By Perry N. Halkitis
In the early days of the AIDS epidemic, treatment options were limited at best. Most who were living with HIV/AIDS, the majority of whom were gay men, attempted to find and use treatments that would save their lives and control the virus from causing further physical deterioration. Sadly, most Americans were blind to the efforts of the AIDS generation, yet a discourse around these efforts is beginning to enter the mainstream consciousness of our society. David France has beautifully captured the efforts of ACT-UP, the leading activist group that fought bravely for the development of treatments, in his 2013-Oscar-nominated documentary, How to Survive a Plague. In a new film to be released at the end of this year, Hollywood actor Matthew McConaughey portrays Ron Woodroof, an electrician from Dallas, Texas, who worked with underground pharmacies to smuggle alternative treatments for himself and other afflicted with AIDS in what became known as the “Dallas Buyers Club.”
It is within this backdrop that thousands of gay men of all races and ethnicities first found out that they were living with HIV in the United States. Until 1985, when the virus was identified, most who were infected lived in fear and apprehension, and were often very progressed in their disease by the time they were diagnosed. As a result, life expectancy was extremely short after diagnosis. For most who had developed full-blown AIDS, and in the absence of any effective treatments, life expectancy was a matter of years.
Close to 30 years later, the landscape of the epidemic has changed dramatically. Testing for HIV is now as simple as a rapid oral antibody test that can be administered at home with a kit one purchases from pharmacy. A vast array of effective antiretroviral treatments helps to keep the virus at bay. In fact, a young gay man who is diagnosed shortly after infection, and whom uptakes a treatments regimen to which he consistently adheres, can by all calculation have a close to normal life expectancy. Yet despite these medical advances, HIV remains a stigmatized disease and some 200,000 Americans are living with the virus undiagnosed.
The perpetuation of the AIDS epidemic among a new generation of young gay men is anathema, made all the worse by the fact that a subset of these men remain undiagnosed and that among those diagnosed only some 20% adhere to their treatments such that their virus is reduced to undetectable levels. How can this be?
For my generation, the AIDS Generation, every effort was made to live and fight this disease on every front—physical, emotional, and social. Quite simply we all wanted to live, and a subset of us who were infected in the prime of our lives find ourselves now entering middle age due to these effective medical advances. Given the harrowing event of our lives in the first decades of AIDS, we are left to wonder why young gay men continue to become infected and why they (when infected) do not take advantage of the treatments for which we fought to be developed. As we approach National Gay Men’s HIV/AIDS Awareness Day on the 27th of September, these are questions with which we must all grapple.
In my view, despite recent advances in civil rights for the LGBT population, including the overturning of the Defense of Marriage Act (DOMA), we as a population continue to be subject to discrimination and homophobia by a significant portion of American society, including the bile of national political leaders. A few years ago, I wrote that “discrimination and homophobia fuel the HIV epidemic.” It is how I understand the health disparities in both the AIDS and the current generation. The health of gay men is compromised by the prejudices, social injustices, and inequities that we experience on an ongoing basis. Only when structural impediments are eradicated will our overall health improve.
Sadly, in the absence of revolution, society is slow to change. Until gay men are on equal social footing as our heterosexual peers, we will continue to endure adverse health consequences. It is for this reason that gay men of all ages must be vigilant about their health and, specifically, why continued testing for HIV coupled with effective administration of treatments once we are diagnosed is the best weapon we have to enhance the health of our population. Young gay men must learn from the lessons of my generation, the AIDS Generation, and we as the elder statesmen of our community must now step forward and help empower a new generation of gay men to advocate for their health and for their lives. The baton must be passed.
Perry N. Halkitis, PhD, MS, MPH is Professor of Applied Psychology and Public Health (Steinhardt School), and Population Health (Langone School of Medicine), Director of the Center for Health, Identity, Behavior & Prevention Studies, and Associate Dean (Global Institute of Public Health) at New York University. Dr. Halkitis’ program of research examines the intersection between the HIV epidemic, drug abuse, and mental health burden in LGBT populations, and he is well known as one of the nation’s leading experts on substance use and HIV behavioral research. Dr. Halkitis hold degrees in psychology, education, and public health. He is the author of The AIDS Generation: Stories of Survival and Resilience.
Image credits: (1) Matthew McConaughey stars as Ron Woodroof in Jean-Marc Vallée’s fact-based drama, DALLAS BUYERS CLUB, a Focus Features release. Used for purposes of illustration, all rights reserved. (2) Public Health Service flyer featuring Patti LaBelle. Public domain via Wikimedia Commons.