Annual Vietnam

At its peak it was an annual Vietnam in America: 50,000 dead. In a year.

And on an exponential growth curve. I think the hardest thing to recover now is that sense of the exponential growth. One had reason to be frightened over where this thing was heading.

There are people in their twenties now who have no idea.

And everyone who got it died, and died quickly, and nothing seemed to help. Nothing. There was one poison (and yes I'm talking about AIDs) AZT, that seemed to slow the descent ever so little, rather like holding an umbrella when you've fallen off a cliff. And that was it.

And then somewhere in the mid-90s, protease inhibitors came along. In a two year period, the number of deaths was cut in half. The epidemic ceased. The disease stopped being an instant death sentence.

This came about six months too late for Robert.

My partner's brother, the nearest person to me to ever have or die from the disease.

Two things seem worth holding onto at this remove: how suddenly the fatalism of the situation vanished, and how suddenly the euphoria over its vanishing vanished as well. And a third thing: how the happy ending is less than perfectly happy.

Even though it had really only entered mass consciousness in the early 1980s, AIDs had taken on the aspect of permanence we associate with cancer, or Alzheimer's. How swiftly learned helplessness is learned! Which is what impelled me to write this: to capture how suddenly the unchangeable, can change, and how quickly people accept something as unchangeable.

The most relevant analogy in my own life at the moment is my father's confrontation with Alzheimer's. I am like a lot of people I think in gradually resigning myself to the irreversible course of his disease.

But there is nothing to prevent the next protease inhibitor (or the next Salk vaccine, or the next penicillin) from arriving, miraculously, tomorrow.

It is very easy to mistake the unprecedented for the impossible.

My point is David Hume incarnate.

But we would be far more proficient in anticipating the remarkable were we to linger on the history of the remarkable. The sheer joy of the Salk vaccine, how seldom we recall it: the joy of parents, the purposeful columns of exuberant school children awaiting salvation in a sugar cube.

Nearly everyone old enough to remember Nixon has had abundant opportunity for the concrete of their cynicism over the war on cancer to solidify. Appropriate to the metaphor of war, vastly inappropriate and expensive weaponry has achieved only the most illusory of progress, while an aristocracy of vampires has entrenched the existing order. We resign ourselves to what 'must' be. But we cannot know that things cannot be otherwise.

Which brings us to the reality of happy endings: for more than a decade after the discovery of the remarkable healing powers of penicillin, it was hugely expensive and so, hard to come by. After decades of widespread use, it has lost much of its effectiveness.

With protease inhibitors it has been much the same, as vast numbers of people with AIDs in lesser- developed countries are unable to afford them.

We do well to remember both that the impossible is often possible, and that it is always short of Utopia.