Is the AIDS Epidemic Over?

       Will false hope be engendered by David Sanford’s remark about being hit by a truck as a more likely cause of his death than AIDS? If that comment is read in isolation, and without some of the irony that it holds, then I agree it might. But let me quote from the counterpoint that appears as a preface to this remark: “I’ve outlived friends and peers, and now I find myself in the unusual position of telling people how I’ve survived this scourge, something I never thought would happen. My condition could change for the worse tomorrow. But today I feel well again.” What is artfully communicated is how capricious life can be, and that the assumption David Sanford made–that he will necessarily die from his illness–no longer holds. I cannot say whether statistically he is more likely to die from AIDS at this point than from a stroke, heart attack, or the wild drivers in Manhattan, because I do not know his exact prognosis. No one does: It is in happy flux. So I read his ‘hit by a truck’ statement in a metaphorical sense rather than as a quantitative assessment of actuarial survival outcome. Similarly, to say he has ‘survived this scourge’ meant to me he’s still with us while so many are not. This does not mean he will survive it forever, or, as he pointedly acknowledges, it won’t all come crashing down ‘tomorrow.’
       I am not trying to evade your question, but it becomes a very subjective reading of phrases in and out of context. Clearly, some may latch onto his ‘truck’ metaphor and tell themselves that the threat of death from AIDS no longer exists. That would be false. But the piece is hardly a Pollyannaish treatment of the uncertainty of his condition, based on the totality of his remarks.
       Andrew Sullivan’s piece is written in an almost prophetic style. It tries to envision how the cultural upheaval wrought by AIDS in the gay male community will shape personal and communal behavior when people may live, rather than die, with HIV. His sentiment, that this will be an epidemic where the majority (at least in the West, where drugs and care are largely available) survive their disease, is not yet medically proven. That could certainly lead to false hope. But it is also a hypothesis that may well be scientifically realized, and it is from this belief that the article explores the psychosocial ramifications of the changing landscape in AIDS treatment and life span.
       Sullivan’s true hopes for his community relate to transmuting the devastating experience of the epidemic into lasting institutions built on individual and joint responsibility, like same-sex marriage, his cause célèbre. Moreover, the guiding metaphor he uses, ‘twilight’ of the epidemic, implied to me the time in our days when clarity is difficult, when discerning form and movement is a challenge. Twilight is also a period of varying length, not defined strictly in meteorological terms. Andrew Sullivan sees in this twilight an end to AIDS as we know it–an AIDS that is rapidly and uniformly fatal–and tries to sketch out how the historical experience of prevalent and certain death can shape his community. Was it premature to explore this ‘social engineering’ which may occur in the gay community? I took his point to be that even if gay men with HIV live longer and healthier, but ultimately succumb to their disease, that they will be changed (and the HIV-negative gay man changed) in profound ways. The true hope Sullivan seeks is to be found in the conversion of so much suffering into new and fulfilling paradigms of gay cultural and political life.
       You can see the baggage I carry in having Talmudic roots–asked to cut to the chase and state simply whether I agree or disagree provokes a multiparagraph weighing of issues, wherein I can see false hope or true hope extracted from the very same statements. Regardless of our differing interpretations, we can agree that human life is always finite, that medical science has afforded many with this disease added time, and that the greatest hope is that this time will be lived wisely.