1,112 and Counting\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n<\/p>
1,112 and Counting<\/span><\/p>\r\n\r\n by Larry Kramer<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n [first\r\npublished in the New York Native<\/i>, Issue 59, March 14-27, 1983]<\/i><\/span><\/p>\r\n\r\n <\/span><\/i><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n If\r\nthis article doesn't scare the shit out of you, we're in real trouble. If this\r\narticle doesn't rouse you to anger, fury, rage, and action, gay men may have no\r\nfuture on this earth. Our continued existence depends on just how angry you can\r\nget. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n I am writing this as Larry Kramer, and I\r\nam speaking for myself, and my views are not to be attributed to Gay Men's\r\nHealth Crisis. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n I repeat: Our continued existence as gay men\r\nupon the face of this earth is at stake. Unless we fight for our lives, we\r\nshall die. In all the history of homosexuality we have never before been so\r\nclose to death and extinction. Many of us are dying or already dead. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Before I tell you what we must do, let me tell\r\nyou what is happening to us. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n There are now 1,112 cases of serious Acquired\r\nImmune Deficiency Syndrome. When we first became worried, there were only 41.\r\nIn only twenty-eight days, from January 13th to February 9th [1983], there were\r\n164 new cases - and 73 more dead. The total death tally is now 418. Twenty\r\npercent of all cases were registered this January alone. There have been 195\r\ndead in New York City from among 526 victims. Of all serious AIDS cases, 47.3\r\npercent are in the New York metropolitan area. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n These are the serious cases of AIDS, which means\r\nKaposi's sarcoma, Pneumocystis carinii<\/i> pneumonia, and other deadly\r\ninfections. These numbers do not include the thousands of us walking around\r\nwith what is also being called AIDS: various forms of swollen lymph glands and\r\nfatigues that doctors don't know what to label or what they might portend. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n The rise in these numbers is terrifying.\r\nWhatever is spreading is now spreading faster as more and more people come down\r\nwith AIDS. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n And, for the first time in this epidemic,\r\nleading doctors and researchers are finally admitting they don't know what's\r\ngoing on. I find this terrifying too - as terrifying as the alarming rise in\r\nnumbers. For the first time, doctors are saying out loud and up front, \"I\r\ndon't know.”<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n For two years they weren't talking like this.\r\nFor two years we've heard a different theory every few weeks. We grasped at the\r\nstraws of possible cause: promiscuity, poppers, back rooms, the baths, rimming,\r\nfisting, anal intercourse, urine, semen, shit, saliva, sweat, blood, blacks, a\r\nsingle virus, a new virus, repeated exposure to a virus, amoebas carrying a\r\nvirus, drugs, Haiti, voodoo, Flagyl, constant bouts of amebiasis, hepatitis A\r\nand B, syphilis, gonorrhea. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n I have talked with the leading doctors treating\r\nus. One said to me, \"If I knew in 1981 what I know now, I would never have\r\nbecome involved with this disease.\" Another said, \"The thing that\r\nupsets me the most in all of this is that at any given moment one of my\r\npatients is in the hospital and something is going on with him that I don't\r\nunderstand. And it's destroying me because there's some craziness going on in\r\nhim that's destroying him.\" A third said to me, \"I'm very depressed.\r\nA doctor's job is to make patients well. And I can't. Too many of my patients\r\ndie.\" <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n After almost two years of an epidemic, there\r\nstill are no answers. After almost two years of an epidemic, the cause of AIDS\r\nremains unknown. After almost two years of an epidemic, there is no cure. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Hospitals are now so filled with AIDS patients\r\nthat there is often a waiting period of up to a month before admission, no\r\nmatter how sick you are. And, once in, patients are now more and more being\r\ntreated like lepers as hospital staffs become increasingly worried that AIDS is\r\ninfectious. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Suicides are now being reported of men who would\r\nrather die than face such medical uncertainty, such uncertain therapies, such\r\nhospital treatment, and the appalling statistic that 86 percent of all serious\r\nAIDS cases die after three years' time. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n If all of this had been happening to any other\r\ncommunity for two long years, there would have been, long ago, such an outcry\r\nfrom that community and all its members that the government of this city and\r\nthis country would not know what had hit them. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Why isn't every gay man in this city so scared\r\nshitless that he is screaming for action? Does every gay man in New York want<\/i>\r\nto die? <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Let's talk about a few things\r\nspecifically. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about which gay men get AIDS. <\/span><\/p>\r\n\r\n No\r\nmatter what you've heard, there is no single profile for all AIDS victims.\r\nThere are drug users and non-drug users. There are the truly promiscuous and\r\nthe almost monogamous. There are reported cases of single-contact infection. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n All it seems to take is the one wrong fuck.\r\nThat's not promiscuity - that's bad luck. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about AIDS happening in straight people. <\/span><\/p>\r\n\r\n We\r\nhave been hearing from the beginning of this epidemic that it was only a\r\nquestion of time before the straight community came down with AIDS, and that\r\nwhen that happened AIDS would suddenly be high on all agendas for funding and\r\nresearch and then we would finally be looked after and all would then be well. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n I myself thought, when AIDS occurred in the\r\nfirst baby, that would be the breakthrough point. It was. For one day the media\r\npaid an enormous amount of attention. And that was it, kids. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n There have been no confirmed cases of AIDS in\r\nstraight, white, non-intravenous-drug-using, middle-class Americans. The only\r\nconfirmed straights struck down by AIDS are members of groups just as\r\ndisenfranchised as gay men: intravenous drug users, Haitians, eleven\r\nhemophiliacs (up from eight), black and Hispanic babies, and wives or partners\r\nof IV drug users and bisexual men. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n If there have been - and there may have been -\r\nany cases in straight, white, non-intravenous-drug-using, middle-class\r\nAmericans, the Centers for Disease Control isn't telling anyone about them.\r\nWhen pressed, the CDC says there are “a number of cases that don't fall into\r\nany of the other categories.\" The CDC says it's impossible to fully\r\ninvestigate most of these “other category\" cases; most of them are dead.\r\nThe CDC also tends not to believe living, white, middle-class male victims when\r\nthey say they're straight, or female victims when they say their husbands are\r\nstraight and don't take drugs. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Why isn't AIDS happening to more straights?\r\nMaybe it's because gay men don't have sex with them. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Of all serious AIDS cases, 72.4 percent are in\r\ngay and bisexual men. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about “surveillance.\" <\/span><\/p>\r\n\r\n The Centers for Disease Control is charged by\r\nour government to fully monitor all epidemics and unusual diseases. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n To learn something from an epidemic, you have to\r\nkeep records and statistics. Statistics come from interviewing victims and getting\r\nas much information from them as you can. Before they die. To get the best\r\ninformation, you have to ask the right questions. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n There have been so many AIDS victims that the CDC is\r\nno longer able to get to them fast enough. It has given up. (The CDC also had\r\nbeen using a questionnaire that was fairly insensitive to the lives of gay men,\r\nand thus the data collected from its early study of us have been disputed by\r\ngay epidemiologists. The National Institutes of Health is also fielding a very\r\nnaive questionnaire.) <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Important, vital case histories are now being\r\nlost because of this cessation of CDC interviewing. This is a woeful waste with\r\nas terrifying implications for us as the alarming rise in case numbers and\r\ndoctors finally admitting they don't know what's going on. As each man dies, as\r\none or both sets of men who had interacted with each other come down with AIDS,\r\nyet more information that might reveal patterns of transmissibility is not\r\n:being monitored and collected and studied. We are being denied perhaps the\r\neasiest and fastest research tool available at this moment. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n It will require at least $200,000 to prepare a\r\nnew questionnaire to study the next important question that must be answered: How<\/i>\r\nis AIDS being transmitted? (In which bodily fluids, by which sexual behaviors,\r\nin what social environments?)<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n For months the CDC has been asked to begin such\r\npreparations for continued surveillance. The CDC is stretched to its limits and\r\nis dreadfully underfunded for what it's being asked, in all areas, to do.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about various forms of treatment. <\/span><\/p>\r\n\r\n It is very difficult for a patient to find out\r\nwhich hospital to go to or which doctor to go to or which mode of treatment to\r\nattempt. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Hospitals and doctors are reluctant to reveal\r\nhow well they're doing with each type of treatment. They may, if you press\r\nthem, give you a general idea. Most will not show you their precise numbers of\r\nhow many patients are doing well on what and how many failed to respond\r\nadequately. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Because of the ludicrous requirements of the\r\nmedical journals, doctors are prohibited from revealing publicly the specific\r\ndata they are gathering from their treatments of our bodies. Doctors and\r\nhospitals need money for research, and this money (from the National Institutes\r\nof Health, from cancer research funding organizations, from rich patrons) comes\r\nbased on the performance of their work (i.e., their tabulations of their\r\nresults of their treatment of our bodies); this performance is written up as\r\n\"papers\" that must be submitted to and accepted by such\r\n\"distinguished\" medical publications as the New England Journal of\r\nMedicine<\/i>. Most of these \"distinguished\" publications, however,\r\nwill not publish anything that has been spoken of, leaked, announced, or\r\nintimated publicly in advance. Even after acceptance, the doctors must hold\r\ntheir tongues until the article is actually published. Dr. Bijan Safai of\r\nSloan-Kettering has been waiting over six months for the New England Journal<\/i>,\r\nwhich has accepted his interferon study, to publish it. Until that happens, he\r\nis only permitted to speak in the most general terms of how interferon is or is\r\nnot working. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Priorities in this area appear to be\r\npeculiarly out of kilter at this moment of life or death. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about hospitals.<\/span><\/p>\r\n\r\n Everybody's full up, fellows. No room in the\r\ninn.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Part of this is simply overcrowding. Part of\r\nthis is cruel. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Sloan-Kettering still enforces a regulation from\r\npre-AIDS days that only one dermatology patient per week can be admitted to\r\nthat hospital. (Kaposi's sarcoma falls under dermatology at Sloan-Kettering.)\r\nBut Sloan-Kettering is also the second-largest treatment center for AIDS\r\npatients in New York. You can be near death and still not get into\r\nSloan-Kettering. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Additionally, Sloan-Kettering (and the Food and\r\nDrug Administration) requires patients to receive their initial shots of\r\ninterferon while they are hospitalized. A lot of men want to try interferon at\r\nSloan-Kettering before they try chemotherapy elsewhere. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n It's not hard to see why there's such a waiting\r\nlist to get into Sloan-Kettering.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Most hospital staffs are still so badly educated\r\nabout AIDS that they don't know much about it, except that they've heard it's\r\ninfectious. (There still have been no cases in hospital staff or among the very\r\ndoctors who have been treating AIDS victims for two years.) Hence, as I said\r\nearlier, AIDS patients are often treated like lepers.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n For various reasons, I would not like to be a\r\npatient at the Veterans Administration Hospital on East 24th Street or at New York\r\nHospital. (Incidents involving AIDS patients at these two hospitals have been\r\nreported in news stories in the Native.<\/i>) <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n I believe it falls to this city's Department of\r\nHealth, under Commissioner David Sencer, and the Health and Hospitals\r\nCorporation, under Commissioner Stanley Brezenoff, to educate this city, its\r\ncitizens, and its hospital workers about all areas of a public health\r\nemergency. Well, they have done an appalling job of educating our citizens, our\r\nhospital workers, and even, in some instances, our doctors. Almost everything\r\nthis city knows about AIDS has come to it, in one way or another, through Gay\r\nMen's Health Crisis. And that includes television programs, magazine articles,\r\nradio commercials, newsletters, health-recommendation brochures, open forums,\r\nand sending speakers everywhere, including - when asked - into hospitals. If\r\nthree out of four AIDS cases were occurring in straights instead of in gay men,\r\nyou can bet all hospitals and their staffs would know what was happening. And\r\nit would be this city's Health Department and Health and Hospitals Corporation\r\nthat would be telling them.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n · \r\n<\/span><\/span>Let's\r\ntalk about what gay tax dollars are buying for gay men. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Now we're arriving at the truly scandalous. For\r\nover a year and a half the National Institutes of Health has been “reviewing”\r\nwhich from among some $55 million worth of grant applications for AIDS research\r\nmoney it will eventually fund. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n It's not even a question of NIH having to ask\r\nCongress for money. It's already there. Waiting. NIH has almost $8 million\r\nalready appropriated that it has yet to release into usefulness. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n There is no question that if this epidemic was\r\nhappening to the straight, white, non-intravenous-drug-using middle class, it\r\nthat money would have been put into use almost two years ago, when the first\r\nalarming signs of this epidemic were noticed by Dr. Alvin Friedman-Kien and Dr.\r\nLinda Laubenstein at New York University Hospital. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n During the first two weeks<\/i> of the Tylenol\r\nscare, the United States Government spent $10 million to find out what was\r\nhappening. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Every hospital in New York that's\r\ninvolved in AIDS research has used up every bit of the money it could find for\r\nresearching AIDS while waiting for NIH grants to come through. These hospitals\r\nhave been working on AIDS for up to two years and are now desperate for\r\nreplenishing funds. Important studies that began last year, such as Dr. Michael\r\nLange's at St. Luke's-Roosevelt, are now going under for lack of money.\r\nImportant leads that were and are developing cannot be pursued. (For instance,\r\nfew hospitals can afford plasmapheresis machines, and few patients can afford\r\nthis experimental treatment either, since few insurance policies will cover the\r\n$16,600 bill.) New York University Hospital, the largest treatment center for AIDS\r\npatients in the world, has had its grant application pending at NIH for a year\r\nand a half. Even if the application is successful, the earliest time that NYU\r\ncould receive any money would be late summer.<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n The NIH would probably reply that it's foolish\r\njust to throw money away, that that hasn't worked before. And, NIH would say,\r\nif nobody knows what's happening, what's to study? <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Any good administrator with half a brain could\r\nsurvey the entire AIDS mess and come up with twenty leads that merit further\r\ninvestigation. I could do so myself. In any research, in any investigation, you\r\nhave to start somewhere. You can't just not start anywhere at all. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n But then, AIDS is happening mostly to gay men,\r\nisn't it?<\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n All of this is indeed ironic. For within AIDS,\r\nas most researchers have been trying to convey to the NIH, perhaps may reside\r\nthe answer to the question of what it is that causes cancer itself. If\r\nstraights had more brains, or were less bigoted against gays, they would see\r\nthat, as with hepatitis B, gay men are again doing their suffering for them,\r\nrevealing this disease to them. They can use us as guinea pigs to discover the\r\ncure for AIDS before it hits them, which most medical authorities are still\r\nconvinced will be happening shortly in increasing numbers. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n (As if it had not been malevolent enough, the\r\nNIH is now, for unspecified reasons, also turning away AIDS patients from its\r\nhospital in Bethesda, Maryland. The hospital, which had been treating anyone\r\nand everyone with AIDS free of charge, now will only take AIDS patients if they\r\nfit into their current investigating protocol. Whatever that is. The NIH\r\npublishes “papers,\" too.) <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n Gay men pay taxes just like everyone else. NIH\r\nmoney should be paying for our research just like everyone else's. We\r\ndesperately need something from our government to save our lives, and we're not\r\ngetting it. <\/span><\/p>\r\n\r\n <\/span><\/p>\r\n\r\n