Shaved head glistening, his muscular form fitted in an elegant brown suit, Salvatore Gaetano Gianni Fortunato cuts a figure every bit as grand as his name. At the moment, however, as he sits in the Manhattan office of his longtime physician, Dr. Jeffrey Greene, he is feeling a bit fragile. "Right now," he admits, "I am a little fluttery and a little anxious."

For 14 years now, Fortunato's visits to the doctor have been the occasion for a verdict—the moment to find out whether he, or death, has the upper hand. That's because he is one of the longest-surviving AIDS patients in America. Infected with one of the earliest known strains of HIV, Fortunato has been carrying the virus in his system for more than 20 years. At 44, he is a living history of the plague, having suffered symptoms from malnutrition to pneumonia, and of course from depression. But he is also "the poster boy for a miracle," says Dr. Greene, one of the nation's foremost AIDS specialists. "Sal is too obstinate to let the virus get the upper hand. He's a very ornery guy."

That may be so, but in large part Fortunato owes his life to the recent development of protease inhibitors—drugs that block one of two enzymes necessary for replicating HIV—which have dramatically increased survival rates. The Centers for Disease Control estimate that 10 percent of patients who have had the AIDS virus 10 years or more are still alive.

Unfortunately, many such patients pay dearly for their longevity. In December 1998, for example, AIDS activist Mary Fisher, famous for her impassioned speech at the '92 Republican convention, announced she was taking herself off the powerful AIDS drug "cocktails" because of the extreme fatigue, nausea and diarrhea they cause. Fortunato fights those same complications, as well as headaches, insomnia, numbed lips—and more. Long-term use of AZT, the first effective AIDS drug, damaged muscle cells in his lower body, and he still takes medication to ease the intense pain there. In 1994, Fortunato also developed a so-called wasting syndrome—sporadic, inexplicable weight loss, which at its worst saw him drop from 172 pounds on a 5'10" frame to 128. (He's now back to 165, thanks to long-term IV therapy with nutritional supplements.)

In 1996, when Fortunato started taking protease inhibitors, the cocktail brought on a rare allergic reaction in the genital area ("one of the most painful things I have ever gone through"). He then switched to his present mixture—saquinavir, ritonavir, 3TC and acyclovir. Fortunato, who works as sales director for a Manhattan graphics firm, takes the eight-pill concoction twice a day, morning and evening. And partly to combat the side effects of that medication, he ingests another set of drugs—25 pills in all—every two hours. "You do it, like you remember to brush your teeth," he says. At first he carried a plastic pillbox that, like a wristwatch, set off an alarm when it was time for his medicine. More than once, when the alarm went off in public, Fortunato heard someone whisper, "He must have AIDS." "It was like a scarlet letter," he says. One day, in frustration, he stomped the pillbox to bits; now he carries his pills in a tea tin that also contains tranquilizers and antidepressants. "I have my crying jags, moments of anger, fear and frustration," Fortunato admits. But when suicidal thoughts creep in, they are banished. "I can't imagine what it would do to my family," he says.

Since 1985, Fortunato has shared a four-bedroom house in tree-lined Maplewood, N.J., with his widowed mother, Jean, 68 ("my soulmate"), and his brother Vincent, 32, a detective with the Essex County, N.J., sheriff's department bomb squad. "There were so many times when we thought we were losing Salvatore, but he bounced back," says Jean. Adds Vincent: "I really believe in faith." So does Salvatore, a lay preacher at St. Stephen's Episcopal Church in Millburn, N.J., who abandoned Catholicism because, he says, it taught that gays were "damned."

Gays were certainly not embraced four decades ago in the Brooklyn neighborhood where Fortunato grew up. His father, Joseph, an apartment-house superintendent, "was first-generation, old-world Italian, and I was raised rigidly," Fortunato says. Young Salvatore was a quiet, solitary sort. He recalls vividly the day his mother dropped him off to start kindergarten. "Mommy, don't leave me!" he cried, bolting from the building. Fortunato never lost that dread, mainly because he felt out of place. "Even at 5, 6 or 7 years old, I knew there was something different about me," he says. "But I had no clue what it was." Others may have. Jean remembers that one mother objected to Salvatore's impeccable grooming: "She said, 'If you don't make him go out and get dirty, you are going to have a fairy for a son.' "

When Fortunato was 7, his family moved to Brooklyn Heights, where schoolmates mocked him relentlessly as a "sissy." In high school, he frequently found "faggot"—and worse—spray-painted on his locker. The abuse coincided with the first strong stirrings of Fortunato's homosexuality—urges he found deeply troubling. But at 16 he started visiting gay bars in Greenwich Village. He told his parents he wanted his own place, and his father found him a studio apartment in their building. Attending Hunter College at night, Fortunato took an internship in the purchasing department of a publishing house, where he later moved up to manager.

In those days, Fortunato frequented a gay bar on Manhattan's East Side. Nearly every time he showed up, a German he scarcely knew would ask him home. Then 20 and a virgin, Fortunato repeatedly declined. But one June night in 1974, he gave in and accompanied his admirer to an apartment, where the man shoved Fortunato inside and, with two accomplices, raped him. "I fought and fought and finally got loose," he says in a broken voice. "I called the police from a public phone and said I wanted to report a rape. When the policeman asked the woman's name, I said it was me, and he laughed hideously. I dropped the phone and grabbed a cab back to Brooklyn Heights."

Like so many rape victims, Fortunato blamed himself. "I was ashamed," he says. The next year, after much agonizing, he told his parents he was gay. His mother wasn't surprised, but Joseph was furious. "I'm sorry, but you are not my son," he said. "Get out." Yet four weeks later he relented, and from then on, says Fortunato, "there was a lot more trust and openness" between them. They also shared a more onerous bond. In 1975, Joseph was diagnosed with Hodgkin's disease; within three years Salvatore was stricken with what may have been an AIDS-related lymphoma. "Dad was a tremendous source of strength and hope for me," he says. "In Lenox Hill Hospital one night, when I had had enough of chemotherapy, I took my dinner tray and flung it across the room. Without a word, my dad picked up everything. Then he said, 'Do what you need to do.' " Joseph died at 55, in 1981, and eventually Salvatore went into remission.

That same year, Fortunato read for the first time about a strange lethal disease afflicting gay men. He abstained from sex at first, and wore a condom thereafter. But it was too late. In February 1985, experiencing fever, sweats and other symptoms, he took the newly developed AIDS test, which revealed he was HIV-positive. "I thought I would be dead in six months," he says. Despondent, Fortunato withdrew from friends and family. "You start feeling, 'No one is going to love me,' " he says. " 'No one is going to touch me.' "

Soon he started seeing Dr. Greene, who had published medical papers describing AIDS-related infections. Early on, Fortunato developed some of them, notably leukoplakia (a white, hairy coating on the tongue), thrush (a throat fungus) and, later, an inflammatory condition of the connective tissue. From then on, he would rely on an ever-changing soup of medications. Over the years, Fortunato has been hospitalized 15 times at a cost of some $500,000, while running up more than $10,000 a month in other medical expenses. ("I spend two evenings a week straightening out my bills," he says.) Most of this is covered through his unfailingly supportive employer of 10 years, RPM-D&L Offset. "Sal is the strongest human being I have ever met," says company president Robert Mastellone. When other employees complained that Salvatore's illness was driving up their insurance rates and asked to switch to a cheaper plan, "I said, 'You'll probably kill the guy,' " recalls Mastellone, who told them they'd have to take their beef to Fortunato directly. "Here it is 10 years later, and we still have the same coverage," Mastellone says. "No one had the nerve."

Apart from his job, Fortunato counsels gay men referred by various sources, preaching safe sex—and fearing the worst. "Young men today are not listening," he frets. "They think they are indestructible." They, of course, haven't known Fortunato's suffering—or his grief. "I have lost 54 friends to AIDS," he says. "We are not talking acquaintances, colleagues. We are talking friends. I will never be over it." As he continues on his medical odyssey, Fortunato sometimes wonders why he has survived so long. "How could one person have all this happen to him and still be here?" he asks. His mother tells him that "there is work for you to do on this earth," and he would like to believe that she is right. In any case, he says, "I have to fight. I don't have a choice."

Richard Jerome
Giovanna Breu in Maplewood

  • Contributors:
  • Giovanna Breu.