On July 3, 1981, the New York Times announced the coming plague with a short news item tucked into Section A, Page 20: “Rare Cancer Seen in 41 Homosexuals.”
Nobody knew the purple Kaposi’s Sarcoma lesions the article described were the mark of a virus that eviscerated the immune system and left the body vulnerable to opportunistic infections. A quote from the dermatologist Dr. Alvin E. Friedman-Kien described the outbreak as “quite devastating.”
Millions would die from what doctors first called GRID, or Gay-Related Immune Deficiency, a name that linked gayness with death. But when it became clear the mysterious illness affected people other than gay men, it was renamed AIDS, or Acquired Immunodeficiency Syndrome.
A French virologist discovered HIV in 1983, but the Centers of Disease Control and Prevention wouldn’t list it as the sole AIDS-causing agent for another two years.
Ten more years passed before researchers announced a breakthrough: protease inhibitors, the first truly effective HIV medication.
Patients who could tolerate the drugs astounded their doctors. Some were pulled from the brink of death. They called it the “Lazarus effect.”
AIDS arrived just 12 years after the Stonewall Uprising. Anonymity gave way to a radical vision of public parades and sexual freedom. Many felt fucking in bathhouses, bookstores, public parks, and clubs were not just revolutionary acts, but part of a revolutionary responsibility. This sentiment collided catastrophically with HIV.
The virus first consumed gay men in sexually liberated New York and San Francisco. Cases climbed exponentially in 1981, and the epidemic soon exploded. Men who seemed healthy on a Wednesday could be dead by Sunday.
Nurses and doctors were disgusted and afraid of the illness and the people who had it. They allowed patients to languish in soiled bed sheets and die alone, while bigoted visitation policies separated them from friends and lovers. In the first story about AIDS to air on a major television network, 27-year-old Ken Ramsauer told Geraldo Rivera that he heard nurses’ aides outside his hospital room speculating “how long the faggot in 208 is going to last.” Ramsauer died four days later.
The explanation for why young, healthy gay men were dying was years away. With little outside help, the community devised its own solutions, including a brand new idea called safe sex.
Dr. Joseph Sonnabend recommended a biopsy the day he discovered swollen glands all over Richard Berkowitz’s body. Berkowitz, who’d left grad school for a more lucrative gig as a sadomasochistic master to suburban men, didn’t take his doctor’s advice until learning another hustler had died. Berkowitz soon yanked his ads from the Advocate, a national gay magazine, and cut his business line.
When Dr. Sonnabend, who had already suspected the coming epidemic, fingered similarly hard lymph nodes on Michael Callen’s neck, he weighed his favorite patient’s promiscuity against his likelihood of musical success, and told him to leave New York, prompting an angry reaction. Callen, after a phone call from an apologetic Sonnabend, agreed to donate a small blood sample for Sonnabend’s study of gay men of a similar profile: swollen glands, a history of STIs, and no lesions. Tests revealed a compromised immune system. Callen called home and told his parents he’d be dead of cancer in six months.
Dr. Sonnabend eventually connected his two patients, who shared a desire to spread the word and a belief in their doctor’s “multifactorial” theory of AIDS. Sonnabend theorized repeated exposure to STIs and human cytomegaloviruses, which cause chickenpox, herpes, and mono, better explained the total immune collapse than the emergence of a new virus (the then-unknown HIV). He saw sexual liberation as enabling this death by one thousand cuts. Callen and Berkowitz concluded gay men did not know the possible danger of sex.

Feeling a responsibility to sound the alarm, they published “We Know Who We Are” in the New York Native, a gay newspaper in Greenwich Village. Warning readers against sex in bathhouses, they wrote, “What ten years ago was viewed as a healthy reaction to a sex-negative culture now threatens to destroy the very fabric of urban gay male life … the obvious and immediate solution to the present crisis is the end of urban gay male promiscuity as we know it today.”
The backlash was instant and scathing. As author and former Native staff writer David France wrote in his 2016 book How to Survive a Plague, the men were called “sex-negative hysterics” and “self-flagellators” in the paper’s subsequent editions. Articles in the Village Voice denounced them. An editorial printed in a Toronto gay paper accused them of spinning 200 diagnoses of “GRID” into a crisis, pointing out that twice as many gay men had died in traffic accidents in the same time period. Callen and Berkowitz were, of course, right—AIDS was sexually transmitted and gravely serious—but sometimes it’s not what you say, but how you say it.
The inspiration for one of the earliest safe sex guides for gay men came with a bang at Berkowitz’s door. A former client had driven from Connecticut in a frenzy to ask if Berkowitz was okay. Berkowitz, who explained what AIDS was, expected the man to freak out. Instead, he asked if Berkowitz would put on his leather and boots while he jerked off.
“I was in shock!” Berkowitz told The Stranger in a phone call last month.
As a sex worker, Berkowitz could imagine a more expansive sexual world, where sex could take many forms. His client reminded Berkowitz safety and enjoyment were not mutually exclusive concepts: “It was an education to me to see how many different ways there were for men to get sexual pleasure that had been haunting them, that they were craving for, where they can access it and pay for it and not be ashamed of it.”
With help from Dr. Sonnabend, Berkowitz and Callen started work on a booklet they called How to Have Sex in an Epidemic: One Approach, published in 1983. Dr. Sonnabend insisted the booklet begin with a scientific rationale for gay men to alter their sexual behavior. Callen and Berkowitz followed that explanation with practical advice.
While the science is dated, the nonjudgmental, sex-positive tone is contemporary.
People would continue having sex regardless, so they encouraged readers to treat their partners with love (even for a night) and their own health as precious. The guidance met people where they were at.

For instance, Sonnabend noticed his patients who were bottoms who liked being fucked were more likely to get sick. The authors advised readers on the risks of receptive anal sex. They acknowledged that some gay men were defensive about these warnings because of homophobic stereotypes. (“Remember that the issue is disease—not sex,” they wrote.) They explained that sperm could carry a virus and infectious agents can easily penetrate the rectal lining. Providing a condom to your partner was the best way to stay safe, they advised. For tops who couldn’t adjust, they suggested another compromise: “Let your partner fuck you without a rubber and make sure that he either pulls out or puts a rubber on before he cums.” How to Have Sex in an Epidemic provided similarly frank guidance on ethics and responsibility, selecting partners, washing up before sex, buying and selling sex, blowjobs, fist fucking, no-risk methods like mutual masturbation and fingering, dildos, and S&M. They addressed the reality that men with AIDS were having sex:
“AIDS patients are human beings and need affection and human contact. AIDS patients object to being treated like lepers and some end up taking this anger and frustration out to the baths and backrooms. The issue of AIDS patients having sex must be viewed from two perspectives: the risk to the patient and the potential risk to the partner.”
France, author of How to Survive a Plague, remembers the booklet changing the culture in New York City nearly overnight.
“It was night and day,” he said. “It didn’t just give you the rules of things to not do, but it said, ‘This is how we can build a life’ in this incredibly dark time.”
Unbeknownst to Callen and Berkowitz, a protesting band of nun habit wearing drag queens in San Francisco called the Sisters of Perpetual Indulgence came to the same conclusions about safe sex and condom use the year before.
The Sisters’ 1982 zine “Play Fair!”—black, white, and pink and illustrated with comic nuns—introduced readers to STIs like syphilis, herpes, hepatitis, and intestinal parasites, as well as Kaposi’s Sarcoma and pneumocystis pneumonia, two symptoms of the “severe problems with immune systems” arising for gay men in large American cities. (The Sisters also added “guilt” to this list, “SYMPTOMS APPEAR: 2 to 3 years of age and persist in many cases throughout one’s life.)
It’s possible that one booklet written by two AIDS patients and their doctor, and another written by drag queens, saved thousands of lives, and that their influence is still felt in every bowl of condoms in a gay bar or health clinic in America. (Moreover, we have a guy from Connecticut with a leather kink to thank). The concept of sexual harm reduction influenced mainstream medicine.
While scientists cracked the biomedical puzzle of HIV, AIDS still kills. Even as researchers develop evermore effective HIV treatments, including injections that can replace months of daily pills, advancements are meaningless without access. Basic human problems of poverty, homelessness, and convoluted healthcare systems have stymied efforts to end the pandemic. (Such a thing is possible. In 1980, the World Health Organization eradicated smallpox, one of the most deadly illnesses in human history, through vaccination).
Donald Trump’s administration is radically hostile to public health and bodily autonomy. Just weeks into his term, he’s already threatening HIV medications for people outside the US. Trump through PEPFAR, which supplies HIV medication to 20 million people in poor countries. Stopping these medications can eventually kill or lead to the emergence of drug-resistant strains. Through executive order, Trump withdrew the US from the WHO, ending decades of our international collaboration on healthcare.
A gag on health agencies ability to communicate with the public, the possible freeze on federal grants, the anticipated cuts to programs that do not align with Trump’s ideological priorities, and (as of publication time) possible Senate confirmation of vaccine skeptic Robert F. Kennedy Jr. to lead the nation’s healthcare system, are all worrying signs that this administration is a threat to accurate health information and equitable access to healthcare services. That’s true for straight people as well. Trump revoked Biden’s executive orders that directed the federal government to protect access to abortion.

For queer Americans who grew up in an era of widely available, government-subsidized drugs to prevent and treat HIV infections, waiting for a treatment that may never come as friends, lovers, and gay rights pioneers sickened and died is nearly unfathomable. People lived for years without knowing HIV caused AIDS. They lived 15 years without a truly effective drug, by which time the virus had killed at least 343,000 people in the US.
For much of that time, gay people still lacked many fundamental rights and contended with federal and local government officials indifferent to their suffering. Sodomy was still illegal in many states, and public opinion was not with gays. The Christian right saw gays as physically and spiritually contaminated, and AIDS as biblical justice.
Still, people with AIDS gave the last weeks, months, and years of their lives working toward a future they might not see for people they would never meet. Their political courage was rewarded with one brighter than many could have imagined—for a time—but look where we are today.
We should take lessons from the early AIDS activists who took matters into their own hands. The story of AIDS, and gay rights, is often told as David slew Goliath, that gay rights triumphed over bigotry and brought the government and its institutions to a heel. But for years, community response kept people safe. Alive. We now face the possibility of the government abandoning an even wider swath of the population. We’ve taken responsibility for our care before, and it worked. But it is not 1981. We need to decide what that looks like in 2025, keeping key lessons in mind:
Progress is not linear, political victories are not final, and territory, once claimed, must be vigorously defended. Who you are can decide whether the government helps you, or potentially hurts you. When systems fail, help the people around you. Passivity and inaction are non-options. Small actions can be meaningful, even the smallest gestures, or simply occupying space.
Sister Roma joined the Sisters of Perpetual Indulgence in 1987 after a chance encounter at Midnight Sun, a bar in the Castro. In walked a character who looked like a showgirl nun. Gregarious, flirtatious, and smiling, Sister Luscious Lashes ordered a drink from a bartender she clearly knew. Roma thought she hadn’t seen anything like her when she walked over and called Roma by her “boy name,” which she never uses anymore. This nun was her good friend Norman Schrader.
Sister Roma was ushered quickly into the order, and fell in love. Looking back to her years in San Francisco before the Sisters, Roma said she acted like she was in a “gay candy store,” where life revolved around partying and boys.
“I must have been insufferable,” she says. “But when I met the Sisters, it was like my head exploded. I was like, ‘Oh my God, I care about my civil rights. I care about my community. I want to help people’ Even though I was raised sort of Catholic and went to a Catholic college, never was I raised to have any kind of spirituality or be of service until I met these crazy fucking drag queen nuns.”
Schrader later died. But Roma and other Sisters continued patrolling the Castro, putting condoms in the hands of strangers in bars. They sought sick people, hunched over cocktails in the dark, and engaged them in conversation. Sometimes these men would ask for hugs. The Sisters always said yes.
