Finally let us re-run the incident and imagine that the accusation — the taunt — is true. The young man returns to his flat — and doesn’t leave it for several days. As one of the large pool of ‘AIDS-Related Complex’ and ‘Lesser aids’ sufferers, his illnesses come and go in cycles, depending on natural resilience and general morale. Now they all begin again: the miseries of recurrence. This is the unique double bind of aids. The virus attacks the immune system, which (it appears) must be weakened enough to receive it; symptoms and prognosis invisibly interact; the sicker you are the sicker you get … Those words on the street. Sticks and stones, perhaps. But, with aids, words too can break your bones.
Everywhere you look you see the double bind, the double jeopardy. In America — land of the profit-making casualty ward, home of the taxi-metered ambulance — the bipartite attack assumes its most heartless form. Growing ever weaker, the sick man faces medical bills that average $75,000 and have been known to reach half a million. The medical-insurance system is a shambles of pedantry and expedience. Some policies are soon exhausted; insurance companies often renege, claiming ‘prior conditions’; if you lose your job you might lose your cover; and with the two-year waiting period to establish eligibility, 80 per cent of aids patients do not survive to draw their first cheque.
‘What happens, usually, is a process of spend-down,’ said Mark Senak of the aids Resource Centre.
‘Spend-down?’ I asked. I sat in Senak’s chambers in downtown Manhattan. He is one of many young lawyers active on the AIDS-relief front. AIDS-sufferers need lawyers: to defend themselves against employers and landlords (in America, as in England, you can legally discriminate against homosexuals but not against the disabled); to transfer assets, to wrangle with insurance companies, to formulate declarations of bankruptcy. Lawyers like Senak have drafted wills for young men barely out of college. Wills, bills, audits, lawsuits — all that extra worry, boredom and threat.
Spend-down turns out to be one of those cutely hyphenated nightmares of American life. Briefly, it means that you spend everything you have before qualifying for Medicaid. Until recently there were further complications. One aids patient was suffering from a rare opportunistic disease called cryptosporidiosis, normally found only in calves. He applied for social security, and was told that he couldn’t have the money. Why? Because he couldn’t have the disease.
Duly pauperised by spend-down, all spent out, the patient becomes eligible for a bed in one of the city hospitals. Here he will encounter the suspicion and contempt that America traditionally accords to its poor. There is no out-patient care, no intermediate care. He is not legally dischargeable unless he has a home to go to. And aids sufferers often do not know if they have a home to go to. You might return to find your remaining possessions stacked outside the door of your apartment. The locks might have been changed — by your landlord, or by your lover.
‘What we have’, said Senak, ‘are diseased bag-persons living on the street. No one will house them. No one will feed them.’ Senak’s personal project is an accommodation centre for sufferers, on the San Francisco model. But the ruinous cost of real estate is only one of the difficulties. The risk categories for aids form a heterogeneous group, colloquially known as ‘the 5-H club’: haemophiliacs, Haitians, homosexuals, hookers and heroin-addicts (these last two frequently overlapping). How do you house a haemophiliac stockbroker with a Puerto Rican junkie? One of the reasons why aids is seen as a scourge of the homosexual community is that there is a homosexual community, however divided.
‘I think we’ve made progress, in changing general attitudes, since the panic began in 1983. Tonight I’m going to see someone in hospital. A year ago I would have had to stop off and buy him some food. The hospital staff wouldn’t take in his tray. But they do now.’
That same week in New York a TV crew — battle-scarred conquistadores, veterans of wars, revolutions, terrorist sieges — walked off a set rather than affix a microphone to an AiDS-sufferer’s clothing. No one has ever caught aids through casual contact. After four years of handling patientsVfood, laundry, bed-pans, drips and bandages, no health worker has yet succumbed. You cannot say this often enough. But how often will you have to say it? In the end one cannot avoid the conclusion that aids unites certain human themes — homosexuality, sexual disease, and death — about which society actively resists enlightenment. These are things that we are unwilling to address or think about. We don’t want to understand them. We would rather fear them.