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Viral Panic: Fear Has Been Useful in the Fight Against AIDS, Until It Wasn't 

Tuesday, Dec 16 2014
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Still, Campos and Wiener see it as a step in the right direction. By all appearances, the epidemic should end here. Yet it doesn't.

"The view in the mainstream is that somehow the HIV epidemic is over," Wiener told the crowd at City Hall. "I'm sick of meeting people who are 18, 19, 21 years old who are positive." The day before the rally, Wiener came clean about his own Truvada regimen in a blog published on Huffington Post, called "Coming Out of the PrEP Closet." We have a powerful tool in our hands, Wiener writes, arguing that PrEP could end the spread of HIV if it had enough political will behind it. Right now, the drug's cost, combined with the misconception that it will promote reckless behavior, has prevented it from being widely available. It's one of many services that aren't reaching the people who need them most, Wiener says.

Between 2008 and 2010, CDC researchers saw a 15 percent decrease nationally in new HIV infections among heterosexuals, and a 22 percent decrease among injection drug users.

At the same time, though, infection rates for gay and bisexual men rose by 12 percent. According to CDC senior adviser Richard Wolitski, that increase was driven primarily by younger populations: LGBT men between the ages of 13 and 24 saw a 22 percent spike in infections. HIV also appears to be rising in communities of black gay and bisexual men who, per CDC surveys, are especially unlikely to know their HIV status. "So not only will they not get access to medical care," Wolitski says, "they'll unknowingly transmit the disease to others."

More troubling, yet, is data indicating that HIV treatment is reaching only a fraction of the people who need it. In 2010, fewer than half of gay and bisexual men diagnosed with HIV nationally were receiving antiretroviral therapy, which would lower their chances of spreading the virus. That could be a matter of health care costs, or inadequate services, Wolitski says, though he also doesn't discount psychological hangups. Surveys that the CDC conducted in 20 U.S. cities between 2005 and 2011 show that many gay and bisexual men aren't following the Centers' recommendation to get tested at least once a year. Some people might feel healthy and mistakenly believe they don't need medical care, Wolitski says. Many simply don't want their lives being defined by a single laboratory test.

And younger men aren't routinely using condoms, either. Rates of rectal gonorrhea and syphilis have also risen in recent years and, according to Grant, only one-sixth of gay and bisexual men report using condoms on a regular basis. He suspects the ratio is even lower for heterosexuals.

That's led analysts to develop two competing theories. One is that Americans have been so paralyzed by the AIDS terror of the last three decades that it's kept them from acting rationally — Grant and others call this "AIDS survivor syndrome." The other is that they're simply not terrified enough.

Zach Murray might count himself among the survivor syndrome victims. The 25-year-old Baltimore native says he was "outed" as a bisexual while studying at Cornell University. That revelation spurred a rumor that Murray was HIV-positive. With no corroborating evidence, he just assumed it was true.

"I literally sat there for five years waiting for an emergency," he says, "for the thing that would force me to find out."

Murray, who is African-American, says he didn't have a ton of black gay or bisexual role models to look to, growing up in Baltimore. There wasn't a Scott Wiener or Bevan Dufty analogue to represent the city's African-American community, he says, and there wasn't the same ferment of AIDS activism that exists in San Francisco. Coming out — or testing positive — meant risking alienation, he explains: "In some communities, [it's] a different experience. Sometimes there's a social death that comes before the diagnosis."

Murray began coming to terms with his sexuality around the time he moved to San Francisco in 2013. He found a black doctor who specializes in HIV, and who he hoped would empathize with a young, closeted man of color. Murray finally got tested this year, and found out he was negative.

"I was just stunned," he says. "I thought I was living with HIV, and it turned out the battle was completely inside my head."

Still, the fear that incapacitated him for so long could also have killed him.

Researchers at the Centers for Disease Control and Prevention believe that fear may in fact be to blame for a recent surge in infections, particularly among Murray's peers.

"More than anything, people are afraid of being socially isolated," Grant says. "Imagine if you have a group of friends who aren't infected with HIV, and you become infected. ... That may mean losing your friends. Or it may mean they become the 'I-hope-everything's-going-well-and-I-feel-so-bad-for-you' kind of friends, which is horrifying."

It may also mean only dating other HIV-infected people — a phenomenon that the late AIDS researcher Jeff McConnell called "viral apartheid." To avoid being shunted into an HIV ghetto, a lot of people won't reveal their status, or be vague about when they had their last test, Grant says. And that's dicey.

The thing about the wildebeests, he adds, is that they go back to their old life as soon as the chase is over — they're not haunted by the specter of another lion coming around. Humans, in contrast, have long memories, unable to forget the trauma of being chased by the AIDS virus. Long-term fear calcified as PTSD — the "survivor syndrome" that Grant describes. It prevents people from getting tested for fear that they'll be ostracized if the results come back positive. Fear becomes its own strange epidemic.

Yet it's perhaps also dangerous to have no direct relationship to that fear.

Adam Zeboski, a 26-year-old test counselor at the San Francisco AIDS Foundation, blames surging infections on a generational rift. "Younger folks never experienced the trauma of losing huge numbers of friends and loved ones during the '80s and '90s," he writes in an email. "For the younger generation, HIV prevention may sit on the back-burner, as they deal with more pressing issues as finding a job, housing, and simply trying to get by."


About The Author

Rachel Swan

Rachel Swan

Rachel Swan was a staff writer at SF Weekly from 2013 to 2015. In previous lives she was a music editor, IP hack, and tutor of Cal athletes.

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