WE ARE THE WORLD

4 Decades, 4 Epidemics and the Future

by Lawrence D. Mass, M.D.

— statement for GMHC’s Fall Gala, 9/22/22, at Cipriani 25 Broadway, New York City

— following an Introduction by Andy Humm

Thanks so much, Andy, for your kind words, and for all you do and are.

First, special thanks to former CEO Kelsey Louie for his years of expansive leadership, with its remarkable capstone of bringing Larry Kramer back into the fold of GMHC. Talk about Mission Impossible! I want to also thank Board Chair Jon Mallow, whose personal warmth and media experience are certain to help shape a new era of vision and outreach. And last but most definitely not least, a special shoutout to GMHC Community Relations Director Krishna Stone for her indefatigable spirit and efforts on behalf of everybody!

GMHC has been family to me for more than half my life. As in the rooms of recovery, I may not always remember everyone by name, but individually and together, you have continuously inspired and sustained me. Thanks for all you do and are, GMHC!

Most people know me as the first to report in the press on the epidemic that would later become known as AIDS, and as a co-founder of GMHC. At 76 and now retired, I’m a physician who specialized in addiction medicine.

I’m also a writer — of journalism, of collections and of my own narrative.

Like most writers, I am impelled to tell my own story.

So here in 4 brief acts, is the story of my experience, strength and hope.

WE ARE THE WORLD

4 Decades, 4 Epidemics and the Future

Act I: Bear Soup

For years I wrote a column called “Bears and Health,” covering topics of interest to its readership of mostly middle-aged and heavyset men — diabetes, prostatism, bariatric surgery, depression, HIV, other STD’s and safer sex. At some point, I became known as the “Bear Doc,” something I cherish every time I look at the little statue I was given of a bear sporting a lab coat and stethoscope.

In July I was back in South Florida, where we still have a large and thriving LGBTQ+ community. notwithstanding the current antigay onslaught. The Bears of South Florida (BOSFL) has dinners, holiday parties, movie and bowling nights, most of them charity fundraisers.

As you might expect for Florida, they also have pool parties. One of the really fun things at these events is what we call “Bear Soup.” The pool gets crowded with frisky buds rubbing up against each other…dot…dot…dot…

When two pool parties were announced for late July. I sent a text to my friends in the organization that in view of escalating monkeypox concerns, these events should be re-considered. They cancelled the pool parties, replacing them with a costume contest and bar tour. With successful vaccination outreach, more pool parties are planned.

Act 2: The Great Work Began

What happened with the pool parties harkens back to the early days of HIV/AIDS. Lacking clear directives from public health officials in the absence of knowing with greater certainty whether we were even dealing with an STD, and in a community without civil rights, we erred on the side of caution. Limit the number of partners with whom you have sex and try to make sure they’re healthy. 4 decades later, and with virtually the same words, this was the initial advice from public health officials for monkeypox.

In the play, The Normal Heart, Ned, the Larry Kramer character, talks with his doctor as she examines him. Trying to get her to understand the importance of sex for gay men, he asks her, so what are you asking us to do? Just stop, she says. Just tell them to stop.

From the outset, that was never going to work, any more than Nancy Reagan’s “Just Say No,” ironically the title of Larry’s later farce about the Reagans, was going to resolve epidemics of drug use. From the beginning, people needed more specific information, guidance and resources. Though it would take Larry’s play, more plays, a great activist movement, and decades of AIDS and other epidemics to more fully appreciate, Larry’s outspoken leadership would prove epochal.

Thanks in no small measure to that leadership, we seem more empowered today to state the truth, however messy, to ask for what we need and to take aim when those needs aren’t met. But also to assume greater responsibility for risk reduction. In part, that’s because we now have civil rights, however imperiled anew by anti-science authoritarianism. It’s a plea for civil rights and the legitimization of same-sex partnerships that always concluded my early GMHC booklet, Medical Answers About AIDS. Then, as now, these are essential considerations in the preventive medicine of HIV and other communicable diseases.

Act 3: Cascading Epidemics

While HIV/AIDS was why we first came together and has been the greatest pandemic challenge of our lives and times, some of us sensed from the outset that even HIV/AIDS would find its place in a yet bigger picture of communicable disease and world health. Though the victories we all worked so hard for were a deliverance from what Larry Kramer called a “genocide” of neglect, HIV/AIDS never was and never was going to be a one-shot, one-issue, one-community “art-of-the-deal” deal.

Although the gay community was initially front and center in the early period of AIDS, our relationships to other minorities and to the broader public became evermore forefront. Predictably, outreach challenges to women, to communities of color, to transgender people, to the food insecure, to the poor, to the homeless, to drug addicts, prisoners, immigrants, the elderly and other marginalized peoples are again emergent with monkeypox, as they’ve remained with COVID.

Recently I’ve seen three plays about being black and gay, two of them about living with HIV. One in Two, by Donja R. Love, takes its title from CDC’s 2017 prediction that one of every two black men who have sex with men will eventually become HIV positive. Clearly, successful treatment and prevention with PrEP, now endangered by reactionary politics, give a far from complete picture of where we stand today with HIV/AIDS. Meanwhile, sluggish monkeypox vaccination outreach to men of color who have sex with men, here and internationally, further impedes HIV prevention and treatment efforts.

The epidemic of COVID19 vividly reenacts our journey with AIDS, especially the anti-science denialism discernible at every turn. That was grossly the case with vehement anti-vaxers and anti-maskers, but as well with a broader public that eventually rebelled against these curtailments of our own precious personal freedom to assemble and mingle.

When beloved gay activist Arnie Kantrowitz, my life partner of 40 years, died from complications of COVID earlier this year, I couldn’t help but wonder if our casualness about masking at home was a factor. It seemed a lot easier to blame the more defiant politicians who unquestionably did aggravate COVID spread and preventable deaths, and in the hundreds of thousands.

“Murderers,” Larry Kramer indicted all of us, including himself, for any loosening of our resolve to defend and protect.

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Between the lines of the reticence of public health officials, another message has been discernible: that in addition to health care advocacy, leadership regarding prevention must also come from within the affected communities. Even if restructuring is notably successful in making CDC more efficient and responsive to concerns and needs, community leadership by community representatives will remain imperative. No more than we would any longer expect directives for women to come from all-male bodies or for blacks to come from those that are all-white, would we expect directives to come exclusively from those outside our communities of those affected by HIV/AIDS.

Try to imagine the gay and AIDS communities without Larry Kramer, Peter Staley, Sarah Schulman, Maxine Woolf, Ann Northrop or Andy Humm, to name a few, or without GMHC or ACT UP.

My nephew Max Lockwood, here this eve, organized early runners marathons for AIDS in DC and is working on a project about freedom that uses NYC area statues as touchstones. He was surprised to learn there isn’t a statue of Larry Kramer. Not yet.

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Patterns of evasion and inadequacy in the arena of public and community health persisted with subsequent epidemics. Among the more concerning of these was hepatitis C. Convincing health officials and providers that men who have sex with men should be advised about and tested for hep C has been a consistently uphill battle.

In the wake of anti-science denialism and extremism, still other epidemics are looming, notably of preventable disease and death from the criminalization of reproductive and transgender medicine and care.

Act 4: All The World’s Our Stage

A study from the 2022 international AIDS conference in Montreal showed amazing success in giving prophylactic antibiotics to young men who have sex with men for spiking rates of syphilis, gonorrhea and chlamydia. This is harm reduction at its best. And harm reduction must always be the priority model for working with people to reduce risk and harm, to reach people where they’re at, so as not to lose precious opportunities to bring them into assessment and treatment.

In the bigger picture, however, and along with clarity and activism for our needs for health care services, the time seems right to acknowledge with greater forthrightness that despite treatment and prevention success, higher STD rates persist in men who have sex with men.

As we’re seeing with monkeypox, community spokespersons, recalling the example of Larry Kramer, are now trying to do what Kramer tried to do: speak personally and more directly to the consequences of lifestyle choices that can, however unintentionally, relegate values of risk and responsibility. Going much further out on a limb, as Larry always did, it was his contention that the price we were too often paying was a relegation of love and commitment. Notwithstanding accusations of moralism from every quarter and as well from me — “Larry Blamer,” he was called — Larry’s voice seems once again prophetic. Even as we continue to cherish values of sexual freedom and liberation, hopefully we can nurture an ethic which finds ways to transform what has become a status quo of recurrent STD epidemics to one that is more in partnership with lower rates of infection and risk. In today’s climate of intolerance and civil liberties endangerment, alas, realization of such an ethic will be all the more challenging.

All the world’s a stage in which we can and must all play our parts. That’s the theme of Shakespeare’s ever-popular romantic comedy, As You LIke It, especially in the Public Theater’s most recent, inclusivity-oriented production.

Shakespeare’s Queen was Elizabeth the First. Centuries later, her successor, Queen Elizabeth II, survived the Nazi bombings of England to become one of history’s longest-reigning and most beloved figureheads. In the wake of her passing, we can draw inspiration from her example of grace under fire, of keeping calm and carrying on, even as we recall how it was left to Princess Diana to show compassion for persons with AIDS.

The final episode of Larry Kramer’s collection, Reports from the holocaust, finds him with his sister-in-law having a painful, personal conversation about gay people and AIDS. It’s an indelible image of the personal and the political. It’s this intimate person-to-person outreach we must continue.

We must continue to speak up and out, beginning with those closest to us. For it is we ourselves who are the family, we ourselves who are the people, and we ourselves who are the world. And it is the greater world, with its ever-recurrent tidal waves of fascism, that is more than ever our stage, and our future.

Thank you.

Larry Mass (he/him)