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A Wrenching Novel Resurrects the Story of AIDS in Rural America

For decades, queer narratives have overlooked those who returned to the heartland with the disease

In 1987, Oprah visited the small town of Williamstown, West Virginia to host a town hall on AIDS. Seated near the center of a full auditorium was Mike Sisco, a gay man who had returned home to his family after being diagnosed with AIDS. His arrival inspired rounds of seething gossip. His being gay spurned hate and palpable fear among the community to the point that his family feared retribution. “They weren’t afraid of me,” Sisco said of his family, “they were afraid of what the community would do to them.” His family needed to look no further than Sisco himself who was quickly ostracized and experienced, in his words, a “social death.” 

The tension reached a peak when, one hot summer afternoon, Sisco went for a swim at the public pool. Hysteria ensued. The event made the front page of the local paper and became a lightning rod for national anger and fear even though, in 1987, we understood how HIV was transmitted. 

When the episode aired on November 16, 1987, the community’s “vitriolic” response to Sisco, someone they all knew and grew up with, made a lasting impression on writer Carter Sickels, who was then growing up queer in small-town Ohio. The snaking Ohio River serves as a border between West Virginia and Ohio, and Williamstown lies just south of the river. Across it, in Athens County, lived Sickels’ grandparents whom he’d frequently visit in the summer. 

Years later, Sickels would recall this scene and write something similar into The Prettiest Star, his recently released second novel, when Brian, the protagonist sick with AIDS, goes to a public swimming pool. His family and everyone from church is there. Brian wasn’t invited. When asked why he went, Brian shrugs, just like the real Sisco did, and replied, “It was hot.” What other reason does one need to go for a swim at the pool? 

Much later, Brian’s mother remembers seeing a rare moment of bliss for her son: “I saw my son floating on his back, and he looked so peaceful. For a few seconds, I didn’t care what anyone else thought; I just wanted him to be happy.”

Sisco’s story and Sickels’ novel spotlight an overlooked aspect of the AIDS epidemic — the rural experience. Seminal texts and documentaries surrounding the HIV/AIDS epidemic of the 1980s are overwhelmingly urban, and rightly so. The outbreak was most severe in big cities like New York and San Francisco. But pandemonium in cities, then and now, often eclipses what’s happening elsewhere in the country. Sickels was intent on telling the story of “people who had to return to these places they were so happy to escape at some point,” he tells me.

Many sick people like Brian, who once escaped to New York and later moved back home, did so for a variety of reasons — they’d lost their job, they couldn’t afford rent, etc. In Brian’s case, New York was a sad, sickly ghost town. So many people he knew — friends, artists, his partner — had perished because of AIDS. Standing on the Chelsea Piers, once a popular cruising spot, Brian contemplates throwing himself into the Hudson River, but ultimately decides to move back home to Ohio. 

By tweaking this one element — setting — Sickels creates a causal reaction chain that modifies the typical AIDS narrative as seen in media and literature and highlights inequities across the U.S. around things like access to health care, discrimination toward queer folk and weaponizing shame. “Much LGBTQ literature from the 20th century is about the movement to the city from the country, often imagined as a movement to acceptance and possibility from alienation and impossibility,” Eric Newman, the gender and sexuality editor at the Los Angeles Review of Books, writes via email. 

But, in a nod to Sickels and others, Newman acknowledges, “There’s been a lot of cultural work and representation in recent years around the place and experience of the rural queer.” 

In fact, HIV/AIDS might be more of an issue for rural communities today than urban ones. According to a 2016 report by the CDC, the top 10 counties most at risk for HIV infection were all in Appalachia. This vulnerability is due to a combination of factors including poverty, a lack of hospitals and high intravenous drug use related to opioids. These findings were bolstered by a chilling 2017 report from the New York Times about “America’s Hidden HIV Epidemic,” which revealed Black gay and bisexual men in the U.S. have higher rates of infection than any country in the world. “This crisis,” reports Linda Villarosa, “is most acute in Southern states, which hold 37 percent of the country’s population and as of 2014 accounted for 54 percent of all new HIV diagnoses.” 

The notion of HIV/AIDS as urban health problems, it would seem, is badly dated and their ongoing impact today is incredibly underreported. It’s no surprise then, that Sickels would devote a whole novel to the alienated, overlooked rural queer experience of the AIDS epidemic. 

The Prettiest Star is also unique in that it features the perspective of Brian’s biological family. “From a writer’s perspective, I knew I wanted to tell the story of this whole family,” Sickels explains. To accomplish this, the perspective rotates throughout the book between Brian, who mostly writes in the form of a video diary, his sister and his mother. In doing so, Sickels convincingly presents a spectrum of care within the family. 

On one end is Brian’s grandmother who has always had a special love for him. He reminds his grandmother of her late brother who was “creative” and ambitious (code words) and is a staunch defender of his — boycotting restaurants that discriminate against him and so on. As is the case with Annie, Brian’s best friend from New York, there is an ease between Brian and his grandmother that Sharon, his mother, envies. 

On the other end of the spectrum is his Uncle Wayne who jokes, “Do you know what gay stands for? Got AIDS yet?,” and Travis, Brian’s father and brother to Wayne, who worries more about what the town will think of his queer son than the fact that his son is dying in front of him. Travis avoids eye contact at almost all cost. What is he afraid to see? In part, it’s a refusal of recognition — recognition that his son is gay and sick. But it also invokes a wellspring of shame he might otherwise stave off. Shame that he has done nothing to care for his dying son. 

Caught in the middle is Sharon, who loves Brian deeply, but remains disturbed by his sexuality and is unsure how to care for him. “I don’t know how to make him feel better,” she laments. “I don’t know what to say to him.” She, too, is susceptible to what others might think. When she receives a letter from Brian saying he has AIDS and that he might come home, she worries, “What if he comes back here and what if people find out the truth, then what will happen to us? What will people think?” 

Nor is Brian immune to shame. Back in New York, with his partner on his death bed, Brian “hated how the doctors looked at me. I was ashamed — ashamed to be gay.” At the time, it was difficult for everyone, it seems, to uncouple being gay and being sick with AIDS. “On my worst days,” Brian confides in his video diary, “I feel the shame most of the world wants me to feel.” His worst days are many. His breath is labored, not only by AIDS dismantling his immune system at an alarming, agonizing rate, but also by the pressure to keep his suffering and his sexuality all to himself. 

Late in the novel, Brian asks himself, “Why does anyone go home? You come back to be seen, to be accepted and to be loved.” But his family is ill-equipped to care for him. This isn’t a sweeping indictment, but a testament to the labor of care. 

“The experience of shame and the struggle to overcome it is a [common] tension,” Newman says. This began to shift, however, thanks to “the legacy of Gay Liberation, which in the 1960s and 1970s focused in large part on getting rid of shame and accepting one’s queerness [and] put shame where it belonged — at the feet of a government and society that was too slow to help address a crisis facing gay men until it started to affect heterosexuals.”

Part of Sickels’ literary and social project is seemingly to broaden readers’ notion of who these narratives are for and who they are about. AIDS isn’t just a queer story. It was an epidemic felt throughout the nation, from Broadway to the foothills of Appalachia. “AIDS,” Sickels writes definitively, “is a story of America.”