25 Years of AIDS

rimrocker · Jun 5, 2006

Article from the NYTimes... but everyone should go back and read And the Band Played On by Randy Shilts... it's one of the most powerful books of the last 50 years.

June 5, 2006
The State of AIDS, 25 Years After the First, Quiet Mentions
By THE NEW YORK TIMES
http://www.nytimes.com/2006/06/05/health/05aids.html?pagewanted=print

On June 5, 1981, in the Morbidity and Mortality Weekly Report from the federal Centers for Disease Control and Prevention, brief note was taken of a peculiar cluster of pneumonia cases in five otherwise healthy gay men.

The item was the first official mention of a scourge that had no name, no known means of transmission, no treatment and no cure.

AIDS, as it would eventually be called, was already spreading fear in America's gay enclaves, where before long half the young men who came of age at the dawn of the gay liberation movement would be infected, stigmatized, ravaged by rare infections and cancers, and die. It soon reached into neighborhoods already burdened by poverty and drug abuse.

For years after that federal report, one of the few certainties was that this disease, to quote other reports, was "invariably fatal." The United Nations estimates that today, H.I.V., the virus that causes AIDS, has infected more than 65 million people, 25 million of whom have died.

Eventually, scientists discovered the virus that caused AIDS and a test to screen for it. They learned the primary routes of transmission — unprotected sexual intercourse, intravenous drug use and prenatal infection. They found a cocktail of medications that slowed the disease's progression, at least in America. In Africa and Asia, AIDS continues to cut a deadly swath.

The Nurse

The difference between then and now is stark for Joan Vileno, a nurse at Montefiore Medical Center in New York. "In those days," she said, "all of our patients died."

Ms. Vileno, 57, said she chose to start her career at an urban academic medical center for the "unique experiences" that setting would provide. But she had no idea how unique those experiences would be. "No textbook could prepare us for what we were about to see," she said.

In the early 1980's, Ms. Vileno held the hands of angry, terrified and scorned patients, mostly intravenous drug users. They were admitted with lethal infections, rarely seen today, that left them gasping for breath, covered with cancerous lesions, blind, demented and wasted to skin and bones.

There were no medications to cure them of a disease then called Gay Related Immune Deficiency, or GRID, although at Montefiore, in the Bronx, the patients were rarely gay. In a study of a drug that proved ineffective, the average survival time of 300 Montefiore participants was eight months.

Today, Ms. Vileno runs a program for AIDS patients 50 and over who have lived long enough to also have the medical problems that come with middle age.

But a quarter-century ago, absent any effective treatment, the staff improvised. "The things we were able to do had nothing to do with our job descriptions," she said.

Many patients were unwilling to come to the AIDS clinic lest they be seen by someone they knew. So Ms. Vileno made house calls. Other patients, shunned by family and friends, all but moved in to the ad hoc clinic — then a bit of borrowed office space with a tiny staff; now a vast and humming operation.

Ms. Vileno once took a toddler home for the weekend so a husband could stay in the hospital with his dying wife. She organized a wedding in the clinic, officiated by a minister married to a staff member.

When funeral parlors refused to handle bodies, for fear of contagion, Ms. Vileno found a willing undertaker and invited him to staff meetings so he would feel like part of the team.

And returning from an AIDS conference in Paris, she went directly to the hospital. Four patients had died that week, one of them estranged from his family. He had designated Ms. Vileno his representative, so the morgue could not release the body for burial without her signature.

"Everything we did was out of the box," she said. "People today think, 'What are you talking about?' But it was a unique point in time, hopefully never to be repeated."

JANE GROSS

The Mother

ATLANTA — Lisa Mysnyk describes the man who gave her H.I.V. as "one of those African-American men who can't seem to stay out of jail." Still, she stayed with him for three years. Sometimes they used condoms. Sometimes they did not.

Ms. Mysnyk, who is also black, now knows that "sometimes" can be a very dangerous word.

"I got caught up in the idea that he wouldn't cheat on me," she said.

Just over half of new H.I.V. infections in the United States are in blacks, according to the federal Centers for Disease Control and Prevention in Atlanta.

Three years ago, her boyfriend tested positive for the virus while in prison. The staff made him call all his sexual partners to warn them about their own risk. When he phoned Ms. Mysnyk, he said he had something to tell her, but he could not seem to get it out. She finally heard the news from a prison nurse.

Her boyfriend called two other women that day, both of them younger than Ms. Mysnyk, who was 34.

While she waited for her test results, Ms. Mysnyk, a single mother of two young sons, told the doctor, "If I didn't have the Lord by my side, I'd be a nervous wreck right now."

When the doctor told her she had H.I.V., Ms. Mysnyk started to cry. Her doctor cried with her.

A few days later, she taught her younger son, who was 7 at the time, how to use a condom. She had a no-nonsense conversation with her 14-year-old about sexually transmitted diseases. "I didn't want him to ever have to be afraid," she said.

In the beginning, her own fear centered on how long she would live and what she could do to keep herself alive. "I started taking all these medications," she said, "and I never liked taking pills."

Ms. Mysnyk takes six pills a day, her virus level is undetectable and her immune system continues to be strong. She thinks she could live 30 or 40 more years as long as the drugs keep working.

She imagines that having the virus is a lot like having any other chronic disease. But unlike most other diseases, she knows, H.I.V. can almost always be avoided.

That is why, when she learned that a young woman who lives in her building was coping with a second unplanned pregnancy, Ms. Mysnyk, rather than offering words of sympathy, asked her a blunt personal question: "Do you and your boyfriend use condoms?"

Her neighbor admitted that sometimes they did and sometimes they did not. "Sometimes," Ms. Mysnyk told her, "isn't good enough."

BRENDA GOODMAN

The Prostitute

MUMBAI, India — With the strut of a baby-kissing politician, Mrs. Shah strolled down the byways of the red-light district the other day, pausing every few steps to offer a hug and a stern lecture to the prostitutes.

Mrs. Shah — tall and serene at 35, wearing a turquoise sari — began each conversation gently, with a joke or a compliment. A woman's makeup, she might say, was looking nice. Then she would lean in closer, glance around for onlookers, and pull out a pamphlet from the AIDS organization for which she works part time. Pointing at explicit photographs, she fired out her lessons: This is how to wear a condom; this is what an infection looks like.

When her shift ends, Mrs. Shah, who is being identified only by her common last name to help protect her identify, resumes her night job. By midnight, if luck is kind, she will be in a cheap hotel, earning a few dollars from a strange man for what she calls the only work she knows. And because she must survive, Mrs. Shah will fail to tell him — even as she insists on a condom — that she is a prostitute with H.I.V.

The United Nations reported recently that India had become the H.I.V./AIDS capital of the world, its 5.7 million infections surpassing South Africa's 5.5 million. Some Indian officials have disputed that number, but the government has acknowledged that the spread of the virus shows no signs of easing.

AIDS is often cast as an epidemic of bad choices. But it is also, in the life of Mrs. Shah, an epidemic of the choiceless.

Since childhood, she has walked on a path leading, with ever greater inevitably, to AIDS. At 13, she was forcibly married to a 35-year-old who kicked her out when she complained of his infidelities. Days later, a woman found her on the platform of a Bombay train station and offered to find her a job as a maid. By evening, she had been sold to a brothel for 10,000 rupees, $220 today.

Once, she said, a customer became a lover, married her and took her away. When he needed money, though, she was back on the street. She protested, and he stabbed her in the cheek and back, burned her with kerosene on the belly and legs and shaved her hip-length black hair down to the scalp.

Two years ago, a test found her H.I.V. positive. "I went crazy," she said. She drank and took pills, trying to kill herself. Then social workers approached her, looking for prostitutes to educate about AIDS.

"I had an idea," she said over a cup of tea, "that what happened to me, I would not let happen to other girls."

ANAND GIRIDHARADAS

The Researcher

SAN FRANCISCO — Work on AIDS remains his calling, but the grand emotions of the early years have subsided. Today, both the disease and Dr. Paul A. Volberding, a physician and researcher who is graying and has an arthritic curl to his fingers, have settled in.

Strangers on airplanes no longer accost him with questions about quick cures, and young men no longer die in his arms. Now if a patient dies, he said, "We think we've done something wrong."

Dr. Volberding, 56, who for many years ran the AIDS program at San Francisco General Hospital, now heads medical services at the San Francisco Veterans Affairs Medical Center. These days his AIDS research, like much of the pandemic, is focused on Africa.

"It feels good to do something so clearly needed that improves health so dramatically," he said of his work in Uganda.

Dr. Volberding has been touched by AIDS since July 1, 1981, his first day at San Francisco General, when he treated a 22-year-old gay man with Kaposi's sarcoma, a disease that until then was seen mostly in the elderly. After he came across other cases, Dr. Volberding did what academics often do: He studied them.

Because established physicians lacked the time and often the inclination to take on what was known as the gay disease, the field was wide open. At 31 and with a staff of one (himself), Dr. Volberding opened one of the first clinics anywhere for people with the disease. A year later, with assistance, he began conducting small clinical trials.

"The patients were so much like us," Dr. Volberding said. "We were all young." Many of them, he recalled, listened to the same music. He still keeps an old Grateful Dead poster on his office wall.

In those early years, Dr. Volberding and his colleague, Dr. Marcus Conant, both professors at the University of California at San Francisco School of Medicine, listed every patient in the city on a blackboard. They knew each by name.

Financing was scarce. Dr. Volberding remembered Dr. Conant suggesting that they wait until there were 1,000 cases, and then the government would take notice.

Many researchers thought they, too, were at risk. Both Dr. Volberding and his wife, Dr. Molly Cooke, also a physician, experienced such fears. Once when Dr. Volberding found a blotch on his skin, colleagues had to reassure him it was not Kaposi's sarcoma. All that has changed, too. Today, Dr. Volberding said, he and his patients commiserate mostly about arthritis and aging.

CAROL POGASH

The Artist

Art is forced by crisis to become political, and so it has been with AIDS, says the playwright Tony Kushner. The early works came in partly as a response to a society that was slow, even resistant, to accept the reality of a new pandemic.

"It was so clearly the dominant culture's mandate that AIDS death and AIDS suffering should be silenced," Mr. Kushner said. "The obvious thing to fight it would be to speak of it and articulate it."

What followed were works like Larry Kramer's 1985 play, "The Normal Heart," and Mr. Kushner's own Pulitzer Prize-winning 1993 drama, "Angels in America."

Only recently, he said, did he begin to reflect on the impact that the early years of AIDS had on the creative culture, especially on writers and artists.

"We were a community that was in a certain sense ideal in terms of responding in an organized fashion," Mr. Kushner said. "As soon as it became an issue of poverty, it lost a degree of organizational support, as soon as it became more or less brought under control in certain ways in the U.S.," he said. "You can't sustain rage for decades."

The great hole in the landscape is hard to comprehend even now, years past the time when AIDS was ravaging the American art world unchecked.

"There's a group of gay men about five years older than me who no longer exist, who would still be alive and producing work, who are gone," said Mr. Kushner, 49. "And there are a number of people I know who survived the epidemic but who in a certain sense didn't survive, who entered a permanent state of mourning."

CAMPBELL ROBERTSON

The Pioneer

Twenty-five years ago, Lawrence D. Mass was running an addiction treatment program in Manhattan for Greenwich House, a social services group whose clients included drug abusers and gay men.

Fertile ground, it turned out, for first documenting the disease that would become known as AIDS.

A little-known physician, Dr. Mass wrote what AIDS chroniclers regard as the first article on the emergence of — well, of something unusual and terrible, but exactly what was not clear at the time. The article appeared in The New York Native, a small weekly written for a gay audience, on May 18, 1981, several weeks before the first scholarly journal weighed in.

Dr. Mass, who is gay, went on to become a founder of Gay Men's Health Crisis and to devote much of his life to fighting the disease he had stumbled onto.

In early 1981, Dr. Mass, then 34, had heard fragments of rumors about strange health problems cropping up in Lower Manhattan, especially among gay men. He found Dr. Steve Phillips, an epidemiologist with the Centers for Disease Control and Prevention, who was following the new mystery. Based on his conversation with Dr. Phillips, Dr. Mass wrote a short article about "rumors that an exotic new disease had hit the gay community."

There was so little anyone knew at first, and so much that people got wrong. But looking back, said Dr. Mass, who still practices medicine in Manhattan, there is one essential truth he believes he had right all along.

"From the start, I said you need to acknowledge our civil rights, you need to recognize our relationships, to have any chance of containing and preventing AIDS," he said. "Shame and fear make it worse."

RICHARD PÉREZ-PEÑA

The Friends

PROVINCETOWN, Mass. — Jay Critchley's recollection of what happened when AIDS first hit this gay-friendly town on the tip of Cape Cod is clear and stark.

"People just disappeared and died," he said. "It was that dramatic, and it was frightening."

It was common to see men with lesions walking in and out of the shops, bookstores and restaurants that line the town's main street, struggling to breathe the salt air, said Mr. Critchley, an artist and massage therapist. Asking someone if he had lost weight was taboo; it meant asking if he was sick. Friends made sure to stay in close contact, because those who fell out of touch were usually dying.

The town's gay residents drew together and cared for the sick. Many went house to house, making sure they were comfortable, safe, well fed. Still, no one understood the provenance of the suffering, and when investigators from the federal Centers for Disease Control and Prevention came to town on a fact-finding mission, many gay men simply assumed that they, too, would get sick and die quickly.

"There was a time when I just waited for it to happen to me," said Tom Sterns, an antique shop owner and 30-year resident. "There wasn't any point in getting tested because they couldn't do anything for you, and I didn't want to face having it."

In the mid-1980's, he finally got tested. The results were negative.

AIDS changed Provincetown itself, for good and bad. In the summer of 1983, many tourists stayed away, fearful of contracting the disease. But gay men in the once carefree community grew cautious about unsafe sex, Mr. Critchley said.

As advances in drug treatment have allowed infected men to lead longer, productive lives, the disease is no longer visible, Mr. Sterns said, and is not in the forefront of every gay man's mind.

But that is leading to more problems, said Mr. Critchley, who sees more men slipping back into careless sexual practices.

With the reduction in fear, the town too has changed. Rising real estate prices and an influx of tourists have chipped away its neighborliness and bohemian flair.

"The town is so dramatically different now than it was 10 years ago," Mr. Critchley said.
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rrj_gamz · Jun 5, 2006

Great read...I can't believe its been that long...Everytime I see Magic, I think of AIDS...funny how things work...When ever you think you had a bad day, think again, it could be much worse...

rimrocker · Jun 5, 2006

When I had just finished packing my car for the trip to graduate school in VA in 1985, my Mom, who had been freaking for weeks because I was leaving Texas and would be more than an hour's drive away... and even worse, would be close to major metropolitan centers on the East Coast, called me aside and said, "We don't need anyone in the family coming down with AIDS." It kind of threw me until I realized it was nervousness about my departure coming through, so I came up with a response: "Mom, I'm not Haitian."

I count myself lucky in that I lived in a brief window at the end of the sexual revolution that conveniently dove-tailed with HS and College where you really only had to worry about unwanted pregnancies and mild stuff like crabs. Sounds like Deckard, among others, had a much wider window and much more fun. Still, it was a different mindset before AIDS that I was fortunate to experience.

I don't think anyone who didn't live through those first few years of the AIDS epidemic can fully understand what a huge deal it was and how it absolutely freaked people out. Not to mention the usual folks who tried to spin it for political gain. Amazing that we now, in so many ways, take it for granted or ignore it.

mc mark · Jun 5, 2006

rimrocker said:

I don't think anyone who didn't live through those first few years of the AIDS epidemic can fully understand what a huge deal it was and how it absolutely freaked people out. Not to mention the usual folks who tried to spin it for political gain. Amazing that we now, in so many ways, take it for granted or ignore it.
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There was a period from around 1989 and 1993 when I had 7 friends die (three within one year period). That was some strange times let me tell you. Everyone in the theater community in Houston in the late 80s, early 90s were freakin'.

peace

bnb · Jun 5, 2006

Man... I remember the Haitian connection too. Haitians and gay men. It was their disease. Lots and lots of misinformation. Hard to believe it's been 25 years.

And condoms became honourable. Good girls carried them. That was a bizarre twist.

bigtexxx · Jun 5, 2006

We desperately need to find a cure for this killer disease

Rocket River · Jun 5, 2006

bigtexxx said:

We desperately need to find a cure for this killer disease
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Never happen

we ain't 'cured' anything since polio
and
they madd about all the money they lost on that one

it is not Economical to CURE anything. .
Expensive and lifel ong treatments. . that is where the money is

Rocket River

Invisible Fan · Jun 5, 2006

The accusation isn't entirely true RR. Vaccines aren't as big a moneymaker as wrinkle creams and boner pills.

The 10 year window is definitely a big disincentive, but it sometimes cost more money to study on a specific disease than say, repackaging ulcer medication by it's delivery system and therefore granting a new patent.

The way I see it, specific cures will be rare. However, genetic discoveries will bring diseases down by the handful. To many people, it'll appear revolutionary.

So we'll probably see AIDS become more silent and abstract. It could socially morph into a perverted lifestyle choice as drugs get cheaper and widespread.

mc mark · Jun 5, 2006

Invisible Fan said:

So we'll probably see AIDS become more silent and abstract. It could socially morph into a perverted lifestyle choice as drugs get cheaper and widespread.
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Already has. I know people who are going on 15 years living with HIV.

I think RR has a point. The money isn't in cures, it's in selling people drugs to keep them alive (and buying drugs).

I can't believe we don't have the ingenuity to cure cancer and HIV.

StupidMoniker · Jun 5, 2006

rrj_gamz said:

Everytime I see Magic, I think of AIDS...
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Every time I see Magic I think of Chris Rock's bit on a guy missing work because his AIDS was acting up. Life imitates art.

robbie380 · Jun 5, 2006

guys let's not forget that we have never cured a virus. even though we have done some cool things with science we are still impotent in many areas. we aren't gods yet.

and to you guys saying that drug companies only care about treating everything else but the virus then you need to open your eyes. we are on the verge of ELIMINATING cervical cancer since we finally have an HPV vaccine. pretty cool stuff. but I guess the cynics will say that is just the carrot "they" are hanging in front of us.

Rocket River · Jun 5, 2006

robbie380 said:

guys let's not forget that we have never cured a virus. even though we have done some cool things with science we are still impotent in many areas. we aren't gods yet.

and to you guys saying that drug companies only care about treating everything else but the virus then you need to open your eyes. we are on the verge of ELIMINATING cervical cancer since we finally have an HPV vaccine. pretty cool stuff. but I guess the cynics will say that is just the carrot "they" are hanging in front of us.
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call me when they cure it

Rocket River

mateo · Jun 5, 2006

robbie380 said:

guys let's not forget that we have never cured a virus. even though we have done some cool things with science we are still impotent in many areas. we aren't gods yet.

and to you guys saying that drug companies only care about treating everything else but the virus then you need to open your eyes. we are on the verge of ELIMINATING cervical cancer since we finally have an HPV vaccine. pretty cool stuff. but I guess the cynics will say that is just the carrot "they" are hanging in front of us.
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Actually most cynics (and realists) might mention that some of the religious right in the govt dont want that vaccine being distributed. They feel it conflicts with their abstinance plans.

Idiots.

robbie380 · Jun 5, 2006

mateo said:

Actually most cynics (and realists) might mention that some of the religious right in the govt dont want that vaccine being distributed. They feel it conflicts with their abstinance plans.

Idiots.
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I don't know why you need to put vaccine. we don't have a vaccine. we aren't close to having a vaccine. HIV mutates too fast. we don't know how to cope with that. I'm certainly not an expert, but right now the best prospects would seem to be to somehow exploit the people who are naturally immune to HIV. those people are the decendents of the survivors of the black plague. that virus attacks in the same way HIV does.

anyhow, the right wing idiots who put the emphasis on abstinance over condom distribution and mandatory testing are the ones responsible for AIDS getting so bad in africa. that combined with the stigma of AIDS and horrible education on the disease. we have wasted so much money and so many lives there because of stupid ideology and not practicality.

Sishir Chang · Jun 5, 2006

robbie380 said:

guys let's not forget that we have never cured a virus. even though we have done some cool things with science we are still impotent in many areas. we aren't gods yet.
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Polio is a viral disease, so is HPV and so is the flu.

Since polio was cured we've cured many diseases. That flu shot you get every year is often a cure for a new disease. The particular strain of flu that is out that year. The difference with AIDS is that the HIV virus is particularly tough virus since it attacks the body's mechanism for defeating it and can also hide in hard to reach reseviors in the body so even if all of the virus is eradicated in the bloodstream there can still be some hiding out in the lymph node. The other problem is that there isn't one single strain of HIV but a few different ones making it difficult to target a single treatment.

Sure there's money in longterm treatment but there will be huge money in a cure and any researcher along with drug company that finds that cure will reap huge monetary rewards. At the sametime the treatments won't continue to remain profitable once their patents run out and now that many countries are bypassing the patents anyway there is less money. As another poster pointed out the drug companies can always find ways to make more money on treating a variety of other ailments.

robbie380 · Jun 5, 2006

chang....you are confusing curing and vaccinating. we can't cure people of viruses when they have been infected. we erradicated those viruses you mentioned thru vaccination.

Sishir Chang · Jun 5, 2006

^ You're right Robbie and pardon me for not being precise with the language. You're correct that those infected with polio aren't cured, in terms of the virus being eradicated and their symptons reversed, but generally polio is considered "cured" since its mostly been eradicated as a widely infectious disease.

A cure for AIDS will be in the form of a successful vaccine to prevent the spread along with treatments that reverse and supress symptons of those already affected.

mrpaige · Jun 6, 2006

robbie380 said:

I don't know why you need to put vaccine. we don't have a vaccine. we aren't close to having a vaccine. HIV mutates too fast. we don't know how to cope with that.
Click to expand...

I think he was talking about the HPV vaccine that's in the pipeline right now (and was mentioned in another post). There was some opposition to that vaccine from some religious groups. There was an in-depth article in FORTUNE a few months ago about the vaccine and the opposition to it that was interesting, but I don't remember the issue number.

robbie380 · Jun 6, 2006

mrpaige said:

I think he was talking about the HPV vaccine that's in the pipeline right now (and was mentioned in another post). There was some opposition to that vaccine from some religious groups. There was an in-depth article in FORTUNE a few months ago about the vaccine and the opposition to it that was interesting, but I don't remember the issue number.
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wow that would be horrible if that is the case. if those self righteous jerks actually had the political power to prevent us from irraticating a cancer then there is something very wrong with this country.

Aceshigh7 · Jun 6, 2006

This is from an article in POZ magazine. Evidently there is a subculture out there now that actively seeks to be infected with HIV as a form of eroticism.

This is completely crazy!

The ultimate intimacy
While many barebackers are committed to staying uninfected and protecting their partners from HIV, the XtremeSex Web site caters to those who are not. In operation for more than two years and open to all gay men -- regardless of serostatus -- it highlights the erotic appeal of HIV-infected semen. XtremeSex offers hundreds of personal ads including those from "bug chasers" (men looking to become infected or exposed to HIV) and "gift givers" (men who eroticize infecting or exposing others to HIV). "Hot hard-body muscular bottom looking to be gang-banged by as many poz guys who want it. I will do whatever you want. No limits at all. I need your charged loads" is a characteristic personal on the XtremeSex Web site.

Rare exceptions to the barebacking norm, these men prize not just unprotected anal sex or even semen but HIV itself as the ultimate intimacy to share with another. In a mind-boggling feat of symbolic reversal, they have taken the dread and deadliness of the virus and transformed it into desire and regeneration. For them, sharing uninfected semen is insufficient because it provides only a temporary bond -- the come dries up, leaving only the memory of the experience. But "charged loads," in the XtremeSex worldview, offer a kind of permanent partnership, a connection outside of time. Once you're infected, you're infected for life. Over and over on the XtremeSex Web site this fantasy plays itself out, and XtremeSexers have used their considerable knowledge of HIV pathogenesis to elaborate it. From the science of how the virus invades -- and then is incorporated into -- the host cell, combining the DNA of one organism with another to make a new form of life, these men have woven a tale of romance. In this way barebacking is equated with "breeding" and infection with "impregnation." Some HIV-negative bug chasers have gone so far as to attempt to consciously choose the individual gift-giver who will "father" their HIV infection. For these men, seroconversion has become a rite of passage rather than a chance occurrence, couched in metaphors of pregnancy.

One HIV-positive man named Paul, 45, is in the process of becoming a gift-giver to a 21-year-old HIV-negative sex partner. Paul has delayed "giving the gift." Though they have had sex without condoms in the past, Paul has never ejaculated inside his partner. He has spent the last few months telling his friend about HIV and its physical and emotional consequences. "I've talked with him for quite some time so that he understands what he's getting into, and evidently he feels it's controllable and wants it," he says. "As long as he is clear on what he's asking for, I'd love to drain a load up his hole. It turns me on knowing how much he wants my come and how much he's willing to deal with to get it."

When pressed, Paul acknowledges the "twisted romantic" nature of their relationship and the unequal power dynamics of their difference in age. His tone of voice, so matter-of-fact, is almost as disturbing to me as what he has to say.

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