As if all the routine stuff I had to do wasn't enough, now there was X-ray rounds.

I started my pediatric internship at Lenox Hill Hospital in New York in the summer of 1981. In name, at least. In fact I spent that first July and August doing a Hematology-Oncology rotation at Memorial-Sloan Kettering.

Memorial is a beyond-tertiary-care cancer hospital. In my two months, there I saw patients from Venezuela, Afghanistan, Turkey--you name it--all with pathology that had confounded experts the world over. It was fascinating and depressing. I did my work, did it well, and got out of there each evening as fast as I could.

The last thing I needed was daily X-ray rounds.

My resident at Memorial insisted we do X-ray rounds every day, whether our patients had had X-rays or not. In typical self-pitying intern fashion, I thought, "Great. Another hour each day in this hellhole." We'd meet the radiologist each morning at 10:00 am, and he would describe interesting and/or instructive films. One morning he put up a film that changed the world.

"I know you guys are Peds," he said, throwing an X-ray up on the light box, "but I thought you might find this interesting. What do you see?" It was a film of the chest, good quality, adult male, good inspiration, but what were those things in his lungs? There were diffuse infiltrates in both lung fields, puffy blooms like dandelion fuzz. The resident and we interns described the film as best we could, but we were stumped by the infiltrates.

"This is a white, previously-healthy, homosexual male who went to his doctor for bluish spots on his skin. A biopsy of the spots showed Kaposi's sarcoma. That's how he ended up here." Kaposi's sarcoma? I'd have to look it up, but I thought only old people got that. "He's also been having some trouble breathing so we got this film. Know what this is?" We all shook our heads. "Pneumocystis carenii." I had only seen one case of pneumocystis and that was during a previous rotating internship: a woman in her seventies who had been on chemotherapy for some type of cancer. I knew, without looking it up, that this was something only debilitated, immunosuppressed people got.

"How did they know to look for pneumocystis?" the resident asked.

"That's the thing," the radiologist said. "He's not the first. There've been case reports of maybe three or four other men with this. All young. All with pneumocystis. And all homosexual."

If anyone saw my face flush, my hands shake, they didn't let on. I'm gay, and while I didn't hide it, neither did I make an issue of it.

"Right now," the radiologist continued, "they're calling it Gay Lung Disease. Nobody really knows what's going on. Someone's suggesting it might have to do with swallowing and maybe aspirating semen as a mechanism of immunosuppression, but why would it show up in a cluster?"

Why indeed? I left the X-ray viewing room, and even then I knew something had changed, that this moment would represent a fundamental demarcation of Before and After in my life. As Gay Lung Disease became Gay-Related Immune Deficiency (GRID) and then AIDS, as HTLV-III became HIV, as rumors of government experimentation and medical genocide swept first through the gay-male and then through the African American communities, that ghostly image on a view box stayed with meÑmy first known encounter with the Plague.

That same summer saw the birth of the American Association of Physicians for Human Rights (AAPHR). The organization was founded to ensure that patients and physicians would not experience discrimination in the healthcare environment on the basis of sexual orientation. The timing of its birth, though, ensured that AAPHR would spend a considerable amount of its time and resources on AIDS.

I joined AAPHR in 1994, the year it changed its name to the Gay and Lesbian Medical Association (GLMA). Since that time I've seen GLMA expand its work in many other areas of lesbian, gay, bisexual, and transgendered (LGBT) health, advocating for equal treatment for LGBT people in government policy, health insurance, and health research.

Still, HIV/AIDS remains with us, devastating communities and continents. Gross and pitiless, it has moved under the radar as the world's attention has been drawn elsewhere. But for those who can think back to their first encounter with HIVÑa rumor over coffee, a tearful call from a friend, a mere bloom on an X-rayÑand can bear to recall the desolation of the past two decades, the fight will never be over.

And GLMA will always be there.

Kenneth A. Haller, Jr, MD, is a St. Louis pediatrician and member of the Executive Committee of the GLMA Board of Directors.