HAS PROVINCETOWN BECOME PROTEASE TOWN?

The "magic of Provincetown" has become a magnet for gay men with diagnoses of "AIDS" or "HIV-positive". For a decade now they have been arriving here -- their medical records in hand, their various welfare benefits established, and their life insurance policy (if any) cashed in -- to spend their final days in Provincetown.

All over the world are gay men whose happiest memories are of vacations in Provincetown, which for most of the 20th century has been the premier gay resort. During the summer all of Commercial Street, from Town Hall west, is a promenade: drag queans mingling with grizzled old men in leather (even in August), bodybuilders strutting their stuff, local residents walking their mutts, and hundreds of all kinds of very nice guys who can relax and be themselves in the fellowship of their own kind. There are middle-aged and elderly couples who have been coming to Provincetown ever since they were young.

But Provincetown is more than a gay resort. Located at the very tip of Cape Cod and surrounded by water on three sides, it is one of the oldest towns in the United States, founded in 1727. It is here that the Pilgrims first landed in 1620, and wrote and signed the Mayflower Compact. The population is diverse, and includes fishermen, craftsmen, and writers. For over a century Provincetown has been a colony for artists, who consider the light to be unique. Most of the land of the Outer Cape is taken up by the National Seashore, which is off limits to development of any kind. Within the space of a few miles are Provincetown's primevally beautiful sand dunes, salt water marshes, swamps, cranberry bogs, forests, sand beaches, the ocean and bay, and a large and beautiful natural harbor. The atmosphere seems to encourage healthful physical activities, and gay men go in for fishing, sailing, swimming, jogging, cycling, and walking. (There are eleven self-guiding nature walks in the National Seashore, and innumerable unofficial trails.)

And now Provincetown has its AIDS enclave, a full-fledged outpost of the AIDS industry. In addition to two AIDS support groups, the Unitarian Universalist Church has established an AIDS Ministry with its own minister. One private clinic alone has 250 AIDS patients, and for those who need or prefer big city doctors, a van makes regular trips between Provincetown and Boston. Drug manufacturers come to town, offering free dinners along with "treatment information" to those who are "HIV-positive". On the average there is an AIDS obituary every week or two in the local papers.

A recent article in the Wall Street Journal by Barbara Carton, "Life After Death: New AIDS Drug Brings Hope to PROVINCETOWN", describes the impact the new class of AIDS drugs, the "protease inhibitors", are having on the diagnosed, their counsellors, and their "service providers". The operative word is "hope", which is also the theme of well-orchestrated advertising campaigns being waged by several pharmaceutical companies. Although Glaxo-Wellcome is still the biggest player in the AIDS market, it is no longer the only one. Its competitors have demanded, and are getting, a piece of the pie.

Hope is portrayed visually in the recent "Be Smart About HIV" ads, sponsored jointly by the National Minority AIDS Council, the National Lesbian and Gay Health Association, and Glaxo- Wellcome. The models in the ad seem radiantly happy, hugging each other. Gone are the hangdog expressions found on the models in Burroughs Wellcome's "Living With HIV" ads of five years ago. The caption on the ad says simply, "See your doctor about new treatment options."; it is clear from the display of teeth in wide-open smiles, that the "treatment options" are good news.

Hope is also the theme of a spate of news stories about AIDS patients near death, who started protease inhibitor therapy, after which they gained weight and energy and began looking forward to a full life expectancy.

Carton's article indicates that this new hope is not without its drawbacks. In one support group there is a joke, "Well, if we're not going to die, do we have to go back to work?" The problem is not trivial:

"People are missing the boat in not designing programs for the long-term survivor with HIV," says Alice Foley, the town's former nurse, who is now retired. "You've got to mainstream them back into a working environment.... A lot of these guys haven't worked in eight or ten years." (Carton 1996)

However, many do not want to return to their previous jobs, which they found "unfulfilling". They refer to themselves as "retired".

How realistic is the present euphoria over protease inhibitor therapy? Not at all. Even if one believes the anecdotal reports, it does not follow that a temporary return to health is a consequence of the treatment. One of the most fundamental mistakes in reasoning is known as the "post hoc ergo propter hoc" (after this therefore because of this) fallacy. The mere observation that event A is followed by event B does not by any means prove that A causes B.

The consensus that the protease inhibitor cocktails are "working" beneficially falls apart as soon as one scrutinizes it. First of all, the anecdotal reports are highly selective. The successes are trumpeted from coast to coast. The failures are blacked out. The situation is piquantly illustrated in Carton's article:

Karin Anderson, who leads a weekly support group in PROVINCETOWN for people taking care of friends or partners with AIDS, says her seven-member group is becoming increasingly polarized. That is because the protease inhibitors are working for half the patients, but the rest are getting much sicker. [emphasis added] The social worker says she may eventually have to split the support group in two. [!] (Carton 1996)

And those who "are getting much sicker" are going down the collective memory hole.