THE 25-YEAR BATTLE AGAINST AIDS

AIDS Virus Digs In Where Life Is Hardest

Special Report: AIDS Anniversary

The AIDS epidemic once cast a deep shadow over the Castro district,
the epicenter of gay life in San Francisco -- populating the streets
with gaunt, blemished faces and young men leaning on canes.

Now that medications have turned AIDS from a quick killer to a
manageable disease, that shadow is receding, brightening and filling
sidewalks with baby strollers, shoppers and couples not yet born when
the plague first descended here 25 years ago.

The tale of this community's triumph over disease surpasses any in
public health memory. San Francisco's gay men now have the highest
testing rates and lowest new infection rates of any hard-hit city in
the nation.

But HIV, the virus that causes AIDS, which has killed more than
500,000 Americans, has not gone away. Instead it has shifted into the
city's most destitute neighborhoods, settling into populations that
are smaller, sicker, more isolated and much harder to reach.

As long as it stays hidden in the margins of society, AIDS will never
be extinguished, said Dr. Willi McFarland, director of HIV
surveillance for the San Francisco Department of Health.

"As long as one infection leads to another, it will continue," he
said. "The battle is not won. It could be sustained indefinitely."

While the number of new infections in the United States has tumbled
from 160,000 per year at the peak of the epidemic to about 40,000
now, "We're in a new danger that rates of infection are rising
again," said Michael Montgomery, chief of the Office of AIDS in the
California Department of Health Services.

In the trash-filled alleys and cheap hotels of the Tenderloin
district, HIV stalks homeless gay men with mental illness, young
women selling their bodies on street corners and disheveled and
hollow-eyed teenagers seeking heroin.

HIV has also extended its reach to sex workers in Oakland, inmates in
Marin County's San Quentin prison, young drug injectors in downtown
Santa Cruz and migrant farmworkers in San Diego County, who queue up
to buy condom-free sex from women selling their services behind trees
and in makeshift rooms of cardboard boxes.

HIV is just one of a collection of chronic problems linked by
poverty. More than three-quarters of the 71 patients who died last
year while in treatment at the University of California-San
Francisco's Positive Health Program also struggled with substance
abuse and marginal housing, said Diane Jones, a longtime AIDS nurse.

"They lead lives of incredible stress," she said. "It is poor people
who are disproportionately getting infected. Poor people are having a
harder time doing well on the new meds. It is poor people who are
predominantly dying."

These patients tend to seek care only when they are very sick, said
Dr. Barry Zevin of the Tenderloin's Tom Waddell Health Center. Some
are already suffering from hepatitis C infection or other illnesses.

"Like many other areas of medicine, it is communities of poverty
where the burden of disease lives," Zevin said. "With treatment, they
can have equally as good outcomes as other populations."

For Ricco Brustie, a young African-American man seeking treatment at
the Tenderloin AIDS Resource Center, the disease has finally become
impossible to ignore. His immune cells are "screwed up," he said. "My
memory's gone."

But his more immediate concern was finding a place to stay: "I just
got kicked out of my place, and I've got a 6-month-old son. I don't
know where we'll sleep tonight."

Unlike previous victims, the people in these hidden corners of the
epidemic aren't activists. They don't sew quilts or lobby Washington,
D.C., for funding. They don't create strong social networks to care
for their sick and dying.

In their silent suffering, they risk becoming invisible.

"Twenty-five years ago, I never dreamt it would go on forever. That
never crossed my mind," said Cleve Jones, 51, who founded the NAMES
Project AIDS Memorial Quilt project after losing his best friend to
the disease.

"We were going to fight until we died -- or until we won," he said.
"We never just accepted that it would be one of those intractable
problems that happened mostly to people we don't know."

When AIDS first appeared as a few cases of a rare type of pneumonia
and an unusual skin cancer in the summer of 1981, it seemed
mysterious but not especially ominous. Its name, acquired immune
deficiency syndrome, reflects the fact that it robs people of their
ability to fight off disease, leaving them vulnerable to infections
and cancers.

As it swept through the Castro and other centers of gay life,
sidewalk conversations began to center on who was ill and who had died.

Over time, fear turned to grief, then anger -- and frustration,
activism and reform.

Many gay men began to use condoms and cut back on the use of drugs
such as crystal methamphetamine, which loosen inhibitions and
encourage risky behavior.

They also began pairing up by HIV status -- positive with positive,
negative with negative -- to avoid spreading the virus.

New drugs cut the transmission of HIV by reducing the number of viral
particles in the body, and thus infectivity. In 1994, AIDS deaths
began falling as well, because of increasingly effective therapies.
Almost overnight, anti-viral medicines created a generation of HIV survivors.

"Early on, every phone call was someone who had died of AIDS," said
Jim Sullivan of Arthur J. Sullivan and Co. Funeral Home, on the edge
of the Castro. "When a young person dies, it's always harder. They're
bigger funerals, because they have a lot more friends.

"Now we get more older people, people dying of old age," he said.
"It's not as sad, because they've lived a normal life like everybody else."

In the early years of the epidemic, people banded together to provide
solace for the sick; now some groups are defunct, while others have
redefined their purpose.

Shanti Project, founded to help cancer patients but diverted for
years to the AIDS battle, has returned to its original mission.

Twenty years ago, attorneys with the AIDS Legal Referral Panel were
busy writing wills for dying clients, said Executive Director Bill
Hirsh. Wills now comprise only 10 percent of their cases; most of
their work involves housing, employment, insurance, workplace and
other ordinary disputes.

At San Francisco General Hospital, the renowned Ward 5A/5B is no
longer an AIDS-only inpatient ward; it now treats chemotherapy
patients, as well as the occasional diabetic, asthmatic or heart patient.

"There is no AIDS ward in San Francisco any more," said Diane Jones,
who was nursing manager of the inpatient ward from 1990 to 1996.

The famed AIDS Memorial Quilt, first stitched together by the
Castro's grieving men, has left town. It is now stored in a warehouse
in Atlanta; individual panels can be rented for display.

Even activism has paled. The once-militant group ACT UP Golden Gate,
known for its theatrical street protests, has changed its name to Survive AIDS!

Among those living with the disease, the stigma is fading. The group
Stop AIDS Now recently held an HIV-positive speed-dating event, as
well as a dance club night.

"We're finding a new normal," said Jason Riggs, 33, of the Stop AIDS
Project. "For so long, all that mattered was HIV. Now we're at a
point where we can begin looking at broader personal issues. People
are regaining an equilibrium as a community."

Health authorities, as well, are beginning to treat HIV like other
infections. The Food and Drug Administration is considering revising
a policy that bars blood donations from any man who has had sex with
another man since 1977. The Red Cross and others argue that screening
methods have improved enough to keep HIV out of the blood supply.

Additionally, the government plans to recommend that doctors offer
voluntary HIV tests as a part of routine medical care for everyone in
the United States from 13 to 64 years old.

In October, federal health officials will require that states report
HIV cases by patient name, forcing them to drop code-based systems
that guaranteed anonymity.

For people living with AIDS, a once-complicated treatment regimen has
eased, as multiple medicines are combined. When anti-HIV drugs were
first introduced, they had to be taken every four hours, day and
night. A once-a-day pill now awaits FDA approval.

"In most respects, this feels like a very different disease," said
Dr. Paul Volberding of the San Francisco Veterans Affairs Medical
Center, who directed the AIDS clinic at San Francisco General
Hospital when it opened in 1983.

Now, he said, most patients are doing well, and "we are starting to
deal with other problems that come with aging."

The Castro, also feeling new vigor, is on the verge of sweeping
changes as new housing and retail developments are slated for nearly
a dozen properties along upper Market Street, creating the biggest
building boom to hit the neighborhood in decades.

There are plans to open a neighborhood gay and lesbian family
resource center, offering child care and adoption and foster care services.

It was once possible to rent a flat for under $200, big enough to
share with friends; now, high rents are squeezing out the
neighborhood's artists, writers, dancers, masseuses and anyone on a
fixed income.

A generation of youngsters, many new to the Castro and unscathed by
its past, see hope instead of despair. "The way we talk about it and
experience it is very different," said Riggs of the Stop AIDS Project.

For many older men, though, there is little left but memories of a
generation lost.

"Every flat, every apartment, holds a story," said activist Jones,
infected since 1979 and now living in Palm Springs.

"For many years, whenever I tried to think about it, it was like
falling backward off a cliff. I would feel dizzy and sick. The loss
was so enormous," he said.

Now "there is still sadness, but it is not debilitating," he said.
"Now sometimes I go days without dwelling on it." Staff writer Yomi
S. Wronge contributed to this report.