Jacksonville native and Air Force veteran Marcus Conant was a dermatologist working in San Francisco in 1981 when he began seeing young male patients exhibiting a rare skin cancer called Kaposi’s Sarcoma. Because KS was one of the first two opportunistic infections to be characteristically identified with AIDS-related immune suppression (the other was the fungally-induced pneumocystis pneumonia, or PCP), Conant’s specialty and proximity to the gay community put him directly in the path of a then-baffling new disease.
It was an interesting fit for him, as early in his career in San Francisco he worked at the Haight-Ashbury STD clinic triaging the fallout from the experimental free-love community. Conant says this clinic witnessed one of the first epidemics of genital herpes, an unfortunately common disease among sexually active Americans today.
(WordPress won’t let me embed the fora.tv video, so here is the link – it is absolutely worth watching.)
There’s a lot of fascinating stuff in here, from transmission patterns among truck drivers to the politics of foreign aid, doctors who don’t want to know if their patients are positive to the effect of crystal meth on casual sex to “black and Hispanic America have not yet come out of the closet.” Conant also gives specific medical recommendations – testing of every sample of blood that is drawn and aggressive monitoring of viral load in patients.
To head off questions I feel I need to disclaim my interest in the subject. I’m not gay, I’m not bi, I’m not bi-curious or anything like that. I’m not involved in any activism when I’m not blogging, and I’m not a doctor on the front lines. I became interested in the AIDS epidemic as a pre-teen and teen as it was a major factor in what they were teaching us in the the nascent “safe sex 90’s.” It was only after a full medical understanding that I became interested in the social environment and fallout of the disease, which dovetails nicely with my amateur study of sexual dynamics (otherwise known as this blog). AIDS is also interesting in that it’s one of the only diseases to completely emerge under the scope of modern medicine and epidemiology, meaning its origins could be rather conclusively traced and its various treatments completely recorded and studied.
While medically and socially it’s wrong to approach AIDS as a gay man’s disease, the fact is that since the first months of its appearance, AIDS has been an ever-present specter in the gay male community, a more singular demon than almost any threat facing any other first-world demographic group. I recently saw an estimate that even today, a sexually-active gay American man has a 1 in 5 risk of becoming infected with HIV in his lifetime.
AIDS, even before it was named such, quickly caught the notice of the Centers for Disease Control, which internally characterized it as the “4-H” disease – referring to its first classes of victims: homosexuals, heroin addicts, hemophiliacs and Haitian immigrants. It’s morbid to consider that AIDS fairly quickly shut down the fast-lane lifestyle of young gay communities in the Castro, New York’s Fire Island and a dozen other North American gay villages, for two reasons: the disease forced behavioral changes in risk groups, and many of the lifestyle’s evangelists themselves died of the disease. It’s fair to note that many young gay men were not participating in the hyper-promiscuous behavior the culture was known for, but after a certain point, it didn’t really matter; the second wave of cases started to hit relatively chaste men, who in the course of a sensible serial-monogamy lifestyle would come in contact with a “reformed bathhouser.”
Public health authorities have long played a tightrope game of trying to contain risky sexual behavior, but not shaming it so much that it simply goes underground where health and social services can’t reach them. This is something like what has happened in places like Washington DC where gay black men (“on the downlow”) are extremely circumspect in their behavior, difficult for public health services to find, and are trafficking the virus between gay and straight communities.