Hold Tight Gently (18 page)

By 1985, Mike felt compelled to conclude that going to a bathhouse seemed like “a highly suspect act of suicide.” Didn’t police (the state) have the right, or even the duty, he asked, to interfere if someone was about to jump off the Brooklyn Bridge, to coax someone down with smooth arguments about how different tomorrow might look, how hopeful new options might present themselves? Yet he doubted if that was a true equivalent. Suicidal moods can pass, but a fatal disease doesn’t cease to be a killer over time. If people could be informed about the deadly risks of the baths and make their own decisions, that would be one thing, but what if you couldn’t disseminate the pertinent literature, or if people chose to ignore it?

Earlier, when Mike had asked one of the men he encountered at the Club Baths if he wasn’t afraid of getting AIDS, the man had calmly replied, “No, I can tell by looking at someone if they’ve got it.” With
foolish attitudes like that around, Mike for a time went back and forth in a painful internal debate about the tricky issue of bathhouse closure. He felt it was a judgment call for which no simple answer existed. In the upshot, the city decided that bathhouses could remain open—but only if they complied with strict regulations about the availability of condoms and information. Only four out of fifteen were still operating at the end of 1985. Mike blamed the bathhouse owners in New York (in contrast to those in San Francisco) for failing “to take any initiative in educating their patrons” and also held GMHC accountable for conducting fund-raising events—but not educational forums—in the notorious orgy bar the Mineshaft.
¹²

As early as 1983 the French scientist Luc Montanier had announced his discovery that a virus—for a time referred to by various names, but which by 1986 had consolidated into HIV—was the likely culprit in depressing the immune system and opening the body to the multiple “opportunistic” infections known as AIDS. The noted and controversial American retrovirologist Dr. Robert Gallo soon after named himself as the discoverer of the virus and a series of complex charges and countercharges followed, with most scientists giving the palm to Montanier. In any case, the discovery of HIV would, on its face, seem to put an end to Sonnabend’s multifactorial theory about the origin of AIDS. Gallo in 1988 denounced the notion of co-factors as “cock and horseshit . . . baloney,” and Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, acknowledged that co-factors “might enhance the expression of HIV” but unequivocally insisted that “HIV is the answer.”

Neither Joe Sonnabend nor Mike agreed. As Sonnabend later put it, “I’d been trained in a view of health and disease that had gone out of fashion by the time this hit. In my day, we were taught to look at disease not simply as something caused by a germ—there are many other factors that affect one’s immunity and the ability to handle infectious diseases.” Not only did Sonnabend feel that ascribing
the
cause of AIDS to a single virus was simplistic, but he also felt that the readiness to believe in a sexually transmitted “killer virus” was due to the theory’s political and psychological appeal to many different constituencies: “People who like ‘family values,’ people who hate gay men,
prostitutes and junkies, people who love to think that extramarital sex can kill. Some gay men liked it, too, because it deflected attention from all the sex taking place in the bathhouse scene.” Of course the fact that a particular theory “appealed” to many people has no bearing on its validity, only on the degree to which it is widely accepted or rejected.
¹³

Nearly a decade later, Mike conducted two interviews with Sonnabend for the declared purpose of trying “to pin him down about where he stands on the question of HIV.” But Mike found him “as usual . . . slippery . . . certainly he’s been more willing lately to at least speak the language of HIV” and to agree that it might well be
a contributing factor
. But Sonnabend was also insistent that in Europe and the United States (Africa is another—still not well understood—matter) “it’s very hard for a man to get this disease from women. Women
are
at risk—not from heterosexual men who aren’t drug users, but from bisexual men and from men who use intravenous drugs.” Sonnabend also contended that there was no convincing evidence of woman-to-woman transmission, and the scientific data bore him out: of the seven reported instances in 1993, mitigating circumstances—usually IV drug use or sex with men—were present in all cases but one. And the scientific and community data verified that “VERY, VERY few lesbians practice safe sex with any rigor,” which theoretically should have led to many more cases of AIDS among them.

Sonnabend continues to this day to insist on “the complexity of what causes disease.” In his view, “there are many more people infected with HIV than people who have AIDS”—as well as some AIDS patients who don’t test positive for HIV. Thus, “genetic factors, genetic susceptibility does exist, even with HIV. . . . [Also,] the presence of other diseases can influence it. . . . All infectious disease, including HIV, is multifactorial.” In his words, “infection may have a single cause—HIV causes HIV infection. Measles virus causes measles infection. Polio virus causes polio infection. Once infected the next step is the disease. Not everybody infected . . . becomes sick. It’s called the attack rate. Whether you get sick seems to depend on the organism, the dose, the way it gets into you, the presence of other diseases and also on environmental, nutritional and genetic factors. The only disease that I’m aware of that has an attack rate approximating 100 percent is rabies.” Sonnabend has never said that there wasn’t a new agent at
work in producing the disease of AIDS, nor has he ever said that the purported new agent was harmless or didn’t exist. “I have no doubt that HIV plays a role in this disease,” he acknowledges; “it’s the necessary but not sufficient cause insofar as cause is defined as a single agent.” As regards disease, he continues to believe (as do others) that AIDS is “the outcome of a constellation of factors acting simultaneously”—which in essence is an alternate description of the “multifactorial” position. In sum, Sonnabend’s view was, and is, that not everybody who is exposed gets infected, not everybody who is infected gets sick, and not everybody gets sick at the same rate.

For his part, Mike pointed out that in regard to HIV “there is a correlation with AIDS; but it used to be accepted in science that correlation was not the same thing as causation.” He believed, following Sonnabend, that there was no one specific cause, that getting infected with HIV was not the equivalent of getting AIDS. He made an analogy with a heart attack or stroke: genetics, diet, exercise, and stress all play a role. In the same way, he argued, HIV is more likely to progress to AIDS if other immunosuppressive co-factors—like multiple infections from multiple sexual partners—were also present. Yet in 1998 Sonnabend would himself acknowledge that he’d been wrong to believe at the beginning of the epidemic that the
only
gay men who came down with the disease had “a history of multiple STDs”; he later encountered some people who didn’t fit that model and yet did have AIDS.

As for Mike, he emphasized back in 1984–85 that we still “cannot explain why Person X with under 200 T-4 [cells] develops pneumocystis and Person Y with under 200 T-4s doesn’t. We simply don’t know very much about the natural history of AIDS.” He suspected that both competing theoretical camps would eventually turn out to be right—“that some role for HIV in causing AIDS may indeed one day be proven . . . [but] there are probably multiple causes, of which HIV might be one important element.” Neither Mike nor Sonnabend ever came close to being an out-and-out “denialist”—that is, a follower of the University of California molecular biologist Peter Duesberg, who believes that HIV is not the cause of AIDS, not even in a contributory sense. In 1984–85, Mike did believe that Duesberg’s arguments deserved serious consideration and needed refutation. He thought Duesberg was “dead wrong about there being no infectious process,” as well as in his suspicion “that it was toxins INTERACTING with
pathogens” that produced AIDS. “Why don’t tops,” Mike asked, “get AIDS if there isn’t an additional infectious component involved?” As for the book
The AIDS War
, by John Lauritsen, another denialist, Mike found it a “tedious, flip reduction of complex and subtle statements.”
¹⁴

Sonnabend separated himself even more emphatically from Duesberg. It was one thing to say, as Sonnabend did, that he didn’t believe HIV had been “adequately demonstrated to be the sole cause of AIDS,” but quite another to say—as Duesberg did—that he’d completely ruled out the possibility that HIV could be the cause. Sonnabend hadn’t ruled it out. He considered it a hypothesis, not a proven fact. When Mike specifically asked him, “So, unlike Duesberg, you do not rule out the
possibility
of a role for HIV in the etiology of AIDS?” Sonnabend replied, “Certainly not.” He even went on to say that in stating that HIV
cannot
be the cause of AIDS, Duesberg was making “categorical, dogmatic statements which I don’t feel ought to be made.” When Mike then asked Sonnabend whether he felt “on balance, that Duesberg has been more good than bad in keeping the debate about the etiology of AIDS open?” Sonnabend said flat out, “I think he’s been bad. . . . It’s easy enough to discredit all skepticism about HIV because of Duesberg.” On another occasion Sonnabend was even more pointed: “Duesberg has no credentials whatsoever to have an opinion—he’s out of his depth.” The strongest evidence in favor of HIV as the cause, Sonnabend went on, is the association of HIV seropositivity with AIDS—“that is a powerful argument which cannot be dismissed lightly or ignored.”

When Mike questioned why other pathogens in the patient besides HIV were dismissed as playing no role in the progression of the disease, Sonnabend suggested the possibility that the presence of HIV antibodies might actually be the opportunistic
result
of whatever is truly suppressing the immune system. He felt it was also plausible—that is, “completely consistent with basic virologic principles—for some unknown percentage of people to be carrying HIV . . . without having ever formed HIV antibodies.”

Could Sonnabend imagine a proof that would ever satisfy him that HIV was in fact
the
cause of AIDS? “Certainly,” Sonnabend responded. “HIV has been found in people who don’t seroconvert [from negative to positive] over the long term. The way to prove the theory would be
to find HIV in seronegative people by taking specimens at autopsies of thousands of people and looking for HIV in tissues. . . . Also, if an anti-retroviral therapy were to ‘cure’ AIDS, that would largely settle the question as well.” Mike’s skeptical mind objected to speculation being presented as established fact, since that excluded the fair consideration of other possibilities. That was precisely Sonnabend’s bottom line as well. Both of them felt that the multifactorial explanation had its own problems, and one major criticism leveled at Sonnabend was that he’d never devised a model to test his own multifactorial theory—a criticism he didn’t deny. What both men required, above all, was an open-minded approach that
invited
diversity of opinion.

Richard Berkowitz and Michael Callen writing
How to Have Sex in an Epidemic
, New York, 1983 (photo courtesy of Richard Dworkin)

The first safe-sex poster, 1983