Grace and Fear Mark AIDS Epidemic in San Francisco : Health: Disease is now the city’s top killer of men. There are as many poignant stories as there are victims.

SAN FRANCISCO —  Richard has seen it countless times--the anger, the sorrow, the bravery of critically ill AIDS patients.

Soon, he says, he’ll know exactly how they feel.

“Not everybody is courageous in the face of AIDS. Some go kicking and screaming and are horrible to everyone around them,” said the former heroin addict-turned AIDS counselor. “I’m not sure how I’m going to act.”

Richard, who declined to use his last name, was diagnosed HIV positive in 1985. “So I’m panicking.”

He isn’t the only one.

The San Francisco health department recently announced that for the first time in any U.S. city, AIDS was the leading cause of death among men in 1992--the first time any illness passed heart disease as the No. 1 killer.

In a tragic coincidence, 1992 was the same year health officials celebrated hitting a plateau in the number of new cases.

What’s even more unfortunate is that many here weren’t surprised by the numbers. “We’ve lost so many friends,” said Richard Chavez, former program coordinator for activities at the Shanti Project.

“It’s frightening to think that nobody is surprised by it,” said Chavez, who is also HIV-positive. “Maybe some people who have been hiding in the sand might say, ‘Oh, my gosh.’ ”

Over the last few years, AIDS has been the leading cause of death among men age 25-44, but 1992 was the first time it crossed all age lines. The largest increase in deaths came in men age 35-44.

In 1992, the latest year data is available, of the 8,143 total deaths in San Francisco, 1,195 men died of AIDS, while 1,094 men died of heart-related disease. In 1991, of the total 8,345 deaths, heart-related disease killed 1,189 men and AIDS killed 1,152 men.

“In traditional medicine, you go to the doctor and get better. In AIDS, you go to the doctor, you go to the doctor, you go to the doctor, you go to the doctor, you go to the doctor, you go to the doctor--and die,” said Richard, the AIDS counselor.

Among all San Francisco residents, AIDS accounted for 15% of the deaths in 1992 and 14% in 1991.

The number of new AIDS cases reported in 1992 was 3,028, but that dropped 25% to 2,264 in 1993. The health department estimated that new cases would drop to 1,204 in 1997.

“AIDS had been inching up as the leading cause of death. . . . It didn’t go from being No. 12 to 1 overnight,” said Mitch Katz, director of the city’s AIDS office.

“Between 1981 and 1984, there were 8,000 new infections each year. Those were entirely among gay men. And now we’re seeing, 10 to 12 years later, the consequences--the high rate of death,” Katz said.

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Although the numbers for 1993 are still being compiled, AIDS is expected to remain the leading cause of death. The death rate isn’t likely to decrease until the late 1990s, Katz said.

The health department warned that although the number of AIDS cases among gay men has decreased, the numbers of youths and intravenous drug users afflicted is increasing.

Richard, the AIDS counselor, doesn’t doubt that AIDS will increase among IV drug users.

The “shooting galleries,” or drug homes, where he used to hang out had three hypodermic needles on the table for about eight people. Some had been used so many times the tips were rounded.

“Some days, I never saw a person above the forearm,” he said.

He was sober on and off and went through some years of shooting up a few times a year, compared with 10 to 15 times a day.

At one point, his girlfriend threatened to dump him if he got stoned. When he did it anyway, he lied to her, saying his friend had just died of AIDS and he couldn’t handle the emotional strain.

The woman then suggested they get tested. In 1985, he got a phone call from a clinic doctor who said she tested negative.

His test was positive.

AIDS is “part of what put me in touch . . . made me part of the human race again,” Richard said. “I’ve spent so much of my life numb and unfeeling. To be feeling is a miracle.”

Richard has been clean for the last four years.

“This is the most productive time in my life, from the standpoint of being a part of rather than apart from,” he said, though he wishes his wake-up call had been something other than AIDS.

“I know I get incredibly teary sometimes when I think about what it would be like. I don’t want to wear a diaper because I’m incontinent when I’m 41. That’s the stuff that’s supposed to happen to you when you’re 85 or 90,” Richard said.

But his spirits rise when he thinks of his work as a counselor, his girlfriend and starting graduate school in the fall.

“If I didn’t get HIV, if I didn’t get tested, I wouldn’t be here today. And I’m supposed to be here and putting one foot in front of the other.”

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Fritz Desir doesn’t know how he got AIDS. What he does know is that he can no longer play soccer. He worries about how he’s going to pay rent and buy food.

Desir, 31, escaped from Haiti in 1980 and spent three months drifting at sea with 30 others before being picked up by the U.S. Coast Guard.

He eventually received political asylum and was sent to San Francisco. In 1992, after suffering a bout with tuberculosis, he found out he was HIV positive.

These days, his energy level--and his spirits--are low. “I can’t pay my rent. I can’t go out and have a good time,” Desir said, sitting in his cramped San Francisco studio.

“She helps me,” he said, meaning his girlfriend, Catherine Crawford. “But I can’t help her like I used to.”

The two share the studio. But both are unemployed; after paying rent, they have $100 left. Recently, a friend staying with them promised to help pay the rent. The friend skipped town.

“We just take every battle as it comes,” Desir said. “My life is in God’s hands.”

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Robert Sterman and Glenn Nelson met via a computer bulletin board. Both knew the other was HIV positive, but that didn’t matter. Their only fear was that they would get sick at the same time.

Nelson’s health started deteriorating first, about a year ago.

So they decided to get married. Though California doesn’t recognize same-sex marriages, the pair exchanged vows at a ceremony before a small gathering of friends and family.

“We both said, when we said our vows, ‘till death do us part.’ And that’s exactly what we meant,” Sterman said.

Nelson died earlier this year. He was 28.

“One of my concerns is people seeing the story and saying, ‘Oh, there’s another gay that died.’ He was a person, “ Sterman said.

Sterman recently began feeling the effects of AIDS.

He stays at home more now, because he’s afraid he won’t have the energy to climb the flight of stairs to his apartment.

“The whole world seems to be moving at a much, much faster pace than me. That gets to be frustrating when you know you used to be at that faster pace.”

Meanwhile, he plans life by the week. And he clings to a little ray of hope.

“There’s hope that they will be able to find a way to control the disease,” he said. “And the hope that at least your journey into whatever the next life is, is as easy as it can be.”