For many Americans, the time of the Coronavirus is marked by deep fear. This stems in part from the threat of the virus itself, but is heightened by a lack of information. It is destabilizing for a country to grapple with a new disease that medical experts are still coming to understand. There is often conflicting information as we continue to learn how the virus spreads, how it impacts our bodies, and how it should be treated. The situation is only exacerbated by what many perceive to be an insufficient, or even callous, response from the federal government. These feelings of fear and shock are new to many Americans. For one group, however, these feelings are echoes from a not-distant-enough past. The fear, the feeling of helplessness, and the invisible threat of sickness and death lurking around every corner are all too familiar for LGBTQ baby boomers who managed to survive the AIDS crisis in America.
Brief overview of AIDS crisis
In 1981, the first year of the AIDS crisis, baby boomers were roughly between the ages of seventeen and thirty-five. LGBTQ boomers, particularly gay men, were impacted like no one else. In an eerie overlap with COVID-19, the first mysterious symptoms of the disease we now know to be AIDS were pulmonary. A month into doctors recognizing that a strange disease was impacting gay men in the U.S., the Bay Area Reporter (1981) published an article detailing what was then referred to as “Gay Men’s Pneumonia,” in which they urged any gay men experiencing shortness of breath to see their doctors. The notoriously slow response to AIDS from medical experts and the federal government allowed misinformation to flourish. That legacy of misinformation is still strong today, with many people still not understanding how HIV is spread or how manageable the virus is with modern medicine. A 2019 study found that half of the HIV negative people polled thought that the virus could be transmitted by an HIV positive person with an undetectable viral load (it can’t) and more than a quarter would not hug an HIV positive person (Avery, 2019).
A generation of LGBTQ people were faced with an extremely deadly disease while at the same time experiencing mistreatment, scorn, and shame on every level: from doctors refusing to treat HIV positive patients, religious leaders implying that AIDS was a deserved punishment, and abandonment by family members, and general disdain from the public at large (Trout, 2020). Perhaps most indicative of the attitude at the time, however, was the lack of response from the man holding the highest office. In spite of the seriousness of the disease, then President Ronald Reagan did not say the word ‘AIDS’ publicly until four years into the crisis. It would take almost two years after that for him to give a public speech about AIDS (ABC News, 1987). Ronald and Nancy Reagan famously laughed at a Bob Hope joke about the Statue of Liberty getting AIDS from either the mouth of the Hudson or the Staten Island Ferry. “Ferry,” of course, being the operative homophone of the homophobic joke. The messaging was clear: the president, and, extrapolating out from him, the culture at large, did not care that gay people were dying.
In light of the extreme oppression LGBTQ people faced, the situation became evident: nobody was coming to save them. Hank Trout, senior editor of A&U, America’s AIDS Magazine, and long-time HIV/AIDS survivor wrote, “We realized that, facing rampant deaths in our community and an apathetic government and a hostile public, the only people who could help us was…us. Our communities coalesced. . . like never before in history” (Trout, 2020, para. 25). A petition started by a concerned nurse led to the creation of the first AIDS inpatient ward (U.S. Department of Health and Human Services [HHS], n.d). In 1981, activist and author Larry Kramer gathered over 80 gay men in his apartment to listen to and raise money for Dr. Friedman-Kien, who was having trouble accessing funding for his research on the mysterious disease (HHS, n.d). Larry Kramer went on to cofound the Gay Men’s Health Crisis and later ACT UP out of that grassroots organizational spirit. TIME Magazine called ACT UP “the most effective health activist [group] in history” (HHS, n.d). The first published literature advocating condom use to stop the spread of HIV came from two gay men living with AIDS. They published under the supervision of their doctor, as they were not doctors themselves, just two men trying to educate other men on how to stay safe (Goldstein, 2009). Community publications and community led organizations became this powerful because they had to be. Community was the only way to help ease the pain and, potentially, stop the rampant death.
LGBTQ boomer health concerns
Of course, COVID-19 has nowhere near the death rate that AIDS had in the 1980s and 1990s. However, LGBTQ boomers are at a heightened risk of complications and death from COVID-19 for a number of reasons. Baby boomers are now roughly 56 to 74 years old. They are either at or approaching the ages in which COVID-19 becomes significantly more likely to be fatal. LGBTQ boomers also face health risks that might complicate COVID-19, according to the limited existing research on this population. Older LGBTQ adults are shockingly underrepresented, almost to the point of being absent, in health research (Fredriksen-Goldsen et al., 2013). What the existing research does reveal, however, are a few significant areas of concern.
In 2011, the Institute of Medicine identified older LGB adults as an at-risk and under-served population (Fredriksen-Goldsen et al., 2013). (They did not include transgender adults in their categorization, which speaks to the ways that transgender people are chronically disenfranchised by the medical establishment, making them even more at risk and underserved than older gay and bisexual adults.) This is a growing problem, with some predicting that the number of LGBTQ older adults in the U.S. will exceed six million by 2030 (Fredriksen-Goldsen et al., 2013). In comparison to their heterosexual counterparts, LGB people are at a significantly higher risk of mental distress, depression, diabetes, disability, high blood pressure, and self-reported poor health (Fredriksen-Goldsen et al., 2013). Breaking down specific areas of concern along gender lines, lesbian and bisexual women in this age group are at a heightened risk of cardiovascular disease, while bisexual and gay men have a heightened risk of poor overall health and are even more likely to live alone (Fredriksen-Goldsen et al., 2013).
There are, potentially, physical explanations for some of these heightened risk factors. LGB baby boomers are more likely to smoke and drink excessively than their straight counter parts, for example (Fredriksen-Goldsen et al., 2013). However, the impact of stigmatization, discrimination, and victimization cannot be overlooked. It is difficult, if not impossible, to measure the impact that anti-gay messaging, which was perhaps at its height during the AIDS crisis in America, had on this generation of LGBTQ people.
Community
One of the most significant dangers of the current pandemic is that LGBTQ boomers have lost what was their primary means of survival during the AIDS crisis: community. Though technology has helped many people deal with isolation caused by various forms of COVID-19 related lockdowns, it is a poor substitute for face-to-face interactions. For a group who survived because of their ability to come together and help one another, the lack of in-person contact with friends can be even more destabilizing. A 2010 Met Life study found that, compared to their straight counterparts, LGBTQ baby boomers have more close friends and rely more heavily on those friends for emotional support (American Society on Aging [ASA], 2010). Additionally, LGBTQ boomers were four times as likely to depend on a friend as a caregiver (ASA, 2010). Caregiving under the current restrictions raises additional challenges. Adding onto those complications, LGBTQ boomers are significantly more likely to live alone than the general population of boomers (ASA, 2010). The mental and physical health implications of these facts in the time of COVID-19 lockdowns are staggering.
Trauma
All of this becomes even more complicated when considered through a trauma lens. In her groundbreaking book Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror, Judith Herman (1992) defined trauma as events which “overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning” (p. 33). Common denominators of psychological trauma include intense fear, helplessness, and threat of annihilation (Herman, 1992, p. 33). Fear of getting the disease, helplessness against the disease, and fear of annihilation for LGBTQ boomers were reasonable responses to a very real threat. The threat of annihilation for LGBTQ people, particularly gay men, in the 1980s and 1990s was real. Though today people who are HIV positive can very effectively manage the virus, in the early decades HIV almost always lead to AIDS, which meant death usually anywhere from a few months to a few years (Allday, 2016)
Herman (1992) also enumerates the difference between trauma caused by nature compared to trauma caused by human forces. Trauma caused by nature can be destabilizing in part because of the reminder of the lack of control humans have over our own lives. We can safeguard all we want, but in the end we are relatively helpless against disease and natural disasters. Comparatively, trauma caused by other people forces us to look into the depths of humanity’s cruelty. LGBTQ baby boomers had the uniquely terrorizing experience of living through a trauma that was started by natural forces but exacerbated by human callousness. Of course, not every person who faces traumatic events experiences those events as traumatizing (Herman, 1992). Thus, clinicians working with this population should not assume trauma, but should be aware of the potential for unprocessed trauma from the AIDS crisis as well as further traumatization by the current pandemic.
Clinical considerations
As is true for any cultural group, it is important for clinicians to understand the unique challenges as well as strengths that an LGBTQ boomer might bring to therapy. As described, LGBTQ boomers face overlapping mental and physical health concerns. Therapists should be knowledgeable about the specific risk factors for these clients. As with any older client, therapists should be aware of the potential for isolation, as well as the deleterious impact of isolation. Most importantly, therapists need to be mindful of intersecting factors of their clients’ identities. Baby boomers at large are either preparing to or already dealing with the ageism of American culture. Transgender people often face significantly more discrimination than their cisgender counterparts, both from people outside and inside the queer community. BIPOC identified clients, women and non-binary clients, disabled clients, and clients with a low socio-economic status will also bring unique forms of marginalization that will likely impact the discrimination that they already face for being LGBTQ identified.
Therapists should take care to note that these clients might have faced discrimination from the medical establishment, and could view therapists as an extension of that establishment. This might be even more pertinent for transgender folks, who have a particularly difficult time finding medical providers who are knowledgeable and non-discriminatory (Safer et al., 2016). Additionally, therapy itself might be suspect for this group. After all, homosexuality was not completely removed from the American Psychiatric Association’s DSM until 1987, at which time baby boomers were roughly between the ages of twenty-three and forty-one. That is a wound that might take significant work to heal. Though ethical codes might prohibit conversion (or reparative) therapy, 29 states currently have no laws prohibiting therapists from conducting conversion therapy (Movement Advancement Project, 2020).
Therapists should not overlook the potential unique resources and strengths of LGBTQ boomers. These clients might have a more traditional family structure, but they also might rely on close friends as their chosen family. Though a lifetime of marginalization can have significant negative health impacts, it can also impart important strengths. When a MetLife study asked LGBT boomers how being LBGT identified prepared them for aging, respondents listed being more accepting of others, having inner resiliency, and not taking anything for granted (American Society on Aging, 2010). These are strong qualities for any client to have and fertile territory from which to explore a strengths-based therapeutic approach. For LGBTQ baby boomers who have survived a plague once and are grappling with aging during a global pandemic, inner resiliency is of the upmost importance.
These clients might have a more traditional family structure, but they also might rely on close friends as their chosen family.
Ciera Coyan is a current MFT student at Antioch University Seattle in the Sex Therapy program and an AAMFT Student member. She received her BA in Women and Gender Studies from Hunter College (CUNY) with a concentration in Sexualities. Her clinical areas of interest include feminist therapy, gender identity, and anti-oppression practices. .
REFERENCES
ABC News. (1987, April 1). President Reagan delivers first major speech on AIDS epidemic in 1987. Retrieved from https://abcnews.go.com/Health/video/president-reagan-delivers-major-speech-aids-epidemic-1987-46492956
Allday, E. (March 2016). Last men standing. The San Francisco Chronicle. Retrieved from https://projects.sfchronicle.com/2016/living-with-aids/story
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders, third edition (DSM–III). Washington, DC: Author.
American Society on Aging. (2010, March). Still out, still aging: The MetLife study of lesbian, gay, bisexual, and transgender baby boomers. Retrieved from https://www.asaging.org/sites/default/files/files/mmi-still-out-still-aging.pdf
Avery, D. (2019, November 25). HIV from a hug? Misinformation persists among young Americans, study finds. NBC News. Retrieved from https://www.nbcnews.com/feature/nbc-out/hiv-hug-misinformation-persists-among-young-americans-study-finds-n1090556
Bay Area Reporter. (1981, July 2). Gay men’s pneumonia. San Francisco, CA: Benro Enterprises, Inc.
Fredriksen-Goldsen, K. I., Emlet, C. A., Kim, H.-J., Muraco, A., Erosheva, E. A., Goldsen, J., & Hoy-Ellis, C. P. (2013). The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. The Gerontologist, 53(4), 664-675. Retrieved from https://doi-org.antioch.idm.oclc.org/10.1093/geront/gns123
Goldstein, G. (2009, June 14). Recognizing the pioneers of safe sex. Los Angeles Times. Retrieved from https://www.latimes.com/archives/la-xpm-2009-jun-14-ca-positive14-story.html
Herman, J. (1992). Trauma and recovery: The aftermath of violence- from domestic abuse to political terror. New York: Basic Books.
Movement Advancement Project (2020, August 27). Conversion ‘therapy’ laws. Retrieved from https://www.lgbtmap.org/equality-maps/conversion_therapy
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology, Diabetes and Obesity, 23(2), 168–171. Retrieved from https://doi.org/10.1097/MED.0000000000000227
Trout, H. (2020, March 24). We need to remember AIDS lessons learned during the Coronavirus pandemic. A&U. Retrieved from https://aumag.org/2020/03/24/we-need-to-remember-aids-lessons-learned-during-the-coronavirus-pandemic
U.S. Department of Health and Human Services. (n.d.) A timeline of HIV and AIDS. Retrieved from https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline
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