Sam Uretsky

Silence Still Doesn’t Cure AIDS

On May 25, HBO will show a version of Larry Kramer’s play, The Normal Heart. Mark Ruffalo plays the character modeled on Mr. Kramer, and Julia Roberts plays a role based on Dr. Linda Laubenstein, one of the pioneers in the detection and treatment of AIDS. Mr. Kramer said of Dr. Laubenstein “She is incredibly important in the history of AIDS, a genuine pioneer and a real fighter for what she believed.” Mr. Kramer himself was a founder of both the Gay Man’s Health Crisis (GMHC) and AIDS Coalition to Unleash Power (Act-UP) both devoted to education and advocacy. The slogan of Act-Up is Silence=Death.

Mr. Kramer’s play is powerful and moving, but it’s a play about a short period, roughly 1981-1986, and a comparatively small number of people. He is writing about New York at a time when the disease, now properly called HIV Disease, was being called “mystery disease” or “Epidemic Kaposi’s Sarcoma”. Later, attention turned to San Francisco, and to Africa, from medicine to the courtroom. Randy Shilts, in his best selling book, And the Band Played On, which was also turned into an HBO special, used the death of Rock Hudson to mark the end of the beginning. Mr. Hudson died in 1985, but it took until 1987 before President Reagan even said the word “AIDS,” and then it was while explaining why the government should not provide sex education.

“How that information is used must be up to schools and parents, not government. But let’s be honest with ourselves, AIDS information cannot be what some call ‘value neutral.’ After all, when it comes to preventing AIDS, don’t medicine and morality teach the same lessons?” At that point there had been 41,027 deaths and 71,176 people were living with AIDS.

It’s important to recognize that AIDS is the advanced form of HIV infection, the point where the virus has compromised the immune system to the point where opportunistic infections start to appear. According to the United Nations, in 2012, “there were 35.3 million [32.2 million-38.8 million] people living with HIV. Since the start of the epidemic around 75 million [63 million-89 million] have become infected with HIV.”

If HIV disease no longer seems to force its way into our consciousness, it’s because modern combination therapy has dramatically extended survival, to the point where the 5 year survival rate for properly treated people with the virus is no different from the general population – but the infection remains incurable, and in many parts of the world modern treatments are simply unavailable.

There’s no question but that the television production will help restore awareness of a serious worldwide epidemic, but there are grounds for fear that it will bring us back to a time when AIDS seemed limited to San Francisco and New York. That model is no longer valid. The HIV rates in California have dropped dramatically, while the data on new HIV diagnosis compared with number of persons living with HIV and AIDS in New York may indicate that people are coming to New York for treatment.

The locus for new diagnoses has moved to the deep South (Alabama, Florida, Georgia, Louisiana, Missouri, North Carolina, South Carolina, Tennessee and East Texas). In 2011,49% of new HIV diagnoses and 49% of new AIDS diagnoses in 2011 were located in the South, a region that accounts for only 37% of the US population. All 10 metropolitan areas with the highest AIDS diagnosis rates in 2011 were in the South. The cities with the highest rates of AIDS cases per 100,000 population are Baton Rouge, Miami, Atlanta, New Orleans and Baltimore. These are states which have refused to expand Medicaid under the Affordable Healthcare Act. Where patients in areas with quality medical care showed no increased death rates over 5 years, patients in the deep south showed an increased death rate after only 36 months. Also, the Deep South showed the highest rate of infection due to heterosexual contact, 15.0 % for males; 88.5 % for females.

The production of Mr. Kramer’s play is an invaluable reminder of the past, but there is also a documentary by Lisa Biagiotti entitled “deepsouth” that has been making the rounds of film festivals and winning awards, and it’s a symbol of the present. “The Normal Heart” was first produced in 1985, and medicine has made remarkable progress in the interval, but in some places, society hasn’t advanced. SILENCE=DEATH.

Sam Uretsky is a writer and pharmacist who in the 1980s worked at NYU Medical Center with its investigational drug service and with physicians who were credited with the discovery of AIDS. Email sdu01@outlook.com.

From The Progressive Populist, May 15, 2014