AFTER QUARTER CENTURY OF AIDS, GAINS BUT NEW THREATS

Twenty-five years since the onset of the AIDS pandemic, many gains
have been made in combating the disease. Yet, the struggle is hardly over.

Since June 5, 1981, when the first cases of pneumocystis were
reported in Los Angeles among gay men, the medical community has made
vast advancements in treatment of the 1 million Americans estimated
by the Centers for Disease Control to be living with H.I.V. While
there is now federal funding for Americans to receive drug treatment,
multipronged treatment approaches and rapid H.I.V. testing (test
results available 30 minutes after testing), public health
specialists maintain that finding a cure for AIDS is still a long ways off.

Dr. Marjorie Hill, executive director of Gay Men's Health Crisis,
said many factors have contributed to the ongoing AIDS crisis.

Twenty-five years into the epidemic has taught us a painful lesson:
H.I.V. is not just about H.I.V. and never has been," she said. The
majority of men diagnosed with AIDS are gay, at 67 percent, according
to C.D.C. African-American males are also disproportionately represented.

Hill said the epidemic is fueled by racial injustice, homophobia and
heterosexism. Until a cure is found, she said, one of the best cures
is education and access to resources.

Dr. Jane Simoni, a professor at the University of Washington, has
done research on victimization, substance use and H.I.V. risk
behaviors among gay, bisexual and heterosexual populations in New
York City. She credits gay men for their resilience in the face of
adversity when the first cases were found.

It could have been a time when they turned on each other or went back
into the closet," she said.

The adversity, Simoni was referring to, was the political climate in
existence in the 1980s. The Reagan administration barely acknowledged
that AIDS existed until a press conference four years into the
epidemic, when Reagan finally used the term "AIDS."

Think back to 25 years ago," Hill said. "Whether it was the federal
government, state government or city government, to a large measure
they were silent. Part of the reason for that silence was because it
was a gay disease and government was silent regarding gay/lesbian issues."

Today, government has not only acknowledged the problem, but funding
has been put in place to aid those in need. Jeffrey Hammond,
spokesperson for the New York State Department of Health, said the
department has supported H.I.V./AIDS initiatives "at record funding
levels currently totaling more than $2 billion in state and federal
dollars annually; the largest funding commitment of any state in the nation."

However, some activists feel that while state funding is more than
what was available 25 years ago, a lot is left to be done to deal
with social stigmas contributing to the disease.

Donald Grove, a data consultant with harm reduction programs who was
involved with the 1997 National Syringe Exchange Survey, explained
how some social stigmas and cries for identity among the gay
community may have contributed to behavior leading to individuals
becoming H.I.V. positive.

We aren't offered in our culture, any way to be gay," he said. "I do
whatever I need to do, to claim my gay identity."

Grove cited the early 1980s and '90s as a time when the general
identity of being gay was partying and a promiscuous lifestyle,
leaving young gay men wondering, "What's wrong with me? I'm not
promiscuous enough!"

Promiscuity, in part, led to the spread of diseases, among them
H.I.V. Grove said there must be more discussion about identity, sex
and sexuality, "so they can come up with their own concepts of who they are."

Current research suggests that in addition to social pressures that
may encourage promiscuity, drug use plays a role in the occurrences
of H.I.V. and sexually transmitted diseases in gay men.

Dr. Alan Clear of the New York City Harm Reduction Coalition said, It
is well documented that gay men have high uses of drug and alcohol."

Recently, public health officials have found high numbers of crystal
meth users who are also H.I.V. positive.

Grove talked about his own experience with crystal meth: "It made me
feel better about myself," he said. "But I would feel so rotten after."

In addition to the euphoria from crystal meth, users cite the drug's
powerful effect on the libido. Clear explained that the form of
crystal meth popular among users today also contains a "Viagralike
component" allowing men to sustain erections for prolonged lengths of time.

Dan Carlson, of the H.I.V. Forum, explained that as a result of these
effects, among gay men, crystal meth is mostly used in the context of
sexual behavior. The concern among public health officials is that
crystal meth users may not only contract or transmit H.I.V. through
unprotected sex after taking crystal meth, but also through used
syringes. (Meth can be snorted, taken anally or injected, the latter
known as "slamming.") As a result, many activist groups in New York
City support syringe exchange programs under which users are supplied
with clean syringes.

Grove explained, "In syringe exchange, what we work on is addressing
what people are doing and not what people ought to be doing."

Hill reinforced Grove's statement by saying, "Needle exchange makes
logical sense...and has saved thousands of lives."

Let's deal with what you're asking for when you walk in the door,"
Grove said of crystal meth users. "Their sexual behavior is not the
only problem in front of them."

Current regulations state that syringe exchange programs can be made
available if a population in a community wants one to exist; the
programs must first be approved by the local community board.

Hill described further concerns for gay men in terms of H.I.V. in the
future. She worries that with the presence of more effective
medicines for dealing with H.I.V., the younger generation of gay men
will not have the constant physical reminder that older generations
may have had.

While H.I.V. is no longer a death sentence, as it was for many people
25 years ago, and that's a wonderful thing, there are still people
dying from AIDS," she said. "There are still people who are becoming
H.I.V. positive because they haven't received the information and
support to stay H.I.V. negative."

Indeed, medications have advanced further than A.Z.T., and what is
considered "monotherapy," or the use of one drug to treat the virus.
Today, Highly Active Antiretroviral Therapy (HAART) is used as what
Simoni called a "multipronged" approach to attacking the virus and
bolstering the immune system.

However, while the number of people dying from AIDS has decreased in
the last 10 years, the infection is still quickly spreading. Simoni
explained that even though H.I.V. drugs today make living more
manageable than before, they are still not cures, as anyone forced to
take the medications for the rest of their lives can readily attest.

Talk to anyone of them," she said. "They'll tell you they are not
easy to take."