Lessons in compassion and optimism

IT WAS an unseasonably warm and sunny Auckland day when I arrived at the surgery in the spring of 1991. I'd been called by the receptionist: ''Look, he wondered if you could come in, Geoff.''

So I knew what was coming. My HIV test results had always been phoned through and her tone was determinedly solemn.

But his wasn't. Yes, I was HIV-positive but: ''This won't kill you. You won't die from AIDS. Don't for a bloody moment think you will. And don't stop work for god's sake; don't start living sick. How are you feeling, anyway?''

''I'm fine. But we're doing this wrong, surely. Aren't you supposed to pop on a tape of Callas singing O mio babbino caro, tell me I've got three months and to get my affairs in order?''

''There's an Olivia Newton-John tape on the bookshelf. Would that do? And it would take much longer than three months to order your affairs, anyway, wouldn't it?'' We both laughed.

He died a few years later, just as the trials of the first protease inhibitors got under way. I'm eternally grateful to him for the fierce optimism he offered me that day; an optimism that he knew couldn't be applied to his own situation and an optimism very few others were offered.

I was in the US in 1981 when discussion around ''gay cancer'' and ''GRID'' first surfaced in the media. Three years would pass before Luc Montagnier and Robert Gallo identified HIV, four before the ELISA test to identify HIV antibodies emerged.

A trickle of deaths grew to full flood in the big metropolitan centres of North America and the impact began to reach across the Pacific as expatriate Australians returned home to die.

At an airport in 1983, I glimpsed a TV news item from an AIDS conference in Denver. A group of people huddled around a lectern as a scared-looking guy read the preamble to the Denver Principles. ''We condemn attempts to label us as 'victims', a term that implies defeat, and we are only occasionally 'patients', a term that implies passivity, helplessness, and dependence upon the care of others. We are 'People with AIDS.'''

The principles were unhesitating in insisting on as full and satisfying sexual and emotional life for people with AIDS, as for anyone else - a claim enabled by gay men reinventing the most venerable of birth control devices for just that purpose.

That same evening I learnt that a friend of mine in San Francisco had hanged himself.

In Sydney, about 4000 gay men would be dead by 1996. But that was then.

Two generations of gay men and a rapidly evolving HIV epidemic later, a robust culture of care among gay men in NSW continues to sustain the most effective example of a contained HIV epidemic - driven predominantly by sex between men - anywhere.

That more guys are choosing to have sex without condoms is understandable given the epic scale of change.

HIV is now experienced in most cases as a chronic manageable disease and that increasingly means - particularly for gay men more recently diagnosed - a life not significantly different (in virtually every other respect) from their uninfected peers.

The upshot is that while our current program engagement seems effective in containing HIV among gay men, it's increasingly apparent that it won't deliver a sustained decline in HIV among gay men; at least not without the addition of new, innovative prevention approaches.

Over the next three years, the NSW HIV sector will deliver new program approaches that will provide the catalyst for bringing HIV transmission to an end. If it sounds ambitious, that's entirely appropriate, because it is. But we can do it. And I've always been an optimist.

This story Lessons in compassion and optimism first appeared on The Sydney Morning Herald.