When the AIDS epidemic struck during the early 1980s, it was the male homosexual community that appeared to be most affected. In San Francisco, California, home to the largest openly gay population in the world, it was as if an epic plague had hit, transforming an ebullient subculture into one where decline, death and near-constant grief were the norms.
Support groups, activist organizations and health networks were formed to meet the crisis. Among them was "Maitri", one of the first hospices in America devoted to those living with AIDS. Two decades after the onset of the crisis, Maitri is still going strong.
A sense of elegance and calm pervades the spacious common areas and 15 private rooms at the Maitri facility in San Francisco's Castro District.
That may be due in part to the 19th century Asian furniture donated to Maitri over the years. Or perhaps it is the riot of fresh-cut California flowers grown and arranged by residents - that gives this hospice its special atmosphere.
Despite its Buddhist roots, Maitri today is a non-denominational facility. But Tim Patriarca, Maitri's executive director, believes it is the painting of a smiling Tara, a green goddess of compassion, in the front lobby that expresses the true heart of the place. "'Maitri' is a Sanskrit word and it means … loving kindness, compassion and 'the way a mother nurtures her child.' So, for us, it was a wonderful choice because that is what we at Maitri want to create," he said. "A real community filled with love and compassion that is more than just a house, that is more than a place to come for either your end-of-life or transition. It's really a place where you will feel warm and welcome. Because we specialize in financially needy people with AIDS." Mr. Patriarca notes that Maitri residents have often known the pain of being rejected by mainstream society even before they got sick.
"Many of the people have had so many judgments piled on them, by being gay, by being drug addicts, by being homeless - you name it. There are so many ways we can judge [others]. But they can come in here and they are surrounded by people who care about them," he said.
The realities of living with AIDS have changed. In 1987, when Maitri was founded, infection with HIV, the virus that causes AIDS, meant almost certain death, and soon. Since then, drugs have been developed to help many of those infected to live much longer lives. Today, Mr. Patriarca says, some Maitri residents are not in imminent danger of death, yet have simply entered one acute phase of a long illness.
"And they need to be somewhere to really get stronger, maybe learn how to take their meds," he said, "and we have a great reputation for our food so we give them great meals and maybe fatten them up, get them stronger, and then hopefully they can move out and live in a more independent setting for a while, and if they need to, they can always come back."
Loretta Wilson, a one-time prostitute and homeless drug user, falls into a third category. Her immune system has been stabilized through medication, yet she is seriously debilitated by the corollary effects of AIDS.
"I'm here because of AIDS and then I had a stroke and my eyes started going bad. So I had to come here," she said. "It's really nice. I've been here three years. They have volunteers to take you out to the doctor or wherever you have to go and we go on trips and stuff. It's really nice. It just feels like one big happy family and stuff."
As with many happy families, life at Maitri often centers around the kitchen. Chef Scott Cardel is deeply aware of how good fresh food, lovingly prepared, can nourish a person, on many levels.
"I think you get to know people through the way that they eat and they get to know us through the way we prepare food," he said. "When somebody who maybe hasn't eaten breakfast for a couple days can put away a couple of Swedish pancakes and maybe remember something from their childhood regarding those pancakes, you feel pretty good."
Richard Hardy is one of 65 regular volunteers at Maitri. He says it was precisely the way practical help and spiritual attitude come together at Maitri that inspired him to join the team over five years ago. "The spirituality here is never just ethereal," he said. "It's always grounded. It's always embodied. And that is what authentic spirituality always is."
Mr. Hardy often focuses on what he sees as the spiritual challenges that AIDS poses, both to those infected by the disease and to those who love and care for them. Mr. Hardy, who lost his own partner as well as countless friends to the disease, has written a book on the subject Loving Men: Gay Partners, Spirituality and AIDS.
"In a crisis or a tragic situation it seems like all the walls are closing in on us, and the more we try to get out of it and try to find a solution, the walls seem to come closer and closer," he said. "The paradoxical thing is, there is only one way out of it, and that is by surrendering to it. But it's not a passive surrender. It's not saying 'I can't do anything, so I give up." It's an active surrender that says 'this is my life now, and I'm going to live it!' And when that happens, everything breaks open… And for some, it's a real struggle."
Even for those with a well-developed spiritual life, the practical changes that an advanced case of AIDS requires can be hard to deal with. Will Norton had been infected with AIDS for over 13 years before lesions had spread so far throughout his body he decided to end medical treatment and come to die at Maitri. Although Mr. Norton once lived in a Christian monastery, he found hospice life hard at first.
"It's definitely been different! I am so used to living alone," he said. "And coming into a communal environment has been quite an adjustment for me. But I've done pretty well with it so far. I've been here a little over a month and I've gotten to the point where I get along with everybody. It's great."
Mr. Norton said that once he settled in, he was grateful that Maitri could tend to his physical needs, leaving him time and energy to focus on his inner life.
"I've been doing a lot more reading, trying to understand other people's perspectives on death and on what happens afterwards. So it's not that I'm just wasting time and twiddling my thumbs waiting to die. I am very actively developing still. Because I wouldn't want to miss anything before I died. I guess that is the way I'd say it. I don't want to miss a single moment…."
Will Norton died at Maitri a few months after this interview. He was just one of the millions of people around the world who have succumbed to HIV/AIDS. Sadly, millions more will die until a cure is found. Until then, organizations like Maitri will continue to provide a caring environment in which people can live their final days in comfort and dignity.