What Mother Teresa could learn in a leather bar; gay men's response to AIDS shows how the larger community can help heal itself.

• Author: Boo, Katherine

At 5 a.m. on February 6, Tony Harding died in a quiet comer of D.C. General Hospital. Like a number of other patients in the public hospital wing, he was young, indigent, uninsured, estranged from his family, and mentally ill. But unlike most of the others, Tony Harding had AIDS. In that, he was profoundly lucky.

AIDS. Luck. It seems unthinkable to couple those words. But in the weeks after Tony's death, I found myself associating them often. For if his death was grim and undignified, the months that preceded it were not. He couldn't pay his rent; it was covered. He couldn't cook his food; it was delivered to him, steaming. He had no medical insurance; he got first-rate medical care, free. He lied on his social security forms; a lawyer straightened things out, pro bono. One Saturday night, he found himself handcuffed in a ward at St. Elizabeths mental hospital. As city officials moved to commit him, friends and advocates negotiated his release. Last Christmas, a man he hardly knew picked him up at his apartment in Shaw and drove him to Nordstrom. He returned with an utterly unnecessary, beautiful pair of shoes.

Tony Harding, mind you, was not an activist or even a minor celebrity in Washington's gay community, nor was he well connected. The son of blue-collar parents from Crofton, Maryland, he spent his brief adulthood as a waiter at the American Cafe and as a clerk at Pan Am. He was, I suppose, an ordinary young man. Yet there was something remarkable about his dying. For a year, as he slowly lost command of his mind and body, he passed his days in the hands of agencies, hospitals, doctors, friends, and strangers. They did not let him fall.

This month, as we note the 10th anniversary of the first official report on the epidemic, the mark of the 110,000th life, this seems perhaps the dullest of silver linin s. But as debates over AIDS activism and medical research dominated our attention, a quiet development occurred in a few American cities. For the first time in recent history, AIDS brought members of the organized middle class into the ghetto of the human services bureaucracy. They found the system lacking, so they changed it. Outside the fragmented, assembly line world of social services, with an army of volunteers, the gay community built a new way of caring for some of society's most vulnerable members. Unfortunately, it is still only for the few.

Four days after Harding, David, another patient in the same D.C. General ward, died. The hospital moved the body to the morgue, recorded the occurrence in its files, and closed the case. Until a patient volunteered the information days later, David's doctor didn't know the young man was dead. David's case, not Tony's, shows how government care for the poor usually works. Which is precisely why the exception-the swords and plowshares of the urban AIDS network-should be shared.

The day Harding's brief obituary appeared in The Washington Post, the Metro section was dominated by a lawsuit against D.C.'s foster care system. Sixty-nine percent of children who were candidates for adoption had never had their files forwarded to the proper adoption unit. Five-year-olds were judged ready for "independent living." Volunteers willing to take children were turned away. In the chaos, some children were simply lost. A social worker explained, "A fire starts and then you put it out and then we move to the next." The children in foster care weren't, it seemed, really children. They were a paperwork problem that sat for years in someone's in-box.

In America, this is how we usually serve the needy: as little as we can get away with. Despite the work of advocates, Americans with steady jobs and health insurance don't hear of-and don't care about-the flaws in the social service system until problems reach crisis proportions. But even when the system isn't scandalous, it can rarely be confused with genuine service. For if poverty, homelessness, and disease have complex sources that demand rifleshot, differentiated responses, those complexities seldom touch the human services bureaucracy-government or nonprofit-because bureaucracies are driven by numbers. Every year, each of the D.C. government's hundreds of social service programs produces a performance evaluation chart that supposedly attests to the good use of its ample budget: a neat, McDonald's-style tally of numbers served. In an environment like this, it's understandable that only what can be counted tends to get done. What is markedly absent is compassion for, and responsiveness to, messy individual lives.

It was this sort of "service" that horrified Cliff Morrison when the first few dozen cases of what would later be called AIDS began to crowd San Francisco General Hospital in the early eighties. Nurses refused to touch the patients; doctors and orderlies rushed through their duties and ran away. As a nurse, Morrison knew this unfriendly service was only an amplified version of the care usually offered the hospital's largely low-class clientele-or, for that matter, average hospital patients anywhere in the country. Patients were jolted awake at all hours for treatments, even when sleep was their only escape from pain. Dinner was microwaved, congealed, often cold. Medical students came at 5 a.m. to examine them. Nurses barged into their rooms without knocking. But now there was a critical difference-the attitude of the new guys on the ward.

"I remember one of the first patients on the unit, a 22-year-old man from Iowa," says Morrison. "He had advanced Kaposi's sarcoma; he knew he wasn't going to live much longer." He wanted his lover to visit, but the rules restricted AIDS activism and medical research dominated our attention, a quiet development occurred in a few American cities. For the first time in recent history, AIDS brought members of the organized middle class into the ghetto of the human services bureaucracy. They found the system lacking, so they changed it. Outside the fragmented, assembly line world of social services, with an army of volunteers, the gay community built a new way of caring for some of society's most vulnerable members. Unfortunately, it is still only for the few.

Four days after Harding, David, another patient in the same D.C. General ward, died. The hospital moved the body to the morgue, recorded the occurrence in its files, and closed the case. Until a patient volunteered the information days later, David's doctor didn't know the young man was dead. David's case, not Tony's, shows how government care for the poor usually works. Which is precisely why the exception-the swords and plowshares of the urban AIDS network-should be shared.

The day Harding's brief obituary appeared in The Washington Post, the Metro section was dominated by a lawsuit against D.C.'s foster care system. Sixty-nine percent of children who were candidates for adoption had never had their files forwarded to the proper adoption unit. Five-year-olds were judged ready for "independent living." Volunteers willing to take children were...