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What HIV Teaches Us About COVID-19


I came out as gay in 1986, the peak of the HIV epidemic. Sometimes this COVID-19 pandemic feels a lot like that.

After leaving my wife and two daughters, I accepted a job as Medical Director of Psychiatry at one of the largest healthcare systems in Iowa. As far as I knew then, only my wife knew about my recently accepted sexual orientation.

This new position required me to serve on a committee appointed to develop the criteria for accepting patients into their new HMO. Physicians from various specialties served on this all-male committee. Like most physician meetings, it began early in the morning before we left to do our clinical work.

I hardly recognized any of the committee members. I had not come out yet, and I had not yet met another gay physician.

The treatment of patients with HIV was expensive, and many were uninsured or underinsured. Well into the meeting, the HMO coordinator who led the session said something like this: I think we discovered a question for the application that will determine if someone is gay so we won’t have to insure them.

One loud and outspoken but valued physician responded in a stage-whisper, What’s the question? Do you like to take it up the ass? Insufficiently-stifled giggles erupted around the room.

But not from me.

The remark paralyzed me. With substantial alimony and child support payments, I needed that job.

* * *

I didn’t feel equal.


HIV was an unknown and invisible enemy. The press and the public spoke of it as a “gay plague.” Televangelists were claiming it was God’s retribution for gay men’s sinfulness.

Perhaps if I’d been following the press more closely during that time, I would have been less surprised by the committee’s response. President Reagan hadn’t mentioned AIDS in public until September 1985, four years after the first case reports.

Historians heavily criticize Reagan for not taking HIV seriously. His press secretary even joked with the press about the fact Reagan had not yet discussed it.

It was not until 1996, in the landmark Romer v. Evans, that the U. S. Supreme Court decided that states could not pass laws that created a class of persons “unequal to everyone else.”

I didn’t feel equal to the other members of that committee.

When my first patient diagnosed with AIDS came to see me, I obsessed about whether it was safe to shake his hand. “Jim” knew of only one possible exposure to the infection.

* * *

During the HIV epidemic, the gay community significantly changed the way they lived. Men were afraid to have sex. Many of the places they met, like bathhouses and cruising areas, were closed or heavily patrolled. Condoms restricted them from flesh on flesh contact, their most potent expression of sexual intimacy.

The LGBT community came together, first in their caring for one another. They created families of choice to replace families that had abolished them. The Lesbian community, mostly untouched by the virus, offered enormous support.

Activists formed organizations like ACT UP to scream in the silence about HIV. I remember walking through Boston Commons, where I saw “Silence = Death” along with a triangle, painted in pink on the sidewalks.

* * *


As I write this, the United States has surpassed 100,000 deaths from COVID-19

The death toll from the pandemic is probably significantly higher than has been reported, because of “excess deaths,” the number of deaths beyond what normally is to be expected for the same period in previous years.

Also as I write this, my Governor, Iowa’s Republican Governor Kim Reynolds, announced she is opening up the state because Iowa “can’t prioritize Iowans’ lives over their livelihoods.” Her speechwriter may regret that comment.

As with HIV, these 100,000 deaths are mostly considered disposable. They are overwhelmingly old people and disproportionately poor, immigrants, and black and Latino. They are unseen and considered by some to be a drain on the economy.

But the disposable idea is wrong. More resources flow from the elderly to the young than the reverse, and immigrants and people of color comprise the infrastructure of our economy. In the same way, the AIDS crisis touched the art world and forever changed art in America.

The virus has emphasized discrepancies between those who have good health care and those who cannot afford it as before.

President Reagan’s failures during the HIV epidemic pale in comparison to President Trump’s. A New York Times article said, “An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.” The President called members of his team “alarmists.”

President Trump was slow to understand the risks and, like Gov. Reynolds, focused instead on protecting the economy.

* * *

We feel mortally threatened by human contact.

Any pandemic raises anxiety levels, but with a consistent lack of leadership and confusing recommendations about dealing with COVID-19, many people are terrified and depressed.

Those who support this administration go about their lives and ignore recommendations about physical distancing and wearing masks. This failure to act accelerates the risk to the most vulnerable and enrages those who are taking precautions.

As with HIV, during the COVID-19 epidemic, we recognize the necessity of physical distance, but we’re tired of it. Individuals experience isolation fatigue. We hunger for touch.

Our bodies need touch. Cam sex in 2020 is the condom of the 1980s. Both prevent exposure to the unseen and undiscoverable virus but fail to satisfy the need for real physical intimacy: no testing, no vaccine, no safety.

When I first learned of the magnitude of the pandemic, I felt paralyzed. I overdosed on Netflix and porn, peanuts and popcorn.

Then I realized that what I was experiencing was grief. I had to cancel my plans to see my daughters’ families in Ohio and Seattle. I wasn’t going to get the hugs from my dominoes group.

I was afraid of dying alone or my husband dying alone with no final hug or goodbye. Machines and monitors, and people in protective equipment would be all that surrounded us. If we were lucky, we might get a voice and a tiny picture on a cell phone.

* * *

Healthy relationships are as essential as vaccines and ventilators for our global recovery.

Recovery, Resilience, and Hope

I began to feel somewhat better after connecting with people I love. And I bought a bicycle, so I could leave the house and enter the world around me without much threat.

I began to think of selfies as a metaphor for a lot of what is wrong with our society. We turn our cameras and desires on ourselves, not on the people and the world around us.

I would like to end this essay with a message of hope.

We will survive this pandemic just as some of us survived the HIV epidemic. We can have a sense of community for this shared experience in the same way HIV brought the LGBTQ community together.

Healthy relationships are as essential as vaccines and ventilators for our global recovery. — Dr. Vivek Murthy, Surgeon General in the Obama Administration.

Connection with us can help us cure the epidemic of loneliness that we have experienced. It will give us resiliency as we learn to work, play and collaborate in a virtual world.

We can once again learn to care for each other instead of ourselves. We can realize that service to others gives us value and purpose and allowing others to help us, all help to build relationships.

We must grieve the loss of goals that we can no longer reach, but this does not prevent us from creating a new purpose.

* * *

Silence = Death

Here’s what I want you to do:

  1. Find something to give your life meaning.
  2. Practice physical distancing but not social distancing.
  3. Give the other person the gift of your full attention.
  4. Embrace solitude by the experience time rather than the measure of it.
  5. Help and be helped.
  6. Give the gift of forgiveness to someone who may not deserve it.
  7. Turn your cam around and experience the world around you.
  8. Be kind and generous to one another.

If we learn from this moment, we will flourish. I am ashamed of my silence in 1986. I will not be silent again. Join me in raising your voice.

Silence = Death

Previously published on “Equality Includes You”, a Medium publication.


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