Cal Fuller is only one of many caretakers recruited by the Howard Brown Clinic to help the PWAs.
The clinic, named for a Manhattan doctor who publicly acknowledged his homosexuality in 1974, is located on North Halsted Street in a plain brown storefront building. The clinic has also played a major role in recruiting gay men for the MACS epidemiological study.
The director of social services at Howard Brown is Bob Rybicki, a clergyman on special leave. He stresses: ”I think that we need to view the AIDS epidemic as a `we` problem. The parable of Christ reaching out to touch the leper is very instructive. I don`t buy for one minute this talk
about `divine retribution.` If we believe this, then we believe in the
`Divine Avenger.` What does this say about cancer or the Black Plague or the Holocaust? No, God is not wreaking vengeance on the PWAs.”
Rybicki says that Howard Brown needs many more AIDS caretakers, both homosexual and heterosexual. ”Many PWAs,” he said, ”will recover from their first bout of PCP and enjoy a honeymoon period of good health. But when the disease strikes again, they`re usually in big trouble, and that`s when they need help. We need attorneys to help the PWAs draw up wills. We need social workers to help them obtain their Social Security disability checks and their public-aid checks, which are usually their primary means of financial support. We need doctors and nurses to help them with their medical problems. We need sympathetic counselors to listen to their emotional problems. And we need many people who are ”buddies,” who can go out and give them haircuts and help them shop and cook for them and, maybe, help get their cars started on a snowy day. And just be with them.
”We have a paid staff of 12, plus 200 volunteers. To meet the needs of the PWAs, especially as the cases increase, we can easily use 30 paid staff and 1,000 volunteers.”
Dr. Gerald Souci, a staff psychologist at Howard Brown, has counseled 450 gay patients, including some of those enrolled in the MACS study. He says he has also ”silently walked in and out of the funerals of 40 or 50 friends. We`ve had a few suicides, too–jumping or overdoses by people I`ve
counseled.” He is on the verge of tears. ”Hey, you do what you can. . . At least, the pressure is off them now, and they`ve found peace.”
Composing himself, he says: ”What`s needed now is a level-headed approach to educate the straight community, especially IV drug abusers, women and teenagers, about AIDS.
”This is everybody`s problem, and we need to mobilize now, not later. We need millions. For the PWAs, we need more counselors, more support groups, more housing for the homeless and, especially, nursing-home beds for the PWAs who require long-term medical care.
”For the general population, we need educational programs that will motivate people the way the gay community has been motivated. You walk into a gay bar today, and you`ll see posters about `safe sex` and condom machines on the wall. We need the same things in the singles bars.”
Souci continues: ”Back in 1983, we were seeing maybe one new AIDS patient a week; now, it`s more like one a day. But only about 1 of every 4 of our patients at risk choose to know their antibody status. Of those who choose to know, about half have tested positive. Those who test positive are shocked, depressed and suddenly living in a world turned upside down. Those who test negative show a `survivor`s syndrome,` with confusion, guilt and sadness, often wondering, `Why did I escape?`
”Let`s face it: The era of sexual freedom is over. The gay community has done a great job of taking responsibility for its own, and most gays are practicing safe sex. The city is especially indebted to the many gay men who have volunteered to participate in the MACS study. I think that the hysteria has peaked, but with this situation about the Cook County doctor, I`m not so sure. At first there was a lot of bias against the gays and the junkies. Now, I think that it`s mostly benign indifference, but the good news is that there`s a growing number of straight people who are trying to help.
”My message to the straight community is this: Relax,
practice `safe sex` and help us take care of the PWAs. We have many volunteers at Howard Brown who are heterosexual, but we need many more.”
For those PWAs abandoned by everyone, the last stop is Chicago House.
Thom Dombkowski, the executive director of Chicago House, a residence for homeless AIDS patients, on the North Side, says that he is about ”interviewed out.” The media have been besieging him, and his answers come almost reflexively:
”We pay $1,300 a month rent for Chicago House and currently have eight residents–five black, three white– and all are gay or bisexual males. To get into Chicago House, you must be suffering from either AIDS or ARC, be homeless and not be abusing alcohol or drugs. All our residents have been men. We once had a referral for a woman, but she refused to give up a 12-year heroin habit. All residents are required to pay as rent 20 percent of their income, which is usually Social Security or public aid. All have separate rooms, and most are healthy and allowed to come and go as they please. Two are attending a city college. We also have two who are in danger of becoming `couch potatoes,`
doing nothing but watching the soaps all day. To date, we`ve had 25 residents –13 black, 11 white, and one Hispanic. Three have died in the residence and another five have died in the hospital.
”It`s estimated that 10 percent of all Chicago patients with ARC or AIDS are homeless, and we have a waiting list of 10 patients. We rent another building in Chicago with space for three patients, and we`re about to close on a building with another 16 units.
”We assign `buddies` to the residents, and social workers and a visiting nurse come twice a week. We provide televisions and video recorders. We have communal dining, but if a resident wants a Big Mac, he`s on his own. We`ve had a few short-term romantic relationships develop within the house. Since most of our residents come to Chicago House directly from the hospital, their average survival time is about eight months. The biggest ongoing need for Chicago`s AIDS patients is long-term medical care in a nursing home. The unsung heroes are the people at Howard Brown and on the AIDS Service at Cook County Hospital.”
The recitation is over, and Dombkowski leads a tour of the house. Three residents sit in the living room, watching an old movie in black-and-white. On the screen a handsome couple are dancing a torrid tango. The PWAs look on with flat expressions. The tango dancer is slim, but the three PWAs are almost ethereally slim. And, no, they do not want their photos taken.
Dombkowski, who stays abreast of AIDS research, notes that it has been demonstrated that not only can the AIDS virus be spread by needles and by man- to-man sex, but it also has been spread from man to women, from woman to man and, most recently, from woman to woman (through cunnilingus performed on a woman with the virus who was menstruating).
Dombkowski says that he tries to keep barriers between himself and the residents, ”so that I can keep my sanity. It`s very easy to burn out.”
He observes wryly that public-opinion polls indicate that 87 percent of Chicagoans understand the reasons for ”safe sex,” but that 75 percent are doing nothing to achieve it. He adds that most Chicagoans are probably either unaware of the PWAs ”or don`t care.”
The interview is over. Dombkowski is leaving this afternoon for a long-delayed California vacation.
V. The virus at work
The stigma attached to AIDS, although intense, is nothing new.
In the 15th Century the Italians called syphilis the disease of the French, who called it the disease of the Italians. The Germans and the English agreed with the Italians, blaming it on the French. The Dutch, Flemish and Portuguese called it the `Spanish disease,` while the East Indians and Japanese blamed it on the Portuguese. The Persians blamed it on the Turks, the Polish on the Germans and the Russians on the Polish.
The search for a cause centered on morality, not microbes, because the early Europeans lacked the scientific basis of ”contagion,” or infectious agents. Instead, the experts of the day were forced to try to explain the epidemic of syphilis as punishment for blasphemy. The whole sorry saga is covered well in Theodor Rosebury`s classic story of VD, ”Microbes and Morals.”
Syphilis struck at a time when blasphemy and heresy were much more serious crimes than sexual transgressions. Blasphemy threatened the very power of the Catholic Church, and it was an open secret that the popes themselves could not resist the lure of the flesh.
In truth, syphilis was caused by a microbe transmitted by sexual intercourse, and the high-risk behavior associated with syphilis was much the same as the one associated with AIDS–sexual intercourse with multiple partners, of whom one or more might have passed along the infectious agent, the spirochete, Treponema pallidum. At the time of syphilis, however, the forces of the Renaissance were still struggling unsuccessfully to liberate the human spirit from the notion of divine vengeance, and the attempt failed. Humanism lost to Puritanism, the search for a microbe bowed to the forces of morality and it was to take five centuries to find the cure for syphilis:
penicillin.
The scientists battling AIDS do not have 500 years, so they are focusing both on the microbe–HIV–and the morality–educating the public about high-risk behaviors. And the clock is ticking.
Illinois reported 345 cases of AIDS in 1986, and that figure is expected to double for each of the next five years, bringing the year-end 1991 total, if the predictions hold, to just over 11,000. ”The cases we saw in 1986,”
Dr. Phair says, ”only represent what was going on in 1982 and 1983. The cases we will see during the next five years will represent what is going on right now.”
The Institute of Medicine-National Academy of Sciences report concluded,
”The committee believes that over the next 5 to 10 years there will be substantially more cases of HIV infection in the heterosexual population and that these cases will occur predominantly among the population subgroups at risk for other sexually transmitted diseases.” The committee is talking about promiscuous heterosexuals, and it estimated that new AIDS cases in men and women acquired through heterosexual sex will increase from 1,186 in 1986 to a national total of 7,000 in 1991. Unless precautions are taken, the toll could rise higher. The committee added, ”In view of the numbers of people now infected, it is extremely unlikely that the rising incidence of AIDS will soon reverse itself. Disease and death resulting from HIV infection are likely to be increasing 5 to 10 years from now and probably into the next century.”
