According to the New Yorker, a decade of good news about AIDS in the Gay Community seems to have come to an end. There are four basic reasons. Three of them were cooked up by America's Pharmaceutical industry.
One was the development of an effective treatment, by means of a cocktail of drugs.
Twenty million people have died of aids, most of them in Africa, where the epidemic grows more devastating every year, as it does in places like China, Russia, and India. Ten thousand people die each day—seven every minute—and seventeen thousand more become infected. In America, however, the sense of crisis has passed. After increasing rapidly throughout the nineteen-eighties, the number of new cases peaked in 1993, and within two years so did the number of deaths. In 1996, when effective H.I.V. therapy became widely adopted, the incidence of aids began to fall dramatically. Few diseases without a cure have evolved as rapidly.
With bars in places like Chelsea and the Castro filling with healthy men, and the continual migration of new people in search of a more open life, some men began to wonder, What’s so bad about H.I.V.? It’s a treatable disease. Pharmaceutical companies ran ads depicting H.I.V.-positive men as rugged and virile.
Another was Tina.
Tina is crystal methamphetamine, a chemical stimulant that affects the central nervous system. It is hardly a new drug, and it has many other names: biker’s coffee, crank, speed. It has also been called redneck cocaine, because it is available on the street, in bars, and on the Internet for less than the price of a good bottle of wine. Methamphetamine is a mood elevator, and is known to induce bursts of euphoria, increase alertness, and reduce fatigue. . . . Crystal first gained popularity in the gay community of San Francisco in the nineteen-nineties, where it became the preferred fuel for all-night parties and a necessity for sexual marathons. Its reputation quickly spread. Crystal methamphetamine is highly addictive, but its allure is not hard to understand; the drug removes inhibitions, bolsters confidence, supercharges the libido, and heightens the intensity of sex. . . . The first thing people on methamphetamine lose is their common sense; suddenly, anything goes, including unprotected anal sex with many different partners in a single night—which is among the most efficient ways to spread H.I.V. and other sexually transmitted diseases. In recent surveys, more than ten per cent of gay men in San Francisco and Los Angeles report having used the drug in the past six months; in New York, the figure is even higher.
The last magic potion is Bob Dole's little blue friend.
Crystal methamphetamine constricts the blood vessels, which makes sustained erections difficult. Viagra reverses that effect. “So now you can go from Thursday to Sunday and have outrageous amounts of sex."
The last factor is the Internet.
“I was seeing a patient at one of the S.T.D. clinics one day,” Jeffrey Klausner, who is the director of the Sexually Transmitted Diseases Prevention and Control Services of the San Francisco Department of Public Health, told me. “It was in the spring of ’99, and we were starting to see a small increase in the number of syphilis cases in gay men . . . . I asked this one guy how many sexual partners he had had in the past two months, which is something we always ask. And he said fourteen. And then I asked him how many he had had in the past year. And he said fourteen.
“That was a little odd,” Klausner continued. “I said, ‘Well, what happened two months ago?’ The man replied, ‘I got online.’
“I didn’t have a clue what he meant,” he said. “Nothing. So he explained it. ‘Well, I am a fifty-year-old, overweight, H.I.V.-positive man. I am balding; I’m not that attractive. But I can go online any time of the day and I can get a sexual hookup. I can go to this site on AOL and I can say I want to meet somebody now for sex. And that’s all there is to it.’ ”
Recounting this story six years later, Klausner still looked mystified. “I asked him to explain. And he told me, ‘I go online and put out my stats—if I am a top or a bottom, what I like to do. I am a top, I am H.I.V.-positive. So I will say, “Does anyone want to be topped by an H.I.V.-positive guy?” ’ ”
Klausner continued to recall the conversation: “ ‘I’ll get five responses in half an hour. And then I will speak to them on the phone. If I like their voice, I will invite them over and look through my window. If I like what I see, then I will be home, and if not I can pretend I am gone. It’s been great. I don’t have to talk to anybody to do it. I don’t have to go out of the house. I can get it like this,’ he said, and snapped his fingers.”
What has been the effect of these four horsemen of the next public health Apocalypse?
After years of living in constant fear of aids, many gay men have chosen to resume sexual practices that are almost guaranteed to make them sick. In New York City, the rate of syphilis has increased by more than four hundred per cent in the past five years. Gay men account for virtually the entire rise. Between 1998 and 2000, fifteen per cent of the syphilis cases in Chicago could be attributed to gay men. Since 2001, that number has grown to sixty per cent. Look at the statistics closely and you will almost certainly find the drug. In one recent study, twenty-five per cent of those men who reported methamphetamine use in the previous month were infected with H.I.V. The drug appears to double the risk of infection (because it erases inhibitions but also, it seems, because of physiological changes that make the virus easier to transmit), and the risk climbs the more one uses it. Over the past several years, nearly every indicator of risky sexual activity has risen in the gay community. Perhaps for the first time since the beginning of the aids epidemic, the number of men who say they use condoms regularly is below fifty per cent; after many years of decline, the number of new H.I.V. diagnoses among gay men increased every year between 2000 and 2003, while remaining stable in the rest of the population.
That is terrifying. Given the nature of infectious diseases there is good reason to believe that such a sexual culture will again be a breeding ground for drug resistant strains of the HIV virus, and perhaps for forms of it that will be much more contagious.
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