The Epidemic since 1991
In 1991, when Before It Hits Home premiered, the cultural and medical outlooks for those suffering with HIV and AIDS were bleak. As one activist noted of the time, "Friend after friend after friend was dying." Circles of friends were decimated. Life partners and spouses planned sparsely attended funerals. Some afflicted perished in ICUs with no visitors. Medical advances had been swift but ultimately insufficient. Cheryl L. West wrote Before It Hits Home one decade into the pandemic; it's been three decades since. Researchers estimate that up to 42 million people -- gay, straight, bi, Black, white, Latino, anyone -- have died from AIDS-related causes in the full four decades since a handful of men came down with immunodeficient-related diseases in the early 1980s. That averages one million people per year for each year HIV has been in our bloodstream; for reference, that average is twice the toll of COVID-19.​
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Since West opened Before It Hits Home, the cultural consciousness surrounding HIV and AIDS has shifted dramatically. Advocacy by such visible figures as Princess Diana, Elton John, and Liza Minelli and the public disclosures of their HIV-positive statuses by NBA all-star Magic Johnson, Pedro Zemora of MTV's inaugural "The Real World," Olympic swimmer Greg Loughanis, "Brady Bunch" dad Robert Reed, rapper Eazy-E, tennis legend Arthur Ashe, and "Who's the Boss?" child actor Danny Pintauro, to name a few, have taken HIV beyond the walls of the stereotypical big city bathhouses and into public view. Tom Hanks's Oscar turn in "Philadelphia," Tony Kushner's earth-shattering Angels in America, and Jonathan Larson's life-affirming phenomenon RENT yielded similar results.
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In 1991, an HIV diagnosis could approach a death sentence; in 2025, due to advances in antiretroviral therapies, HIV is a chronic condition, as some who are HIV-positive have viral loads so low the virus in undetectable. "Living with HIV" produces 336% more results in a Google search than "dying of AIDS." People who test positive for HIV are living longer than they ever have; we've now reached the point in efficacious treatments where those who are HIV-positive are dying of natural causes and not AIDS-related complications. (That statement required less nuance before COVID.)
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To be sure, awareness advocates, researchers, and healthcare workers warn we're not ready to shut the door on the disease. Yes, medications such as PrEP (pre-exposure prophylaxis, which can prevent exposure to HIV from becoming infection) and PEP (post-exposure prophylaxis, a medication likened to a morning-after pill in the case of exposure to HIV) offer more protection than Wendal in West's play was ever afforded. (Below is a video produced by the Centers for Disease Control about PrEP.) There have even been cases in which infants born HIV-positive have cleared the infection (even if the science has been inconsistent).
Thankfully, the toll has lessened substantially. Incidence of infection has slowed since its mid-1980s peak, as organizations such as the Gay Men's Health Crisis and ACT UP in New York City and SisterLove and The Balm in Gilead in the South brought awareness and advocacy to under-served communities, as the use of condoms was promoted widely and as prevention programs, including early sex ed in schools and needle exchanges for IV drug users, yielded marked successes.
In 1991, people were dying of AIDS; in 2025, people are living with HIV.
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Such increases in visibility and advances in medical treatments worry some researchers and healthcare providers, as new generations grow of age without the personal and cultural memories of the epidemic's earlier eras and the havoc the virus wreaked on whole social circles, families, and communities. "It's not like it was" and "It's not that big a deal" aren't rare refrains, particularly within communities of gay men who use certain smartphone apps. PrEP and PEP are not silver bullets; HIV is a virus, and viruses have no cure. And for those without access to health insurance (disproportionately people of color), PrEP can cost $2,000 per month, and market manipulations are not rare for HIV treatments: the most notorious was the 2006 overnight rise in the anti-parasitic Daraprim, the drug overseen by so-called "Pharma Bro" Martin Shkreli, the price of which rose in 2015 literally overnight from $13.50 to $750 per pill. Randy Shilts's And the Band Played On (1987) documents early breaches in medical ethics by HIV researchers. (The 1993 film starring Matthew Modine will infuriate equally.)
Some viruses are countered by a vaccine, including COVID-19 and coronaviruses that preceded it. But there is no HIV vaccine. Researchers are getting closer every year, and there's hope the speed of the COVID vaccine will shine a path for the development of an HIV vaccine. When Cheryl L. West wrote Before It Hits Home, a vaccine was unimaginable, but we may yet see it in our lifetime. People are living with HIV, and that's a truth often unavailable to those living in the world of West's play. If Wendal were playing his saxophone in 2025 and not 1991, for years he'd play on. Others are playing on instead, and that's music to our ears.
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