Timothy was a teenager. His best friend was Samantha, a girl he’d grown up with and cared about fiercely. He knew it was time to tell his mom he was gay. Samantha kept reminding him that it had to be done. Yet he couldn’t seem to muster the courage. Every time he decided it had to be done, he would lose his nerve. Timothy was never one for conflict; it simply wasn’t his personality. His mother’s Christian faith made the situation more delicate. He knew she wouldn’t be pleased. He also knew she needed to know. He loved his mom; he couldn’t bear her not knowing such a fundamental truth about her son. So he wrote her a letter. Some subjects are better described in words on a page. Some people are more apt to listen when they’re alone with a letter.
The letter was difficult for Timothy’s mom to read. Although she couldn’t know it at the time, it would be only the first in a line of letters that Timothy would send her when he had bad news. It was always easier for him to share news by writing it rather than face-to-face. Even though he knew it was better to tell certain news in person, he dreaded the feeling of disappointing his mother. When Timothy’s mom was finished with the letter, she called her own mother, Timothy’s grandmother, back in Idaho. She had to share the news with someone. A similar pattern would take shape when Timothy decided to tell her he was HIV-positive a decade later.
Timothy, like Christian, was close to his grandmother. He could never acknowledge his sexuality directly to her, much like Christian, and yet, also like Christian, she already knew. There was an unspoken understanding at the foundation of their relationship. Both their grandmothers seemed to know them better than they knew themselves.
Christian was nervous as he prepared to tell his parents, face-to-face. He was eighteen and had known forever. Christian’s family was very different from Timothy’s. He had a close relationship with both his parents and felt their love and support. He knew they might have some concern, but he also knew they would accept him. True to form, Christian’s parents embraced him seconds after hearing the news. They didn’t worry or make him feel abnormal.
Their response a decade later, however, when Christian told them he was HIV-positive, was not as calm. Christian was nervous about telling them. He had known for a month and had told only a very few friends. His first thought after being diagnosed had been his parents. He was so anxious to know what they would think of him; how their opinion might be changed; if they would look at him differently. On his three-day visit home, he waited until the last possible moment, finally stirring up his courage. His mom burst into tears at the news, and his dad supported her weak frame. Christian couldn’t stay to watch; he left quickly after telling them, retreating back to his apartment in Berlin. His relationship with his family suffered under the strain. His parents were worried for their son’s life, for they saw HIV as a death sentence. They had other worries, too: They lived in a small town and couldn’t help but wonder what neighbors would think, how it would be perceived in their community. But they loved their child more than any of these fears. Their relationship eventually healed.
Jessen’s family was much like Christian’s. They were both close-knit families from small towns. Jessen’s parents knew early on that he was gay, so when Jessen came out to them, they were unsurprised. As it happened, all of their children were gay, two sons and a daughter. All of their children would leave the farm on which they were raised, drawn to the city of Berlin. Incredibly, all of their children would find work shaped by HIV.
Supportive families like Jessen’s and Christian’s make a big difference in the emotional health of a gay person who’s come out and also influence their physical health. Studies performed in multiple ethnic backgrounds all show the same result: If an individual’s family is unsupportive of their sexual orientation, the person is more likely to binge drink, to use illicit drugs, and to suffer from depression. In contrast, gay men with supportive parents are three times more likely to use condoms during sex and be regularly tested for HIV. At its heart, this intuitively makes sense. Our parents help shape the way we see ourselves as adults. Therefore, if our parents don’t support us when we reveal our sexuality, our self-esteem takes a blow. We have less reason to take care of ourselves. This may be why the suicide rate is so much higher, 8.4 times higher, in gay and bisexual adolescents than in their heterosexual peers. Coming out is a precarious time in the life of a teenager. We can only hope that the explosion of new studies looking at the profound influence that parental approval has on the health of gay and bisexual children will influence the behavior of future generations.
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After Timothy was diagnosed with HIV, his behavior took a sudden turn. He found the dating world split between those with the virus and those without. It was almost as if there were two populations of gay men—those condemned to die and those free to live. He belonged to the first group. The dating practices of that group were different. They could pick each other out at a crowded bar by the lesions caused by Kaposi’s sarcoma and by sunken cheeks, symptomatic of the wasting disease caused by AIDS. Even if a person with the virus eats normally, and many cannot, diarrhea, vomiting, weakness, all contribute to a wasting away of muscle. This is called cachexia and is not unique to AIDS. Those with end-stage cancer often suffer from cachexia, becoming weaker and weaker, no matter how much they eat.
For HIV, the pattern is complex. Those with the virus often experience fat redistribution. Lipodystrophy (where lipo stands for fat, and dystrophy an abnormal change) is a distribution of fat, often occurring in the fat of the face, resulting in sunken cheeks. Puzzlingly, we don’t know exactly how this occurs. It seems to happen to a larger extent to those on antiviral therapy. Our current thinking is that therapy taken to beat back the virus may also be damaging cellular mitochondria. Mitochondria are the “power packs” of the cells, tiny organelles inside each of our cells that pump out the vast majority of energy our cells need to function. The therapy taken to target the virus also appears to target the mitochondria in fat cells, particularly those in the face. Without the mitochondria, these cells die off, giving the cheeks a hollow, sunken look. HIV-positive people with this condition, while it is not dangerous, find themselves stigmatized; after all, the mark of the virus is out where everyone can see it, on their faces. Today, we’ve been able to find new drug combinations that are less likely to create lipodystrophy. This isn’t always effective, since sunken cheeks are not exclusively tied to drug therapy. Others have turned to implants and fillers that can hide sunken cheeks. There are even patient-assistance programs available to provide these fillers so that people with little money don’t have to live with HIV’s telltale signs.
But in 1996, after Timothy learned he had HIV, none of these advances existed. It was easy to recognize those with HIV. When dating, Timothy found himself looking for sunken cheeks. He purposely sought out men with the red and purple bruised marks of Kaposi’s sarcoma. For Timothy, he looked for these marks as the signposts of his new community. He wanted to be responsible. He didn’t want to infect anyone else with the virus, so when he went to bars, he sought those who also had HIV. It was a new kind of segregation for Timothy. It made him feel as if he had lost part of his identity. He was no longer the gregarious partygoer he had once been. Instead, he sulked in bars, looking for people he could identify with.
One night he went to a bar in Berlin down the block from Jessen’s clinic. At street level, the bar seems normal. However, in the back, there’s a crawl space that leads down to a second bar that never sees daylight. It’s called a dark bar because it lets in no light, either natural or artificial. Timothy picked this bar one particular evening to bask in anonymity. It was a place where he didn’t have to worry about how he looked, or how anyone else looked, only how he felt. It wasn’t the kind of place you went to find your soul mate. It was all about sex at the dark bar. In the early morning hours, he touched the face of a young man sitting across from him. He knew what he had come there for, but still, he wanted to talk. So he did. He sat in the dark bar, talking to a man he didn’t know. His feelings seemed to pour out of him, a rare experience for Timothy. The comfort of being invisible was a powerful drug, making him talk about things he rarely admitted to himself. He left that night with a man who would not be simply a one-night stand but instead his closest friend, his soul mate, the love of his life. He couldn’t know that the man he held in his arms that night would one day, years from then, stand beside him during the most traumatic time of his life. Lucas would become everything to him, an essential part of his treatment and eventual release from HIV. But all of that was years away.