The experience of mass death works on a survivor or community in strange ways. Praise it as healing or damn it as denial, but sooner or later we forget those days we spent in hospitals -- deep in grief, or numb, or just plain bored -- waiting for friends to die. Looking back, I sometimes feel as if that past took place on another planet. Too much suffering and loss for too long has taught us, at best, to live in the now -- thankful for the gift of another day’s consciousness, if not health, but expecting little of tomorrow. After 20 years, HIV, our evil genius of a retrovirus, has humbled us, and while humility has its virtues, vision isn’t one of them.
It takes hope, even hubris, to raise a visionary. “This puny little virus, which can be killed with alcohol when it’s on a needle, is outsmarting us every single second of our lives,” the AIDS community’s greatest visionary, Larry Kramer, announced recently as if from that other planet. “It simply should not take so long to outsmart it. That is the opinion of this crazy man. It is taking so long because too many people want it to take so long.” Kramer’s sanity has long been a subject of debate, but his track record for reading the future of the epidemic is not. Starting in 1978 with his novel Faggots -- and its immortal words We are fucking ourselves to death -- Kramer has had the hubris to impose his vision (GMHC, ACT UP and the new troublemakers WAKE_UP [see www.wakeupthenet.com]) on a desperate but hopeful people. So when he spoke of the cure, almost in passing, during a typical temper tantrum of a speech at Stephen Gendin’s memorial service last July (P0Z, "Be Very Afraid," October 2000), I pricked up my ears: No one believes in the cure anymore.
Or almost no one. Project Inform’s Martin Delaney, the longest-running treatment activist and no crazy man, not only believes in the cure but can almost taste it (see “Here Comes the Cure”). This may come as a shock, to say the least, the conventional wisdom being that the complete elimination of HIV -- a virus that insinuates itself into our DNA, turning the very essence of life to its own ends -- is many years and genetic-technology breakthroughs away. But as Delaney sees it, we don’t have to kill the virus to control it. Working the same visionary vein in which he took the idea of “the dangerous drug holiday” and turned it inside out to introduce “structured treatment interruptions” -- last year’s only noteworthy treatment advance -- Delaney now makes the case for what he calls “a functional cure”: the coexistence of our immune system and its unwelcome guest whose fruit is a long, healthy life free of day-in, day-out therapy.
This holding in check of HIV (on the hepatitis model) will work, if at all, not by some magic bullet but by the on-and-off use of drugs that suppress the virus and then boost and reprogram the immune system. (No, your medicine cabinet will not be completely empty of all pill bottles come 2010. Pardon our enthusiasm on the cover.) Certainly this will disappoint those who dream of exorcising from their body every trace of HIV, and the stigma and dread it carries. It will also disappoint those high-tech priests of eradication and Nobel Prize hucksters who would perform the casting out. And it may even disappoint such long-term survivors as Kramer himself whose immune systems may be too sick to take them to this future. And because it will disappoint, it will likely be dismissed by many as pure theory, one more Compound-Q promise made only to be broken. This would be a grave error because imperfect and unproved as it is, Delaney’s functional cure has the distinct benefit of being achievable, and soon, with tools already at hand.
What isn’t at hand is belief. To read Patrick Califia-Rice’s "Magical Mystery Cure“, for which the San Francisco transgender author and activist polled a long list of community names, is to recognize that the old doubts and suspicions are as thorny as ever (”It’s medically impossible,“ ”Drug companies won’t profit from it,“ ”Governments don’t care about the people at risk,“ ”Society wants the disease to exist to punish immorality“), while a few new paranoias have also bloomed (”The focus is all on a vaccine and prevention,“ ”Barebackers have made an incurable superstrain,“ ”HIV is harmless"). This tangle has strangled hope.
Add it up, and I dare you not to conclude that however deeply we may sometimes ache for an end to AIDS, we have, down the years of tragedy and trauma, ultimately lost sight of what a life liberated from this scourge would be like. Do we really believe that the best we deserve is a “chronic, manageable disease” and “safer sex” forever? Are we too beaten up by death to ask -- no, demand -- something more? One thing is sure: Visionaries like Larry Kramer and dreams like Martin Delaney’s don’t arrive every day like the mail. Attention must be paid.