Since leaving Bates in 1982, I have often wondered what I would be doing with my life if the HIV epidemic had never happened. I would obviously have a different professional life, since as a philosophy major at Bates I never considered the field of public health. At my current age of thirty-seven, I would probably be far less familiar with the hollow face of terminal illness. And the role of gay activist that I first explored on the Bates campus would have taken me in different directions that now I can only imagine.

In December 1995 I had the pleasure of returning to Bates to share my perspective as a Bates alumnus working in the HIV field in Boston. The experience felt in some ways like coming full circle, particularly since the presentation was held in Chase Hall where, fifteen years earlier, I listened to a visiting sex educator from Brown University and for the first time heard someone talk openly about gay and lesbian youth. It was there that I recognized myself.

Since that time, dozens of colleagues and acquaintances, three men I've had relationships with, and several friends have died. As I write this article, my closest friend is dealing with his second year of an AIDS diagnosis. When I think back to my time at Bates in the late seventies and early eighties, I become frustrated, realizing that the broad range of issues facing lesbians and gay men have now been eclipsed by the HIV epidemic. For many Americans gay has come to equal AIDS.

My identity as a gay man drew me into the HIV epidemic, and I must admit that if HIV had only affected addicts, the poor, and communities of color, I would not have taken the same professional path. This somewhat shameful realization -- bolstered by twelve years of HIV work -- has led me to believe that our failure to curb the epidemic is rooted in our society's refusal to confront issues involving race, class, and human sexuality. I have also seen HIV statistics used politically in order to garner public support for the fight against AIDS.

For example, if we examine the period between 1989 and 1993, the percentage of all AIDS cases in Massachusetts attributed to male-to-male sexual transmission dropped from 52 percent to 34 percent. However, over this same period the absolute number of cases among gay men remained relatively constant (514 in 1989; 499 in 1993). A simple choice by a person wielding these statistics -- whether to emphasize the constant numbers of cases or the decrease in percentage of cases among gay men -- can support dramatically different public perceptions. Those who aim to illustrate that "gay men have stopped the spread of the epidemic through their extraordinary efforts to change sexual behavior" may choose to emphasize the drop in overall percentage of cases. Politically, this information could be used to argue for continued support of prevention efforts among gay men. On the other hand, one could highlight the constant numbers of AIDS cases among gay men and argue that prevention efforts have not worked and should be discontinued.

While documenting that behavioral change has occurred among gay men, studies show that a significant number of gay men in Massachusetts continue to choose unprotected sex with infected partners and are becoming infected themselves. It is my opinion that individual choices such as these have very little to do with the success or failure of prevention messages or with "lack of self-control" among homosexual men. Human sexual decisions are more likely to be based on emotional vulnerability, loneliness, or love than the cognitive understanding of viral transmission.

Consistent with national trends, we are also seeing a more rapid rate of growth in HIV among women and heterosexuals in Massachusetts. Cumulatively as of June 1, 1996, 11 percent of AIDS cases have been attributed to heterosexual transmission and 18 percent have occurred among women. Activists, health-care providers, politicians, and the press have used these statistics to frame HIV as an equal-opportunity virus that is now killing "the good people." Safe sex for everyone and red ribbons for every lapel has become standard rhetoric. Whether heterosexual or homosexual, we are told that no sexual partner is safe, that it is impossible to trust anyone, and that we are all at significant risk for infection.

I believe that this overstated message has evolved because it has proven impossible to sustain interest and public support for fighting AIDS unless the epidemic is perceived as rampant. In reality, increased HIV among heterosexuals does not support the fear-based message that HIV has infiltrated the general population. The vast majority of heterosexually transmitted HIV has occurred among our most disenfranchised populations, including the poor and people of color. Among women reported with AIDS in Massachusetts, more than 59 percent are women of color and 47 percent report a history of injection drug use. This is consistent with the spread of epidemics throughout history, where lack of access to education, health care, adequate nutrition, and sanitary water and living conditions create correlations between disease and poverty. This constitutes an extraordinary health crisis in itself, but unfortunately it has been distorted in order to raise alarm among the general population.

Our challenge in the field of public health is to reveal the true face of AIDS using all the epidemiologic evidence, while at the same time retaining public support without distorting people's greatest fears about pleasure, disease, sex, and death.

The voice I hear as I bring this essay to a close is that of a young man in a graduate course at Boston University, where I presented information on "HIV and the Gay Community." With tremendous rage he blurted from the back of the room, "Why don't you just stop?"

I have rarely heard a more honest expression of our collective frustration in dealing with the AIDS epidemic, where our most basic feelings about race, class, and sexuality are brought to the surface: "Why don't you just stop being gay? Why don't you just stop shooting drugs? Why don't you just stop being poor?" Unless we get to a place where these fundamental questions are on the table, I doubt that AIDS will ever be behind us.

Robert Carr '82 is director of HIV Client Services, Counseling, and Testing with the Massachusetts Department of Public Health.