By NATHAN A. PAXTON
I encounter the HIV epidemic in unexpected places, particularly when I take my dachshunds out for a walk.
I live near the Historic Congressional Cemetery in Washington, D.C., and one of the programs of the cemetery allows some of us to walk our dogs among graves of the well known and almost anonymous. The graves of J. Edgar Hoover, Elbridge Gerry (he of the “gerrymander”) and John Philip Sousa get most of the attention.
In quieter ways, I can read the toll of the killing years among gay men in Washington. Most often, the signs are demographic: single men, not buried in a family plot, who died between the early-‘80s and mid-’90s, between the ages of 25 and 55. Sometimes I’ll find these graves in clusters, as if friends and lovers wanted to share proximity in death as in life. Often, though, I will find these graves by themselves, and I wonder what story lies behind the solitariness.
Some graves proclaim their gayness loud and proud, like that of Leonard Matlovich, the first active duty member of the armed forces to challenge the ban on gay and lesbian people serving in the military. Another mentions being a “proud gay educator.” Once you know what to look for, you see these men everywhere. As Walter and Russell sniff and bound jauntily among the headstones, the three of us walk among HIV’s dead, just as we walk among Union and Confederate dead.
I study the politics of epidemics, especially HIV, and it’s often said that one’s research manifests one’s own demons. My own years of research on the development of different countries’ HIV/AIDS policies stemmed, I came to see, from a personal recognition, as much as intellectual motivations.
But for the accident of the year in which I was born, it is quite probable that—as a gay man in America—I would not have been alive to do my work and live my life. HIV, first understood as AIDS, made its first recognized appearance in gay men, and it is often still thought of as a “gay disease,” here in the United States and in the developing countries I study.
Had I been born just a few years earlier, I would be smack in the midst of that generation that first showed the evidence of one of the worst plagues in human history. It is quite probable that I would now be dead.
Living in the San Francisco Bay Area in the late ’90s, it was hard not to notice that gay men between 40 and 60 were sometimes rare, even missing. Friends who had been living there less than 10 years earlier told stories: My friend Billy spoke of attending two memorials a weekend for months on end; Len remembered wearing full sterile garb to visit dying friends in the hospital in 1982; and people at my church, gay and straight, remembered constant care rotas for a changing and diminishing set of friends and lovers. Len, a retired professor, told me that caring for his ailing mother in the late 1970s kept him home and out of the bars: “That’s probably what kept me alive.”
As a social scientist, I think I have a pretty good understanding of the probabilities behind many everyday actions and circumstances. It is sobering to realize that only a matter of years may separate one from the near-certainty of the disease. Even now, I accept as normal that some of my friends have not escaped the laws of probabilities and plagues. Friends of mine speak of a time in their lives when they could count more friends and lovers who were dead than alive.
Each Dec. 1 is World AIDS Day, and we generally don’t much mark the day here in the United States. For many folks, this titanic killer has become a “mere” chronic disease, thanks to the antiretroviral cocktail therapies available to us. As a result, gay men, for example, have been able to turn their social and political efforts toward a variety of other issues: marriage, employment protection, open military service.
We are hardly out of the woods, even in the United States. Recent CDC reports indicate that unprotected anal sex among gay men in America has increased 20 percent since 2005. The same trend has occurred in several other Western countries. While amazing progress has occurred in sub-Saharan Africa, HIV infections and AIDS deaths are on the rise in East Asia, Eastern Europe and Central Asia, and the Middle East and North Africa.
Even while MSM are the most-affected group in the United States and other developed countries, the most common type of HIV-infected person in the world today is a young woman of African descent. The epidemic varies greatly and remains consistent in its pervasive burrowing into those at the margins of our cultures: sexual minorities, drug users, women, sex workers and black people.
UNAIDS will tout good news this Dec. 1. The rate of annual new infections has decreased all over the world, falling by a third over the last decade. New infections and deaths are down in many regions and countries, including many of those most affected, in the Caribbean and sub-Saharan Africa. Treatment access has increased dramatically in this last decade. ARVs have transformed from global luxury to what scholars Joshua Busby and Ethan Kapstein have called “merit goods” — goods whose consumers assert they have a basic moral right to have, like lifesaving drugs once priced too high to consider providing on a mass basis throughout the developing world.
There will also be bad news. Men who have sex with men are 13 times more likely to be living with the disease. In east Asia and the Middle East, the number of infections is on the rise. Sexual behavior has become more risky in many places, with increasing numbers of partners and less consistent condom use. There are still more than 35 million people — roughly the population of California — infected with the virus.
Most of the people who have died or will die from AIDS have not been and will not be obvious to those of us who walk in cemeteries, with or without canine companions. The statistics of their deaths won’t reveal the manner of that death so easily. We will not be able to tell who the African-American men and women who bear some of the highest burdens in this country were. There will be little evidence in their cemeteries of the widespread injection drug use in Eastern Europe and Central Asia that spreads the disease there. The same will be true of sex workers, transgender people, closeted men who have sex with men and poor women throughout the world. We will forget them more easily, in death as in life.
Just as HIV has proven amazingly adept and complex in the hiding places it finds in our human bodies, it has proven equally adept at hiding in the bodies of our societies. HIV survives and thrives in our biological and social bodies, adapting itself to work quietly and slowly, doing its work at the edges until it is powerful enough to harm those bodies. The complexity of HIV’s biological place pales before the social complexity in which it is enmeshed. If there is an evil in any disease, it lies not in the vector itself but in what we humans do or do not do for the people living with it, that is, by the evil we have done and the evil done on our behalf.
It is easy to miss the first casualties of the HIV epidemic, and most of my human cemetery friends have never noticed the plethora of these dead until I point the matter out. In another world, some of these dead would be alive and walking their dogs among the grass and granite, chapel and colombarium where they are now buried. The HIV-infected and -affected of the future will be much harder to find, more invisible than the men that Russell, Walter and I have become familiar with on our walks.
Nathan Paxton lives in Capitol Hill and teaches political science.