Another bioterrorist - my perspective - Brief Article

Imagine a biological agent that kills its victims with stealthy efficiency, threatening to kill tens of millions, topple governments, and wipe out generations. It's not anthrax, which can be cured with readily available antibiotics and is not spread from human to human. Smallpox? I'm afraid not, since a vaccine was invented decades ago. No, this ultimate killer weaves its genetic material into its victims' cells and doesn't let go until death. It uses humans as sexual suicide bombers and makes unwitting victims of otherwise upstanding citizens.

I'm talking about HIV. The problem is, nobody seems to be listening.

I am a 41-year-old Jewish doctor who grew up being taught all about the Nazi Holocaust. I took away a profound life lesson: When good people remain silent in the face of great evil, evil destroys.

I have spent my entire career fighting AIDS. As a medical student in the 1980s, I saw frightened hospital staffers sliding dinner trays under the doors of dying AIDS patients. Now protease inhibitors have given us an unprecedented ability to stabilize HIV disease, and we view AIDS as a manageable chronic infection. Yet what have we done with this remarkable opportunity? Unfortunately, the answer is, Not much.

In the past nine months I have witnessed a growing stream of middle-aged professional gay men--men who had for years kept the safer-sex flame alive--come to my office with gonorrhea, syphilis, and new HIV infections. When I ask "What happened?" the reply is always the same: "I wasn't thinking."

Gay men are now becoming HIV-positive at rates not seen since the mid 1980s. Party drugs, sex clubs, barebacking, and multiple partners are all the rage, indulgences fueled by cruising for sex on the Internet.

Where is our horror and indignation? Why are our community leaders so silent? What became of our tearful promises to lost loved ones that we would "never again" allow something so preventable kill our own people? The freight trains from our metropolitan gay communities to the Auschwitz of AIDS are running full speed, and we are doing precious little to stop them.

Every time my medical partners and I diagnose HIV in yet another gay man who should have known better, we scratch our heads. Is every generation doomed to repeat this nightmare? Drug use and the arrogance of youth cannot explain it away. There must be something more fundamental at work.

Has the newfound health of previously dying people given us a false sense of security?. Have pharmaceutical ads--with fit, bright-faced models portraying AIDS patients--numbed us to the uglier realities of living with HIV infection? Do we care more about blundering bioterrorists than the mass destruction that HIV continues to wreak upon us? Or have HIV and AIDS just become yesterday's news?

Whatever the cause of our complacency, we would be wise to invoke the mantra of Holocaust survivor Elie Wiesel: "Never shall I forget." Twenty years ago we first recognized what we now call AIDS among otherwise healthy young gay men. But today, our community faces an eerily similar social backdrop: ignorance, unprotected sex, prejudice, complacency, poverty, drugs. The difference is, this time we know better.

Yet if we embrace the fact that each of us truly can make a difference, we may overcome. I challenge each of us to rededicate ourselves to five basic principles:

* Respect yourself and those around you.

* Behave responsibly and set a good example for our youth.

* Educate yourself, remember our past missteps, share the knowledge.

* Become an activist: Volunteer, fund-raise, reach out, show up.

* Advocate for those who can't speak for themselves.

Simple concepts these may be, but so critical are they to our health and the future success of our people that they bear adoption as a mission statement for every generation. Only then can we take comfort that we are honoring the memory of those whose lives were cut short by the first wave of the epidemic.

Cohan is a board-certified internist and HIV specialist with Pacific Oaks Medical Group in Los Angeles.

COPYRIGHT 2001 Liberation Publications, Inc.
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