NYU’s Perry N. Halkitis charts ‘The AIDS Generation’
BY SCOTT STIFFLER | Since 2010, Perry N. Halkitis, PhD, MS, MPH, has been a regular contributor to Chelsea Now — writing on matters surrounding gay men’s health. Past articles have focused on topics such as post-9/11 behaviors (September 7, 2011’s “HIV Researcher Charts ‘Terror Sex’ in Aftermath of 9/11”) and February 22, 2012’s “Mythologies and Misunderstandings of HIV-Negative Test Results.” Many of his writings are available on chelseanow.com, by accessing his name as one of the tags (on the left side of our home page).
Recently, Halkitis returned from a four-month sabbatical — his first in the 15 years he’s been with New York University, where he works as Associate Dean for Research and Doctoral Studies and Professor of Applied Psychology, Public Health and Population Health, as well as Director of CHIBPS — the Center for Health, Identity, Behavior & Prevention Studies (visit chibps.org). Follow him on Twitter: @DrPNHalkitis.
In the November 30, 2011 issue of Chelsea Now, Halkitis wrote the article “Reflecting on the AIDS Generation” — exploring many issues that would form the basis of his upcoming book, “The AIDS Generation.” Published by Oxford, it’s expected to be released on World AIDS Day (Saturday, December 1, 2013).
Chelsea Now: What is The AIDS Generation?
Perry N. Halkitis: It’s the generation of men who came of age in the late 70s and in the 80s, who are men in my age group. Today, they’re in their late 40s and into their 50s. They know no adult life without AIDS. These men came of age during a time of great loss and confusion and tragedy, and they’re still here 30 years later.
They’re contemporaries of the figures we see in “How to Survive a Plague.”
The book specifically focuses on fifteen men who’ve been living with HIV their entire adult lives and were infected prior to 1996…which was the turning point of the epidemic.
In what way?
Because of the development of highly effective antiretroviral therapy. So this book documents the life experiences, over the last thirty years, of these men who became infected at a time when there was little hope. It also delineates the various strategies they used to survive the epidemic.
Where did you find the participants?
They are all New York City-based men who were born and raised in various parts of the country. They’re different races and ethnicities, so it’s not a homogenous group. It’s fifteen interesting and distinct voices. I love “How to Survive a Plague,” but that’s one voice of the men of the AIDS Generation, and it’s an important voice — that of those who were involved in ACT UP [AIDS Coalition to Unleash Power] and TAG [Treatment Action Group]. There’s one such man in my book, and there are fourteen others different voices of men who were directly not part of those movements.
What are their differences and similarities?
None of the men I’ve spoken with let the epidemic, let the disease, define him — and each of them spoke about different ways that they tried to “outsmart” the virus, which included not only physical and medical strategies, but social and emotional strategies that they used to keep their lives viable and on track.
I interviewed all of these guys and kept interviewing them, and went back and forth. It was pretty powerful.
In early September , I brought them all together to meet each other, and it was like a band of brothers was formed.
Did any of them know each other before that meeting?
No. A couple of them knew me, but they didn’t know each other. To me, that was one of the most beautiful experiences of this book — watching these men in this room talking to each other, crying with each other, supporting each other after living their whole lives fighting this disease.
Does the book have any takeaway strategies for those newly diagnosed with HIV?
The subtitle of the book is “Stories of Survival and Resilience.” The last chapter is about what we’ve gleaned from the experiences of these men that informs those who are newly infected how to confront this disease and manage it in their lives. The last chapter focuses on this model on resilience.
I’m saying to you that it’s more than just the medical. I talk with equal conviction about the medical approaches and the psychological approaches as well as the social strategies these men used in their lives to remain viable.
I’ll give you one example of that. If we think about the community organizations that were formed at the beginning of the epidemic, like GMHC [Gay Men’s Health Crisis] or ACT UP, we tend to consider these as social contexts where people who were infected went to either for services or to fight for the development of effective treatments. They were either activist or social support organizations — and I’m not denying that. But what I’m saying is there’s another way to think about those organizations, around issues of social capital and social cohesion.
Explain those terms and how they figure into your observations.
What I argue is those organizations absolutely had a purpose and delivered effectively on their missions. But at the same time, what they provided was a context for those who were living with HIV to engage with others like themselves to create greater social cohesion in this community which creates empowerment in one’s life, which is a form of social capital.
There’s pretty clear evidence in the public health literature that higher levels of social capital leads to better health outcomes.
The literature, the research, shows us that people who are empowered are going to demonstrate better outcomes than people who are disenfranchised.
In the book, I talk about these organizations as a way of enhancing social capital for gay men who are living with HIV. What we learned is, they are beneficial to one’s health, these social structures — and it saddens me that they’re not there at the same level anymore.
Why do you think that is?
Because after 1996, people thought the epidemic was under control — and because we started to think about this diseases in a purely medical way instead of what I refer to as a biopsychosocial way.
The whole movement to PrEP [Pre-Exposure Prophylaxis] is another example of the biomedicalization of the epidemic. When we’re thinking of people with a chronic disease, if we want to frame it that way, then it cannot be solely about the medical. As we see very clearly form the PrEP studies, they show us that the medications work — but only when the behavior is present.
Many of your articles for Chelsea Now have linked self-image and homophobia to everything from infection rates to coping strategies. It sounds like the book expands on this.
It ties into everything I’ve done. My approach to HIV is to think about the disease as a social and psychological construction, not just a medical one. It also ties into how I think about HIV prevention, which is, if we’re going to eradicate this disease, we have to address the burdens that people who are at risk from it are experiencing in their lives. For gay men, that means discrimination and homophobia, which I believe fuels the epidemic.
I’ve shown, and others have shown, that people with more psychosocial burdens, more discriminations, more victimization, have worse health outcomes. Gay men don’t engage in risk behavior in a vacuum. I believe that these behaviors are fueled, in part, by societal norms around homosexuality.
A good parallel is racial and ethnic discrimination. The health profiles [of racial and ethnic minorities] are diminished when compared to whites — in a similar way that gay men’s health is diminished when compared to straights. You can take it a step further if you think about a black gay man. He has even greater vulnerability because of his sexual orientation and his race. So it’s not surprising to me that I see the AIDS epidemic manifesting not only in gay men, but particularly in African America gay men.
That all ties in, this thinking around HIV prevention, management and treatment. You cannot think of this disease solely as a virus that is simply to be treated with medications.
At 5pm on Wednesday, March 13, Teachers College Columbia University will sponsor a screening of “How to Survive a Plague” followed by a moderated panel discussion with Dr. Halkitis and the film’s director (David France). A reception will follow. This free event (picture ID required) takes place in the Cowin Center Auditorium (525 West 120th Street, at Broadway). RSVP required, by vitising www3.tc.columbia.edu/events/index.asp?eventID=11937.