My patient was on the cover of the New York Times recently. It was a Thursday morning and I was scheduled to see D, a patient coming to the Center for Special Studies after testing positive for HIV in the emergency room a few days prior. Getting HIV-positive patients into care is a very important first step in treating their disease. Our HIV clinic has an arrangement with the ER to schedule a new-patient visit for those whose rapid HIV test results indicates the presence of infection. While all patients should be offered HIV testing in the emergency room, patients may decline the test. The ER is much more likely to recommend and even urge testing when the providers there know they can refer patients to us if the results are positive. I’d seen D’s name on my schedule for Thursday and I read from the chart that D was a gay Hispanic man in his early twenties who had been seen in the ER for a cut on his leg and had agreed to be tested for HIV. And now he was scheduled to see me. That morning the Times ran a front page article entitled, “Poor Black and Hispanic Men are the Face of HIV.” I didn’t know if D was rich or poor but I could guess that he was one of the people the article was describing. (http://www.nytimes.com/2013/12/05/us/poor-black-and-hispanic-men-are-face-of-hiv.html)
D was born just about the same year that I started working as an HIV specialist. Those were very dark times; our patients were very sick, many died, many were isolated from friends and family for being positive, for being gay, for being gay and positive. Odd how those two words – gay meaning carefree and happy, and positive meaning, well, optimistic, upbeat – could apply to someone desperately ill and lonely.
But that was a long time ago. D never knew those days. Today we have effective, well-tolerated medication and we can control the virus. People who get into care early can expect nearly a normal lifespan. On his first visit D sat in front of me and admitted that he didn’t really know much about HIV but he thought some of his friends might also have the infection. D didn’t seem upset or sad at his diagnosis. He didn’t wonder where he got his infection, or from whom. I’m going to start him on some medication soon but first I asked him to start taking a vitamin every day. Taking medication consistently is the most significant aspect of successful HIV treatment. I am hoping D can handle taking a vitamin every single day and get used to the habit so that when I give him a prescription for antiretroviral therapy he’ll be in the swing of things and won’t miss any doses.
D and I don’t talk about his being on the cover of the New York Times. In that article I learned that 80% of gay men under the age of 25 with a new HIV infection are black or Hispanic. D says he has had a partner for the last year and that they both tested HIV negative one year ago. At first they used condoms but stopped months ago. D says they do not have sex with other partners. I wonder about the veracity of this last statement but the important thing is that D is here now. And I remind him that he needs to use condoms with each sexual encounter.
The Times’ article talked about the challenges faced by young gay men of color coming out to their families and the difficulties encountered when young people are not accepted for who they are. This contributes to the risk of unsafe sexual behavior in compromised settings and to the continued spread of HIV among this population, particularly as many infections are transmitted from older men who are positive but either not in care or not adhering to their antiretroviral therapy. Young gay men of color are a vulnerable population, but it’s unlikely that they see themselves that way. Young men do not often think of themselves as vulnerable. I’m hopeful that D will stay in my care and take his vitamins and then take his HIV medications when they are prescribed. It’s a first step after being on the front page of the New York Times.