Night Lifeline

How the city is dealing with an increase in HIV diagnoses among young gay men.

by Tom Namako

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Published: Jul 30, 2008

Ryan Case

The husky Latino man wearing a striped polo shirt walked swiftly from the back of the RV. He held a blue sheet of paper several inches from the face of his partner, a smaller Latino man sitting in a bucket seat.

"I'm positive," the husky one said.

The other eight people in the RV, including one likely transsexual woman in a red dress and several social workers, went silent. People usually don't declare HIV test results in public.

"I mean," the husky one said, now grinning, "I'm positive that I'm negative."

Everyone smiled awkwardly, unsure if this was supposed to be funny, or, maybe, some sort of brief payback from one young lover to another. They were, after all, arguing minutes earlier about whether they would honestly share their results with each other. (The husky man seemed reluctant.)

Both men left, exiting the RV and turning down Chancellor Street. Earlier that Thursday evening, they were at Key West bar, and now, at about 1 a.m. they were making their way to Woody's, on 13th Street, for Latino night.

This might not be the traditional setting for an HIV test, but it's definitely becoming the norm. Years ago, drawing vials of blood and waiting two weeks for results gave way to a finger-prick or cheek swab and a 20-minute wait. Since today's tests are light on equipment, the process has been moved out of stuffy clinics and into mobile testing units — RVs that can be parked in parts of town where incidences of the disease run high, like the Gayborhood, West Philly and areas around Kensington.

But as technology gets better (soon, those 20-minute results will come back in 10), the results seem to get more worrisome in Philadelphia. In the past few years, the number of late teens and early-twentysomethings contracting the disease seems to be increasing.

In 2004, about 15 percent of all new HIV infections in Philadelphia were found in men, aged 19 to 24, who had sex with other men, according to Kathleen Brady, medical epidemiologist for the city's Department of Public Health. In 2007, that number jumped to more than 26 percent. "As an epidemiologist, that's very concerning to me," Brady said, "because that's the future of our population. It's a little scary."

Social workers on the ground are seeing the same thing. According to Nurit Shein, executive director of the Mazzoni Center, an LGBTQ health clinic, 20 people between the ages of 17 to 21 tested positive for HIV at the center last year. "This year, that number doubled," she says.

The overall number of new HIV and AIDS diagnoses in Philadelphia fluctuated around an average of 1,146 a year from 2002 to 2006, according to DPH's 2007 HIV/AIDS Epidemiological Update. The numbers were pretty consistent.

So why the increase of diagnoses among youth? It could be that more young people are becoming infected — although that trend hasn't been proven, and Gloria Casarez, the mayor's LGBTQ liason, says "I don't think we need to sound that alarm." It could also be that faster, more accurate tests are reaching more people than before.

Both, says Brady, are plausible explanations. Regardless, "the fact is that we're finding them," says Elicia Gonzales, a worker in the mobile testing unit and a manager for the Collective, a multi-agency HIV prevention program. "And no matter how you find them, people have to know how to handle the disease and know where to go for services."

The mobile testing units are one way the city is responding to the new statistics. Outreach workers spend late Thursday night into Friday morning outside Gayborhood bars, handing out condoms and lube from Halloween-style pumpkin-shaped buckets and asking if people would like to get tested.

Those who do come in are seated on the floral-pattern couches in the camper, and asked to fill out a questionnaire that makes most people blush or develop a look of grave concern (i.e., "Do you use condoms or barriers when sharing sex toys?").

At the back of the RV is Richard Laboy, a young health education specialist with GALAEI, a Latino LGBTQ outreach organization. He's wearing a black T-shirt and camouflage cargo shorts, and he asks a series of questions to find out if clients recently did anything that could expose them to HIV. Laboy then holds a plastic, T-shaped device to the client's finger, and after a quick click, the finger is bleeding. Laboy wipes off the first bead with cotton, gently squeezes the client's finger like a tube of toothpaste, and grabs the second bead with a thin plastic stick. He dunks it in a small vial of solution, and in 20 minutes, the result is in: One pink line means negative, two means positive.

The vast majority of people who test positive take the bad news in stride. There are usually tears, and Laboy helps them plan out what to do in the next 48 hours, such as whom, if anyone, to tell. He points them to places for counseling, further tests and medication. Some people, though, don't take it well at all. Yexsy Alicea, a services coordinator with GALAEI, recalls one person trying to jump out an office window after being told she was positive.

Nothing so dramatic happened last Thursday night. A young Indian man came bounding out of the back room and down the RV's stairs — obviously negative. A few other young women left looking similarly relieved.

By 2 a.m., the workers had brought in 12 people to be tested, and not one was positive. It was one of their easiest nights in some time. "That was rare, and relieving," said Alicea.

The concern for young people, explains Brady, is that they'll underestimate the risk level of their behavior, and, what's more, think that because HIV is easier to manage now than in the past — a regimen of several anti-retroviral drugs is down to about one pill — that they can postpone getting tested.

"These increases have been going on for about a year and a half. It's not a steep increase, but, you know, we should have seen it coming," says Shein, noting that, unlike during the height of the epidemic in the late 1980s and early 1990s, young people aren't seeing friends die rapidly from the disease. "If it's not in your face, you don't think you have to do anything different."

(tom.namako@citypaper.net)

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