Media Review JANACReview Media Vol. 11, No. 2, March/April 2000
Mortal Men: Living With Asymptomatic HIV by Richard MacIntyre, PhD, RN. New Brunswick, NJ: Rutgers University Press, 1999. ISBN 0-8135-2596-9. In July 1981, a short article published in The New York Times reported the outbreak of a rare cancer among gay men in New York and California. At that time, few if anyone suspected an epidemic of phenomenal proportion was right around the corner. Today, almost 20 years later, over 12 million men, women, and children have died of AIDS, and it is estimated that over 30 million people are HIV infected. The AIDS epidemic has become the most significant health care concern of this century. It affects people of all ages, genders, ethnicities, and sexual orientations. Its financial and social implications are overwhelming, and as the new century approaches, these implications promise to become even more significant. Many communities across the United States have been severely affected by AIDS, and a large array of national, state, and local services have been developed to assist those diagnosed. Scientists have aggresively studied the signs and symptoms associated with AIDS, but have focused little attention on the study of those with asymptomatic HIV disease. Many people infected with HIV remain asymptomatic with their disease not seeming to progress for many years. Scientists once believed the virus was dormant in the body for years, causing little damage or adverse effects. However, in 1995 scientists concluded that there is no dormant phase of HIV disease because the virus continually replicates itself destroying CD4 cells, blood, tissue, and lymphatic cells. The immune system of those with asymptomatic HIV disease is in constant battle with the virus, and most of these individuals have fewer T-helper cells or CD4 lymphocytes (which are considered a primary target of HIV). Yet, despite a
belief by many scientists that individuals with asymptomatic HIV disease are quite ill, a group of these individuals have not shown signs of becoming sicker. There is little understanding of why some HIVinfected persons have lived for more than 14 years without symptoms. In the 1990s, antivirals were introduced, but many of those with HIV hesitated to take these drugs if they were asymptomatic. Many were confused with the different opinions with regard to the use of these antivirals. People were concerned about the dosages and monitoring methods, and whether those with asymptomatic HIV should risk provoking the horrendous side effects often experienced from these antivirals. People with asymptomatic HIV were being asked to “trust a profession and an industry that seemed infused with the politics of power and profit.” Clearly there is a need to explore the factors and issues influencing the lives of those with asymptomatic HIV. Mortal Men: Living With Asymptomatic HIV is a coherent, succinct reference for anyone interested in exploring the life and views of gay men living with HIV. The author, a doctorally prepared registered nurse who is an acknowledged expert in the field of HIV, has been living with asymptomatic HIV for 14 years, having tested positive for HIV in 1985. This text is a reworking of his dissertation research and illustrates the highly emotional levels of anguish, fear, uncertainty, and lack of trust that most people featured in the book experienced at one time or another. The author’s own story is presented first but continues to unfold throughout the text as the narrator guides the reader through 10 histories of gay men living with asymptomatic HIV. The organization of the text offers
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 11, No. 2, March/April 2000, 100-101 Copyright © 2000 Association of Nurses in AIDS Care
the reader easy access to separate stories of courage and details of how these individuals worked to develop an understanding of health and disease. The clinician who is trying to design or improve protocols of care for the asymptomatic HIV client will find information that is concise and cogent in each chapter of the text. The book provides a glimpse into the life of the author and the lives of 10 other gay men, who take the reader on an emotional tour of their core personalities and their true identities. The book details how these bright and articulate gay men confronted and lived with HIV and coped with various trials and tremendous rejection. Most important, it details how they dealt with conflicting theories, metaphors, and pressure within their own communities. The book also describes how these men faced life, fear, anger, and death.
The author of Mortal Men: Living With Asymptomatic HIV successfully reflects the observations, thoughts, and feelings of men “who have lived in the eye of the storm.” The work is limited by the author’s own personal experience, but his openness to search for truth and meaning in life makes the book a unique collection of thoughts and feelings that pays tribute to those who have suffered from this serious and often terminal illness. A number of treatment modalities have surfaced in the past 10 years that do bring hope but also raise serious questions. The lessons learned from this book, along with the illuminating anecdotes the men provide, can help to expand our vision about the issues facing people with HIV disease. Jacqueline Rhoads, PhD, RN, CCRN, ACNP-CS Louisiana State University Health Sciences Center