Kramer vs. Kramer

BY SKY GILBERT

Larry Kramer and I used to be as different as two people can be. Mr. Kramer is an infamous AIDS activist and author of the play The Normal Heart. He was diagnosed with HIV in 1988. Back then, Kramer pleaded with his fellow fags to stop having sex. He also put an enormous amount of faith in doctors to find a cure. My response to the crisis was very different: I encouraged fags to roll on the condoms and have all the sex they wanted. And from the beginning, I was skeptical about anti-HIV drugs.

But last year, Kramer changed his tune -- at least, with regard to the medical establishment. He became so angry with his doctors that he allowed a photo of himself in his underwear to be printed for all the world to see.

It was not a pretty sight. The 65-year-old man exhibited the kind of side effects that frequently result from prolonged use of protease-inhibitor drugs: fat displacement (skinny legs and face, and distended belly) and a hunchback.

But more importantly, Larry claimed he was dying from chronic hepatitis caused by his medication, not from HIV.

Well, it looks like this time Kramer's got a point.

And he's not the only one making it. An article in September's POZ magazine tells Cathy Oluf's perplexing story. This Los Angeles woman was diagnosed with HIV in 1995. She started out feeling healthy and doing fine. Then -- on the recommendation of a zealous physician -- she began a standard regimen of ddi and d4t along with nelfinavir (Viracept). Oluf, like most diagnosed with HIV, bought into the hype from the drug companies, which urged patients to "hit hard, hit early" with the new drug cocktails. She stayed on the drugs until the toxic side effects almost killed her. Then she stopped taking them. Now she's feeling great and doing fine again. POZ claims that the protease inhibitors were "hypermarketed and overprescribed to tens of thousands of healthy patients who ... went on to develop vexing side effects."

New scientific evidence supports this assertion, pointing to the severely toxic nature of the highly prescribed drugs. Dr. Amy Justice, associate professor of Health Services Research at the University of Pittsburgh, recently released statistics indicating liver failure has become the most common cause of death in people with AIDS. (Remember when people with HIV died from pneumonia and Kaposi's sarcoma?) She says this means that "liver injury may be a major limiting factor in the effectiveness of current HIV treatment."

I'm no medical expert, but anyone with a brain can use his or her own common sense and see what's going on. This is not an AIDS problem anymore than it is a gay one. It's a problem that is deeply ingrained in the medical profession itself -- a profession that is highly influenced by powerful drug companies -- and which, more importantly, cannot seem to treat people as individuals.

HIV, like cancer, is not an equal-opportunity killer. Some people diagnosed with HIV die very quickly. Others have been living contentedly for so many years with the virus in their bodies that they're beginning to wonder if they're ever going to get sick at all. It seems that heredity, environment and emotional factors all contribute to the way in which diseases affect us. Unfortunately, even the most well-meaning doctors have too often been trained to see their patients as part of a demographic instead of as individual human beings.

I don't deny some people diagnosed with HIV need protease inhibitors (just like some with cancer need massive chemotherapy). But everyone is different, and not everybody needs to "hit hard and early" with AIDS drugs -- just as I don't believe every woman who has a speck of cancer in her breast needs to have that breast removed. Cancer and HIV frighten people so profoundly that they can be bullied into over-medicating. However, sometimes just a change in lifestyle or a mere wait-and-see may be the best prescription.

Here's my advice: if you've been diagnosed with HIV and feel healthy, and your doctor pushes you to take the protease inhibitors, just say no! It may not be a good idea to say you're acting on Sky Gilbert's advice; just tell your doctor that people are different.