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Who Still Dies of AIDS, and Why

In the age of HAART, the virus can still outwit modern medicine.


The Departed From left: top row, Glenn Williams, Thomas Morgan III, Bill Harmon; second row: Bob Hattoy, Vilma Santiago, George Drayton; third row, Mark Hayes, Stephanie Williams, Willi Ninja.  

In the video, filmed last November, Mel Cheren appears understandably dismayed. He’s being interviewed by a reporter for CBS News on Logo, a gay-themed news program; he’s sitting in a wheelchair, and he’s talking about the indignity and the irony of dying from AIDS at a time when AIDS should be a chronic disease, not a fatal one. Cheren, a music producer and founder of West End Records, had been an AIDS activist since the earliest days of the epidemic. It was Cheren, in 1982, who gave the Gay Men’s Health Crisis its first home, providing a floor of his brownstone on West 22nd Street. In the interview, Cheren talks about what it’s like to lose more than 300 friends to the AIDS epidemic, outlive them all, and then get diagnosed yourself at age 74.

Indeed, the fact that Cheren had plenty of sex through the height of the epidemic, had been tested regularly, and had apparently emerged uninfected had led him to believe that testing was no longer necessary, or at least so one doctor had told him half a dozen years earlier. He’d only learned the truth after he began losing weight, had trouble walking, and was finally referred to a specialist who didn’t consider AIDS an unreasonable diagnosis for a man of Cheren’s experience and advanced years and so ordered up the requisite blood test. “There was one guy,” Cheren says in the interview, explaining how he might have been infected. A male escort. “We really hit it off, sexually … ”

By the time Cheren learned he had AIDS, he was already suffering from a rare, drug-resistant pneumonia, what infectious-disease specialists refer to as an opportunistic infection, and he had lymphoma, an AIDS-related cancer that had spread to his bones.

Within a month of his diagnosis, Cheren was dead. The official cause was pneumonia, although, as his cousin Mark Cheren points out, cause of death in these cases is a moot point. “Infection from pneumonia was probably the culprit,” he says, “but only because that acts quickest when you don’t stop it.”

Dying from AIDS, or dying with an HIV infection, which may not be the same thing, is a significantly less common event than it was a decade ago, but it’s not nearly as uncommon as anyone would like. Bob Hattoy, for instance, died last year as well. Hattoy, 56, was “the first gay man with AIDS many Americans had knowingly laid eyes on,” as the New York Times described him after Hattoy announced his condition to the world in a speech at the 1992 Democratic National Convention. Hattoy went on to work in the Clinton White House as an advocate for gay and lesbian issues. In the summer of 1993, he told the New York Times, “I don’t make real long-term plans.” But the advent of an anti-retroviral drug known as a protease inhibitor, in 1995, and then, a year later, the multidrug cocktails called HAART—for highly active anti-retroviral therapy—gave Hattoy and a few hundred thousand HIV-infected Americans like him the opportunity to do just that.

If the pharmaceutical industry ever needed an icon for evidence of its good works, HAART would be it. Between 1995 and 1997, annual AIDS deaths in New York City dropped from 8,309 to 3,426, and that number has continued to decline ever since. The success of HAART has been so remarkable that it now tends to take us by surprise when anybody does succumb, although 2,076 New Yorkers died in 2006 (2007 figures are not yet available). Though many of the most prominent deaths, like Cheren’s and Hattoy’s, tend to be of gay men, the percentage of the dead who contracted the disease through gay sex is now reportedly as low as 15 percent (with a large proportion still reported as unknown). Intravenous-drug users make up the biggest group, 38.5 percent, and women account for almost one in three of total AIDS deaths.

One of the ironies of the success of HAART is that it has fostered the myth that the AIDS epidemic has come to an end, and that living with HIV is only marginally more problematic than living with herpes or genital warts. This is one obvious explanation for why HIV infection is once again on the rise among young men—specifically, MSMs, as they’re now known in the public-health jargon, for men who have sex with men—increasing by a third between 2001 and 2006. Among those 30 and over, the infection rate is still decreasing, notes Thomas Frieden, commissioner of the city’s Department of Health and Mental Hygiene, suggesting that the increased rate of infection among men under 30 is due in part to decreased awareness of the disease or the toll it can take.

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