Watching How to Survive a Plague, I was struck by the footage from the Sixth International Conference on AIDS, which shows some of the same people at the conference as working today in HIV treatment, policy, research and programming, both among the government research wonks and the activists, some of whom have become wonks. This footage also includes sex workers, who have been part of the gay rights movement and AIDS activism from the beginning. Members of the AIDS Coalition to Unleash Power (ACT UP) and Prostitutes of New York (PONY) overlapped and held different roles in the different organizations. This aspect of HIV activism is sometimes neglected, sometimes to save the positions now held by former sex workers, out of not knowing everyone's whole lives, and sometimes perhaps out of stigma an discrimination.
Sex workers have supported activism in response to HIV out of need, and as part of ACT UP and other organizations. Sex workers and gay rights activists were already mingling and moonlighting together prior to the advent of HIV. The Stonewall riot included many people who sold sex among the cross-dressers and others at the Stonewall Inn. A few years earlier, many transgender sex workers were part of the riot at Compton's Café in San Francisco. These were seminal events of the gay rights movement.
Seeing the movie is to be transported to another time, an era in which HIV patients were rejected by health care providers, hospitals and funeral parlors. A world in which Senator Jesse Helms condemned gay people for "sodomy" and wanted gay and lesbian people to "keep their mouths shut." A world in which it was acceptable for Pat Buchanan to use the threat of the virus to tell people to be celibate and when George Herbert Walker Bush told people to change their behavior, essentially parroting Buchanan in telling gay people to stop having sex. Since the late 1980s and early 1990s when this footage was taken, this has changed and gay people are more visible and hold positions of respect and power in our society. The AIDS pandemic galvanized a movement because this was a matter of life and death. Now that there is successful treatment, it is easy to forget that much of a generation of gay men were killed by the virus between 1981 and 1996, affecting the lives of everyone who loved them. The fact that the hateful statements of Bush and Helms are unthinkable in US politics today is in great part due to the work of ACT UP and other activists, including sex workers who have been part of AIDS activism all along.
How to Survive inspired me and depressed me. Seeing what a group of motivated people accomplished fairly quickly is encouraging. Seeing that a small group within the affected populations still bears disproportionate burden of HIV, in the US in general, in places with more severe epidemics such as specific urban centers like Harlem and Washington, DC, and in places where marriage is considered a risk factor because HIV prevalence is so high, mostly in but not limited to countries in Southern Africa. Key populations at higher risk of HIV include not only men who have sex with men but also sex workers and people who inject drugs. Sex workers and people who use drugs have not made the same strides as gay people have in many places; many sex workers and people who like drugs hide these activities. They do so with good reason: they could lose their jobs, their homes and custody of their children. These are all things that gay men and women faced here until very recently.
I was depressed when thinking that sex workers and drug users are still fighting to be at the table in the ways that men who have sex with men have achieved at least in some places. Even though sex workers and people who use drugs have been part of mobilizing against HIV for thirty years, they have not had the same support from the people who have become mainstream AIDS advocates in the same way since men who have sex with men have been able to affect the HIV pandemic.
There are sterling exceptions, and many are in this important movie. They are role models for a movement for the necessary movement to bring other remaining marginalized groups to the discussions that form policy on HIV, which affects their lives in the form of the disproportionate HIV burden they carry, which is now in this country and elsewhere becoming more prevalent among women in general. One clip includes a man in a clinical trial at a demonstration asked about the trial, and the fact that there were no people of color and no women in the trial. This has changed, and is critical now that we know that African American women in the US are five times as likely as other women to contract HIV. Gay men fought to be present at discussions of HIV research and to help set the agenda; it's necessary that the coalitions working on these issues make the effort to include all affected communities, especially sex workers and people who use drugs.