Clear thinking on AIDS, and about time

Saturday, August 2, 1997

THE VIRUS WITHIN:
Sexual Ecology: AIDS and The Destiny of Gay Men
by Gabriel Rotello
Dutton, 320 pages, $35.95 (Cdn)

Reviewed by
COLMAN JONES

Although AIDS has come to represent the most deadly disease ever spread through sex, syphilis was once capable of evoking the exact same fear and dread, thanks to its ability to lie dormant, undetected, producing hideous and often life-threatening symptoms years later, just like its modern-day counterpart. When penicillin made its debut in the 1940s, the drug's miraculous ability to cure syphilis - at least in its early stages - promised to eradicate the infection, as the rate of reported new cases plummeted to an all-time low.

But the miracle didn't last: By the early 1960s, the incidence of syphilis had shot up again, especially among gay men in the throes of a then-blossoming sexual liberation. The resurgence of the disease had nothing to do with any shortcomings of the drug, however, but instead to the "ecological" aspects of disease - those in which host, parasite, and a range of social and environmental factors all interact to produce the breeding ground for an epidemic. In this case, the explosion of bathhouses and other venues for repeated anonymous sexual encounters provided the spiral-shaped syphilis bacteria a unique opportunity to spread through a vulnerable population, leading to record levels of the disease in gay men by the late 1970s.

It's this analysis of sexual ecology that Rotello, a gay New York journalist and long-time activist, brings to bear on the AIDS epidemic. It's a courageous and long overdue analysis that is sure to inflame the politically correct forces that have constructed AIDS as an "equal opportunity" disease. In his book, Rotello seeks to dismantle this and other cherished myths surrounding AIDS, myths he contends actually hinder the job of bringing this plague to an end. For example, by promoting condoms as the main AIDS prevention strategy, Rotello argues, educators are failing to address a host of other larger factors in gay culture that help propagate the epidemic, from sex clubs to other sexually transmitted diseases to substance abuse.

His treatise will win him few friends, especially among sexual libertarians, who will undoubtedly argue that Rotello is simply adopting the sex-negative morality that gay men have fought so long to overturn, and thereby feeding into the hands of the religious right. But the book is far more than just a simple backlash against sexual excess: As a long time gay activist, Rotello displays a unique understanding of the forces in society that led to the development of modern gay culture. In fact, his main desire is to recreate what he calls a "sustainable gay culture", in which gay men are both sexual and healthy. This will only come about, he argues, if the community squarely faces its own role in providing the fertile soil for the epidemic to take root.

Having spent years researching AIDS from a historical perspective, I found this latest entry in the field both inspiring and at the same time incredibly frustrating: inspiring for its thoughtful overview of the origins of AIDS and its implications for the gay community; frustrating for its pronounced blind spots in the area of science, especially immunology. While Rotello correctly points out that neither AIDS nor HIV are strictly new, he still slavishly adheres to the mainstream assumption that nothing else besides HIV matters, scientifically speaking. In doing so, he sweeps aside huge unanswered questions about possible microbial co-factors, questions that have profound implications for future research - a surprising omission, given his exhaustive review of the various behavioural and sociological factors contributing to the epidemic.

For example, while Rotello argues convincingly that the virus has been present in human populations for centuries, he clings to the commonly-accepted idea that it hid away in small pockets before spreading insidiously across the globe, wreaking havoc along its path. In doing so, he ignores the considerable body of evidence suggesting billions of people may have always carried the virus in a latent, harmless state, without ever falling ill, nor even making the tell-tale antibodies associated with a "positive" HIV test. Indeed, researchers are finding more and more people who can fight the virus off with the same strong cell-based immune response known to provide protective immunity against a variety of viral and bacterial infections.

This finding of widespread "seronegative" exposure and immunity to HIV - which may well constitute the norm - raises fundamental questions about whether the virus is sufficient, in and of itself, to bring about the syndrome, or whether other agents (which may vary between the different risk groups) are needed to set the AIDS process into motion. In fact, it's not clear whether the subsequent immune chaos following activation is caused by HIV itself, or the factor (or factors) that set it off.

In the sexually acquired form of AIDS, one of these factors may be syphilis, ironically enough, a disease to which hundreds of thousands of gay men became repeatedly exposed throughout the 1970s and early 1980s. Rotello notes this frightening statistic, but seems unaware of the major questions being raised over the reliability of the existing methods for diagnosing re-exposure to syphilis. Also unclear is to what extent such syphilitic re-infection itself devastates the immune system (and may always have), perhaps waking up an otherwise inactive HIV in the process.

These questions, of course, are absent from almost all AIDS writings, which reflect a "new virus-new disease" paradigm. Still, it's refreshing to see Rotello point out AIDS is actually a centuries-old syndrome brought into focus by changes in social mores and improved diagnostic tools. He has made an important contribution in setting the current prevention strategies in a broader context and reminding his peers of the dangers of focusing solely on medical solutions while ignoring behavioural aspects. The question now is whether anyone will heed his warning call.

Colman Jones' 1996 radio documentary, Déja Vu: AIDS in Historical Perspective, won a Science in Society Journalism Award from the Canadian Science Writers Association. Jones writes for Toronto's NOW Magazine.