“So that breakthrough that we thought was going to happen in ‘88 or ‘89 if we just worked fast enough—it did happen, but not until ’96. And so a lot of people died. Maybe if Reagan had started putting money into AIDS earlier, they wouldn’t all be dead.”                                            — Mark Harrington

In an earlier class, we discussed how New York City urban planners used the policy of ‘benign neglect’ and ‘planned shrinkage’ to target specific populations (mostly low-income people of color) to decimate entire populations for urban renewal. These programs were ultimately ineffective due to the resilience of the inhabitants of these areas. Even today, these areas are in the process of regrowth and revitalization.

In a similar fashion, David France’s How to Survive a Plague highlights the way conservative leadership in the United States failed HIV/AIDS victims from the 1980s onward. Conservative figures such as Ed Koch, Ronald Reagan, George Bush Sr., Jesse Helms, and Archbishop Joseph O’Connor used their political powers to downplay the severity of the AIDS epidemic in New York and associate the spread of AIDS with immorality. This served as the prevailing justification for the inadequate funding and foot-dragging in AIDS research. This in turn influenced the policy in some New York City hospitals of turning away or refusing to treat patients with HIV due to a lack of education or concern about the prognosis of the illness.

The parallels between the neglect of HIV/AIDS victims and neglect of ailing communities are striking. When AZT first emerged on the market after FDA approval, the initial costs were prohibitively expensive: at $10,000 per patient per year (around $21,000 today, adjusted for inflation) for a drug that was minimally effective, class distinctions in the gay community of Greenwich Village became a matter of life or death. Similar to how the Rand Institute botched the statistics regarding fires in the Bronx, the early refusal of hospitals to treat HIV/AIDS victims influenced the statistics regarding the prevalence of HIV in the early 80s. Clearly, the process of decimating communities by denying them essential services was not a tactic used only to build highways.

The quote from Mark Harrington above points out some pressing questions regarding this grim era in New York’s history: if ACT UP did not exist, at what point would AIDS have been considered a public health crisis? Did the NIH willfully neglect the gay population of New York City to thin out a “problem population”?