Two plagues: the invisible war zones of HIV/AIDS and opioids

Just about every retrospective on 2017 includes something like this:

Last year, more than 63,600 people died of drug overdoses, up from more than 52,400 in 2015. About two-thirds of overdose deaths — more than 42,200 — were linked to opioids. ... In comparison, ... more than 43,000 died due to HIV/AIDS during that epidemic's peak in 1995...

As a longtime gay San Franciscan, I live with memories of what it was like to live through the HIV plague years -- deaths were all around. When you encountered an acquaintance who looked a little wan, you wondered if he would be the next to go. You'd realize that the house down the block where the neighbors always seemed to be changing was an AIDS residence. Phone poles were covered with flyers for AIDS charity fundraising events. Gay newspapers carried pages of obituaries.

I thought I'd assemble some short notes on the many similarities and the many differences between these two murderous plagues, just to clarify my own thinking.

SimilaritiesIf the current epidemic is intense where you live, I'm sure that you feel as if you are living in a war zone that is invisible to most of your fellow citizens. The gay film historian Vito Russo captured the feeling in 1988:

Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you've lost more of your friends, but nobody else notices. It isn't happening to them. ... No one else seems to be noticing.

Occasionally mainstream media will send a reporter to look into your plight. Each epidemic had archetypal victims whose suffering served as the image of the malady: fags and Haitians with HIV; "left-behind" rural whites today. In each epidemic, there were others, usually poor and dark, caught up in the plague, but a textured human panorama was largely beyond the perceptual capacity of sensational, yet conventional, media. Most of these reporters mean well ... but I would not be surprised if their subjects end up feeling unseen.

In both epidemics, one of the most prominent people who was/is not noticing was/is the president of the United States. Ronald Reagan wouldn't even say "AIDS" for six years as the disease spread, until his buddy, the actor Rock Hudson, succumbed. Donald Trump mentions his epidemic and even appointed a commission to suggest action -- but has done nothing except try to take Obamacare away from people who need treatment for addiction.

And in both epidemics, society at large gawked at the dying and shielded themselves from the horror by believing that the sick people were at fault for their pain. AIDS is a disease, not a sin (we more or less know that now); opioid addiction is a disease (when will we figure that out?)

DifferencesWhen young gay men in Los Angeles, New York and San Francisco started dying around 1979, nobody knew what was killing them. Medical researchers rather quickly realized that finding a cause (it turned out to be a retrovirus transmitted through sex and blood products) and inventing a vaccine (they didn't) might win the scientist who could claim success a Nobel prize (it hasn't). An ugly competition ensued between Dr. Robert Gallo of the National Institute of Health and Professor Luc Montagnier of the Pasteur Institute in France over who had identified HIV (human immunodeficiency virus) first.

It was not until the mid-1990s, that drug treatments were invented, making AIDs a longterm, chronic disease among affluent populations, though poor and marginalized (colored) people still die disproportionately if infected.

Nobody is wondering today what is making people addicted to opioids (pain pills, heroin, and fentanyl) and frequently to overdose. The trajectory of morphine dependency has been known for over a century. And there's not much fame or honor in treating addiction; doctors and others working in the field are still paid less than other health workers.

Because we do understand addiction, we also know a lot about how to treat it. Addiction changes human physiology; drug dependence is a physical condition with secondary mental, social, and emotional symptoms, not a sin. Like high-blood pressure or depression, there are longterm drug treatments that work. But the stigma of addiction (and the cost of treating "unworthy" patients) keeps these treatments unavailable to most addicts.

People with AIDS and their loved ones in the '80s and '90s sometimes came to their suffering with enough relative class, race and economic privilege so that they could fight for their lives, and by extension the lives of the less privileged. AIDS activism demanded research and treatments from sluggish governments and medical institutions. In particular, people with AIDS and their friends became very good at highlighting "innocent" victims -- hemophiliacs, children born with the virus, health workers exposed to infected blood -- whose very existence showed that this was a disease, not some mysterious curse on bad actors.

It's not yet clear what opioid addiction activism would look like. Being strung out is not conducive to protest, though neither is having a collapsing immune system. It's probably the loved ones, the families burying sons, daughters, husbands, and wives, who may emerge as the activists. But they'll have to get over the shame associated with addiction; many families just don't dare to talk about what hit them. Neither did those ornery fags in the '80s either, until speaking out came to seem a matter of life or death.

Sam Quinones' Dreamland gives hints of how opioid activism might emerge. One of the "gateways" to addiction in the heartland (everywhere?) is high school football; young men strive to overcome almost inevitable injuries and easily and "honorably" end up habituated to pills. A few parents have taken the lead in sounding the alarm after a child died of an overdose. And where did those pills and other drugs come from? Albany County (New York State) is suing big pharmaceutical companies for deceptive marketing of their pain killers. This kind of suit has not yet fared well, but this is the sort of effort for which activism can sometimes create a positive environment.

People caught up in the opioid epidemic need to find their version of Vito Russo's proud harangue:

Someday, the AIDS crisis will be over. Remember that. And when that day comes -- when that day has come and gone, there'll be people alive on this earth -- gay people and straight people, men and women, black and white, who will hear the story that once there was a terrible disease in this country and all over the world, and that a brave group of people stood up and fought and, in some cases, gave their lives, so that other people might live and be free.

***In addition to Dreamland, I would strongly encourage anyone wishing to understand the opioid epidemic to follow the journalism of German Lopez at Vox. Lopez has spent the last year learning and growing into this topic. This post would have come out long ago if I had't stopped to read it all -- and that was well worth my time.