JUNE 14, 2001


by Gary R. Cohan, M.D. from the Advocate

It’s been 20 years since it began, and now the holocaust of AIDS is threatening to decimate a new generation of gay men—not to mention the continent of Africa. How can we not have learned better by now?

I am a 40 year-old Jewish doctor, and I have spent my entire professional career fighting AIDS. From the earliest days of the pandemic, when, as a medical student, I witnessed frightened hospital staff sliding food trays under the doors of dying AIDS patients, to the present era, when we view HIV as a manageable chronic infection, it appears as if everything has changed. Those frail, skeletal, purple lesion–covered figures once seen hobbling down Los Angeles’s Santa Monica Boulevard have been replaced with robust, vibrant, productive people. 

A generation ago, we dreamed of the day when AIDS would no longer take so much from us—our innocence, our loved ones, our hope. That day arrived in our community in 1996 with the advent of protease inhibitors and their unprecedented ability to stabilize the AIDS virus. And what have we done with this remarkable opportunity? Unfortunately, the answer is “not much.” 

Ever since my bar mitzvah (in 1973), I’ve been fascinated by the social and political forces underpinning World War II’s Holocaust. In Nazi Germany specific groups of socially dispossessed human beings were randomly targeted for extermination by a ruthless, efficient killing machine. The politics of hate and indifference fueled the devastation. The world reeled in horror only when the true extent of these crimes against humanity was brought to light after the liberation of Europe’s concentration camps. A short 50 years later, the unthinkable has happened—people are denying that the Holocaust ever happened. Hate groups are once again flourishing worldwide and spreading rapidly via the Internet. Human nature tends to have a very short memory, even for the most heinous of events. 

The parallels to the modern AIDS saga are remarkable. Twenty years after the devastation began, new infections in the United States are on the rise, nearly to levels seen at the beginning of the pandemic. The Centers for Disease Control and Prevention reported last week that 14.7% (one in seven) minority gay men age 23 to 29 become HIV-positive each year. The young, the poor, women, children, and minorities are being hit hardest. 

Where is our horror and indignation? Where are the impassioned speeches? What ever happened to safer-sex campaigns? Where are the celebrities wearing red ribbons at every awards event? Why are our community leaders and politicians so silent? What became of our tearful promises to the loved ones that perished from AIDS that “never again” would we allow something so preventable to kill our own people? It seems as if the freight trains from our inner-city ghettos to the Auschwitz of AIDS are running full speed and we are doing precious little to stop them. 

Those of us who witnessed the long nightmare of the pre-1996 AIDS pandemic are scratching our collective heads and asking ourselves, Why is this happening again? Are we doomed to repeat this nightmare with every new generation? While it is clear that recreational drug use and the arrogance and ignorance of youth have a role to play, there must be something more fundamental at work here. Has AIDS just become “yesterday’s news”? Has the newfound health of previously dying people given us a false sense of security? Have we all moved on to care more about AIDS in Africa than at home? Are the currently fashionable, more fund-raiser-friendly conditions du jour—like breast cancer and Alzheimer’s—blinding us to the continuing grim statistics of the domestic HIV pandemic? Have the pharmaceutical industry’s advertisements for HIV medications portraying AIDS patients with healthy, bright-faced models numbed us to the uglier realities of living with HIV infection? 

In the harrowing tale of his concentration camp experience, Night, Holocaust survivor and Nobel Prize laureate Elie Wiesel invoked the mantra “Never shall I forget.” It has since become a watchword for the modern human rights movement. As a society, we have committed to remember World War II’s extreme example of man’s inhumanity to man and to combat future atrocities with ever-present reminders such as books, Web sites, feature films, public school education, antidefamation organizations and permanent Holocaust memorials around the world. A beautiful, moving, but infrequently displayed quilt is no substitute for a comprehensive effort on our part. History demonstrates that unless people are reminded constantly of their past mistakes, they are, in George Santayana’s words “condemned to repeat” them. 

On June 5, 2001, we marked the 20th anniversary of the landmark report that my colleagues in Los Angeles sent to the Centers for Disease Control in Atlanta, chronicling the first five cases of something going horribly wrong with the immune systems of young, otherwise healthy gay men. Two decades later we are faced with an eerily similar set of social forces that fueled the firestorm of the 20th century’s AIDS pandemic: ignorance, unprotected sex, prejudice, complacency, poverty, and recreational drug use. The difference this time is that we have no excuse for new HIV infections. We should know better. Yet because people have forgotten, more will suffer and die. The threat of a cyclically recurring nightmare of AIDS has become quite real. It calls out for our unwavering vigilance and our undivided attention, if we care to listen. 

Anne Frank’s May 3, 1944, entry in The Diary of a Young Girl argues that the individual bears much responsibility for the evils of this world. She wrote, “I don’t believe that the big men, the politicians and the capitalists alone, are guilty of the war. Oh no, the little man is just as guilty; otherwise the peoples of the world would have risen in revolt long ago.” Her words still ring true in the 21st century. If we fight our own ambivalence and embrace the fact that each of us can truly make a difference, then we may overcome. I challenge every person in our community to rededicate themselves to five basic principles: 


• Respect yourself and those around you.

• Behave responsibly and set a good example for our youth.

• Educate yourself, remember our past missteps, and share the knowledge.

• Volunteer, fund-raise, reach out, and become an activist.

• Advocate for those who can’t speak for themselves. 

Simple concepts they may be, but so critical are they to our health and the future success of our people that they bear repeating as a mission statement for every generation to come. Maybe then we won’t find ourselves in another 20-year cycle of death and disease. And maybe then we can take comfort that the memories of those whose lives were cut short by the first wave of the pandemic have been honored. 

Dr. Cohan is a physician in Los Angeles.