In 1990, I lived across 3rd street from the Hell's Angels clubhouse and heard the engines roar. I awoke to Rosa's Cafe on the corner, where my sugary cup of hot Cuban coffee awaited me even in July. Quentin Crisp, and that drag doyenne of the pyramid, Hapi Phace, lived right up the block. And The Bar, our local drink tank, was also right around the bend. I scored the best Jamaican hay in a candle shop, where colorful wax and beads were a beard for the spiciest weed in New York City. You were handed a card in bronze, silver or the elusive platinum. I am happy to say, because I was a Third Street regular, I reached platinum status in record time.
I needed that weed. My sweetheart was covered in Kaposi Sarcoma, vomiting blood in our bathroom, using a blow dryer to heat his freezing body. He was dying, pre-antiretrovirals, and in 1992 he succumbed to AIDS. I was 27, he was 29. Was I too young to be laying to rest someone I loved? From 1986-1996, that's all I did. Burying the dead is what holds my memories together; sinuous links between each funeral are taffy pulls in a row of salt water towns dotting "Cape Fear".
I need an AIDS vaccine like I needed it yesterday. One that works on two fronts: prevents transmission, and eradicates HIV from my body. That, or promising new gene therapy, are the only ways we will ever halt an epidemic devouring the world community. We need a medical Manhattan Project. The Federal Government: NIH, CDC, FDA, and Big Pharma, and AIDS Inc., can you all get on board? Even the medical universities, funded generously by the NIH (an example of a working federal response), can the NIH stay on board?
The CDC's blueprint is stuck pre-1996. Their prevention drive is fruitless, and their push for a cure -- non existent. In 1990, ACT UP, The AIDS Coalition To Unleash Power, demonstrated against the CDC. Maybe it's time to return and demand a modern response to the epidemic, one without fifty miles of red tape separating every organization from every dollar spent localizing HIV prevention. How do they best quantify the success or failure of their own prevention efforts at the CDC?
"Black and African American men have the most severe burden of all racial/ethnic groups in the United States" -- An excerpt from the CDC's main page.
Well what are they doing about it? Because it's not enough. By their own statistics, rates of transmission are rising every year in the gay community. The CDC's website is the most transparent federal report card on the Internet, and they flunk themselves every semester. The CDC's own Division of HIV/AIDS Prevention's annual report does not in any way reflect or maximize impact, as it's title suggests. And all those faces smiling back at me in their colorful brochures do not reassure me that HIV transmission is being minimized. Turning those numbers around is your job, and as Director, Tom Friedan, and HIV/AIDS Director, Jonathan Mermin, you need to get your grades up.
Big pharma isn't going to chase down a cure. It won't be Gilead, who makes my ARV, Stribild. It's Gilead who created the $84,000 pyramid to the cure for Hepatitis C. Gilead's only motive appears to be money for their shareholders. They are the corporate tax on my life. My survival depends on a cut to Gilead, a cut to AIDS Inc., another to the MD, and one to the shrink. If I have anything left over, I buy a nice clean shirt to cover my bones. For dinner I'll eat my shoe like Chaplin in "The Gold Rush". Gilead makes big money, they should send out free, blue t-shirts to all adherents with a beverage, clean water to swallow it all down.
The dusk on the AIDS epidemic is really a white night. The sun has never set. It took a combination of three pharmacological strategies to manage HIV. Prevention models would be wise to promote every available option in every conceivable combination. Gilead also makes Truvada, the PrEP pill. If you're sexually active, I recommend you find out about the one a day PrEP pill. It has side effects in a percentage of users, but nothing like the side effects of HIV. I warn you, Gilead makes money. Gilead could make money on a vaccine too, and they do make bank on all those pills, but their greed should not stand in the way of saving lives.
Which means leading the charge for a vaccine is the work of the people, often working through our government. It is our government's job to regulate and facilitate medical science, to foster incentives, and usher in the end of AIDS. And it's the healthcare industry, advocates, activists, workers, the people's job to make sure they do. We have everything vested in a cure, Gilead has everything invested in greed. I really have no expectation that Gilead or their cronies can be counted on to destroy their own brain-child: the chronic manageable illness. The world would devour a vaccine like rain in the Mojave Desert, but corporations are little black clouds, and the rest of us are doers of rain dances until further notice.
Those who come up with a cure will be humanitarian, maybe egomaniacs searching for a Nobel in medicine, whatever their motivation I accept it without reservation. Because without a vaccine, or gene therapy, we will not see an end to HIV/AIDS in this world, not in my lifetime. The longer the epidemic goes on, greater condom fatigue sets in motion an elevated risk of transmission. There are other populations, and other reasons why people deviate from the path of prevention, but for most gay men condom use is rejected. What replaces it is the unknowable pleasure of fear and a desire for sexual risk taking, all normative. It's rather thrilling to deviate and play Russian roulette, at least until you discover the bullet is in your chamber. But right now, especially in the Black/African American community, that gun is fully loaded.
HIV, as you may or may not know, is a tricky little bugger, but so was polio and penicillin. The only way out of this fog of sexual panic, AIDS phobia, social dysmorphia, the anxiety, the big what if, the stigma, the cost, the wreckage, mileage and profiteering, racism and classism, homophobia, is if all institutions interested in stopping AIDS aimed higher. It can end. AIDS can be crushed into a petri dish and cultured to protect lives instead of destroying them. A vaccine is our best shot, genetic research too. Now who will take the hill? Where HIV and I are concerned, the last balm left in Gilead is that wily AIDS cure.