Perry N. Halkitis is dean, professor, and the director of the Center for Health, Identity Behavior & Prevention Studies at the Rutgers School of Public Health. His latest books "The AIDS Generation: Stories of Survival and Resilience" and "Out in Time: From Stonewall to Queer, How Gay Men Came of Age Across the Generations" were published by Oxford University Press.
On the eve of the 40th anniversary of the CDC’s first report on what would become known as HIV/AIDS, Perry N. Halkitis, PhD, MS, MPH, sends out an urgent call to continue this fight and rededicate resources to finding a cure.
My friend Steve died on May 30 from AIDS-related compilations. He was just 53 years old. An acclaimed film editor, he had been working with me and our colleague Liz on a film project on HIV and aging, when I last saw him as he lay unconscious in his hospital bed the Sunday before his passing.
In this last year and a half, SARS-CoV-2, the virus that causes COVID-19, has claimed nearly 600,000 lives in the United States and 3.5 million lives worldwide; however, another viral pathogen that emerged 40 years ago continues to slowly, steadily, and insidiously kill people.
The culprit is HIV, the virus that causes AIDS. It took the life of Steve and so many gay men of my age group who I have come to define as the AIDS Generation.
June 5, 2021, marks the 40th anniversary of the initial report by CDC that described the death of 5 men in Los Angeles from a rare lung infection known as Pneumocystis carinii pneumonia, an opportunistic infection that is one of the illnesses that define a person living with HIV as having AIDS.
Since that time, complications from HIV have resulted in more than 700,000 deaths in the United States and 40 million deaths worldwide. As recently as 2019, 690,000 succumbed to the ravages of the disease.
Although more slow acting in its devastation than SARS-CoV-2, HIV continues unabated with no cure in site. Despite 4 decades of efforts to control this disease, some 40,000 Americans, mostly gay and mostly men of color, continue to become infected annually. And unlike the emergence of 3 vaccines to combat COVID-19 in record time, one is left to wonder, why has this same sense of urgency not been directed toward a vaccine for HIV? Most such efforts have resulted in botched results.
I would be remiss to not describe the advances that have been made to combat and control AIDS since the first decade, at which time a culture of blame, confusion, and fear evolved in the United States, akin to what we have witnessed in reaction to the COVID-19 pandemic.
In the last 25 years, HIV/AIDS has been transformed into a chronic, somewhat manageable disease due to the proliferation of antivirals developed by pharmaceutical companies. A person whose infection is detected early and who takes a combination of antiviral treatments, known as ART, every day without missing doses and lives a relatively healthy lifestyle, cannot spread the disease sexually and has a relatively fair possibility of having a somewhat normal life expectancy.
However, this is a hypothetical and ideal scenario, which few with HIV will likely experience, and these treatments are not cures.
Steve was detected to be living with HIV after the advent of ART. Despite his best efforts to control the virus in his body through treatment, exercise, and diet, he was struck down by non-Hodgkin lymphoma, another complication for those living and aging with HIV. Truly, Steve’s death and the death of all those who have succumbed to AIDS indicate that controlling the complications of this pathogen are less well understood and managed than is being portrayed by pharmaceutical companies’ exuberant and promising TV and print ads for ART—particularly among older adults.
My own research has documented the life experiences of those gay men who have been living with HIV for decades who are now seniors. While they continue to survive, few of them fully thrive physically, emotionally, socially, and financially. You see, HIV, like SARS-CoV-2, is caused by a biological agent, but both AIDS and COVID-19 are hardly simply biomedical phenomena.
Both viruses disproportionately impact and overburden marginalized groups like people of color, sexual and gender minorities, older adults, and other populations because of the social and structural underpinnings of these epidemics—a well-known fact to those of us in public health, less well appreciated or reported by those in medicine. It also speaks clearly to how ill prepared we are to address HIV in elderly adults whose lives are already overburdened by myriad other life challenges.
I have long believed that as a country, we know little about how to provide services to a new generation of older Baby Boomers and Gen Xers and near nothing about those who like Steve are over 50 and gay and HIV positive.
In the United States today, more than 50% of those living with HIV are over age 50. This percentage will only continue to grow, mainly due to the existing and evolving pharmaceutical advances. While yes, this can be heralded as an amazing breakthrough—considering all of my 6 other close friends died of AIDS complications in their 30s prior to the advent of ART, including my partner, Robert Massa, who was the AIDS editor of The Village Voice—there is much work to be done.
Aging with HIV is as complex as the physical manifestations of aging, and inflammation due to the virus in one’s body, coupled with the daily bombardment of treatments, leave many susceptible to unknown consequences. I scoff at those who have refused the COVID-19 vaccine fearing its emergency approval will cause long-term damages.
To them I say, “Look at us.” There are people of my generation who take daily doses of medications to simply stay alive and are living a life of experimentation unaware of what these drugs will do in the long run.
During the height of the Trump administration, 6 members of the Presidential Advisory Council on HIV/AIDS resigned in protest of President Donald Trump’s health policies in June 2017, and the remaining 10 members were dismissed by Trump at the end of that year. Although the group was reconvened in 2019, HIV/AIDS has remained relatively ignored by the Biden-Harris administration—understandably so, given the nation’s battle with COVID-19, terrorism due to white supremacy, and the economic burdens caused by an administration that failed to control COVID-19 throughout 2020. But now we are well on our way to controlling that virus in part because we have taken up biological, social, political, psychological, and financial arms to fight it.
The war on HIV/AIDS requires the same arsenal.
As we commemorate the 40 years since AIDS was first detected and we celebrate Pride Month in the United States this June, I call upon President Joe Biden and Vice President Kamala Harris to forge a call to arms to renew our battle against HIV with a focus on HIV and aging.
Many of us would be willing and ready to join the fight so that we truly can bring an end to HIV/AIDS. We want to help people not only survive but to age and thrive, so that millions of others do not have to continue to be retraumatized at the loss of those whom we cherish. Do it for those living with and affected by HIV; do it for our nation; do it for Steve.