San Francisco Chronicle - Monday November 20, 1989
Randy Shilts

You can't get away from news of the people who have died, people who seem to be just like you. You're overwhelmed by the knowledge that it could have been you.

Death becomes a preoccupation. Sleeping is difficult; nightmares are frequent. A vague, nameless depression sets in.

Such lingering feelings have dispatched thousands of earthquake-shaken Northern Californians into post-traumatic stress counseling in recent weeks, as they found themselves unexpectedly facing issues of mortality and vulnerability.

For a huge portion of the region's population, however, these anxieties were hardly novel. In San Francisco alone, an estimated 35,000 gay men -- or about one in 20 city residents -- are infected with the human immunodeficiency virus and grappling with these issues every day.

STRIKING SIMILARITIES

Experts say the psychological stresses imposed by the earthquake bear striking similarities to those raised by infection with a virus that can kill you.

Their point: For a few weeks at least, everybody in Northern California can understand what it's like to be infected with HIV.

As one local 36-year-old gay man, infected with the AIDS virus, put it last week, "Now all these straight people know what my life has been like every day for the past five years."

Authorities on stress, however, caution that even the most traumatized of earthquake victims will have to stretch their imaginations to conceive what it's like to live day-to-day with the knowledge that you are HIV-positive.

John Martin is an expert on psychological reactions to disasters, having conducted research on such catastrophes as the Three Mile Island nuclear accident. Now, he's studying the long-term emotional effect of HIV on gay men, because he believes that HIV engenders the same issues of stress and coping as do other calamities.

"To understand what it's like for people dealing with AIDS, you have to imagine what it would be like if a new earthquake came every week and things were still falling down and people were still dying -- week after week," says Martin, a psychology professor at Columbia University.

"One of the things about other natural disasters is that they're time-limited -- the earthquake or hurricane happens and then it's over," he says.

"With AIDS, it all keeps repeating. You've got people who since 1982 have thought they were going to die. They don't die. They just get a little sicker and sicker while they watch their networks of friends get decimated."

Another difference between an earthquake and HIV infection is that the experience of a natural disaster strikes everybody in a region equally, usually resulting in a camaraderie that pulls people together.

HIV-infected people, however, typically must work and live within a larger society that barely recognizes the huge numbers of HIV-stricken people in its midst. This leads to a depressing sense of isolation.

Given this, one local psychologist says that the avalanche of attention to seismology in recent weeks became something of a comfort to his HIV-positive friends.

"There was some relief for them that they could think about something other than AIDS," says Steve Morin, a clinical psychologist who now works on AIDS issues for U.S. Representative Nancy Pelosi. "There was a distraction from the horror of their regular thinking."

INTRIGUING RESILIENCE

Another researcher suggests that what makes the stress issue for HIV-infected people most intriguing is not that it has turned a generation of gay men into basket cases. It clearly hasn't. Instead, research psychologist Susan Folkman says she "marvels" at the resilience of those who keep going against overwhelming psychological odds and with little social support.

"Ordinarily, we live with ambiguity about our mortality and that ambiguity protects us," says Folkman, who is beginning to do stress research on local gay men through the Center for AIDS Prevention Studies at the University of California at San Francisco.

"We aren't built to know about our mortality and yet people who know they are HIV-infected have had the ambiguity about their mortality reduced significantly," she says.

"What's impressive is that people do manage. They manage to keep working, providing care for loved ones and they keep sane. There's this concentration of people who are heroes and we can learn a lot from them."

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