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Chapter One

1. WHEN PLAGUES END

The sense of what is real ... the thought if after all it should prove unreal...
--Walt Whitman, Leaves of Grass

FIRST, THE RESISTANCE to memory.

    I arrived late at the hospital, fresh off the plane. It was around 8:30 and there was no light on in my friend Patrick's apartment, so I went straight to the intensive care unit. When I arrived, my friend Chris's eyes were a reddened blear of fright, the hospital mask slipped down under his chin. I went into the room. When I first caught sight of Pat, he was lying on his back, his body contorted so his neck twisted away and his arms splayed out, his hands palm upward, showing the intravenous tubes into his wrists. Blood mingled with sweat in the creases of his neck, his chest heaving up and down grotesquely with the pumping of the respirator, a huge plastic tube forced down his throat. His cold feet poked out from under the bedspread, as if separate from the rest of his body.

    The week before, celebrating his thirty-first birthday in his hometown on the Gulf Coast of Florida, we had swum together in the dark, warm space he had already decided would one day contain his ashes. It was clear that he had known something was about to happen. One afternoon on the beach, he had gotten up to take a walk with his newly acquired beagle, and had glanced back at me a second before he left. All I can say is that, somehow, the glance conveyed a complete sense of finality, the subtlest but clearest sign that it was, as far as he was concerned, over. Within three days, a massive fungal infection overtook his lungs, and at midnight, the vital signs began to plummet.

    I remember walking slowly back to the intensive care room when a sudden rush of people moved backwards out of the room. His brother motioned to the rest of us to run, and we sped toward him. Pat's heart had stopped beating and after one attempt to restart it, we surrounded him and prayed: his mother and father and three brothers, his boyfriend, ex-boyfriend and a handful of close friends. When the priest arrived, each of us received communion. I remember I slumped back against the wall at the moment of his dying, reaching out for all the consolation I had been used to reaching for--the knowledge that the worst was yet to come, the memory of pain survived in the past--but since it was happening now, and now had never felt so unavoidable, no relief was possible.

    Perhaps this is why so many of us have found it hard to accept that this ordeal may be over. Because it means we may now be required to relent from our clenching against the future and remember the past.

IF I COULD PINPOINT a moment when the reality sunk in for me, it was a summer evening in 1996. I was at the July 30 meeting of something called the Treatment Action Group, an AIDS activist organization, in Manhattan. In its heyday, in the early 1990s, this group had lived and breathed a hard-edged skepticism. They were, after all, the no-nonsense successors to the AIDS action group, ACT UP. But as soon as I arrived--for a meeting to discuss the data presented at a recent AIDS conference--I could sense something had changed. Even at eight o'clock, there was a big crowd--much larger, one of the organizers told me, than the regular meetings. In the middle sat David Ho, a pioneering AIDS researcher, and Marty Markowitz, the doctor who had presided over some of the earliest clinical trials of the new "combination therapy" for HIV infection. As the crowd stared at them and they stared nervously back, the two scientists interspersed their whispers to one another with the occasional, gleeful smile.

    The meeting began with a blur of data. Ho and Markowitz detailed again what had already hit the headlines: how, in some trials of patients taking the new protease inhibitors used in combination with older AIDS drugs, the amount of virus in the bloodstream had been reduced on average by between a hundred- and a thousand-fold. Within a few weeks of treatment with the new drugs, they elaborated, levels of up to six million viral particles in a milliliter of a patient's blood had been reduced to below four hundred in most cases. That is, no virus could be found on the most sophisticated tests available. And, so far, the results had lasted.

    When Ho finished speaking, there was, at first, a numbed silence. And then the questions followed, like firecrackers of denial. How long did it take for the virus to clear from the bloodstream? What about the virus still hiding in the brain or the testes? What could be done for the people who weren't responding to the new drugs? Was there resistance to the new therapy? Could a new, even more lethal viral strain be leaking out into the population? The answers that came from Ho and Markowitz were just as insistent. No, this was not a "cure." But the disappearance of the virus in the bloodstream was beyond the expectations of even the most optimistic of researchers. It was likely that there would be some impact on the virus--although less profound--in the brain or testes, and new drugs were able to reach those areas better. And since the impact of the drugs was so powerful, it was hard for resistance to develop because resistance is what happens when the virus mutates in the presence of the drugs--and there was no virus detectable in the presence of the drugs.

    The crowd palpably adjusted itself; and a few rusty office chairs squeaked. These were the hard-core skeptics, I remember thinking to myself, and even they couldn't disguise what was going through their minds. There were caveats, of course. The latest drugs were very new, and large studies had yet to be done. There was already clinical evidence that a small minority of patients, especially those in late-stage disease, were not responding as well to the new drugs and were experiencing a "breakout" of the virus after a few weeks or months. Although some people's immune systems seemed to recover, others' seemed damaged for good. The long-term toxicity of the drugs themselves--their impact on the liver and heart, for example--could mean that patients might stage a miraculous recovery at the start, only to die from the effects of treatment in later life. And the drugs themselves were often debilitating. After testing positive in 1993, I had been on combination therapy ever since. When I added the protease inhibitors in March of 1996, the nausea, diarrhea, and constant fatigue had been overwhelming.

    But I remember that meeting all too vividly now, and the simple, unavoidable future it presaged. The next day, in a friend's apartment, I spoke the words I never believed I would speak in my lifetime. "It's over," I said. "Believe me. It's over."

MOST OFFICIAL STATEMENTS about the disease, of course--the statements by responsible scientists, by AIDS activist organizations, by doctors--do not concede that the plague is at an end. And, in one vital sense, obviously it's not. In the time it takes you to read this sentence, someone somewhere will be infected with HIV. Worldwide, the numbers affected jump daily--some 30 million human beings at the latest estimate. Almost all of these people--and a real minority in America--will not be able to have access to the treatments now available. And many, many of these people will still die. Nothing I am saying here is meant to deny that fact, or to mitigate its awfulness. I am not saying here (nor would I ever say) that some lives are worth more than others, or that some lives are worth more attention than others. To speak of the experience of some is not to deny the experience of others or to deny its importance. But it is not illegitimate to speak of what you know, while conceding a large part of what you do not know. And there is a speciousness to the idea that what is true is somehow untrue because it isn't everything.

    So I do not apologize for the following sentence. It is true--and truer now than it was when it was first spoken, and truer now than even six months ago--that something profound in the history of AIDS has occurred these last two years. The power of the new treatments and the even greater power of those now in the pipeline are such that a diagnosis of HIV infection in the West is not just different in degree today than, say, in 1994. For those who can get medical care, the diagnosis is quite different in kind. It no longer signifies death. It merely signifies illness.

    This is a shift as immense as it is difficult to grasp. So let me make what I think is more than a semantic point: a plague is not the same thing as a disease. It is possible, for example, for a plague to end, while a disease continues. A plague is something that cannot be controlled, something with a capacity to spread exponentially out of its borders, something that kills and devastates with democratic impunity, something that robs human beings of the ability to respond in any practical way. Disease, in contrast, is generally diagnosable and treatable, with varying degrees of success; it occurs at a steady or predictable rate; it counts its progress through the human population one person, and often centuries, at a time. Plague, on the other hand, cannot be cured, and it never affects one person. It affects many, and at once, and swiftly. And by its very communal nature, by its unpredictability and by its devastation, plague asks questions disease often doesn't. Disease is experienced; plague is spread. Disease is always with us; plagues come and go. And some time toward the end of the millennium in America, the plague of AIDS went.

    You could see it in the papers. Almost overnight, toward the end of 1996, the obituary pages in the gay press began to dwindle. Soon after, the official statistics followed. Within a year, AIDS deaths had plummeted 60 percent in California, 44 percent across the country as a whole. In time, it was shown that triple combination therapy in patients who had never taken drugs before kept close to 90 percent of them at undetectable levels of virus for two full years. Optimism about actually ridding the body completely of virus dissipated; what had at one point been conceivable after two years stretched to three and then longer. But even for those who had developed resistance to one or more drugs, the future seemed tangibly brighter. New, more powerful treatments were fast coming on-stream, month after month. What had once been a handful of treatment options grew to over twenty. In trials, the next generation of AZT packed a punch ten times as powerful as its original; and new, more focused forms of protease inhibitor carried with them even greater promise. It was still taboo, of course, to mention this hope--for fear it might encourage a return to unsafe sex and a new outburst of promiscuity. But, after a while, the numbers began to speak for themselves.

    It remains true, however, that anyone who even understood the minimal amount of the science could have predicted these figures as early as 1995. By that steamy summer night in 1996, the implications were unavoidable, and you could sense it in the air. After the meeting, as we spilled out into the street, a slightly heady feeling wafted over the crowd. A few groups headed off for a late dinner, others to take their protease drugs quickly on an empty stomach, others still to bed. It was after ten o'clock, and I remember wandering aimlessly into a nearby bar, where late-evening men in suits gazed up at muscle-boy videos, their tired faces and occasional cruising glances a weirdly comforting return to normality. But as I checked my notebook at the door and returned to the bar to order a drink, the phrase a longtime AIDS activist had spoken to me earlier that day began to reverberate in my mind. He'd been talking about the sense of purpose and destiny he had once felt as part of his diagnosis. "It must be hard to find out you're positive now," he had said, darkly. "It's like you really missed the party."

AT SIX O'CLOCK in the morning in Manhattan's Roseland Ballroom, the crowds were still thick. I'd arrived four hours earlier, after a failed attempt to sleep beforehand. A chaotic throng of men crammed the downstairs lobby, attempting to check coats. There were no lines as such, merely a subterranean, almost stationary mosh pit, stiflingly hot, full of inflated muscular bodies, glacially drifting toward the coat-check windows. This was, for some, the high point of the year's gay male social calendar. It's called the Black Party, one of a series of theme parties held year-round by a large, informal group of affluent, mainly white, gay men and several thousand admirers. It's part of what's been dubbed the "circuit," a series of vast, drug-enhanced dance parties held in various cities across the country, and now a resilient, if marginal, feature of an emergent post-AIDS gay urban "lifestyle."

    Until the late 1990s, almost nothing had been written in the mainstream media about these parties, except when they had jutted their way into controversy. A new circuit party, called "Cherry Jubilee," in Washington, D.C., incurred the wrath of Congressman Robert Dornan for tolerating drug use in a federal building leased for the event. The annual Morning Party in August in Fire Island, held to raise money for Gay Men's Health Crisis in New York, was criticized on similar grounds by many in the gay world itself. But slowly, the proliferation of these events (they numbered at least two a month in cities as diverse as Miami and Pittsburgh) became impossible to ignore, and the secrecy that once shrouded them turned into an increasingly raucous debate on the front pages of newspapers across the country. Despite representing a tiny sub-subculture and dwarfed, for example, by the explosion of gay religion and spirituality in the same period, the parties seemed to symbolize something larger: the question of whether, as AIDS receded, gay men were prepared to choose further integration, or were poised to leap into another spasm of libidinal pathology.

    The Black Party, like all such events, was made possible by a variety of chemicals: steroids, which began as therapy for wasting men with AIDS, and became a means to perpetuate still further the cult of bodybuilding; and psychotherapeutic designer drugs, primarily Ecstasy, ketamine (or "Special K"), and "crystal meth." The whole place, without this knowledge, could be taken for a mass of men in superb shape, merely enjoying an opportunity to let off steam. But underneath, there was an air of strain, of sexual danger translated into sexual objectification, the unspoken withering of the human body transformed into a reassuring inflation of muscular body mass.

    I had never known these events in their heyday, in the late 1970s and early 1980s. Begun in a legendary disco in Manhattan, the Saint, they had mesmerized an entire generation of homosexual urbanites. I was taken to one in the mid-1980s, as the plague had begun to descend, but even then, its effects were hard to determine. What you saw was an oasis of astonishing masculine beauty, of a kind our society never self-consciously displays in the open. I remember feeling at first a gasp of disbelief, a sense that, finally, I was surrounded by visions that had once only existed in my head. These people were not boys, they were men. And they were not merely men, they were men in the deepest visible sense of that word, men whose muscular power flickered in the shadows, men whose close sweat and buzzed hair and predatory posturing intimated almost a parody of the masculine, men whose self-conscious sexuality set them apart from the heterosexual world--and indeed from the homosexual world outside the hallowed precepts of this space. What would the guardians of reality think, I remember asking myself, if they could see this now, see this display of unapologetic masculinity, and understand that it was homosexual?

    The critics of these events have predictably lambasted this glorification of the masculine. They have seen in it an echo of the gender oppression directed by straight men against gay men and lesbians and heterosexual women, an appropriation by homosexuals of the very male supremacy that stigmatizes and marginalizes them. And indeed, in the darkness of that night there was an unmistakably Darwinian element to the whole exercise. While the slim and effeminate hovered at the margins, the center of the dance floor and the stage areas were dedicated to the most male archetypes, their muscles and arrogance like a magnet of self-contempt for the rest. But at the same time, it was hard also not to be struck, as I was the first time I saw it, by a genuine, brazen act of cultural defiance, a spectacle designed not only to exclude but to reclaim a gender, the ultimate response to a heterosexual order that denies gay men the masculinity that is also their own.

    And much of it was not merely playacting. To be sure, if you looked around, you saw an efflorescence of masculine symbolism that was as strained as it was crude. Thick torsos, bull necks, and ribbed abdominals were draped with the paraphernalia of the archetype: leather, sports clothes, sneakers, tank tops, tattoos. But behind it, a more convincing affect: beyond the dancing and socializing, a kind of circling, silent interaction, a drifting, almost menacing, courtship of male brevity and concision. It was raw male sexuality distilled, of a kind that unites straight and gay men and separates them from women: without emotion, without knowledge, without apparent weakness, armored with testosterone and an almost marblelike hardness of touch.

    There was a numbness to it, as well. The first few times I went to these events, I made an elementary mistake of trying to engage my fellow partiers, of trying to catch their eyes or strike up conversation. But they were anesthetized, almost as if this display was only possible by distancing themselves from their mental being, pushing themselves into a drug-induced distance from their minds and others', turning their bodies into images in a catalogue whose pages they turned, in a bored, fitful trance. And as the night stretched into morning, and as the drugs reached their peak in the bloodstream of these masses, the escape became more complete, the otherness more perfect, the paradox of reclaiming their selves more intense as the outside world got up, made coffee, and busied itself about the day. I remember once leaving one of these parties at 11:30 in the morning, a dark, cavernous blur of flesh and body still imprinted on my mind when, in an instant, we were thrust out onto the streets of Manhattan, unthinking strangers walking briskly past in the bright whiteness of a cloudy morning. None of this, I felt, cared for us; none of it even knew of us. Which was both a thoroughly depressing and energizing thought.

    What these events really were not about, whatever their critics have claimed, was sex. And as circuit parties intensified in frequency and numbers in the 1990s, this became more, not less, the case. When people feared that the ebbing of AIDS would lead to a new burst of promiscuity, to a return to the 1970s in some mindless celebration of old times, they were, it turns out, only half right. Although some bathhouses revived, their centrality to gay life all but disappeared. What replaced sex was the idea of sex; and what replaced promiscuity was the idea of promiscuity, masked, in the burgeoning numbers of circuit parties around the country, by the ecstatic high of drug-enhanced dance music. These were not merely mass celebrations on the dawn of a new era; they were raves built upon the need for amnesia.

    They were, of course, built on drugs. And the kind of drugs was as revealing as the fact of them: Ecstasy, a substance that instantly simulated an intimacy so many men found almost impossible to achieve, and an exhilaration they could not otherwise allow themselves to feel; ketamine, a powder that tipped them into an oblivion a part of them inwardly craved; crystal meth, a substance that gave them an endurance and power they hadn't yet been able to attain for real; and anabolic steroids--literally, injected masculinity--providing an illusion of male self-confidence where far too little of it existed for real. These drugs are illusions--pathetic, debilitating--and also telling illusions. They are rightly seen as the antithesis of the new era of responsibility and maturity the end of AIDS actually promised. But they are also, perhaps, merely the cheapest version of such an era, lasting hours, not decades, and bought with money, not life.

    In the circuit parties you see perhaps the double-edged nature of a segment of gay male sexuality as clearly as anywhere else: the physical shallowness and emotional cowardice, the cult of youth, and the longing for masculinity; but also the desperate need for belonging, for support and reassurance, above all for intimacy, for a world which can offer gay men, if only they could seize it, the chance for the emotional reality which this spectacle of alienation merely intimated and postponed.

    As the early morning stretched on, my friends and I stood in the recess of a back bar as the parade of bodies passed relentlessly by. Some of them glided past, intent on some imminent conquest; others stumbled toward me, eyes glazed, bodies stooped in a kind of morbid stupor, staring at the floor or into space; others still stood in corners, chatting, socializing, their arms draped around each other, a banal familiarity belying the truly bizarre scene around them. Beyond, a mass of men danced the early morning through, strobe lights occasionally glinting off the assorted deltoids, traps, lats, and other muscle groups. At the party's peak--around 7 a.m.--there must have been around six thousand men in the room, some parading on a distant stage, others locked in a cluster of rotating pectoral muscles, embracing each other in a drug-induced emotional high. And then the habitual climax, the sound of the Black Party's signature song, "Left to My Own Devices," a gay elegy of longing and detachment, descended on the scene:

I could leave you,
Say Goodbye.
I could love you,
If I tried.
And I could.
And left to my own devices, I probably would.

    And as the music pounded, and the men swarmed closer together, and the posture of maleness and intimacy melded into one hazy blur of movement, I found myself moving quietly away. For a group of men who had just witnessed a scale of loss normally visited only upon war generations, it was a curious spectacle. For some, I'm sure, the drugs helped release emotions they could hardly address alone or sober; for others, the ritual was a way of defying their own infections, their sense of fragility or guilt at survival. For others still, including myself, it was a conflicting puzzle of impulses. The need to find some solidarity among the loss, to assert some crazed physicality against the threat of sickness, to release some of the toxins built up over a decade of constant stress. Beyond everything, the desire to banish the memories that will not be banished, to shuck off--if only till the morning--the maturity that plague had brutally imposed.

    But even so, I couldn't be among them. It was too much to experience--at least, not together.

[CHAPTER ONE CONTINUES ...]