Whatever happened to the crisis?

>> The AIDS epidemic pushes 20

commentary by MATTHEW HAYS

It was with some trepidation that I approached writing a piece of commentary for World AIDS Day. Lord knows, I've written about the epidemic before, but it seemed like everything that had to be said had already been said. Why revisit a subject that's just going to depress everyone, anyway? Isn't the crisis, as so many career-making gay pundits suggested a few years back, really over anyway?

Semi-facetious rhetorical questions aside, I confess to being a part of the problem. A rather severe sense of complacency has set in regarding AIDS, among the public generally and gay men specifically. Ever since protease inhibitors dramatically altered the lives of those suffering from full-blown AIDS, the crisis has, at least on the surface, abated. Death rates have dropped as T-cell counts have jumped and viral loads have evaporated.

As expensive as the drugs are, they have worked wonders, and those who are on them report having a new lease on life. Syndicated gay columnist Dan Savage summed up much of the media's response a couple of years ago when he declared that the AIDS crisis was over. At least as we knew it, he later explained.

Having rolled with the nasty blows associated with living in communities ravaged by AIDS, gay men might be forgiven for joining in the it's-over party, however prematurely. The idea of not being gripped by doubts after every one-night stand, of not having to attend several funerals a year and of not pondering the concept that AIDS could be your ultimate departure point from this earth were understandably appealing.

Costly complacency

But the complacency, quite naturally, has come with costs. Numerous ongoing studies of men who have sex with men--crucial surveys which allow us a glimpse into the hows and whys of HIV infection rates--indicate that safe-sex practices are sharply falling. The Canadian AIDS Society reports that, while HIV infection rates among injection drug users declined between the years '96-'99, the same cannot be said for men having sex with men. According to the latest estimates from Health Canada, during the same period the infection rate among men who have sex with men grew by 30 per cent.

And the protease inhibitors have had severe limitations, as physicians and scientists said they would from the beginning. Those on the meds report fatigue at the gruelling drill of taking 20, 30 or even 40 pills a day. After one of my friends went off the cocktail citing nausea at the strict pill regimen, his viral load jumped. He was soon on another pill regimen (patients are often counselled not to return to earlier regimens), one which appears to be working but that has left him with bouts of severe vertigo and dire sleep problems (his unconscious state is riddled with nightmares).

Meanwhile, Toronto's Casey House, one of the first AIDS hospices in North America, reported a leap in AIDS deaths in October (96 per cent of those admitted in the previous six months had died, the kind of figure that hadn't been seen in several years).

Irresponsible responses

The most striking thing about all of this is its sheer predictability. Go out and find the lowest-I.Q. gay man in some depressing bar in the Village and he'll tell you: the new anti-AIDS drugs came with no guarantees and thus the crisis was never really over. But despite that, gay men responded to this glimmer of hope with a wanton disregard for every bit of conventional wisdom regarding safe-sex practices.

I hardly mean to point fingers on World AIDS Day. Indeed, I recognize myself as part of the complacency problem. In previous years, I would always write some form of commentary in this space to commemorate World AIDS Day. Not for the past two years, when, for whatever reason, I didn't feel the sense of urgency I had in the past.

AIDS educators have long been wringing their hands, trying to isolate the causes of lapses in safe-sex practices among gay men. One cannot dismiss the allure of denial. If, as I think is almost certainly the case, gays are intentionally placing themselves in a collective state of denial about the epidemic, things are worse than we thought. As any educator or psychologist will tell you, denial is one of the toughest mindsets to break.

If this theory is correct, AIDS educators, and by extension, the media who carry their messages, have an incredible obstacle to overcome. Wish everyone luck. We're all going to need it.

Dec. 1 is World AIDS Day