The disease has receded from the spotlight, but the HIV infection continues to spread -- and invade the lives of Philadelphians.
Shortly after testing positive, Johns confronted his fuck buddy. “I told him, ‘You need to be tested, because I’ve definitely come in you, and I’m definitely positive,” says Johns. “And he got tested, and he’s positive. Absolutely. He seemed really upset at first but I was like, ‘You’re the only person I’ve been unprotected with.’ That was not the story in his case.”
In spite of everything, Johns bears no animus for his friend. “I don’t harbor any ill feeling toward him,” he shrugs, sipping a raspberry tea inside a 10th Street coffeehouse. “We never committed to anything. We’re still friends. ... We’re still fuck buddies. I just let my guard down, you know? That’s exactly what happened. I let my guard down.”
A comparatively high percentage of Philadelphians are letting their guards down and becoming infected with HIV/AIDS yearly, according to a September 2008 update published by the city’s department of public health. Employing a new calculating model developed by the federal Centers for Disease Control, the department estimated the number of Philadelphians who became infected with HIV in 2006 at around 1,400. (Health department officials say they had no formula for estimating yearly infections prior to ’06, so there’s no comparison figure. The department has not yet estimated 2007 and 2008 infections.)
Moreover, the CDC’s national infection estimate for ’06—56,300, up 40 percent from the agency’s previous longstanding national estimate of 40,000 new infections per year—included the eyebrow-raising revelations that Philadelphians age 13 and older were being infected at a rate five times the national average (114 infections per 100,000 people here compared to 23 infections per 100,000 people nationally) and 50 percent higher than New York City’s. The health department update noted that 67 percent of the new infections were occurring in African-Americans, 70 percent in males. Fifty-five percent were occurring among heterosexuals, while 32 percent were occurring among men who have sex with men (MSM) and 13 percent among intravenous drug users.
Some 30,000 Philadelphians are believed to be living with HIV, says Mark Seaman, director of development for Philadelphia Fight. Perhaps as many as a quarter of them aren’t aware they have it.
Joseph Ondercin, a physician assistant who treats HIV-positive patients at Philadelphia Fight, a comprehensive AIDS service organization on Locust Street, thinks some people’s notions that they aren’t risk-group members poses the main virus-control obstacle.
“Everybody’s heard the good news, there’s treatment,” he says. “But that doesn’t necessarily lead them to say, ‘I’ve put myself at risk and I need to be tested.’”
Most people understand how heterosexual HIV-positive men pass the virus to their female partners, the primary fluid recipients during conventional intercourse. But some men continue to believe they’re not putting themselves at risk by having sex with iffy women. This remains a concern for those who are fighting to stop the spread of HIV/AIDS.
“Fluids are exchanged in a lot of ways during sex acts,” says Ondercin, pointing out that straight men continue to have sex with prostitutes who are highly infectious because they’re not in treatment, then go home and pass the virus to their wives or girlfriends.
David Metzger, director of the University of Pennsylvania’s Department of Psychiatry’s HIV-prevention division, knows a thing or two about the virus. A self-described HIV-prevention researcher, he’s been studying the epidemiology of HIV in Philadelphia for 20 years. Although he’s aware that a percentage of the infected men who claim to be exclusively heterosexual probably aren’t being entirely forthright, Metzger is convinced the virus is indeed being passed today more through heterosexual than MSM or IV drug activity.
“The first 10 years were predominately MSM,” Metzger says. “The second were predominately injection drug users and now, since 2002 for sure, the majority of HIV cases in Philadelphia are among African-American heterosexuals with overrepresentation also from the Latino community.”
Metzger agrees that controlling HIV within the heterosexual population is proving problematic in part because many heterosexuals don’t view themselves as being at risk and consequently don’t get tested. Testing is the key to prevention, he says, since people who test positive tend to get on meds that reduce their viral loads and thus their infectiousness. Many also begin adopting safe sex practices.
Regarding the lopsided racial percentages, Metzger is sure the virus from the early years has been disproportionately present in impoverished African-American neighborhoods principally because those residents typically have poor access to health care. Most of them don’t see doctors very often, and thus don’t become aware they’re infected until they’ve passed the virus around.
“Cumulatively, even if you go back to the early days of the epidemic in Philadelphia, it was predominately black, and it’s not because blacks are more risky than whites,” he says. “We allowed the virus to get more deeply rooted in those communities before we instituted aggressive prevention campaigns. And we’re living in the aftermath of that delay, which goes back 10, 15, 20 years. There’s just more virus in those neighborhoods.”
Metzger implies that local health- department officials shouldn’t necessarily be skewered over the sound-bitey “five times the national average, 50 percent New York’s average” stuff. In his view, comparing cities with one another and with the nation as a whole is wrongheaded.
“It’s the wrong metric,” he says. “You have to get down to the neighborhood level. If you look at a neighborhood in Philadelphia and match it to the same neighborhood in New York, you’ll see similarity in terms of HIV infections.”
After more than 25 years, the HIV/AIDS epidemic is of course more about human beings than demographics. And thanks to pharmacology, any healthy-looking man or woman you pass on the street could well be engaged in the same battle R. Vincent Johns finds himself in. But although the virus no longer mars faces, cancels lives or spreads fear the way it once did, the bug continues to give its hosts a lot of shit to deal with.
There’s the awful stigma, of course, which virtually everyone agrees has barely diminished since the early years. But on a more pragmatic level, having HIV is cumbersome, what with the never-ending medical appointments, the blood work, the shot-taking, the pill-swallowing and the side effects that can include diarrhea, nausea, fatigue, anemia and a laundry list of other nasty stuff.
The African-American woman in the photo looks about 60, maybe 65. Her graying hair in a tidy bun, she wears a neat blue and white silk dress with a bow at the neckline. She tilts her head and gives a melancholy half-smile for the camera. Above her head are the words "I Never Asked. I Wish I Did." Inside the brochure this sweet-looking lady tells her story. She'd been widowed. She began dating a longtime friend. They never discussed sexual history, and because of her age, birth control wasn't an issue. Now she has HIV. It seems strange, even freakish, but it's all too common. HIV/AIDS is the No. 1 killer of black American women between 25 and 34. But the fastest growing segment of HIV incidence is among black women in their 50s and 60s. Grandma has AIDS. Women get together to discuss many different things. We talk about family, we talk about politics, we gossip endlessly. But when it comes to talking about HIV/AIDS and the simple things we can do to prevent it, our mouths are shut. Philadelphia-specific HIV statistics are grave. Averages here are higher than the rest of the nation, especially among women. Philadelphia's response is appropriately targeted, with some of the...
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