risk of AIDS?’ – is unlikely to be answered definitively before the results of these epidemiological studies are in, several years down the road.
Much of the media hype surrounding AIDS has died down. So much of it was hysterical and inaccurate that this is probably a good thing. It did serve to bring attention to the issue and undoubtedly helped boost federal funding of AIDS research. Fortunately, the intense paranoia and homophobia that accompanied the “publicity epidemic” has also abated, due primarily to accumulating medical evidence that AIDS is not casually con-tageous.
Another reassuring fact is that the number of us contracting AIDS is not increasing as fast as was initially expected. AIDS is in no way disappearing but neither is it spreading nearly as fast as some feared a year ago. There are several very theoretical postulations surfacing as to why this is the case. About 3/4 of all AIDS cases reported continue to be gay men. Perhaps, some speculate, the rate of increase is slowing because gay men have significantly altered their sexual lifestyles. The truly phenomenal drop in rectal gonorrhea and syphilis case rates among gay men, for example, is a very concrete statistic offered to indicate a dramatic behavioral change that could be affecting the rate of spread of AIDS.
Another interesting speculation is that the gay male community is already saturated with the AIDS agent(s). That is, that sexually active gay men of the late 1970’s and early 1980’s have almost all been universally exposed to the culprit. Why then hasn’t everyone come down with it? Well, perhaps there are a whole constellation of factors involved in coming down with AIDS and exposure to the causative agent alone may not be enough to result in contracting the disorder. Implied here is the possibility that one could develop AIDS at some time in the future if the necessary constellation of variables came into play. All this is speculation for sure!!!
So what do we do now based on epidemiologic evidence? Dr. Dave Cohn and his associates at Denver Disease Control feel that, at this time, the best advice is what has already been offered:
1) Be aware of those symptoms that may indicate the development of AIDS and seek medical attention if you are concerned. If you don’t know what the symptoms are – find out.
2) Decrease the number of different men with whomyou have sex and familiarize yourself with those sexual practices that are associated with increased risk of sexually transmitted diseases and refrain from them.
3) Take good care of yourself. Dr. Cohn says: “Given the fact that the cause and cure remain elusive and considering the potentially devastating consequences of AIDS, ‘prevention is the best cure’, has never been more true.”
In case you haven’t seen it, the Colorado AIDS Project has a green pamphlet called BE WELL 3 available. It succinctly describes symptoms and suggestions for decreasing the possible risk of exposure to the AIDS agent (s). A call to the Gay and Lesbian Community Center (GLCCC) at 837-1598 will provide you with the information needed to get your hands on this material.
I’m including the following graph and information in an attempt to summarize the AIDS situation here in Colorado. My sincere apologies if it sounds objectifying of those dear ones currently struggling with AIDS in their lives.
NUMBER OF CONFIRMED CASES OF AIDS,
BY MONTH OF DIAGNOSIS
Of the 31 persons diagnosed with AIDS inColorado:
- 29 are men
- 2 are heterosexual women
- 21 are alive
- 10 have died
- The age range is 22 to 62
- 11 have presented with Kaposi sarcoma (KS)
- 16 have presented with Pneumocystic carninii pneumonia (PCP)
- 1 has presented with KS and PCP both
- 2 have presented with lymphoma
10 (including several of the above) have presented with other opportunistic infections
- 25 are from the Denver metropolitan area
- 5 are from the southeast quadrant of Colorado
- 1 is from central Colorado
- 27 (87%) are homosexual or bisexual men
Nationally the percentage of AIDS cases that are gay is 71%. It is higher in Colorado, and will probably remain so, because there is no significant Haitian population in the state and a much smaller IV-drug using subculture than in areas like New York City.
An issue the community is currently grappling with very intensely, as are gay and lesbian communities all over the country, is ‘what can and should we be doing for those who have contracted AIDS?’ Perhaps an important first step is to realize we, all gay and lesbian people, are persons with AIDS. It has, and will continue to, affect us all in very profound ways. A second step I would suggest is for us all to spend a short time each day sitting quietly by ourselves or in groups and in our own ways visualizing ourselves as a vibrant and healthy people. ‘Cause you know – we are !!!