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Most service providers plead patience, arguing that the long-term efficacy of the new treatments remains to be seen, that no major restructuring of the AIDS bureaucracy should take place until all the facts are in.
"There are 3,000 people with AIDS on a waiting list for housing in San Francisco, but there is no one on the waiting list for protease inhibitors," says Laura Thomas, a former ACT UP San Francisco member who now serves on the HIV Health Services Planning Council for the city's Health Department and works as a policy analyst for the San Francisco AIDS Foundation. (Some states don't pay for protease inhibitors. Still more have lotteries where the drugs are doled out in a macabre crapshoot. But S.F. officials have pledged to pay for as many new AIDS treatments as needed.)
In S.F., the conflict has grown nasty. AIDS activists have begun cannibalizing their own. Thomas' boss, Pat Christen, the executive director of the S.F. AIDS Foundation, has been singled out for a vitriolic sticker campaign, the sort of attack once reserved for right-wing bigots and homophobic cops.
Stickers placed all over town picture Christen as a feline, whiskers and all. "Dump Fat Cat Pat," they read, while announcing her $131,000 annual salary. (The anti-Christen campaign originated with a union dispute at the foundation, but has been adopted by certain advocates of the money-for-drugs side of the debate.)
Not surprisingly for a fight over money, the dispute is complicated by race and class. Many of those arguing for new funding priorities are economically secure, white gay men. Like Getty. And the programs they are attacking serve an extremely poor, sometimes homeless, often drug-addicted population, made up in the main of African-Americans and other minorities. If they prevail, it will ultimately be easier for the indigent to receive drugs. But at what cost?
Also, it's probably no coincidence that the waning support for social services comes at a time when AIDS rates for gay men are declining (though they still make up the greatest number of cases) and the rates for women, heterosexuals, and IV-drug users are increasing. For example, between 1986 and 1996 S.F. AIDS cases among women rose from 16 to 61. For heterosexuals, cases rose from 6 to 19 over the same time. And heterosexual IV-drug users went from 20 to a startling 127 cases. Meanwhile, AIDS cases among gay and bisexual men dropped from 1,679 to 688.
As the pandemic continues this shift away from gay men who can afford the new treatments, and as AIDS promises to become for them a chronic condition rather than a fatal disease, what's occurring is nothing less than a fracturing of S.F.'s AIDS coalition, in its best moments the uniting of straight and gay, white and people of color, toward a common and urgent purpose. Born in San Francisco, it now may die here, too.
As the fight over AIDS dollars escalates, a sobering truth will emerge: With the advent of new treatments, the fight is no longer against one pandemic, but two.
Joey straddles both pandemics, the one containing hope, and the other offering only temporary comfort. No wonder the future so perplexes him.
More than most, his story illustrates the need to keep faith with the old methods of caring for those who will not make it out the other end of the disease. Indeed, Joey is a living argument for protecting AIDS-related social services, which kept him alive long enough to try the new drugs.
Ten years ago, Joey hit bottom, without a friend or family member in the world to help him. Step by step, he used nonprofit agencies, like rungs in a ladder, to climb back to where he is today: with a roof over his head, a job, and, most important, the wherewithal to take the drugs that could, just maybe, save his life.
Joey very clearly remembers when things started to go wrong for him. He was about 7 years old, sitting on the couch with his mother and her new boyfriend watching TV in their Albany, N.Y., home. The boyfriend told him to go to bed. It was the guy's first night over at the house, and he was a total unknown to Joey. For him to be giving orders, with no intervention from Joey's mother, rocked Joey's world.
The relationship between the young boy and the boyfriend, who would later become his stepfather, deteriorated from there. Growing up as an effeminate gay teen-ager made things all the more difficult.
At the age of 14, fed up with his stepfather, and after torturing his parents with drug abuse and petty crimes, Joey flew into a fit of rage and broke the front window of his stepfather's carpet store. Thinking he was teaching Joey a lesson, the man pressed charges. Joey was sentenced to one year in the Albany County Jail. There three correctional officers raped him. Though the guards were convicted of the crime, Joey says his parents' concern during the crisis was merely for the family name.
After the ordeal was over, Joey left home and never looked back. Starting as a dancer in seedy gay strip joints in Times Square, NYC, turning tricks to survive, and mainlining speed, he ended up in S.F. by the mid-'70s. He danced at the Spartan Theater, hooking all the while. But he never stayed in one place long. "Part of it was a sense of adventure and part of it was running," he says. He spent time in so many places he can't remember them all today.
Back in S.F., he met Julio, a wealthy, married real estate investor from Spain. It was a unique relationship. After having sex once, Joey and Julio never did again. But they began living together in the Castro. Julio's sex life with men didn't extend beyond cruising Polk Street and bringing home male prostitutes. Every Tuesday night, Joey, Julio, and Julio's wife -- who lived elsewhere -- would have dinner together.
