It’s still here.
Another World AIDS Day passes, in the twenty-fifth year of the plague, and these are the sad facts:
- 40 Million people in the world are infected
- 3 Million people died last year from AIDS
- In the US, to date 529,113 people have died. More than our battlefield casualties in WWI, WWII, Korea, Vietnam, the first Gulf war and Iraq combined
- While infection rates worldwide leveled off in the late 90’s there are pockets of resurgence: Uganda, the UK and among young gay men in the US
Fifteen years ago, when the plague was laying waste to a generation of gay men, the question was whether action could be taken in time to build a firewall around the epidemic until a vaccine or drug to eradicate the virus could be developed. Despite the profound and wrenching violence done to bodies, societies and sex itself, people still spoke of cures. We just had to be vigilant until the beast was destroyed. But we underestimated the threat from this pathogen and its infernal genius for destruction — a virus that doesn’t just lurk in the marrow of our bones, but also in the dark places in our brains where our deepest needs and desires are hidden from the earnest instructions of safe sex pamphlets.
The Beast Within
Last year the Washington Post [reported] that, according to a survey by the Rand Corporation, fifty percent of black Americans believed that HIV was man-made and part of a government plot to decimate their communities. It’s tragic that such destructive beliefs persist, though understandable given the cruel history that blacks have endured in this country and the nature of the disease itself. It’s hard to imagine a more perfectly designed killing machine: an invisible agent that depends upon the craving for euphoric abandon — whether via sex or drugs, or both — to transmit itself from body to body, where it goes about its work of slow invisible destruction of the host in a way that guarantees re-transmission to other hosts in a geometric progression. If God existed then this thing, that perverts and exploits the mechanism of reproduction, turning it into a vector of disease and death, would surely be Satan. But there’s no God and no Satan, only natural selection and an organism relentlessly, amorally, exploiting its niche.
Despite billions of dollars and millions of people working for 25 years to thwart it, the virus thrives because it exploits not just an individual’s impulses toward pursuit of pleasure, but also societal resistance to directly manage such pleasure and the economic conditions that put people — such as women in Africa — at risk. It always struck me, back during the crisis of the late 80’s and early 90’s, that the public health response to the epidemic in the gay community was for the most part to pass out free condoms and pamphlets preaching safe sex methods, rather than directly address the epidemic of substance abuse that fueled irrational sexual abandonment. They were trying to treat the proximal cause of infection (transmission of body fluids) with appeals to rational (sober) thought, when the underlying causes could not be reached through rational argument. The infection rate dropped not because of conscious appeals to the forebrain — it was because of stark terror at the possible consequences. Fear, that other deep motivating force, trumps desire. The infection rate seems to be rising among young gay men in the US not just because drug abuse is still rampant but probably because, thanks to anti-retroviral therapy that delays AIDS onset and pharmaceutical marketing that presents infected men as looking healthy and happy, HIV doesn’t seem so scary anymore.
Things have been worse, but, barring a 25-years-too-late magic bullet, it’s hard to see how they’ll get much better. According to the UN, while overall infection rates as a proportion of population have mercifully stabilized, because of general population growth the number of new infections will increase year over year. Political and religious resistence to even the first-line defense of sex education and contraceptive use [continues] after all these years to hamper attempts at prevention. Science and medicine have been effective at slowing the progression of AIDS and improving the quality of life of those infected who can afford treatment, but progress in less technological areas is lacking. How much is the infection rate among women around the world related to poverty and how best to address that? What are the long-term epidemiological consequences of infected people living longer? If infected people — who can infect others — live longer and more effective methods of preventing high-risk behavior aren’t found, is it a net good? Science seems still to be playing catch up with the basic psycho-social factors driving high-risk behavior: see this [announcement] of recent findings that drug use contributes to high-risk sexual behavior. Talk about a day late and a dollar short…
The Way We Live Now. Forever.
You’ve been in my life so long I can’t remember anything else.
– Ripley, Alien3
It’s hard to remember a time when sex was not associated with risk of viral death. The consequences of the pandemic go far beyond the catastrophic health effects on those stricken ill. In the social and political realm it sets up in-group/out-group distinctions among people that makes foreigners more foreign, different people more different. Dangerous. At the level of the person it makes us wary of our own desires, fearful of the impulses that act to bring us into the deepest communion with others, unless it is mediated with petrochemical barriers. But maybe even that isn’t safe, says the little voice inside. We may avoid connection, trying to balance fear of death against a lonelier existence, which in itself is a life sentence of sorts.
And we wait for the physicians, geneticists and bio-engineers to issue a reprieve — a way to kill the virus. Given the inability or unwillingness of social scientists, politicians and religious leaders to face down the messy details of motivation and economic injustice that contribute to people becoming infected, it all depends on finding the magic bullet.