What AIDS Can Teach Us About Coronavirus
In Depth
Dr. Ross Slotten didn’t set out to become an AIDS specialist. It just happened. He and another doctor had opened a practice in Chicago in 1984, after having established themselves as gay-friendly practitioners. With the clientele of gay men came AIDS. And with AIDS came the realization that Slotten could do little to contain the virus. “In 1992,” he writes in his new memoir Plague Years, “I had the dubious distinction of having signed more death certificates in the city of Chicago—and by inference the entire state of Illinois—than any other physician. How many deaths had I witnessed; how many more could I withstand before breaking down?” Slotten estimates that his practices have treated well over 1,000 people with AIDS. The majority of them died.
Plague Years charts the early years of the epidemic, from the shock of its onset to the despair as the understanding of the fatal virus sharpened. Culled from his journals, Slotten’s memoir contains grueling accounts of the patients Slotten had no chance of saving (including his first boyfriend, though they’d broken up when he went to Slotten for treatment) and his own experience as a gay man staring down a disease that was decimating his people.
But crucially, it contains hope. I spoke to Slotten via FaceTime in May from his home in Chicago (he maintains a practice in the city), and he told me about an unintended message relevant to our current pandemic. “When I wrote it, there was no idea of covid-19, but as I reflect, there’s an unintended message in this book,” he told me. “Most of the book is dark, but we found a way through it. It’s not over, clearly, but we live in a time where you can have HIV and you can live to be an old man. Right now, with covid, we can’t see our way through it. We don’t know how this is going to end. It’s going to end in some way. There’s light somewhere at the end of the tunnel.” An edited and condensed transcript of my conversation with Slotten about AIDS and his book is below.
JEZEBEL: People have talked a lot about the parallels between AIDS and the coronavirus. Given your experience, do you see that? Is 2020 reminiscent of the early ’80s to you?
ROSS SLOTTEN: There are some things that are reminiscent, but they’re very different pandemics, really. To me, this seems like AIDS compressed into weeks. AIDS played itself out in years. The similarities are that there was an element of denial that this was really happening, both politically and among people in general. I think people didn’t grasp, intellectually, what this meant. With HIV/AIDS, it was [prevalent in] marginalized groups. There was a time when people were fearful of gay people or drug users or whatever the grist group was, so there was a time when people were scared, but it was a different kind of terror. I’d walk back and forth to the hospital seeing sick patients, but the rest of the world looked totally normal. Now the whole world seems abnormal because everybody’s at risk. I think also we came to realize that AIDS was almost universally fatal. [Covid-19] is not universally fatal by any means. The fatality rate is probably less than one percent. But over millions, that’s a lot, and it’s scary because it’s unpredictable. I think in many ways there are more differences than similarities. My patients with HIV are not terrified of covid-19. They’re nervous. In the ’80s and ’90s, we were terrified. This is scary but not terrifying.
In the ‘80s and ‘90s, we were terrified. This is scary but not terrifying.
I can think of few things scarier than the onset of AIDS when no one knew what was going on as people were dying. That’s scarier than any horror movie.
It was terrible. It was shared by the community but not society at large, so a lot of the time, we felt abandoned. The protestors in the AIDS era were saying, “Government, you’ve gotta get more involved, you guys are ignoring us.” The protesters today are saying, “Government, leave us alone. Get out of here. Let us be free.” It’s so bizarre. It’s a parallel but an opposite parallel. We felt so abandoned but then, thank goodness, the government began to get more involved and scientists began to listen to the community. There was a collaboration that happened. I see the opposite now. Instead of a collaboration, I see people splintering off, based on politics and partisanship.
In the book, you write about moving through the highly sexual world of pre-AIDS urban gay life and not really having the sex drive or interest in random sex that many gay guys apparently did. When you started seeing guys come into your office and then dying as a result of AIDS, were you at all judgmental?
I had to learn to hold back my own prejudices or my own biases when I’m dealing with people. Let’s say someone comes in with HIV and they could have prevented it. If I say, “What were you doing? Why did you do that?” how does that help them? It doesn’t. Internally, I may be angry about something, just like when I walk down the street here and I don’t see people wearing masks. That pisses me off. I try to help people prevent things, but if something happens, the last thing they want is for me to say, “That’s so stupid.” That makes them feel terrible and it doesn’t help. I learned that early on. I can say, “This is my own way of behavior and what I think in my mind,” but I’m not going to shame them.
So much of this book came from your journals. Did it cross your mind that you could be working on a future book?
I really didn’t know. I was living through a historical moment at that point. I didn’t really keep a journal consistently before HIV. My first journals had nothing to do with HIV, it was my experiences as a doctor dealing with old people. But then as the epidemic began to flare, I thought, “Maybe I could write something about this.” In my mind, I thought maybe I could write something someday, but it wasn’t the primary motivation of keeping a journal.
You share a lot about your personal life in this book. Is it weird to think of your patients being able to access so much about you now?
I’m not so concerned about patients. Family members, a little bit. That kind of stuff. My former partner of 24 years, he broke up with me in 2007. We had to maintain a relationship in some way because we owned properties together. He’s a doctor on the same staff, same hospital. We had to have some kind of a cordial relationship. He knew I was writing a book. I never shared any of the writing with him. He’s not a reader. It’s my story. He’s part of it, and I didn’t feel like I had to get his approval. I’m not looking for it.
Beyond the sharing of your story, why was it important to you to publish this book?
When I wrote it, there was no idea of covid-19, but as I reflect, there’s an unintended message in this book. Most of the book is dark, but we found a way through it. It’s not over, clearly, but we live in a time where you can have HIV and you can live to be an old man. Right now, with covid, we can’t see our way through it. We don’t know how this is going to end. It’s going to end in some way. There’s light somewhere at the end of the tunnel.
There are lessons to be learned. I think we should be more humble about things. We don’t want AIDS to come back. It could.
To me, this is a Holocaust memoir. You could say, “What’s the value?” This was a historic event. We went through something terrible. There are lessons to be learned. I think we should be more humble about things. We don’t want AIDS to come back. It could—not necessarily because people are careless. All it takes is a government to say, “We’re not funding HIV medications anymore. We’re taking ADAP [the AIDS Drug Assistance Program] away.” This could happen. With this president, anything could happen. HIV will probably someday be an STI that hangs around, like syphilis or gonorrhea. It’s very hard to get rid of sexually transmitted disease. But people need to know what kind of impact it had on society. Young people need to know. It’s history. But I’m not wagging my finger to say, “You guys are bad.” They may never have seen someone die of AIDS, but they’re taking PrEP. People understand the rationale behind it. The people I deal with take that seriously, but I want people to know this is what happened. It’s not like, “We saved you,” but, “We don’t want this to happen to you.”
What do you think of the fact that so few of your patients have died in recent years, yet the virus disproportionately impacts communities of color? Does that have more to do with your clientele, or is it the overall lack of access to medical care experienced by members of those vulnerable communities?
I have a diverse group of [patients], but a lot of people just don’t know. They wouldn’t come to me. I think that there’s a tragedy in this country. I think it’s a public health tragedy. The covid epidemic is really magnifying it. We don’t take good care of our people. We don’t have a health system that protects people, that tracks people, that tries to help people. We block. I don’t know if we’re going to learn a lesson here. Look at guys in Southern states—there was an article in the New York Times. They have no access to medicine because the states don’t support it. This is morally wrong. In a city like Chicago, and I’m sure New York is the same way, there are many avenues to care. It’s not like it’s not available and there is outreach. I think part of it is learning how to talk to people so that they believe you and come to you, but it also requires community support.
I’ve heard people describe the years in the ’90s before the antiretroviral revolution as the darkest times because rates were skyrocketing and the media had basically abandoned HIV reporting. Did that affect your spirit?
No, I think I’ve developed a good repression mechanism. It gets pushed down deep. I think that’s my defense mechanism. Sometimes it bubbles up in different ways like anxiety. In the middle of the night, I’ll wake up and think about death. Sometimes a haunting memory will pop in my brain, especially when I was writing this book. I think because I repress stuff, it doesn’t affect me in an obvious way. I probably have some PTSD, I would imagine. I’ve never really been burned out. I think it’s because I found ways to divert my energy. There are times where I’m like, “I can’t go in tomorrow. I can’t do this.” It’s so stressful sometimes. At least with HIV, I could fly to Botswana. [With covid], I can’t do anything. We can’t go to the lakefront because they’ve locked it down. There’s no diversion.
We don’t take good care of our people. We don’t have a health system that protects people, that tracks people, that tries to help people. We block. I don’t know if we’re going to learn a lesson here.
In the book, you write about how AIDS opened the path to marriage equality. This is a general point that has been made already, though your framing is different than that which I read previously. I’ve seen people claim that because AIDS decimated radicals who had no interest in assimilation, what was largely left over were less sexually centrist gay men whose primary cause became marriage equality. In your telling, however: “By bringing so many well-known, talented, and influential people out of the closet, AIDS paradoxically humanized gays and lesbians. AIDS didn’t accomplish this feat alone, but it was an instrumental factor, especially after it ceased to threaten mainstream America and was transformed by the miracle of modern medicine into a chronic and manageable infection.”
I don’t buy that [other] argument. This is an evolutionary process not driven by just one stream. It requires lots of different factors. It requires acceptance by larger society. There were people who wanted marriage equality in the ’70s and ’80s and they were radical. That’s kind of a cynical explanation. The climate evolved into one of acceptance. AIDS brought people out who were not out. People saw icons, famous people dying of AIDS. The whole conversation changed. I think as AIDS as a threat began to recede, people were less afraid. I lost a lot of patients who were straight because, I’m sure, they saw a lot of sick people in my waiting room. They just disappeared. No medical record transfers. I think if marriage equality came up today—literally today—it wouldn’t happen.
What do you make of the sexual liberation that many urban gay men today enjoy, which PrEP (and antiretrovirals) have clearly helped facilitate?
I’m happy that people can be who they are. One thing I’m not happy about is I saw one guy with gonorrhea during the covid pandemic. And this guy is in his 50s. I said, “That’s not social distancing.” He said, “I grilled the two guys I have sex with blah blah blah.” I said, “Obviously, they’re doing more than you think.” Someone else came in with pharyngeal chlamydia. I’m happy people can be themselves and not get HIV. I’m not happy people are getting syphilis and gonorrhea. That’s not such a fun thing. It’s not a moral thing. But it is like the pre-’80s. People can be who they are. I’m really happy they have that option. That’s not me, I’ve never been a promiscuous person, but I don’t think it’s bad for people. I’m glad they can do it.
You had one sex partner from 1983 to 2007. Have you ever felt like you missed out?
I have a philosophy sort of like: No one’s perfect. I’m not perfect, my partner’s not perfect, but there are pluses and minuses. Is it really worth having sexual contact with someone and maybe getting an STI? At that time, there was still no PrEP, but having multiple sexual partners just isn’t me. It’s not my personality.
One of the things I appreciated most about your book is your discussion of your shortcomings and idiosyncrasies. You did heroic things, but this is not a hero narrative.
I could have said no, I’m not going to deal with this. Let someone else. But it became so impassioned that I think it made me a much, much better doctor. There was an epiphany I had. I had a patient dying of pneumocystis pneumonia, and his partner was so mad at me. He came up from behind, and I thought he was going to punch me. I just said, “We’re on the same side.” That was one epiphany. The other was when I realized I couldn’t save people. They were going to die. It didn’t matter what I did. So how could I make those weeks or months better for them? How could I make the transition less painful for them and their family and their lovers? It became a way to get past it. Otherwise, it was so dreadful. They’re dying, I do everything I can, and they die. It’s a terrible feeling for a doctor. Those epiphanies helped me get through the pandemic. If we had no [antiretroviral] treatments, I don’t know if I would be doing it right now. It would just be too much. I think I would have burned out.