Are gay men listening? From the front lines David Ho's right-hand man says the battle is far from over.

When Martin Markowitz joined the Aaron Diamond AIDS Research Center in New York City in 1991, the news about HIV left little room for optimism. His own experience as a physician and openly gay man added to his sense of gloom. "Almost everybody in New York had died, and then another generation died, and maybe a third," recalls Markowitz. "It was a never-ending cycle. "

Now, says Markowitz, the atmosphere is entirely different. "I don't think I know anybody who has died in the past two years, or maybe even three," he says. "It's amazing, considering that five years ago I knew too many. There's a dramatic difference. " I

As director of clinical research at the Aaron Diamond Center, Markowitz has been in a unique position to see the remarkable changes in the epidemic. Working closely with David Ho, the center's director and Time magazine's 1996 Man of the Year, Markowitz has witnessed firsthand the advances in research and treatment that just two years ago seemed impossible to imagine.

"It's been a wild year," says Markowitz. "Hospital beds are empty, and for the first time in 15 years, people are not dying. That's tremendous." At the same time, research has made enormous strides in understanding the virus itself. I deed, the advent of the zero viral load, an undetectable level of HIV in the bloodstream that Markowitz jokingly calls "nirvana," has created a dizzying array of categories among gay men. "There's HIV-negative, HIV-positive, HIV-positive undetectable -- it's fragmented, like a country-club mentality, " says Markowitz. However, the emphasis on a zero viral load may be misplaced, he claims: "I have guys who started a protease-inhibitor regimen who have never been undetectable but have never progressed. "

Yet Markowitz allows that not all the news has been good. "It's been a hard year some ways too, because a lot of people weren't benefiting from the `miracle' -- not because it wasn't a miracle but because of people's drug history and therapies they had undergone too quickly in the past," he says, referring to the previous medical regimens of some patients, which might have lessened the chance of success with new treatments.

In the next year those failures may attract even more attention, particularly if the death rate from AIDS complications begins to rise. Still, Markowitz says, any increase would be "a blip" among patients who were "very, very sick when they started." In such cases, he says, "one can't expect these things to work forever" but instead that they might help patients hold on until the next breakthrough in treatment.

The perceived rise in unsafe sex, as indicated by a reported increase in gonorrhea cases at some gay clinics, is, to Markowitz, "madness." He attributes some of the rise to young gay men who don't understand the risks they are taking, but he also blames the short-term memory of the gay community. "It's sort of like the Holocaust," he says. "People are one or two generations away, and they think it didn't happen." Nor does Markowitz think much of one potential preventive measure that has drawn much attention -- the live-virus AIDS vaccine. "It will make people sick, " he says, " and we have enough sick people. "

While Markowitz says his experience as a researcher makes him cautious about commenting on public policy, he is bothered by the way AIDS is being reevaluated in public debate. "I don't like to see stories that AIDS should not be treated as a special disease," says Markowitz, referring to a November New York Times article.

If anything, he argues, the "exceptionalism" with which critics increasingly tar AIDS should be the standard in all health care. "The answer, based on my experience, is not that people with AIDS shouldn't be treated specially," Markowitz says, "but that everyone deserves the right to have good medical care, to be taken care of, to have a say in what happens to them.

"I think we should come around it from the other way," he continues. "I don't want to empower people who want to take that negative point of view, who say that even AIDS activists say AIDS shouldn't be special. I want to empower the do-gooders, not the do-evils."

Rather than questioning the model of AIDS care, advocates for other diseases would do well to adapt it, says Markowitz. "Nobody gave the gay community anything," he says. "They went out and did it themselves. People have to help themselves."

If that sounds like a big task, it may be because Markowitz is accustomed to them from his own research in trying to defeat the virus. "Solving problems like these is not easy," he says. "There are no quick fixes or easy answers. But it's going in the right direction now. If you know the enemy, then you can try to beat it."