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1987
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1heNewj_o_u_rn____a1__6~~-¡e~-b~0_4.31-987 NewsJoumal
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Between the VInes
6
Krishnas commune . . . compost collects . . . composers compete.
The Body Politic In trying to join the Women~ Center, Students for Lift challenged basic political assumptions about feminism. Can the women~ movement afford a pro-life wing? By Ann Wierda.
Features
Lion Tamers Instead qf writing on walls or screaming at roommates, try a body massage or cognitive restructuring. Stress management uses these techniques to soothe the savage beast. By Skye Wilson.
15
Special Section: AIDS at Yale and in New Haven Three articles look at how AIDS is transforming our communiry.
16
Dangerou s Decision s By Jennifer Sachs.
24
Tracks of the Disease By Daniel Waterman.
32
"All Fall Down" An essay by John Boswell.
Books
38
Respecting the Strike From the perspective qffour union supporters, Yale's 1984-85 dispute emerges as a case study of the model labor action. By Harry Robinson.
The New J o urnaVD ecem ber 4 , 1987 3
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Another Course Saffron-robed and bald, beating drums and crashing cymbals, they color Elm Street with otherworldly designs. Yalies with designs for this world only turn their heads and scuttle to the safety of Cross Campus. The Hare Krishnas are in town, and apparently they're here to stay. The Krishnas, who first appeared in New Haven in 1973 and spent two months selling books on the Green, have returned periodically to conduct educational programs at Dwight Hall. But according to Acaryadeva, the current chairman of the International Society for Krishna Consciousness (ISKCON) and a visiting lecturer in New Haven, "the Krishnas are permanent." The principle lure of New Haven is Yale. As Acaryadeva explained, the Krishnas plan to establish temples in academic centers where "some of the most intelligent people tend to congregate," and to cultivate "an enlightened class, ideal in its conduct and enlightened in spiritual knowledge." This enlightened class, they hope, will guide America to a spiritual awakening. Steve Shutt, a Yale history Ph.D. candidate who teaches meditation classes in Dwight Hall and is familiar with ISKCON, asserted that the present group of Krishnas is well-suited to Yale. He feels that they use an approach significantly different from the shock tactics and psychological.tinkering commonly associated with the Krishnas. Pointing to their knowledge of Western and Eastern culture and religion, Shutt said that the New Haven Krishnas seem very intellectually inclined. About 500,000 people have joined the Krishna movement in the United States since it appeared in New York City in 1965. The movement began in India 5000 years ago and has gathered a large international following. It is 4 The New Journal/December 4, 1987
complete indifference or sheer bewilderment, but some brave ones· have spoken to us." Acaryadeva added, "We have to go out and meet people. We have a lot of communicating to do."
•
-Kirk Semple
Sarvatma: a different drummer.
based on extensive literary sources, primarily the writings of the Lord Sri Krishna in the Bhagavad-gita. According to Acaryadeva, through a strict program of chanting, diet, and discussion, Krishna devotees attempt 1'to attain a spiritual knowledge that will purify their soul and bring them to a higher and expanded consciousness." Acaryadeva established a new center last May on Park Street to bring this opportunity to New Haven and Yale. Its doors are open to the inquisitive on Thursday evenings for informal discussion about reincarnation, spirituality, and existentialism over a meal of homemade vegetarian pizza and pear juice. On Sunday evenings the Krishnas hold a more formal program of chanting, a lecture and discussion, followed by a multi-plate vegetarian feast. Even though several Yale students have attended these sessions, the Krishnas have not received the overwhelming response from them that they had hoped for. Dina Diya, a firstyear student in the nursing school's nurse-midwifery program and a Krishna devotee of 15 years, feels that the Krishnas will have a greater influence on the community as people become more aware of the movement. The Krishnas' parade, or "hari nama," has introduced many Yale students to the group. "That really scares people," admitted Sarvatma, an Argentinian who left his editorial position on a surrealist Uruguayan newspaper and now runs the Park Street center. "Most people respond with
Place of Refuse Sometimes people forget. "There's nothing sadder than an empty porch," said Becky Seashore (TD '88), who as co-coordinator of the Compost Cooperative makes morning van runs twice a month to pick up recyclable food wastes from the homes of the Coop's members. Apart from the occasional absent compost bucket, however, Seashore and her colleague-in'compost, Betsy Lyman (For. '88), find their involvement in the Compost Cooperative a satisfying way to exercise their ideals as environmentalists and to generate awareness about wasted resources. The Coop, now in its second year, hopes to exceed last spring's final membership of 79. Although most members among this year's increasing roster of 35 study at the Yale Forestry School, participants include a smattering of Yale professors and undergraduates, as well as one rabbi. Members of the Coop agree to collect their leftover foodstuffs in a five-gallon compost bucket and to donate them to the Coop every two weeks. In addition, members divide the cost of garbage bags, buckets, xeroxing and gas- a total contribution of under ten dollars a year for each participant. Finally, each member is asked to take part in the dirty work, joining the two coordinators in one hands-on compost pick-up run per year. Although one member characterized the pick-up run as an activity after which "you just come home feeling gross," Coop members consider the inconvenience worthwhile because it
...
"You just come home feeling gross."
gives them an opportunity to return organic materials to the soil, rather than allowing them to be dumped into a city landfill. Seashore emphasized the value of overcoming the environmental limitations imposed by living in a city. In addition, she admitted, "com posting is just a helluva lot of fu n ." One diversion in which composters indulge is to guess the intimate details of other members' lives by examining their discarded leftovers. "All of a sudden there will be a half bucket of coffee grounds," said Seashore, "and you'll know this person is stressing out." The Coop's pick-up crew transports the leftovers from each home to the Forestry School for collection by Yale's uncrowned king of compost, P eter P inchot (For. '88). From the organization's inception last year, Pinchot has been the sole recipient of the hundreds of gallons of compost generated by members every month. When last measured, his burgeonipg compost heap was twelve feet long, fo:Ur feet wide, and over two-and-a-half feet tall. Pinchot uses the compost to help fertilize vegetables on his small private farm in Guilford, feeding his family with the produce he grows. Although Pinchot. may seem a bit hard to satisfy when it comes to organic matter, asserting that "I always want more compost," the Coop has announced that he is "more than willing to share" his collection of decomposing food scraps. At least one other Coop member, Professor Bill Burch of the Forestry School, plans to take h im up on the offer. Seashore says that the Coop's a rrangement is not ecologically flawless, pointing out that those who use compost would ideally produce it themselves. Still, she feels that "all these things should be done in the end because they're fun and they bring people together." She would like to see the Coop renamed The Leftovers Alliance and imagines the perfect compost run as an affair which would include capes for all participants, a blaring red siren, and a mounted compost bucket for the
roof of the van "like those rotating K entucky Fried Chicken buckets."
•
john Gill
Measuring Up Sung Kwak straightened the tie of h is tuxedo and took a last glance in the mirror. It was concert night for the New H aven Symphony Orchestra (NHSO), and in 15 m inutes Kwak would lead the orchestra's 85 musicians through a program of Mozart, Mendelsohn, and Tchaikovsky. Kwak moved about backstage with a conductor's composure. Would the concert go all righ t? H e flashed a quick smile. "I hope so." Kwak was the first of five finalists competing to succeed Murry Sidlin, music director of the NHSO for the past 11 years. According to violist Marvin Warshaw, the NHSO became a "more respectable orchestra" under S idlin's guidance. Richard Lightfoot, chair man of the search committee which will select Sidlin's replacement next May, claimed that "Murry built the orchestra." The N H SO hopes to find someone who will follow Sidlin's lead. When the N H SO announced their search for a new director in 1986, they received over 275 applications from across the nation. The search committee, which includes three board members, two musicians, and the orchestra's general manager, rejected about half of the candidates, citing inadequate credentials. The search committee requested recordings from 50 applicants and eventually proposed five finalists after more than a year of biweekly meetin gs. The NHSO chose applicants "in the ascendant portion of their car eer," Ligh tfoot said. H e pointed out that New Haven has a reputation for being an "arts-in tensive community" and that
the new di rector must consequently show a great deal of artistic leadership. K wak, the current music director of the Austin Symphony Orchestra and a forme r conductor for the J offrey Ballet, seems to have the necessary credentials on p aper. But Lightfoot stressed that a resume does not stand alone. "We have a sophisticated audience and a reputation for adventurous programming," he said. "We can't have someone who is archival." Paul Kantor, o n e of the two musicians on the · search committee, said that the orch estr'i members also want an exciting leader- someone "inspired and inspiring." K antor pointed out that the selection process, in which musicians and management work together, differs from that of many orchestras. ''Here," he said, "the board members have been very open to the musicians' comments. They really have listened to what we have to say ." The musicians have a chance to get to know each finalist during a week of meetings and social events. Kwak, who visited New H aven in October, also met with NHSO fundraising groups, staff, and volunteers and held a press conference for local media. But the focal point of K wak's stay was the time he spent with the orchestra-approximately 13 hours spread over five rehearsals. According to Kantor, this is a "luxurious amount of time" to prepare for a concert. At the end of the week, Kwak led the o rchestra in front of an enthusiastic crowd in Woolsey Hall. · After the concert, K wak chan ged from his tuxedo into a conservative suit and tie. Musicians came to shake his hand, and a friend brought roses. Asked if it was a good concer t, Kwak beamed and replied, "It was a good week." Four . other conductors now stand between h im and his next New H aven audience.
•
-john Kim
The New JournaUDecember 4, 1987 5
Between the Vines/ Ann Wierda 路
The Body Politic "Look around Yale. You don't see a pregnant woman walking around this campus." A woman defending the pro-choice stance on abortion was speaking at a recent forum. True enough, I thought. I did not even have to pause 路in an attempt to recall any pregnant women I might have seen in class, in the library, in the dining hall. I followed her subsequent pro-choice arguments also without a pause. Unplanned pregnancy disrupts a woman's education and employment, many times leaving her in economic and emotional despair. These familiar arguments defending the right to abortion provide the basis for my own feminism. Two days later, as I sat across a dining hall table from three women of Students for Life, a pro-life organization on campus1 that basic understanding seemed vague ly threatened. The lac~ of direct clash between their pro-life arguments and my pro-choice beliefs bewildered me. Over and over, these women threw out the same words, the same rhetoric, that I had heard in the mouths of prochoice believers. As we talked, I had the strange sensation that words had separat~'d from meanings and were floating freely around the table. "Look around Yale," Shannon Summers (BR '90) said. "You don't see a pregnant woman on this campus." She continued, "This institution is not gtvmg women options. It 1s sending out signals that a woman cannot have a baby and be a student here. There is no room for a pregnant woman at Yale." The degree to which her argument reflected rr:y assumptions about a woman's choice disconcerted me. Yes, a woman should have the option. to have a child, if she so chooses. Yes, there should be a "place" for a pregnant woman. But does this reasoning constitute a "prolife" argument or a "pro-choice" argument with a different emphasis? And does feminism have room for both ideologies? I heard the strong words of Katie Oberlies(LAW '88):"I am a member of 6 The New JournaVDecember 4 , 1987
I '
Students for Life, and I am a feminist." To this woman, the right to abortion did not lie at the center of feminism. She did not expect her stance on the issue to place her outside the movement. Then she and other members of Students for Life sought inclusion in the Yale Women's Center. The Center decided that the right to abortion contained such basic femionist significance- a woman's right to privacy in terms of her own body- as to make it a definitive line for feminism. Feminists could have differing opm10ns on prostitution, pornography, or the ERA, but not on abortion. Students for Life fell on the wrong side of the line and found themselves defined out of feminism and the Center. Traditional definitions of feminism exclude many women from the women's movement, just as they exclude Students for Life from the Women's Center. In fact , women have no unified political ideology and no comprehensive way of defining their interests. Not all women call themselves 路feminists , and we can easily acknowledge this division. But accepting the idea of division and
political difference within the ranks of feminists becomes more difficult. Definitions of feminism -mean different , possibly contradictory, things. When one woman's feminism undermines the validity of another woman's, the larger whole of the movement begins to lose meaning. The questions facing the Women's Center-and any organization which calls itself simply "women's"- go beyond the incessant questioning of whose feminism counts as real. For at some point the women's movement has to reconcile its relationship to an incredibly diverse body of women. Is the movement obligated to include all the views of women merely because they are held by women? Or is the primary commitment not to some inclusive representation but to a specific political agenda, a specific feminism? The Women's Center dealt with these questions when it reevaluated its statement of purpose. That statement grew out of the realization that the Women's Center had run- up against rbe wall of its own homogeneity. In restructuring the Center with the路hope that it would become a "place for all
Feminists could h ave differing opinions on prostitution, pomography, or the ERA, but not on abortion. women," the women recognized the strength feminism gathers from a multiplicity of class, cultural, and racial experiences. Did they turn away from this recognition in excluding Students for Life? I soon realized that my first answer to this q u estion, a simple "yes," proved too easy and ignored many d imensions of the decision. There was much more at stake in this instance than an opportunity to enhance the Center's diversity. Incorporating these women could undermine the Center's political orien tation and its ability to work for certain political beliefs. I n denying entry to Students for Life, the Center affirmed a specific political agenda which they d id not want compromised. In effect, they rejected the obligation to represent all women when some of them held views in basic con tradiction to th e Center's commitment to feminism. For every belief there exists · an opposing belief. If I choose to fight on one side, I must consider the other side, attempt to understand it, and even respect it as an alternative. But I still remain committed to fighting against it. There is a precarious balance to fmd between accommodation and focu sed pursuit. Too often society has ex pected women's political efforts to strike th at balance on th e side of accommod ation . 1 respect the women of the Center for claim ing their political nature outright, and even more, for claiming ~e right to fight for their political mterests. T hese interests, no longer synonymous at Yale with the word "feminism," have found opposition in Students for Life. The women of this group vehemently insist that they are feminists; they deny a n y ties to national pro-life groups, except one entitled Feminists for Life. As an organization, they do not claim that abortion should be illegal. Their objectives includ e exploring the morality of abortion, exposing the potential harms which accompany the procedure, a n d a d vocati n g fu ll consideratio n of the alternatives.
"We give you the attention and consideration that you deserve"
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But as individuals, their objectives differ from the organization's rhetoric. 280 York Street Mon.-Fri., 8 am·10pm When questioned, members of Stu- New H aven Sat., 9 am·5 pm dents for L ife express the belief that 777·1111 Sun ., Noon·5 pm abortion should be illegal except in rare cases. G iven their strong personal views, I question their honesty in refusing to take an offical stand on the new books legality issue. More important, I lose special orders respect for them as a women's group because they fail to back up their out-of-print personal views with a political course books statement. In the case of abortion, women cannot separate the personal from the political. Ultimately, these women threaten my right to abortion, and that threat touches a raw emotional chord 290 York Street within me concerning right and 787-2848 wrong. Every struggle for human rights begins with this instinct for what A Yale tradition since 1978 a human being deserves. I must reject the intellectual arguments of these women because of the same instinct which supports my pro-cho ice beliefs- the feeling that each human being has the fundamental right to control her own body. In the end, women at Yale lost control of their own Center, as Dean Sidney Altman decided that all women's groups, specificaJiy Students for Life, must have a place there. Altman's command made the women's attempts to work out their own arrangement seem beside the point. But quite the opposite is true. The conflict at Yale represents important changes m the broader women's movement. "Feminism" no longer connotes a single political ideology, and women's groups cannot assume a common purpose with aJI who call themselves feminist. One sign of the movement's development is this new level of political dissension within its ranks. Women must go beyond old definitions of feminism to identify political ideas w hich promote their best interests.
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•
Ann Wierda, a senior in Morse, helped restructure the Yale Women~ Center last spring.
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Lion Tamers Skye Wilson
"In modern times we usually don't have extemal lions. All of our lions are inside of us now."
8 The New Journal/ December 4. 1987
In Yale's stacks, the wntmg on the tables and walls, scribbled in black pen and colored markers, speaks of love and trouble. "I don't belong here, I am too stupid! My professors all hate me!" someone has written on one desktop. On another: "All I want to do is sleep for a few weeks, like my dog at home. Is that too much to ask? I won't pee on the rug." Basic questions appear: "Why me?" and "Is love a media myth?" There is also an offering of advice. "Music can keep you sane," someone writes. "If you screw up on one test or paper or even in one whole class your life will be far from over. " But the graffiti has a limited effect. "I can't keep on like this. I have to do something NOW ," one tabletop reads. "This can be a very bad place. Here I am in the stacks, last week of school, and- some-
one- a guy- breaks into muffled sobs two aisles down." Humor, advice, longing, and despair surface in a variety of g raffiti , but they often come from the same source, stress. Stress has an effect on both physical and emotional well-being, and in recent years has received increasing attention from the medical field for its link to physical illness. In a meeting of mind and body, stress management formalizes ways to prevent "stressin g out," a condition with symptoms as mild as cold hands and as threatening as chest pain. The coronary heart disease that such pain can signal has become the major cause of premature death in the United States. The medical establishment has responded to this high inciden ce with an increased interest in stress manage-
ment over the past 10 years. Its endorsement of stress management techniques, supported by health psychologists, has attracted a following in the general population. According to Deborah Kraemer, professor of psychology at Yale, dramatic data proving the benefits of stress management has come from studies of heart disease patients. But others with less serious problems, such as insomnia and tension headaches, have also found help. Success in treating minor stressrelated ailments remains untested. Studies on short-term effects of stress management in patients without disease do not exist due to the recent
Small discomforts add up to more stress than do major life stressors.
our ego or threats to things that we value, but that triggers the same bodily response," Roderick Watts, a stress management counselor and psychologist, explains. Dr. Watts, on the Medical School faculty, coordinates the adult programs at the Consultation Center, a clinic near the Yale campus that serves the Connecticut Mental Health Center, the Department of Psychiatry of the School of Medicine, and the Community Consultation Board, Inc. He addresses stress management in a number of workshops for business and nonprofit groups and teaches its techniques to the Yale community during midterms and finals. From outside Watts' office, children's voices fade in and¡ out, signaling activity in the Center's special programs. "We are preventionoriented in general- anything like consultation, education, and training designed to prevent mental health problems before they occur," Watts says. For worried students as well as cor-
porate bosses, stress management fits within this model and often results in lowered health care costs. Students attend Watts' seminars because they have difficulty coping with academic and personal pressure. Joa~ Slepian (SOM '93), familiar with these problems, has d1scovered how stress management addresses students' needs. She spent six years as director of counseling services for Hartwick College in upstate New York and found stress management an important par t of her work. A trained clinician with master's degrees in counseling and clinical social work, she came- to Hartwick without any formal training in stress management. Upon witnessing inappropriate student responses to stress, such as heavy drinking, she recognized the need for a healthful alternative. "Once you identify the stressor and the situation and what is going on you can do one of three things. You can change yourself, you can change the situation, or you can change your
nature of the field. Its techniques-such as learning to approach work as a positive challenge instead of as a sure-fire proof of failure- still lack the credibility which comes from clinical investigation. Preliminary work has examined stress in terms of physical and mental reactions to a variety of "stressors." Commonly, the body responds with such ch.anges as increased heart rate, glucose production, and muscle tension. Long before labs existed to measure them, these responses served an obvious, adaptive function. "If a lion jumps out of a tree and you have these physiological reactions, you're going to survive better because you are going to be more energized, you are going to be more alert, you're going to have more sugar in your blood for energy to either run away from the lion or to combat it," Kraemer says. In the short term, that fight or flight response can save lives. •rn modern times we usually don't have external lions. All of our lions are inside of us now, and we push our buttons mentally in response to threats to The New JournaVDecember 4, 1987 9
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perception of the situation ," Slepian says. But to effect these changes, o n e may choose from a variety of methods. "A lot of things fit into the stress management picture Some might be more effective in some situations. But it is a real smorgasbord," she explains. Whatever technique applies to a spectlic case, Slepian and others advise that stress m anagement begin sooner rather than later. They seek to avoid intervening o nly during crisis. "You really have to think about your lifestyle in total and think ab out how you need to develop one that is going to manage stress rather than responding to crises," Watts says. But living a calm life takes work. According to Kraemer, that work aims at encouraging "generalization," a state in which techniques translate to day-to-day life. The most basic psychological technique, cognitive restructuring, teaches how to rework old thought patterns and perceptions. Watts refers to these patterns as little tapes everyon e plays in their h ead; wheri played too often
they can become psychological traps. Someone equating straight A's with success as a human being will undoubtedly suffe r from stress the night before a .deadline. Kraemer talks about this problem in terms of a pyramid. "Yo u think it is due tomorrow and if you don't do it, then you'll get a bad g rade, and then you'll never get a job, and so on until finally everyone in the world knows your name and hates you," she says. I n order to rewrite those tapes, Watts helps the clients uncover their self- statements and change them in order to make their expectations more reasonable. Colin Clarke (PC '89) could have benefited from Watts' attention three years ago. H e m anaged a high-volume D o mino's Pizza restau rant that generated Sl million a m onth . During busy nights- nights of "1 00 pizza hours," in which the restaurant received 100 . orders per h our-Clarke g rew impatient with his e mployees and could not instruct them calmly when they made mistakes. U sing cognitive r estructuring
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techniques, a stress management counselor would help Clarke evaluate the effectiveness of his actions, the reasons he avoided instructing his employees, and the undue burden he placed on himself. Together the counselor and Clarke would then identify the changes needed in Clarke's approach. They would design a stepby-step program, beginning, for example, with taking a minute to show one employee the proper procedure without anger. According to Watts, som eone working in this manner can replace past habits with new behaviors. "I like the old Zen idea that instead of pulling an unwanted bush out by the roots, you plant a new one next to it and attend to that. The old one will die of its own accord." Other cognitive techniques include time management, assertiveness training, and problem solving. Together they function to make daily life more manageable. "If you learn to use your time more efficiently, often being )n a bank line having four people ahead of you might not be stressful because you have allotted more time for that activi' ty," Kraemer explains. In fact, studies have shown that lines and other small discomforts add up to more stress than do major life stressors. Without appropriate day-to-day coping skills, chronic stress-induced problems will occur. According to Kraemer, stress proceeds in four stages: appraisal-alarm, acute reac-
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tion, exhaustion or burnout, and development of disorders as serious as coronary heart disease. Obviously, intervention at the first stage, appraisalalarm, . is the most desirable. As Kraemer explains, when an intervention such as cognitive restructuring does not occur, the acute reaction sets in. This phase includes the normal physiological response of an adrenaline rush and increased heart rate. Then if the individual continues at the second level over a period of time, exhaustion or burnout follows. D evelopment of disease, the last stage, potentially ends in death. Applied to the second stage of stress , physical coping strategies reduce the body's n atural response to a stressor. Watts begins his treatment by teaching clients to breathe, a skill he calls "centering o neself." As simple as it sounds, correct breathing eludes many people. The most common method, breathing from the chest, comes from a hold-over response designed to increase oxygen capacity for making split-second decisions; over a period of time, it has no effect except to help keep the body in an anxious state. The proper procedure, breathing from the diaphragm, lessens the involuntary physical stress reactions. Two other relaxation techniques treat the physical, non-chronic problems related to stress. The first, relaxation response, involves constantly repeating a simple word or phrase in order to focus attention inward and avoid "mind wandering." S ta ring at an object has the same effect. Prog ressive
muscle relaxation achieves a similar calmness by systematically contracting and releasing muscle groups until each feels fully relaxed. The clinician might instruct, "Grin with as wid e a smile as you can, tensing the muscles of your jaws, cheeks, tongue, and lips. Release. R epeat. Pucker your lips, as if you were trying to kiss someone. R elease. Repeat." With mastery of the basics, one can go on to more complicated techniques, such as those Watts teaches in his advanced workshops. These include creative visualization , meditation, selfhypnosis, and in certain cases biofeedback-although Watts does not use biofeedback in his work . V isualization encompasses some of the most creative ways to relax. Psychotherapist Angela Corrao uses images of water, the sun's warmth, and a field of flowers. "Think of the most relaxing place you've ever been," her voice lures, growing soft , each syllable expanding to fill the space of two. "See yourself ly ing o n a warm b each, and all of your cares and worries and tensions are rolling out with the waves." Already a gentle speaker, she instinct ively becomes more soothing. Her small office, filled with books such as New Mind, New Body and R elaxation R esponse, becomes a sandy oasis in the basement of SSS. The waves lap a round her canary yellow walls and the sun replaces the overhead lighting. She then prompts self-statements. "My arms are getting heavy and relaxed," she says. "My body is growing calm and quiet. My arms are fee ling warm
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and heavy." Corrao uses biofeedback for her patients in the TMJ Facial Pain Clinic at the Yale Psychophysiology Center, where she serves as clinical coord inator. TM.J stands for temporomandibular joint disorders, which are problems that affect the joint between the temple bone and lower jaw. The TMJ Facial Pain Clinic treats patients with discomfort due to congenital problems, a n injury such as a car accident, or chronic trauma from clenching or grinding the teeth, a habit linked to anxiety. To modify behavior, a biofeedback machine depicts involuntary responses through visual or aural representation. For example, patients can learn to increase blood flow to their hands by invoking images of warmth and gauging
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their progress with the biofeedback machine . Corrao uses biofeedback for measuring jaw muscle tension; the technique has proved successful also in treating migraines. Studies on the medical effectiveness of biofeedback and relaxation response reveal clear benefits for those in the fourth stage of stress development. School of Medicine Professor Linda Powell has co-authored the most recent findings on the relationship between lifestyle and risk of heart attack. These studies form the basis for research in stress management, according to Kraemer. But she emphasizes that stress alone does not cause heart disease, though it increases the r isk. To remedy the lack of substantial studies for non-disease patients, Watts
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has taken preliminary steps to formulate his own. Testing 300 women before and after 15 stress management training sessions, he seeks to use the data comparisons to probe the effectiveness of the techniques. An extensive questionnaire will determine success on measures of substance use, psychological and physical symptoms of stress, and improved function ing in roles as mothers and employees. The way Watts has designed his study indicates how he views stress management: as a science with hypotheses to be tested and proved. And stress management does involve more than grandmotherly care,
"If you don't do it, then you'll get a bad grade, and then you'll never get ajob, and so on until everyone in the world knows your name and hates you." although it follows a similar logic. "Everybody instinctively takes some quiet time," says Watts. He explains that society encourages us to devalue this idle time. "If we are sitting in a room with music on and the lights down and burning some incense, we tend to think that's wasting time. In some ways, by saying this is a specific technique, we give it some legitimacy so that people can do it and recognize this is important." Even writing on walls, if it helps someone to calm down, claims its own importance. In terms of stress management, graffiti represents a crucial step- developing the awareness that something has gone wrong .
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staff of TN]. 14 The New journal/December 4 , 1987
....,.............,..ber, 1983, Hampton Sides recorded the New Haven intravenous drug (IVD) abuser and had given birth to a baby with AIDS. Though doctors her of carrying the disease, Lana was still on the street, hustling. At the time, 2500 cases of full-blown AIDS had been ~-;- ~eoonted worldwide, 25 in Connecticut. At least one New Haven man ..._~~.ti died from the disease. In September of 1985, Rich Blow reported in The New Journal on the progress of the epidemic. Nationwide, 12,000 people had come dow.n' with full-blown AIDS. "Now," he wrote, "the virus is in an intermediate stage where the number of risk groups has grown but the majority of Americans are still not threatened." For the virus to begin ~1S?4.Jrn. t9 the general population it was "simply a function of time." ~ d/ time has passed. Doctors no longer talk about "risk groups" about "risk activities." In the United States, 57,000 people have come down with full-blown AIDS, and experts suspect that as many as one in every 1000 Americans now carries the Human ]!nmupodeficiency Virus, which usually leads to AIDS. In New ~' 119 people have developed AIDS. Last year, a Yale graduate student died of the disease, and others in the Yale community are infected. Now, four years after we first reported on AIDS, The New Journal presents three faces of the epidemic. Jennifer Sachs examines Yale's efforts to protect the community and undergraduates' efforts to protect their bodies. Daniel Waterman looks at how the city is grappling with the spread of AIDS among IVD-abusers, 25 percent of whom may now be infected. And John Boswell, Yale professor of history, compares the AIDS epidemic to past plagues, discussing how Western society has come tO deal with the sick and the dying.
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The New J ournal/December 4, 1987 15
Dangerous Decisions Jennifer Sachs Over winter break, workers will install two coin-operated condom dispensers in each of Yale's residential colleges. These dispensers, filled with brand name, medicated latex cond oms, will be located in the single-sex bathrooms next to the dining halls. Though students might prefer to have them nearer to their bedrooms, the machines will at least be closer than Store 24, or WaWa's, or the pharmacy at University H ealth Services (UHS) . By installing the condom dispensers, Yale will be publicly committing itself to
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16 The New Journal/December 4, 1987
certain assumptions about its undergraduate population: th at Yale students are sexually active, and that a percentage may already carry the v irus that can cause AIDS. The proposal to install the dispensers originated in July and gained acceptance only last month- the lag due p artly to summer inertia, but mostly to bureaucratic tie-ups. Yale College Dean Sidney Altman said in early November that h e was "n ot aware" of the particulars of discussions regarding the dispensers and that the decision to install them rested in the hands of the Council of Masters. The chair o f that group, Berkeley Master Robin Winks, refers specific inquiries to Dr. D aniel Rowe, Director of University H ealth . Rowe says he has had the dispensers ready to go for some time, but needed approval from the Dean's office. This delay points to a peculiar problem in the care and treatment of AIDS . The disease affects so many facets of society that it has blurred the boundaries of responsibility: health care providers now act as judges of se-Xual practices, and public officials daily confront issues of medical ethics. Defining a response to AIDS that balances these separate concerns can tax the resources and imagination of an y instit1,1tion. A confused or halfhearted response, however, could be fatal to the students, the financial health, and the vitality of Yale. Last April the University hired Sally Rinaldi , a registered nurse with a master's degree in public health, as its AIDS educator. Rina ldi came from Yale-New H aven H ospital, where she had served in a similar capacity. She works at UHS three days a week, com.piling AIDS information and answering telephone queries about the disease. She also helps to coordinate the AIDS education program of guest speakers, information for freshman counselors, and pamphlets. The program tries to encourage students to practict' "safer sex," d efined as sexual activity in which partners do not exchange fluids- such as semen o r saliva-which might transmit the
AIDS virus. R owe, whose cheerful optimism has e ndeared him to his staff, seem s e n thusiastic about his new employee. H er presence here, he feels, means that "Yale has made a real comm itment to AIDS education." Cathe¡rine Teare (ES '88), who works as Rinaldi's assistant, disagrees. "She can't do an excellent job in a half-time position. And she's hamstrung by the administration, who won't allow anything too explicit to be put out." The pamphlets distributed at UHS show couples in discreetly sexual poses: arms caressing shoulders, hands on backs. Posters on th e ground floor of the Health Services building, of a green blob carrying a gun or a spear. above the warning "AIDS KILLS," do not conjure up thoughts of sex, responsible or otherwise.
"A lot of the girls we're messing around with we've been messing around with since freshman year." Rinaldi's main accomplishment at Yale has been to encourage the formation of student groups to educate their peers. She assisted the organizers of the AIDS Task Force at Yale (ATFAY), of which Teare is a member, in planning AIDS Education and P revention Week in November. Rinaldi also works with about a dozen students, many from ATF A Y, who will participate in monthly educational forums and presentations on the disease. Administrators feel that the most effective dissemination of information about AIDS occurs when students hear it from their peers. ATFAY has attempted to reach the undergraduate heterosexual population with controversial table tents that tell the story of a monogamous couple's discovery, right before graduation , that both part-
ners carry the virus. These efforts, like Rinaldi's, falter, because would-be edu cators often do not know what specific knowledge gaps exist or how to address them. " It has to be discussed amon g students," Teare says. "But I don't know h ow it can be done. For all I know, everyone knows all about AIDS and practicing safe sex- but I d oubt it. " Other sch ools have begun to examine the level of awareness about AIDS on their campuses, and the statistics have not been encouraging. An a rticle in the February Chronicle of Higher Education reported that 74 percent of 13,000 students surveyed at Stanford did not discuss sexually transmitted diseases with their partners, and more than a quarter did not know what constituted "safe sex¡." An u n official survey conducted on 2000 students at Brown University last spring revealed that only 24 percent had changed their sexual habits because of knowledge about AIDS. And a University of Connecticut psych ology professor recently released the results of a questionnaire which showed that 70 percent of the students he in terviewed practiced what he termed "u n safe sex." H ow does Yale compare? The 'University has not undertaken any comprehensive studies to gau ge e ither the extent of sexual activity or the effects of AIDS awaren ess on students here. Although Altman, Rinaldi , and other health offic ials all voice concern that many Ya.le students ignore the dangers of AIDS, none h as sp ecific information to support these fears. Rather, they base them on assumptions about the nature of being a college student: "I re member being one m yself," Altman says. "There's a tendency to think that you're immo rtal ." The New J ournalJDecember 4, 1987 17
PERSPECTIVES
Dr. Daniel Rowe, director of University Health Services: He proposed the condom machines to protect "my population."
Conversations and interviews with undergraduate men' and ""omen suggest that they are neither as cautious as Altman would like them to be, nor as ignorant as Teare s~spects they are. On this campus, the level of awareness about the medical aspects of the disease- facts and fallacies about transmission and the types of behavior that contribute to risk- appears fairly high. Most of the approximately 30 respondents to an unscientific survey of 300 undergraduates indicated that they knew AIDS could not be transmitted easily: "not by casual contact, shared razors; in general, very difficult to transmit. . . . " Knowledge does not always correlate with attitudes, though , and many Yale undergraduates seem to share a comfortable feeling of isolation and insularity from the disease. Almost all students responding to the surve), except those who said they were virgins, acknowledged some measure of personal danger. when asked directly if they were at risk. But answers to a more general question, "Who is at risk? " did not always include the respondent. "Mostly homosexuals and H a itians and people from Zaire," one heterosexual replied. Another answered, "prostitutes and their 'customers,' men who've had homo18 The New Journal/December 4 , 1987
sexual intercourse, IV drug users, peo~ ple from Haiti, Zaire, and a few other countries." Even when speaking directly about AIDS at Yale, students can avoid confronting its relevance to them. J ohn Rozen says that he thinks about AIDS fairly often, and he knows that the disease has affected many different groups: "Male homosexuals, IV drug users, and women who sleep with a lot of guys." He doesn't think that A IDS poses a particular threat to "his circle," especially since most of his friends-are not gay. They sleep with. numerous women, usually use condoms, and do not discuss the possibility of disease before or after sexual activity. "Discussion breaks up the continuity of sex," he says, smiling. As evidence of his own invulnerability, Rozen cites recent studies indicating that male-to-female transmission of the AIDS virus is more likely than female-to-male transmission. Fraternity brothers Tom Blake and William Klein, however, now treat women as calculated risks. They have cut down on their "roadtripping," using condoms when they do but preferring to date women whose sexual histories they can determine. "There's more incentive to be with someone you know," Blake says. He and Klein have
an "AID S index," a one-to-ten scale by which they rate the likelihood of infection o f their women friends. Michael Lindgren, an outgoing heterosexual man who rarely uses condoms because they are "a pain in the ass," agrees that some degree of knowledge about a partner's sexual history is helpful. The college community is so small, he adds, that "a lot of the girls we're messing around with we've been messing around w ith since freshman year," and he knows which of his friends have slept with which women. "That's what's nice about Yale," he says. Rationales like this nearly bring Dr. Robert DeBernardo out of his seat. The clinical immunologist, who heads the AIDS policy' committee at UHS and serves as the Medical Coordinator for A IDS , responded to this outlook in a November 6 editorial to the Yale Daily News. In it, he wrote that "No matter how careful one may be, after enough different partners you will encounter an infected partner .¡ . . . If one out of every thousand airplane flights crashed, would you fly?." DeBernardo also disputes the contention that condom use alone can protect against AIDS. Ht> says that infection is "strictly a statistical sort of thing. Certainly the rate of transmission is not 100 percent. And certainly it's not zero. You can take your choice in between." Although opinions on the efficacy of condoms vary, studies that show them to have a 30 percent failure rate in preventing gonorrhea seem to indicate that they are not failsafe. DeBernardo warns that, while people should use condoms, h e does not advocate "using them and forgetting everything else." The ideal option , he says, is a monogamous relationship in which both partners know they do not carry the virus. Heterosexual women may need to follow his advice more closely than their male partners. Female susceptibility to AIDS has received national media attention, especially with therecent n ews that women tend to die more quickly of the disease. During AIDS Education and Prevention Week, a
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talk on Women and AIDS was one of the best attended events, attracting a crowd o f over 30 women and two or three men. Chris Norwood, the featured speaker, noted that heterosexual women show an infection rate three times th at of other groups, including intravenous drug users. P erhaps as a result of the barrage of publicity, some wo m en express almost irrational fears of infection. Sarah Crocker has had only two sexual relationships in the past three years, one of these long-term and m o nogamous. In the other,- her boyfriend and she were so careful that "we might as well have been having sex ac ros~ the room from each other,": she
Some students may be unwitting carriers. jokes. Yet she still fears infection so much that she has considered getting tested for human immunodeficiency virus (HIY), the virus which can cause AID S. C rocker admits that her fear might seem like paranoia, and probably is excessive. She blames a society that puts most of th e onus for sexual responsibility on its women. "Women have always internalized a responsibility for sex that men h aven't. It's less affrontive to thei r consciousness to have to think about sex," she says. Since the news that condoms provide a degree of pro!ectio n against AIDS, advertising has Increased dramatically, nearly all of it directed at women. R ebecca Patterson , a single senior woman, says she has considered purchasing a supply of condo m s to keep in her room. I f a
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sexual situation arose and neither she nor her partner were prepared, she says, "I can certainly see where I would be- I don't know if lazy is the right word -lax enough not to actually use a condom." She blushes. "But buying condoms would be pathetic, considering I'm not sexually active at the moment." According to recent market surveys, women have begun to purchase condoms in much larger numbers than they did before the A IDS epidemic. For male homosexuals, once thought to be somehow more susceptible to the disease, attitudes and practices began changing years ago. Adam Stone, . a gay junior, says that "every person that I've slept with at Yale has practiced safe sex. It was never brought up, it just happened." Stone, whose room is decorated with .UHS safe sex pamphlets, has had six or seven partners since he came to Yale; he does not have anal sex, would not perform fellat io, and avoids deep kissing. H e also does not sleep with women, although other gay men here do. Scott Schleicher was "actively bisexual" during his sophomore year at school. He used condoms "when there was no other birth control," and with regularity in homosexual sex only since the end of that year. R aising his voice to be heard in a crowded dining hall, Schleicher explains that a number of his old female partners did not know about his bisexuality. Never tested for .,.
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H IV postt1vtty, he does not think he has AIDS. Schleicher's relaxed attitude finds its opposite in one wh o, like Crocker, apparently has little to fear. Neil Orne has had one relationship since he came out at the end of his sophomore year, with a man who had practiced safer sex with his former partners. Still, he was so terrified at the prospect o f AIDS that he convinced his boyfriend to get tested. "We talked about it a lot . I was very scared . . . unreasonably so," he now admits. The test was negative, but Orne still considers taking one himself. "Someday I may get tested just to have a piece of paper that says I'm negative."
He and Klein have an "AIDS index" by which they rate the likelihood of infection of their women friep.ds Orne and other men and women, gay and straight, must weigh the comfort of that piece of paper against the extreme anxiety engendered by the test itself. Despite her fear of A IDS, Crocker will probably not take the HIV test. " I'd go g ive blood. That would be less threatenin g," she says. The Red Cross automatically tests all donated blood for HIV, and informs people who test positive. Schleicher has considered taking the ELISA test which, with approximately a 95 percent accuracy rate, determines the presence of HIV, but rejected the idea. He says that he practices safer sex and argues that the high number of false results makes the test u seless in any case: "I'd rather live wit h the knowledge that I could get it and I could give it." One student who was tested says that the trauma o f the wait outweighs any p otential benefits to those who already use condoms and practice safer sex. Students who do choose to get tested in New H aven have several options. They can, as Crocker is considering,
AIDS
donate blood. They can go to the AIDS testing site located at One State Street and pay a nominal fee for an anonymous test. Or they can go to UHS, which in the past six months has tested over 200 people. As part of Yale's health coverage, UHS otTers both the ELISA and the more accurate Western Blot tests and pre-and posttest counseling. UHS also differs from the State Street site in that the testing performed there is not anonymous. UHS h as just initiated the policy of recording HIV test results on students' medical charts. Before September, individual health care providers decided whether to include HIV positivity or not, and how prominently. Because the information carries such a great stigma, the UHS AIDS policy, established in September and currently awaiting the approval of the Board of University Health, mandates that test results remain confidential. Under the terms of the new policy, people who come in to be tested must first receive counseling from their primary care providers. If the provider decides to order the test, which they may advise against at their own discretion, the patient will be assigned a code number so that the name does not go to the laboratory . The results of the test, whether positive or negative, will be forwarded to the provider, who will insert them in a sealed envelope in the medical chart. So that the envelope itself wit! not act as a warning signal, ten percent o r all medical charts will carry one. If the test is positive, the provider will inform two people: the patient , who will then undergo posttest counseling, and DeBernardo. . The AIDS Policy Committee agonIzed over the balance between confidentiality and anonymity in testing. "We have to walk that tightrope," DeBernardo says. He feels that the policy in its current format otTers the best, though admittedly imperfect, Protection for both health care workers and patients. It stipulates that only in "need-to-know" cases should the envelope be opened, and the n only by the primary¡ provider. DeBernardo concedes that exactly what constitutes
Chair of the AIDS Policy Committee at UHS, Dr. 'Pobcrt DeBernardo feels that the balance between confidentiality and anonymity in testing ia "a fair compromise."
a "need-to-know" situation is a subject of some contention; he seemed unsure of how the rule would eventually be applied. As stated in the policy guidelines, "need-to-know" involves two scenarios. If an HIV-positive patient receives vaccines, serious and possibly fatal complications can result, so some forms of treatment require awareness that the person is infected. Also, if health-care workers come into unprotected contact with a patient's body nuids through skin cuts or abrasions, they should check the patient's envelope. Although the policy states that "blood drawing and routine patient care during exams and surgery DO NOT constitute a "need to know," DeBernardo says that "the interpretation is to a certain extent left open. There may be some physicians looking at the file who reaJly shouldn't be." Given the constantly evolving knowledge about AIDS transmission, the concern of health care providers seems understandable. To protect caregivers, UHS uses guidelines for dealing with patient waste and bodily Ouids that the Centers for Disease Control in Atlanta issued this year. Providers are to treat all patients as if they are infected, wearing gloves and masks if exposed to bodily Ouids. This approach can entail enormous logistical problems. "Does every piece of
material that we use in this building get put in a red bag? And docs it get scaled? And put in the incinerator?" R owe asks. He shakes his head and sighs. "Right now we aren't putting g loyes on to pick up a baby. Somewhere along the way, you have to have a reasonable approach to AIDS." U H S administrators admit that of the I 19 diagnosed cases of full-blown AIDS in New Haven, some are members of the Yale community-faculty, University employees, or graduate students. Last year a female law student and a recent male law graduate died of the disease. But health administrators will not discuss details of these cases and refuse to provide information about the possibility of AIDS, AIDS-related complex (ARC), or HIV positivity among the undergraduate population. DeBernardo and Rowe daim that they do not know of any undergraduates who have tested positive this year, but they would probably not admit it if they did. University officials have, thus far, not commented on any queries about infected undergraduates. Rumors persist nonetheless, perhaps strengthened by the feeling among some undergraduates that Yale officials remain silent because they have something to hide. One st~dent reported a rumor that 250 undergraduates may have been exposed to The New JournaVDecember 4, 1987 21
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the virus, a number at which Dd\ernardo laughs. The doctor is slower to dismiss the words of Michael Chapian, the coordinator of ATFAY, who alleges that eight undergraduate and graduate students have had 10 leave Yale suffering from AIDS, ARC, or the stress of HIV positivity, and that approximately one dozen students admitted to Yale as freshmen this past September knew before entering that they were HIV positive. He admits that Chapian may have access to information which UHS does not share. R owe denies that Chapian could know wht>ther incoming freshmen had tested positive for HIV. "The health history report that the freshmen get does not include any H IV information," he says. Chapian says that he learned about the 12 HIV positives from a contact at the medical school, and that he personally knows "more than two" undergraduates who tested positive at sit('S otht•r than U H S. Regardl~ss of the number of known positive$, DeBernardo 'lays that ..Those who are known HI V positivt· arc only the tip of tht· in·bt·r~." Sonw students may be unwittin~ <arrit•rs. Those cast·s that U H S administrators and providers do know about, they treat according to th<' guidelines of tht> UniH·rsity A IOS policy. Asympwmatic HIV positives will have full access to all Uniwrsity activities and faciliti<.·s, whilt• pt·opl<' suffering from AIDS or ARC will b<'
reviewed on a ~ase-by-case basis. A cautionary note precedes these guide· lines: "Th e following policies are based on the current state of medical knowledge, which is subject to change as new information becomes available." The H ealth Care plan currently covers AIDS treatment, which DeBernardo estimates can run as high as $70,000 per year for each patient. If U H S is faced with a sudden increase in the number of cases covered by its insurance plan, he says, "it's going to be a financinl burden ." Some of this cost will be assumed by students, through small increases in their Yale medical insurance. R owe says that, fo r now, U H S will rely on its own "stop-loss" insurance, which picks up the costs of catastrophic illness for health main· tenance organizations after a certain point, to prevent stud ents from feeling the pinch. Stop-loss insurance is now inexpensive. but D eBernardo believes it may soon skyrocket in response to greater demand. An administrator at Yale-New H aven adds that hospitals which h ave attempted to provide in· sured treatment for AIDS patients have begun to go bankrupt. "Work that out for yourself," he says. " If the H ealth Pla n had to foot the bill for a number of patients, it would be diffi C'ult to imagine how they would re· main solve n t, unless the University subsidized them." Neither D e Be rnardo n or Rowe can predict what U H S will
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do then, although they both insist that Health Services will continue to provide coverage for A,IDS treatment. De Bernardo's characteristic brevity dissolves when he discusses the H ealth Serv ices' need to keep all options open in dealing with AIDS. H e plans to recommend reevaluation of the UHS policy on a yearly or semi-yearly basis, noting that more anonymous testing may eventually prove desirable. Then again , he says, a time may come when HIV positivity does not bear the stigma, or create the fear, that it does now . "Maybe we can get more civilized and the information can j ust go in the regula r medical record," he says.
Providers are to treat all patients as if they are infected.
•
]rnnifer Sachs, a senior in Ezra Stiles, is managin.~ editor of TN]. Kirk Semple, a Junior in Timoth_y Dw(~ht, contributed to this article. A ll names C!f students, except Catherine T eare and Michael Chapian. art' /Jstudon_ yms.
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The New J ournaVO..<'t't\lber 4. 1987 23
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Tracks of the Disease Daniel· Waterman It is Richard's first visit to the Dana-3 clinic at Yale-New Haven Hospital , and he has brought his wife and their 18-month-old baby with him. They sit quietly in one of the many examining rooms that line the hallway of Dana-3, where twice a week the hospital's AIDS Care team gathers to meet and evaluate some of the 300 patients they currently treat. Dr. Warren Andiman, chief physician at the· AIDS Care Clinic, has not met Richard before. H e is a new patient, but Dr. Andiman knows the story of Richard and his family long before he enters the room. Their file tells a story he has seen many times. A New Haven man in his late twenties, Richard had used drugs since the age of 15, mostly heroin and cocaine toward the end. Four years ago, Richard got lucky. He enrolled in a methadone program to fight his heroin abuse, and after two years of treatment 24 The New Journal/December 4. 1987
he gave up drugs entirely. He has not touched them since. Richard began to work regularly, and two-and-a-half years ago he married his wife. Soon after, they gave birth to a baby boy. Last August, when Richard checked into a local hospital suffering from extreme weight loss, doctors determined that he had a low white blood cell count. On the advice of a physician , Richard underwent a test for the presence of the Human Immunodeficiency Virus (HIV) antibody in his system. The test returned positive. Richard was feeling the first symptoms of infection with AIDS. In September, both his wife and child underwent the test for AIDS. Both tests came back positive. "All I ever expected all the time I was doing drugs was hepatitis," Richard tells Dr. Andiman. "I didn't even know about A IDS. I thought my whole life was turning around, doctor."
None of the family suffers from the many opportunistic infections which attack a body whose immune system has been weakened by the AIDS v irus. For the time being, they will live normal lives. All Richard can do now is to request psychiatric care for the trauma the family will face and for the tremendous guilt he feels at having infected his wife, who has never touched drugs or alcohol, and his child. Richard and his family reflect a tragic set of circumstances that is becoming more prevalent as the AIDS epidemic grows in the United States. Intravenous drug (IVD) abuse has become a major source for the spread of the AIDS virus. With it come problems which are unlike those encountered by any other risk group. In cities like New Haven-urban centers with poor, minority populations- a new picture of the AIDS epidemic is emerging. Intravenous drug abuse
By 1992 Connecticut can expect a death rate of five to ten people a day from
AIDS. now accounts for only 17 percent of AIDS cases nationally. But in New H aven well over 60 percent of all AIDS cases are intravenous dru& abusers, the sexual partners of IVD abusers, or the children of an IVD abusing parent. AIDS has brought an added dimension of danger and fear to an already horrible probl~m. IVD abusers have always faced a debilitating addiction; but before AIDS, they at worst risked catching hepatitis from sharing a needle. Physical addiction, isolation, and financial destitution still lead addicts to use dirty "works." Now, however, AIDS threatens to infect and kill thousands of IVD abusers, their sexual partners, and their children . Homosexual and bisexual men still account for two-thirds of the 57,000 AIDS cases nationwide, but many gay men have responded by practicing safe sex and reducing promiscuity. In cities like San Francisco, the gay population is primarily white, middle class, and literate. AIDS information reaches the homosexual community through standard educational cha nnels. Those who wish to reduce risk of contact with the disease can change their sexual habits In comparison, IVD abusers must survive in an isolated world. While homosexuals can fight the disease as a community, no community of IVD abusers exists, other than in "shooting galleries" where addicts gather to purchase and shoot heroin and cocaine- where the chance of exposure to HIV from contaminated needles runs highest. Heroin users do not discriminate when desperate for the drug that they need . Unlike unsafe sexual practices, hero;n abuse is addictive and almost impossible to beat alone. "It's total madness," said Malcolm , a 35-year-old reformed IVD addict. "A lot of people are thrown in and there's no getting out alone. I've never seen anyone pull themselves out." Often homeless or indigent, New Haven's almost 10,000 IVD abusers ·are vulnerable like no other risk group. According to officials at the Connecticut State H ealth Department, only
1,060 of those IVD abusers are known for the treatment of substance abuse, to be undergoing any form of drug administers methadone to some 280 abuse treatment. Even those who wish reforming IVD abusers. A synthetic to enter a program often cannot. A narcotic, methadone is itself an addicthree to four month waiting list forces tive drug which alleviates withdrawal addicts seeking treatment to continue symptoms and stops craving without to deal with their addiction alone. giving a "high." AIDS has made those three or four For Bryant and her staff, dealing months a time in which they could with intravenous drug abuse is a trying easily contract a disease which no job in its own right. AIDS has brought clinical treatment can cure. new dimensions to their work. "The Geraldine Bryant can speak con- true stress comes from seeing someone fidently about the IVD-abusing whose life is debilitated by drugs. but population. As director of the Orchard who comes in for treatment," Bryant Street Methadone Clinic and a mem- said. "They begin to turn around their ber of the Mayor's Task Force on world. A mother with children begins A IDS, she has become an outspoken 'to be concerned about their welfare, activist for AIDS education in New health, and appearance. She gets a job, Haven. Her clinic, one of three and then she comes in and tells us she methadone units run by the APT has AIDS ." Approximately 25 percent foundation. a nonprofit organization of APT's methadone patients who have Aa director of the Orchard Street Methadone Clinic, Geraldine Bryant haa come to know the IVD-uaing population wdl.
Tht• Nt·" .JournaiJ[)e,·.omb.. r 4. 1987 :.!5
consented to be tested are HIV positive. That statistic, spread out over the other 8,800 IVD abusers in New Haven who have never entered treatment, suggests that up to 2,200 IVD abusers are now out there, out of touch and unaware that they carry the AIDS virus. "There are people who are out there using, who may not have contracted [AIDS] but will if they continue to stay out there," Bryant said. "They will share needles and works if they .are desperate or ill. They are not concerned about catching a disease at that point in their life. They will catch it and spread it because they cannot get into treatment." The waiting list for methadone treatment and the IVD abusers who are now known to be H IV positive only partially indicate the seriousness of New H aven's AIDS crisis. New Haven currently has 119 cases of diagnosed full-blown AIDS, the stage of the disease in which opportunistic infections attack the body. H owever, a report issued recently by the Mayor's Task Force on AIDS estimates that about 6,000 people in New Haven are now HIV positive. By 1991 New Haven can expect 700 to 800 cases of fullblown AIDS, many more cases of ARC (AIDS-related complex), and thousands who are HIV positive. Most of the individuals who will come down with full-blown AIDS by 1991 are already infected. It is too late to save them. New Haven now faces two major problems. First, it must prepare. the city and its health care programs for the wave of dying young people which will flood the city's hospitals in the years to come. By 1992 Connecticut can expect a death rate of five to ten people a day from AIDS. Second, New Haven must begin to work toward saving the thousands of others, mostly poor minorities associated with IVD abuse, who risk infection. City workers and volunteers have only begun to address these problems. Bryant believes that to prevent addicts from becoming infected, outreach wor26 The New JournaUDecember 4, 1987
Contaminated needles, or "dirty works," can give addicts a disease that no clinical treatment can cure.
kers must teach them to use drugs safely. Though some cities considered distributing free needles, fear of promoting IVD abuse ruled out that option. The alternative in New Haven and elsewhere is to teach IVD addicts to sterilize their needles and to supply them with the necessary materialsbleach or alcohol packets. At the same time, outreach workers distribute condoms and discuss safer sex practices to protect the partners of IVD abusers. Educators can reach potential AIDS vJcttms only by penetrating the neighborhoods, schools, soup kitchens, and welfare motels. But once inside, outreach workers still face the barrier of an "unbelieving" community. According to Bryant, IVD abusers often think that they are immortal. "No matter how much you warn them, they believe AIDS is a distant, far-off threat and that it could never happen to them." she said. "Intravenous drug
users have experienced so much that is terrible .in life and have survived. They are convinced that their luck is going to hold out. We know this is not true." Even if successful, outreach education will begin to show effects only three to seven years after full-scale programs are implemented, according to the Mayor's Task Force report. Much time and many lives will pass before New Haven can begin counting off those years. Outreach education remains far from adequate. Only this October the city government dedicated three full-time workers from the city Health Department to AIDS outreach. They will enter neighborhoods and communities cut off from AIDS education to work with IVD abusers, referring them to drug treatment centers. The city initiated the program at the recommendation of the Mayor's Task Force on AIDS, which Mayor Biagio DiLieto created
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" last year to coordinate AIDS services in New Haven. "We're no strangers to any of this," said Dominick Maldonado. "These are our own communities." Maldonado worked for eight years at Crossroads, a 45-bed residential facility for the treat· ment of IVD addicts in New H aven, before becoming one of the city's outreach workers. The move from Crossroads to the streets will not be difficult for him. He grew up in New H aven, and knows the streets well. He has seen friends become IVD addicts, and he has seen friends die from AIDS. Yet Maldonado remains op· timistic about the IVD community. "The majority of addicts do want to change," he said. "But you cannot tell them to stop using until they are ready themselves. All you can do in the meantime is make the connection be· tween drugs and AIDS, and teach them to use [drugs] safely if they're going to use at all." Despite his optimism, Maldonado admits that three outreach workers cannot educate thousands .of addicts. Fortunately, they are not a.l one. Long before the city government began to take action, a few privately run community groups like AIDS Project New Haven (APNH) carried the burden of outreach . APNH began in 1983, soon after the first AIDS cases in New Haven were diagnosed. Those patients were mostly gay, and APNH began as a resource for New Haven's gay population, providing an AIDS hotline, referral, counseling, and sup· port services. These services have expanded. But as the majority of AIDS patients in New Haven shifted from homosexuals to IVD abusers, APNH found itself revising its tactics to accommodate a population with many different social problems. Working out of a one-room office at College and Elm streets, APNH now deals principally With IVD users and their sexual part· ners. Where posters, pamphlets, public forums, and talks once sufficed for risk education, APNH outreach Workers must now pound the streets, P&ssing out condoms and bleach, COunseling, an'd making referrals to
drug treatment centers. "To have an impact you can't have a distanced approach," said George Appleby, chairman of the board of APNH. Appleby is a member of both the Mayors and Governors Task Forces on A IDS, and sits on the faculty of the Graduate School of Social Work at Southern Connecticut University. He became involved in A IDS work in 1984, soon after his best friend died of the disease. "You need immediate per· sonal contact. Eighty-five percent of the IVD users out there are unknowns who haven't come in for treatment, and they don't wear signs." APNH now has over 150 part-time
"By being an AIDS worker you share the pariah status of the people you work Wl.th . " volunteers staffing their various counseling and support services, but only six part-time outreach workers. Appleby realizes the desperate need for more workers, but volunteers commit· ted to street work are hard to find. The work is difficult and intimidating. Many APNH volunteers burn out from too much time and stress in the field. "When your volunteers are primarily white, middle-class people trying to relate to poor blacks and Hispanics, it can be difficult building up a system of trust," Appleby said. "Working the streets is not something we feel comfortable with, but it has to be done. We're concerned with getting to all the populations we need to." These concerns have led workers to the shooting galleries themselves, where drug suppliers allow workers to enter safely and pass out alcohol or bleach for cleaning works. "It protects their clientele, as strange as that sounds," Appleby said. Workers must contend with other barriers, such as addicts' distrust of outside assistance arising from fear of the narcotic officers who
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patrol the same territory. AIDS educators must also fight ignorance, fear, and a lack of public support in the New Haven community as a whole. H omophobia and mistrust of anything associated with the word AIDS has plagued the fight against ignorance. "By being an AIDS worker you share the pariah status o f the people you work with," Appleby said. His volunteers have faced anger and badgering from audiences while lecturing, as well as conflict with family members and friends. "This community is not supportive of A IDS Project New H aven, or AIDS education in general," Appleby said. APNH even met with resistance from th~ state when they tried to put AIDS posters on buses. "DON'T PASS THE SPIKEUSE CONDOMS," the ad reads. According to Appleby, APNH fought with the State Commissioner of Transportation and the State Department of Health for six months before going to the Qivil Liberties Union with their case. "It was because the ads would be offensive. The word 'condom' was a red flag," Appleby said. The state eventually gave in. White and middle-class, APNH outreach workers appear as outsiders to the city's IVD-abusing population, who are mostly black and Hispanic. To ·fight AIDS in minority com-
28 The New Journal/ December 4, 1987
munities, outreach requires initiative from within those populations. While the city's Hispanic community has organized itself to combat AIDS, Bryant is frustrated with the slow pace of action being taken by black community leaders. New Haven's black population accounts for almost 60 percent of the city's AIDS cases, but remains cut off from educational cam· paigns. Bryant would like to see black civic leaders who have access to those communities take the responsibility for educating them. "Black ministers, city and community leaders have got to stop turning their heads because they think it is not a problem for them. It is, and we cannot continue to ignore it." Bryant said that the Hispanic com· munity in New Haven has risen to the needs of its population, who require bilingual education, information, and counseling. Hispanos Unidos Contra SIDA began last June when 30 members of New Haven's Hispanic community gathered to discuss the AIDS problem. "Everyone made a comm;tment to ' work," said Maldonado, a founding member of Hispanos Unidos. After drafting a work plan in October, Hispanos Unidos incorporated their board of directors. Since then they have created two bilingual pamphlets on AIDS prevention- one put to· gether by IVD abusers for IVD
AIDS
abusers, and one for the general public. They have started support groups for patients and family members and will soon begin to conduct outreach work of their own . Hispanos Unidos is an exception. AIDS activists in New Haven would like to see more initiative of this sort, but a largely disinterested community combines with a lack of funding to hamper such efforts. Ironically, while APNH focuses on the IVD-abusing population, it receives most of its funding from New Haven's gay population, according to Appleby. APNH gets no money from the city and received only $7,000 total from the state. But it is slated to receive another $37,000 from the state to hire a full- time director, who will spend time applying for grants. APNH and Hispanos Unidos formed independently and have survived independently. They owe their existence to concerned volunteers ·and financial donors. Both groups and the Mayor's Task Force would like to :see the state government take a ~ore responsible role in fighting AIDS, which poses a large threat statewide. Connecticut ranks seventh in the nation for incidence of AIDS, and the State Department !Jf Health Services contends that it is actively moving against the disease. Their solution, however, is one which New H aven AIDS workers believe wastes time and money and ultimately hinders their own efforts. In August the Department of H ealth Services contracted with Expand, a Maryland-based consulting firm, to study the statewide needs for combating the sp':ead of AIDS. In January, Expand will present to the state a "conceptual framework paper" with suggestions for planning and developing AIDS education and counseling. That paper cost $185,000, and the state has agreed to finance whatever program Expand suggests - a nother $400 ,000 to $500,000. "I don't think most people in New Haven think that's a wise use of funds ," said Sher . Horosko, coordinator for the Mayor's Task Fo rce on
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AIDS. "Why would you b r ing in a consulting firm from Maryland to look at this problem, instead of funding organizations that are already working locally, and struggling? It makes no sense to us." The Mayor's Task Force advised Mayor DiLieto who, with other community leaders, wrote a strong letter of protest to the State Commissioner of Health opposing the project. Protestors marched in front of the H ealth Department in H artford, but the contract was still signed. According to Dr. Sheryl Henderson, state coordinator for Expand, the group is still assessing Connecticut's A IDS education needs and has not yet made any specific recommendations. Horosko, Appleby, and others feared that Expand would attempt to set up its own services in New Haven,
Often homeless or indigent, New Raven's almost · 10,000 IVD abusers are vulnerable like no other risk group. which would split available resources. The heads of all three New Haven organizations met with Henderson last month and were assured that no service duplications would take place. However, Expand's role in fighting AID S statewide and in New Haven remains unclear. "In the meantime, we're doing it," Appleby said. "They'll go through a period of planning and assessment. We've already done that." As it is, Connecticut's efforts lag far behind those of other states' social, medical, and outreach services. New Haven already contains over 50 percent of the state's AIDS population, and some A IDS workers fear that the city could become a magnet, drawing AIDS patients from throughout the state. San Francisco, because of its
AIDS
sophisticated AIDS care programs, became the magnet for California. But New H aven's services are inadequate for its own ever-growing A IDS population, without confronting an infl ux of patients from th e rest of Con necticut. San Franciso develo ped sophisticated care programs because th e m~ority of its A IDS pop ulation, gay men, has a strong power base in the city governm ent. By comparison, New Haven's A IDS population has no power base at all. T he city's IVD abusers must depend o n the efforts o f outsiders to combat the vicious cycle which is slowly consuming them. Volun teer groups and n ow the city have begun to address the problem of AID S and IVD abuse. But their efforts are dwarfed by the vast population of minorities and IVD users whose needs th ey hope to meet. The current rift between the state and New H aven is damaging the cause · of AID S education and hurting the AIDS patients themselves. "My clear impression is that there is a lack of urgency 6n the part of state planners," Appleby said. "The more you delay education funds, the greater the chance that more young people are going to be infected with the virus." In the meantime people are dying. R ichard and his family a re only one case. The AIDS clinic at Yale-New H aven hospital has already lost two entire families, 81 people in all. "I think it's going to get much worse before it gets better," Bryant said. "Many more minorities and drug abusers will die before people begin to pay attention." Six thousand New Haven residents may already carry the AIDS virus. Condoms, bleach , and counseling can begin to protect the uninfected. But until outreach receives the support it needs, the cycles of H IV infection will continue to turn.
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L--·•••••••••••••••••••J The New Journal/December 4, 1987 31
EssayI John Boswell
''All Fall Down'' '
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Plagues have held a mirror to the cultures and peoples they affiict for as long as literature has recorded the fears and follies of humans. Writings from Exodus tO Camus' La Peste h ave chronicled the reactions of individuals and nations to biological catastrophe as a means of exploring human souls and behavior. This is partly because the terrifying effects of plague- sickness and death- are themselves staples of both history and literature, being the chief plot devices nature uses in settin g the length and shape of human lives. They are at once natural and unnatural , universal and singular, absolutely predictable and totally unnerving, and therefore ideal for both literature and history, which must decipher the constants of the human heart by exploring its reactions to particular and extraordinary events: Plague adds another dimensio n to 32 The New Journal/December 4, 1987
the revealing power of sickness and ~eath by transforming an essentially Individual experience into a communal one. Long ago, the deceased were "laid to rest" on family land and thought of as the members of the family or comrnunity who had gone before; in the lllodern world the dead are all gathered away from the areas used by the living and hidden away behind cemetery Walls. The sick are kept away from the healthy, often in special buildings for th_is purpose. These distinctions and their social embodiments are created by profound anxieties about sickness and dying, which in the twentieth century have taken on the air of the bizarre and macabre rather than being thought of as normal events in the lives of humans. Medicine and its amelioration of the frailty of the body have contributed to this, but it is also in large measure the result of loss of faith in
personal or social values beyond good disorders the natural plot line for inhealth and a pleasant life. d ividuals that notions of "lifetime" colPlague demolishes these barriers lapse. and looses on the living and healthy the The most haunting images of plague anxieties supposed to be contained in the Western tradition are those of beyond hospital and graveyard walls. the Black Death of 1348-1350, which Disease and mortality become com- killed about one-third of the entire munal experiences and worries. population of Europe in two years .. Its Healthy people must think about effects were so devastating that the disease, must experience sickness other political and religious structures of than their own, must face and cope Europe were profoundly transformed . with death. An unusual increase in the Astonishingly, much literature comnumber of sick, especially if related to posed at the time takes little notice; a communicable illness, can so terrify some of it seems utterly oblivious. The the healthy that they cease to believe in cynical and ribald tales told in the the distinctions which formerly pro- Decameron by aristocrats who fled the tected them. Whole societies can begin plague and sealed themselves off from to think of themselves as diseased and a dying world are the best known lidying, even when the majority are not, terary legacy of this. The nursery because the horror of plague breaks rhyme "Ring around the rosey" (a through the cultural barriers which description of one of the symptoms) is had protected the ordinary person an incongruously light-hearted refrom seeing the inevitable, or so minder of a later occurrence of the Tfie New JournaJ/December
+, 1987 33
PERSPECTIVES
same plague, and one of the few cultural muniments to record the magnitude of its horror: "all fall down." But the Black Death is by no means the most disruptive plague on record. Most of the Indian population of South America died within 50 years of the arrival of Europeans from the plague of smallpox the Spanish brought with them. Because the conquistadores were accustomed (and more immune) to smallpox themselves, because they neither understood nor cared about the Indians dying by the millions, andmost poignantly, perhaps- because the culture which might have recorded the revelations of this plague perished along with its creators, nothing survives to share the secrets of the human heart which might have been learned from what was perhaps the most devastating single pestile'hce iq history. Like other plagues, the AIDS epidemic is both universal and particular. In the communities most affected by it so far, one sees the classic responses to plague. Some find that the walls which protected them from death
and sickness have collapsed, and they regard themselves as members of the community of the dying even if they are apparently healthy. Others -like Boccaccio's storytellers- shore up the old walls, build new ones, or escape to fantasy. But in several ways the AIDS epidemic and public reaction to it are unparalleled. The walls around disease and death have been greatly buttressed in the twentieth century not only by preoccupation in industrial societies with the health of the body but also with the concept of being "normal"- a concept which has replaced "mor al" or "good" in politically based, religiously plural societies. In moralistic cultures everyone is conscious of being a sinner, a fact ·which mitigates the degree of alienation visited upon or felt by those who transgress the rules. "Normality" is a much more alienating concept, since it frequently applies to someone's being rather than to behavior which he could alter. Serious illness is abnormal in health-obsessed America, and few things are as alienating as be-
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34- The New JoumaVDecember 4, 1987
ing seriously unhealthy. This blaming and punishing of victims for not being "normal" is particularly devastating in the cases of the largest groups of people with AIDS in America, gay men and drug addicts. Even without fear of contagion, having a fatal illness would isolate them from American society. When communicability and social stigma are added, the rejection, callousness, and indifference become overwhelming. It is not too difficult to see why, in a society deeply troubled by drug abuse on the part of political, artistic, and sports elites, the public might choose to view heroin addiction as a reprehensible m oral choice rather than as a pitiful form of suffering. The circum!!tances of the poorest and most alienated Americans are quite different from those of the rich and powerful, and one might more charitably regard their addiction as a desperately wrong choi~e of remedies than as a malicious crime, but it is still understandable that people entertain ambivalence about problems of drug abuse. It is less easy to understandindeed, very hard for me to see-why the pathetic, excruciating consequences this often entails are then conflated with addicts' bad choices, inducing at best utter indifference to their fates and at worst active revulsion and hostility. The plight of middle-class persons affiicted with lung cancer after years of smoking, with heart disease after years of being overweight or failing to exercise, with injuries sustained in an automobile accident while intoxicated, with financial ruin after fiscal dishonesty- these prompt compassion in most humans, and soften judgements about erstwhile failings. Even if we see that in some way their misery is related to their previous actions, we are reminded that misfortune is as common to all of us as are unwise or selfish choices. For some reason, the unwise choices of poor blacks and Hispanics in America's urban centers seem to place them out -of reach of compassion or empathy from most Americans, including, tragically, the government.
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HAIR STYLES Complete Styling Services for Men and Women It is as bad for gay men, which is more surprising in some ways, because they are not usually separated from the indifferent majority by emolional, social, or physical distance. They come from o rdinary families of all social classes. The wall dividing them from the majority is not demarcated by a ghetto or a color or economic standing. The notion that Western society has been characterized by generally increasing progress and tolerance on social issues like the position of gay people is a misprision. Probably at no time and place in Western history have attitudes toward gay people been more hostile than in the United States and Europe throughout most of the twentieth century. This is related to the historical vagaries and inconsistencies of the transition from moral values to pseudo-scientific ones noted above. In the ancient world "norms" for human beings were largely social and behavioral: there was public agreement and expectation about how to be a good citizen, a good parent, a good child, a good friend, based on codes of conduct which anyone could fulftll. There was little or no consciousness of gay people as a distinct category of human being; they could and did fulfill these duties as well as anyone else. Men known to have erotic interest in other men occupied high pos1t1ons, were extremely influential and often much admired. Christianity introduced a different set of norms, marginally worse for gay people. From about the the fourth century of the Christian era to the Renaissance, the predominant public norm was holiness: a complex concept derived from Christian scriptures and teaching, social taboos and decorum, and personal sentiment. This norm could be applied in two ways to gay Jleople. They could be viewed as "separate but equal"-i.e., bound by the same rules of holiness except for the variable of gender. A Christian ceremony of union for same-gender couples perfomed widely in the Early Middle Ages, a genre of debates in high medieval literature about the relative merits of homosexual vs.
heterosexual love (in which the gay side wins two out of three), complaints in twelfth and thirteenth-century literature that gay clerics enjoy special advantages- are all traces of the "separate but equal" approach. A second, better-known strand of though t opposed homosexual behavior categorically. It held that to meet the standard of"holiness" a sexual act must not only occur within a marriage, but also be procreative. This narrower view was mostly limited to ascetic strains in the early church, but gradually gained ground in Europe from the twelfth to the fourteenth century, at a time when many other minorities (e.g., Jews) were also incurring greater social stigma and ostracism, and it eventually swept the other one before it. By the end of the Middle Ages, homosexuality was considered a serious sin everywhere in Europe, and there were penalties for it in most civil lawcodes. This put gay people in an inferior category, but it is crucial to note that it was a category everyone else also occupied at times: what was wrong with gay people was that they were sinners, but it was "normal" to be a sinner. Every human being since the Fall but Jesus and the Virgin Mary had been or would be a sinner. Even the people who promulgated this view of sexuality admitted that most conjugal acts performed by most couples did not meet its standards; it was, therefore, not so disturbing that gay people failed them as well. It was the modern world that created the barriers now isolating gay people so effectively. Beginning in the eighteenth century, having for the most part lost interest and faith in the transcendental values underlying the idea of"holiness," European society increasingly replaced it with the concept of "normality." And as medicine has advanced and the residents of prosperous industrialized cultures have become more focused on their bodies and less interested in non-material values, a paramount arena for assessing the "normal" in Western thought has come to be "health"- physical and
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psychological . The unholiness of homosexuality has been transformed into "unhealthiness." Though one might suppose that being "unhealthy" would provoke sympathy rather than hostility, and that gay people would therefore be better off violating the standard of "normality/health" than that of holiness, this is not the case. Most Americans do not think of themselves as standing outside "normality." They are not conscious of having anything in common with the "abnormal" or diseased, either physically or mentally. Such people belong in a category utterly distinct, one the average person not only disapproves of but fears . Much obsession with health is focused on protection from things that cause disease or unhealth, exemplified in the concern at many levels in this country that homosexuality will "spread" if not actively restrained. It was, by a bitter twist of fortune , not many years after the American Psychiatric Association had removed homosexuality from its diagnostic list of illnesses, signalling the widespread conviction on the part of the scientific community that homosexuality was part of the "normal" range of human sexuality, that AIDS became prominent in the gay community, reestablishing in the imaginations of many people the link between homosexuality and disease. A diagnosis of AIDS is often the first public indication of someone's homosexuality, and may expose him to forms of ostracism he had managed to avoid during most of his life, since gay people, unlike most minorities, can often pass undetected in society. Yet another element of alienation results from the fact that large numbers of gay men cannot turn to their families for support. Most victims of plague or any serious disease rely on their families if the public rejects them . And most minorities can find strength and comfort in the family- at least some of whom usually experience the same pain- if society oppresses or demeans them. Gay men do not come from gay families, and have often not disclosed
their homosexuality to their relatives out of fear of hurting them or being rejected. They are alone with their suffering in a way matched by few victims of any such disaster in human history . Many of the lessons in human behavior taught by, the AIDS epidemic could have been learned from earlier plagues or writings about them, but most were not. Some new lessons have emerged from AIDS. Promiscuity among gay men, for example , a factor in the spread of the disease, has been sensationally exploited in the media, debated in the medical community , and fulminated against in Congress. None of these good, shocked people ask themselves a question about the majority's relation to gay people that the epidemic itself might have posed to them: How can society blame gay men for promiscuity when, for nearly a millennium, it has systematically denied social, legal, and religious acceptance to gay couples? Promiscuous encounters can be hidden from view; permanent relationships cannot. No one questions where an unmarried man goes at night, but every level of American society, questions the position of an unrelated person of the same gender as a lifetime partner. With every passing year it becomes more difficult for most gay people tb explain to family, friends , bosses, landlords, et al., who the "friend" in the house is. A culture which oppresses, penalizes or stigmatizes all forms of homosexuality can hardly expect gay men to form visible and permanent unions. Blaming AIDS victims for their lifestyle is a classic case of blaming the victim, not unlike the conquistadores' conclusion that the Indians were an inferior people be-
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New Haven, on Yale Campus The New Journal/December 4, 1987 37
Books/ Harry Robinson
Respecting the Strike Q: What was the strike all about? A: Well, we ate out , studied alone in our rooms, and the bathrooms never got cleaned. For many students, discussions of the clerical and technical (C&T) workers' strike of 1984-85 might never delve any deeper. But a reminder of the actual grounds for dispute is especially important now, as negotiations continue toward a contract to succeed the one signed in January of 1985. On Stn'ke for Respect: The Clerical and Technical Workers' Strike at Yale University, 1984-85, fills that bill. Written by four pro-union activists, the book chronicles the formation of Local 34 and the events lea<.iing up to the union's first contract, offering commentary on labor-management relations at Yale. The book's authors- Yale history graduate students Toni Gilpin and Daniel Letwin, Gary Isaac (LAW '85 ), and Jack McKivigan, associate director of the Frederick Douglass Papers and a lecturer in the History department-have two aims. Firs~. they attempt to introduce Local 34 by providing an overview of the establishment and contracting of the union·. Second, the authors try to extrapolate some general themes from Local 34's experience about how to bargain collectively. These goals are not incompatible. Unfortunately, the obvious bias with which the authors portray the Local 34 story precludes their presenting an objective case study from which convincing conclusions may be drawn. As recounted in On Strike for Respect, Local 35 of the Federation of University Employees, Yale's union of service and maintenance workers, successfully organized Local 34 from within the campus. Local 34 won certification at Yale in May of 1983, in what the authors describe as an emotional elect ion that followed 30 years of fai!P.d attempts. The margin of victory was a slim 39 votes out of 2505. On Stn'ke for Respect boasts an impressive cast: Local 34, "whose membership is mostly female, disproportionately minority, and by and 38 The New J ournal/December 4, 1987
large inexperienced in unions, let alone strikes;" Local 35, whose members realize that "if Yale finds it can take down one union it's going to take down all of them;" the aggressive current president of Local 34, Lucille Dickess, who contends that "many . . . joined the union because the value of their work was ignored by the University;" and John Wilhelm, chief negotiator for Local 34 and business manager for Local 35 , a man involved in every major decision made by Local 34 since its inception. The authors provide a mosaic of interviews that keeps the "homegrown" and personal aspect of Local 34's struggle at the forefront. Without concentrating on any one figure, they portray a union that depends on its democratic nature to succeed. In the beginning, some C&Ts resisted taking an active role: "I thought that having a union on campus meant you had organizers,
The authors go ou t of their way to scold the administration. a nd they called meetings and gave you information and you signed a card; if they wanted to sign somebody up they signed them up," one woman said. But eventually many workers recognized the potential benefits of shaping their own union. "People felt 'How•can we possibly talk about contract proposals when none of us has ever seen a union contract before . . . ?' But then we started gradually to realize that all we had to do was to examine very carefully our work lives here at Yale and how we would change them . . .. " The memhers of Local 34 quickly learned that achieving union status was "quite a different thing from winning a first contract." Step by step, On Strike for Respect examines the formulation of union demands, the election of a negotiating team , and the early bargaining sessions.
Negotiations during November and December of 1983 proved fruitless. The union held rallies and vigils to call attention to their status- no progress. In March 1984, the union offered to submit to binding arbitration. The administration rejected the proposal. The union threatened to strike. In mid-March, Local 35 agreed to honor Local 34 pickets in the event of a strike. An interim resolution on April 4 p revented a strike, as the union and administration agreed to a partial contract codifying language on all issues resolved to date. This contract left wage, benefit, ap,d job security issues outstanding. The spring and summer months passed without action, and in fall of 1984 Local 34 again threatened to strike. On September 26, the union erected pickets at Yale. Early that morning, picketers outside the Old Campus urged passing motorists to show their support. Many honked in response. Ten weeks later, with no new agreement and morale at a low, the members of Locals 34 and 35 returned to their jobs for the two weeks before the holiday break. They pledged to walk out again in January if agreements on both the 34 and 35 contracts (Local 35's contract expired in January of 1985) had not been reached. The effects of the strike on the C&Ts are well documented in On Strike for Respect. Financial hardships affected all union members. In the first few weeks, "everybody [got) nervous and [said) 'when are they going to settle? When are we going back to work? I need money, my family needs money." Later, local clergy interceded on behalf of union members to secure postponements of rent payments. The strike bore ethical burdens as well. Prior to a "nonviolent witness" in which demonstrators would be arrested, one woman said, "Last night I had to sit down with my kids and talk to them about why I was going to oreak the Jaw and get arrested after I'd been telling them for the last ten years, you ·never break the law; you always do what a police officer says."
Despite the trials of tl.e union membership, most media attention was directed toward the travails of the students. As the Los Angeles Ti,.,.s described: Since September 26, about 400 classes have been moved to chilly church basements, dimly lit movie theaters, crowded living rooms, and packed pizza parlors. Twelve of thirteen student dining rooms are closed. Laboratories are curtailed; the law school is deserted. Bags of garbage are piled in the halls, dormitory bathrooms remain uncleaned, and litter lines the neat Old Campus. Police on horseback patrol near the massive Gothic buildings.
I n 1984, there was noth i n g in Commons.
covered the strike, points out that for of the administration team is accurate all the attention this matter received, for the outset of the negotiations, the "there is no language in the contract authors fail to indicate that Yale's vice that addresses the pay equity issue president for administration joined the negotiating team in the fall of 1984, directly." On another front, the union also when a strike seemed imminent. scored away from the negotiating taThe authors are also misleading in ble by publicizing the anti-union their account of salary proposals made reputation of Yale's newly engaged law by Yale. They describe Yale's initial firm. But controversy about the salary proposal in January of 1984, lawyers did not convince the ad- and comment later that Yale augministration to change its plans. An at- mented the proposal on the table by torney from the firm t-f'aded the ne- only .4 percent during the month of The authors posit that this extensive gotiating team for Yale throughout the April. They never mention that Yale media coverage, coupled with rallies strike. Similarly, the auth01s describe raised its offer twice during the inand vigils aimed at establishing the how the union aroused tremendous tervening two months. themes of comparable worth and rapublic support for the notion of having cism, pressured the administration inboth sides submit outstanding issues to On january 19, 1985, 20 months after to acquiescing to a contract and agreebinding arbitration. Once again, certification, Local 34 signed a fuU ing to union demands. But Local 34 public outcry did not cause the ad- contract. Despite powerful evidence already had a partial contract in ministration to include a binding ar- that both sides made concessions, the September of 1984, which indicah s bitration clause in the Local 34 con- authors hail th is contract as a union th at the administration recognized the victory. Their suggestion that students new union's legitimacy. Furthermo¡ , tract. in support of their themes, the of labor relations can draw valuable this thesis presumes that Local 34 was authors also omit relevant information lessons from the union 's tactics falls indeed victorious in the dispute, an from their accounts. Avowed pro-labor victim to this unsubstantiated opassum p tion worth questioning. In activists, they clearly want to make the timism . many cases, the authors' pro-union best possible case for the union and the For a case stu dy to be convincing it biases overwhelm the validity of their worst one for the University; they must take an unbiased approach to its arguments. neglect to interview any administra- subject, indicate points of contention Few people, least of all administration officials who might dispute their or uncertainty, and account for these tion officials, deny that Local 34 conaccounts. This approach leads to factors in its conclusions. Instead, the trolled public sympathy throughout the strike. But the importance of public misrepresentations. authors of On Strilce for Respect sweep For instance, the authors go out of aside information that weakens their relations to the final outcome must be their way to scold the administration arguments. Written differently, this questioned. Certainly the theme-orifor insisting on holding negotiating book could have been a more sucented protests made. for excellent press sessions with Local 34 ofT campus. cessful review of the last strike with an and were good for union morale, but They do not mention that negotiations eye to future negotiations. As it is, it to consider their control of public atwith Local 35 had always been held at provides excellent insight into Local 34 tention as synonymous with the nearby Park Plaza Hotel, and that and the process of union development. achievements at the bargaining table is the administration was not establishing And at least some answers to the stuerroneous. For example, the national mwia focused on the union themes of a new precedent for Local 34. In dent asking, "What was the strike all another section they chide the ad- about?" "pay equity" and "comparable worth." ministration for appointing a neThe Yale administration had to answer gotiating committee made up of"seven charges of sexism and racism throughlower-level administrators and facu lty OUt the strike. But Steve Hamm, the New H aven Register reporter who members." Although this description Harry Robinson is a junior in Davenport.
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The New JournaVDecember 4, 1987 39
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