The Ghosts of Pandemics Past: HIV and AIDS

Even though we are not in the Christmas season, Charles Dickens’ classic Christmas Carol could not be more timely. The novella recounts the comedy of Ebenezer Scrooge, a grouchy miser who undergoes a torment on one Christmas Eve in London, visited by the ghost of a former business partner and then three ghosts who reveal the past, present, and future to him. When day breaks on Christmas Day, Scrooge becomes a cheerful and kind man willing to show grace and charity to people all around him.

The part of A Christmas Carol that’s most relevant right now is the part about angels visiting Scrooge to reveal the past, present, and future to him. Scrooge sees bleakness in his own long-lost history, his present state of parsimony, and his future in hell. The experience shows that certain character failures endure over time. Unless he breaks the cycle his morbid life story will come full circle and he will have never tasted happiness around him.

Right now everyone can talk about nothing other than the coronavirus, since it produced a crisis that keeps us all currently locked in our homes. But many of us live like Scrooge right now, cut off from the world and forced to confront things about our lives that we have avoided thinking about. If I rewrote A Christmas Carol for our current day, I would have a callous quarantined American visited by a ghost of pandemics past, a ghost of pandemics present, and a ghost of pandemics future.

The ghost of pandemics present could take the complaining American to see all the suffering people struggling to pay for medication for their diabetes, cancer, heart disease, and countless other ailments that we sometimes forget are plaguing the nation. The ghost of pandemics future could take our protagonist into the future to see the starving children in the year 2060, depleted by scurvy because the failed economy can no longer produce enough food to feed them; not to mention the graveyards full of suicides, asylums full of clinically depressed people, and basements full of drug addicts, all ravaged by melancholy and distress over a national system that crashed and couldn’t work anymore.

But whom should the ghost of pandemics past show to our protagonist? Let’s call this protagonist Tony, after Tony Fauci. The possibilities of past plagues are endless: the Antonine plague and plague of Cyprian that struck ancient Rome, the black death in medieval Europe, the yellow fever of the mid-nineteenth century, Spanish influenza, or polio.

But no. The point of Scrooge’s journey into the past was to see himself as he was, when he was younger, to understand how he became the dreaded curmudgeon of the present. We would have to bring Tony to see something recent enough to afford him the possibility of seeing himself in the drama.

And so we must think of HIV and AIDS, the virus that haunts our current discussion like so many ghosts. Deborah Birx and Tony Fauci, the ever-present spokespeople for Mike Pence’s task force on the virus, both made their careers in the AIDS industry. Birx served with several international organizations that received copious funding to support AIDS, including PEPFAR. Tony Fauci has headed an institute for allergies and immunology since the early 1980s. In such a capacity he has played an integral role for over 35 years in shaping the American response to HIV and AIDS.

Together Birx and Fauci have come to act like a modern day Richelieu and Mazarin, gaining enormous powers over the entire country based on the perception that they alone have the expertise to deal with a crisis that takes priority over every other consideration.

Yet Birx and Fauci, while experienced in virology, come from what I would call the AIDS Industrial Complex: the vast bureaucracy that leveraged the AIDS epidemic lavish funding (far outstripping the research into any other disease), and which failed spectacularly to stop AIDS. Since I was involved in the gay community in the 1980s and 1990s my memories of AIDS loom vividly, as I am sure they do for someone like Fauci.

So if the Ghost of Pandemics Past took Tony back to the 1980s and 1990s, what would the ghost show him? Let me share what I remember so clearly from the dawn of the AIDS epidemic and how it felt for someone inside the gay community.

In the earliest years of AIDS, the scientific community had no real clue about what was going on. They had a list of groups that they deemed high-risk, which included Haitians, hemophiliacs, heroin injectors, and homosexuals (the four H’s). It took a while for them to figure out that the intravenous drugs and homosexuality were the baseline risk groups. It then took even more time for them to figure out how the virus was specifically transmitted.

While AIDS is much harder to transmit from person to person than COVID-19, certain aspects made its emergence mysterious in ways that remind me of the outbreak of COVID-19. For COVID-19, strange details thwart our efforts to know the disease and address it. We don’t understand why so many contract it but do not show any symptoms whereas a small subset find the virus so powerful that they die from it. This calls to mind the problem with AIDS and its long, mysterious incubation period.

AIDS felt particularly devastating because people could be carrying the virus for as long as 10 or 20 years before it became active in decimating one’s immune system. Scientists never really unlocked the secrets to why the virus that causes AIDS — HIV or the human immunodeficiency virus — can stay dormant for so long but can rapidly take over the white blood cells in certain people. As a result, many men who had engaged in homosexual activity but weren’t publicly identified as gay carried the virus unknowingly for many years, infected a lot of people, and then suddenly came down with bizarre life-threatening illnesses that they couldn’t explain. This made it important to find a test to detect the virus in people, but it took a while for them to fine-tune a reliable antibodies test that would not yield false negatives. I first got tested for HIV in 1991. I remember going to a testing site at Bronx Lebanon Hospital; I had to wait several weeks to get an appointment, was told that that the test would only work if I’d passed a “window period” of six months since my last possible exposure, and I would get the results six weeks later. The better part of a year would be spent not knowing whether I had the virus. Faster tests and a shorter window period became available later.

I wrote an entire screenplay called the Window Period about this experience. It’s been fifteen years so I figure I’ll post it for free on this site this week.

The confusion and uncertainty about AIDS lasted for years and this bodes poorly for us now that we have to deal with COVID-19. Maybe it has a crazy window period the way AIDS did. It’s all very hard to tell. I was not surprised to hear that as many as a third of the COVID-19 tests were faulty and generated false results. This reminds me of the chaotic feeling that surrounded AIDS in the 1980s and 1990s. It may be a while before we have any testing that’s meaningful and accurate.

COVID-19 and HIV share another point. There was a foreign angle, with origins in a different continent that presented a challenge to those who wanted to generalize information about the disease. Today it’s China. Back then it was Haiti and then Africa. The statistics coming out of Africa pointed to the sexual transmission of AIDS happening mostly in heterosexuals, though this information dripped out little by little. Just as we find now that the epidemiological patterns of China, South Korea, and Japan do not translate seamlessly into the patterns of Europe and North America, so the mismatch of conditions between Africa and the USA bewildered people. For whatever reason, in the USA, AIDS was really a disease of intravenous drug users and homosexual men.

The response by AIDS researchers in the 1980s and 1990s went through two distinct phases. In the beginning, there was generalized and overly alarmist panic. “Experts,” including Tony Fauci, wanted to play it safe and say that everyone was at risk of getting AIDS if they did anything intimate with anybody, got close to a hypodermic needle, or got a blood transfusion. Two likely motives drove the initial phase of EPAT, or Everyone Panic All the Time. One was the sincere fear that the unknowns surrounding the virus meant that anything other than complete alarmism might leave large numbers of people vulnerable. That made sense. The other was fear of being called homophobic. The gay community mobilized quickly in the 1980s, most notably with the GMHC, the Gay Men’s Health Crisis, and ACTUP, or AIDS Coalition to Unleash Power. The waves of death did not lead the community to introspection and soul-searching; rather they doubled-down and turned their rage outward. They claimed that society had discriminated against homosexuals and didn’t do more to stop the virus, while also claiming in contradictory fashion that it was homophobic to call AIDS a gay disease.

Larry Kramer’s shocking novel Faggots came out in 1978, chronicling the experience of a gay Jewish man turning forty in New York City. When Kramer wrote this, he did not know that AIDS would ever appear. Kramer felt, by intuition, that the gay community was becoming oversexed and perverted. His novel reflected that with its gut-wrenching, painfully long passages about orgies, burning bathhouses, anonymous sex, dangerous fetishes, and even incest with underaged nephews. Toward the end of the novel Kramer writes of a Jewish man whose taboos have been so totally cast aside that he indulges a fantasy to be interred alive by sadists dressed as Nazis. The text of the book actually includes lines about a coming Holocaust when the gays would “f**k themselves to death.”

Kramer could hardly be called a homophobe. He cared tremendously about the gay community and wrote Faggots as a stark prophetic warning. He did have an eerie ability to see into the future and predict that mass sexual license would lead to mass death. But the gay community reacted harshly against Kramer’s novel, trying to block it from bookstores and library shelves. The more the country sank into the AIDS crisis, the more gay activists wanted to throw Faggots down the memory hole and pretend that Kramer’s fiction had no basis in reality.

The deep, corrosive guilt that many gay men felt about the consequences of their own reckless abandon led them to do many destructive things. Having come out of the closet as gay, they hid en masse in a new closet. The new closet was the denial of how gay sex harms people, how the gay community dehumanizes gay men by encouraging the kind of gay sex that goes on, and how right the conservatives like Anita Bryant were about homosexuality all along. As I tried unsuccessfully to explain to Christian conservatives throughout the 2010s, the epidemiological and medical case against homosexuality is as strong as the biblical case against homosexuality. There is no community of gay men that does not practice anal sex, oral sex, or other practices that bring high health risks. These health risks are in no way equal to the health risks posed by monogamous heterosexual intercourse which benefits from the complementary physiology of the penis and vagina.

As the AIDS epidemic grew, many gay men felt an existential threat. If they admitted that their sexual practice was the problem, they would have to concede that their sexual desires are also a problem–and that the resistance to homosexuality in the medical profession, the military, and the church was not unfounded. As crazy as it would seem to go on the attack during an epidemic caused by their own behavior, they felt the only other option would be to admit that they were wrong and give up the gay identity. They took a chance and went on the offensive.

They took a chance and it paid off. As it turned out, medical professionals reacted with cowardice and discomfort. They chose not to know the full extent of sexual behaviors outlined in Larry Kramer’s Faggots. They descended into an Orwellian word game. This meant, in the 1980s, deliberately avoiding any statements to the effect that homosexual men were more at risk than other people. To keep the gay activists happy, they created widespread hysteria as heterosexuals with almost zero chance of contracting AIDS were told they might get it at any time. The solution was, according to the scientists, to use condoms. Condoms, condoms, condoms.

Condoms, condoms, condoms. Thus went the refrain for thirty years. Like loyalists to the Sexual Revolution, they could never tell people to abstain from sex of any kind. But they also feared being held accountable for mass death, so they came up with the ultimate solution. They told men to wrap their genitals in uncomfortable latex before engaging in intercourse. And of course the care and precision necessary to put the condom on correctly meant that every intimate moment required a clinical and unromantic phase where the lights must be on, the man must maintain an erection while examining a piece of latex, and he must roll it onto his member the correct way so it would not break or come off during an act of sex.

The condom solution set the entire country up to fail. The logic behind this went like this: it isn’t realistic to tell people not to have sex since they will do it anyway. Which always led me to ask, if you can’t trust people to show enough self-command to abstain from sex, how do you expect them to show enough self-command to follow these unpleasant guidelines about enclosing their sensitive genitals in an uncomfortable piece of latex before a wild moment of passion?

During the first phase of the institutional response to AIDS, the advice given to the public was overly general and unrealistic, which was bound to lead to failure. This was the decade when Nancy Reagan told people “Just say no” to drugs. The next decade would be the time of telling lovers, “no means no.” Overly simplistic but utterly unrealistic policy prescriptions can kill people. That’s what happened with AIDS.

Many men listened intently and wanted sincerely to practice safe sex. They paid attention in health class. I remember, for instance, in 1988, being bussed out to a freshman orientation program in a grassy enclosure. We sat in circles while Yale upperclassmen gave us packages that included condoms and information booklets. We did want to follow their instructions as they told us it was important to have fun but to make sure we would conscientiously roll this glorified plastic bag over our private parts just before expressing our deepest affection and intimacy to women we loved.

Some men lived with condoms. I don’t think any man really enjoys them or thinks they are the same as having sex without them. By the late 1980s, the country had condom and AIDS fatigue. Many decided, ultimately, that sex with condoms was as bad as having no sex at all. Since the predominant message from the culture was that sex was good and one should have it, they just started throwing the condoms away. They didn’t want the painfully uneasy moment of applying it to themselves while their girlfriend was sitting and waiting. The game of trying to stay erect while engaging in such a cold and bureaucratic procedure soured many nights of passion. And people tired of having condom wrappers that littered their bed of love.

This led, then, to Phase II of the AIDS response. By 1990 it became clear that heterosexuals in the United States were not a high-risk group. The high-risk group was homosexual men. The gay community was demanding that they be protected by institutions. So the advice from the medical profession became twofold. First, a doubling down on condoms, but now focusing specifically on gay men. Second, a vigorous commitment to drug research so that gay men could live with HIV and not see infection as a death sentence.

What I am about to say might shock you but I will explain how this played out in the 1990s. I was 19 when the decade began and had just lost my mother. I threw myself into the gay world even more deeply now that I was on my own in New York City. By eight years later, in 1998, I left the gay lifestyle. I cannot say that I cured myself of all desires or urges immediately–it would take years for the last vestiges of homosexuality to taper off as I grew into a happy marriage to a woman and the thoughts vanished. But I got out of the lifestyle. In interviews, Christians have often asked me how I did it, and I have strived to be honest about why I left the gay lifestyle. I left largely because I saw what HIV, and particularly the AIDS industry, was doing to the gay community. I knew there was no happy future for the gay community. If I stayed in it, there would be no happy future for me either.

First, the condoms. In the gay community you had some men who insisted on using them for intercourse. I stuck with the program. Those of us who followed the condom rules had deeply unsatisfying sex lives because the condom destroys intimacy. It just does. I don’t care how many times they lecture you about how great condoms are, the act feels cheap and impersonal when those pieces of latex and the litter ruin the moment. And the problem is, even if condoms protect you from HIV, they do not protect you from the common cold, flus, lice, herpes, and many other things that get passed back and forth between people. The condom-using community adapted to unfulfilling sex that failed to bring about intimacy. Their adaptation necessitated that they replace quality for quantity. Sex became something between strangers that happened once; then people vanished. With the higher quantity of partners came the realization that you couldn’t really trust any individual, which meant you would never get past having to use condoms. And the number of partners brought a litany of other infections. I remember the sore throats, the flus, the stomach bugs, and many other illnesses.

Then one group of gay men threw caution to the wind and decided to stop using condoms. Some such men were able to cast away the condoms because they fell in love and got into long-term relationships (not using condoms obviously helped this along.) In many such relationships, however, one of the two men in the couple was carrying HIV and ended up giving it to the other guy. Other anti-condom men simply chased after many partners and became promiscuous anyway. This latter group of men bargained with life and decided they could live with virus because they would die without real, meaningful intimacy. They became the consumer base for the multi-billion AIDS drug industry from which Tony Fauci and Deborah Birx drew their valuable careers.

In Phase II, the drug companies became the saviors of the gay community, their “bridge over troubled water” as Simon and Garfinkel would call it. The drug cocktails grew expensive but elaborate, the fruit of the splendiferous budgets devoted to AIDS research because of the fear-inducing power of the gay lobby in state capitals. By the mid-1990s certain terms became so commonplace in the gay community you almost forgot that to most Americans they’d sound frighteningly biochemical: “viral load,” “white cell count,” and “G-O-D’s,” the acronym for “Girls on Disability.” The gay lobby pushed for generous social benefits for people with AIDS, first to get their medications and then to cover their housing and general health care.

A culture had solidified by the late 1990s, a gay culture that saw HIV as a symbiotic pet with a mutualist tie to the community at large. The gay community will never let full, real numbers out about how many people have HIV. In fact, they have gotten many laws passed to make it illegal to try to find such information out. Nonetheless, I have seen figures that around 15-20% of the gay community has HIV, including about 50% of the gay black men past middle age. The rates creep up, flatten out, and then creep up again. The most alarming trend has been the increase in boys aged 14-19 getting HIV, the group with the highest increases during the 2010s.

In the new gay culture, HIV was normal. You just take a pill and go on your way. Nothing will be any different for you relative to anyone else. By 2000, many gay porn companies decided to film sex without condoms because they found people didn’t like watching people have sex with condoms. I was gone by then, keeping up on gay news only through my dwindling reserve of gay friends left from that time of my life. I called a few recently, because I worry about them now with the quarantines. They don’t want to sound scared, but I think they’re terrified. If the supply chain of expensive drugs is cut off because of disruptions tied to coronavirus, they can’t get their pills and will have to face the microbe-ridden world around them without any of the pharamaceutical shields they’ve gotten used to.

They’re scared of the backlash that might come their way. They’re also terrified of coronavirus because they know — despite what anyone on the news might try to tell you — that gay men are highly vulnerable to this new disease. With HIV they could be in serious trouble. Even without HIV, the truth is that gay men have had a lot of infections because of all the other bugs they catch even when they use condoms. They have a million reasons to be immunocompromised.

The Ghost of Pandemics Past would have to force Tony Fauci to remember what the AIDS industry told gay men in Phase I and Phase II of the AIDS epidemic. Fauci was a key player in that world. He could have pushed to change the message. He’s responsible. Under pressure, blinded by profit motives, the AIDS industry chose not to tell gay men the truth.

The truth is, gay sex is dangerous. It always has been. If it isn’t HIV, it will be something else. The kind of sex two men have leaves both open to many more pathogens and risks. If Tony Fauci really had a keen mind about all this, he would have told gay men to stop having sex. He would have leveled with them in the 1980s, when people still had the freedom to speak this way, and he would have told them to reconsider their fervent investment in the gay identity. Maybe you’re not born that way (nobody is.) Maybe you can be happier, without the disease and risk that come with this lifestyle, if you just define yourself a different way and give up on trying to make this work (you can.) Maybe all the people who told you this isn’t who you are, don’t hate you but actually love you and don’t want you to be sick (they mostly do.) Maybe there’s a reason homosexuality has never been respected by civilizations for thousands of years. It’s simply too dangerous for the bodies that we inhabit.

I don’t trust the current leaders in the coronavirus response. They seem to repeat the mistake of Phase I, telling everyone that they’re at imminent risk and have to stop doing everything for months at a time. This will probably lead to a finale much like the condom fatigue that ended Phase I of the AIDS epidemic. The general population will finally grow tired of this and rebel. And then the scientists will have to hone their response to suit the people who really are at risk.

But what will Phase II of the coronavirus look like then? The unknowns haunt us like Scrooge on Christmas Eve. Perhaps Fauci and Birx have been compelled to examine how their industry managed AIDS. Maybe they have felt something like contrition and will try to compensate for the damage done to gays and the community at large in the era of AIDS. I doubt it. And that’s why I think the Christmas Carol ending by Dickens is happier than the ending we’re going to live through.