A Young Man, a Demon, and a Virus
On Aug. 30, the Centers for Disease Control and Prevention reported the results of the first study of HIV infection rates among young urban men, ages 15 to 22, who have sex with men. The news was not good. In the seven major cities studied, 7 percent of young men were infected—and, bear in mind, these are young young men, still at the beginning of their sexual lives. Ten percent of the 22-year-olds were infected. Among African-Americans, the numbers were higher still. "We're not back to the mid-1980s," when the virus was spreading rapidly, says Dr. Linda A. Valleroy, a CDC epidemiologist who worked on the study. "But it continues."
It is hard to know for sure, but new infections of HIV (the virus that causes AIDS) appear to have stabilized at about 40,000 cases a year, according to the CDC. The vast majority of those cases were avoidable. HIV, after all, is not easy to catch. So why have infection rates stopped declining? What is going on out there?
Jim is 23. He is a man of medium height and light build, with wavy auburn hair and an agreeable face that is lent a triangular shape by his prominent cheekbones. His mother and father became acquainted while using and, for a time, dealing drugs. Later, after his mother was clean, she warned Jim ceaselessly about the dangers of drugs, warnings that he heeded. After her marriage to Jim's often jobless father ended, she raised Jim and his five siblings. His father got involved with crystal meth, borrowed money from Jim, did jail time for shoplifting, and then disappeared. Jim thinks his father may be living in Tijuana, Mexico.
His mother was happy for the first year or so after the divorce but then became manic-depressive and, at times, abusive. She would rage and throw things and hit; she would curse men and predict that Jim would turn out as bad as the rest of them, just wanting sex. For stability, Jim turned to school and church. But he told some church people that he saw nothing wrong with two men marrying each other; by then he was having homosexual fantasies. The pastors barred him from participating in church services and skits for younger children. Jim gave up on religion.
School, however, went well. He was admitted to the University of California (Berkeley). Freshman year, at a gay and lesbian community center, he told a coming-out session that he was unsure of his sexuality. A 28-year-old man offered him a ride home and expressed attraction. They had sex without a condom. "I was in denial about the fact that maybe there were bad people in the world," Jim says. "I wanted to believe that everyone was good. That's what kept me going—thinking that good things were going to happen, and people were essentially good."
Afterward, Jim rushed to have an HIV test and to receive counseling: "All of the education you could imagine," he says. "They really tried to help me make a better decision." An anxious week later, the result came back. Negative.
Jim next fell for a straight man in his dorm, to no avail. He imagined a relationship with an ideal man, but did not know where to find such a man or how to pass from sex to a relationship. He would meet men in sex clubs and exchange phone numbers (after exchanging glances, and more), but nothing ever seemed to come of it. "I would try to date them, but it would always wind up not working."
As the months passed, he despaired of finding a partner, grew depressed. He saw no hope for combining passion with intimacy and began to rely on sex for a sense of human contact. In the fall of 1997, he took to frequenting parks and the booths in porn shops. "Afterward, I felt guilty and kind of dirty, but at the same time it didn't last, so I had to go back. I started to get addicted, basically, to anonymous sex with lots of people."
By the time he was 21, the sex clubs were a fixture in his life. He used protection, but condoms broke. They broke more and more often, so that he sometimes wondered what was the point. "In terms of unsafe sex," he says, "there was a progression."
In November 1997, he entered a period of numb despair. "Since I'd had so much failure with all these different relationships, I just lost hope at that point. It was like I didn't care any more. I was giving up, a little bit." That month, he probably had 100 unprotected encounters.
Every so often, alarms rang and red lights flashed. On five occasions during the past few years, broken condoms or absent condoms would send him, panicked, to clinics, where he received counseling and medication to reduce the odds that the virus would take hold. Each time he would shudder with fear and with sickness from the drugs, and he would swear to change. Each time, the results brought a reprieve. Negative—negative—negative.
But, as he danced on the tightrope, he began to feel giddy. "Part of me felt that if I was having so much unprotected sex and I hadn't contracted HIV, I thought maybe I had a natural immunity to it." In 1998, he tried to be more careful about protecting himself, but he spent the summer hustling for money to pay for his apartment and for school. (All this time he was a successful undergraduate at Berkeley.) Meanwhile, the unpaid sex with strangers continued.
More warnings: In the spring of last year, he was raped in a sex club and bled for a week. Two months later, after a porn-shop encounter, the bleeding resumed. He was in the hospital for three days before it stopped.
Part of him was rational and tried to take control. He would swear abstinence but break down after a month. He was often moving between apartments and felt rootless, isolated. His gym workouts were increasingly making him an object of pursuit. This year, in the spring, he says, "I kind of went a little bit haywire." He would visit the sex clubs three times a week, having multiple encounters, many of them unprotected. "When I got in a certain mood, it triggered me to want to have sex, and I didn't want condoms to get in the way."
In June, yet another warning: The health department called. One of his recent sex partners had contracted HIV; the department suggested that Jim get tested. He did. Still negative.
"I felt good about that," he says. "I started to realize it was an addiction. I had to have sex every day in order to feel good about myself." At last, urged by counselors, he began attending Sex-Addicts Anonymous. A week into the program, however, he slipped, and failed to use protection. On July 1, as he swore "never again" yet again, he came down with a bad case of something like the flu. Once more, he went to be tested. This time, he was full of dread.
"I had this feeling it was going to be positive," he says. In mid-July, the results came back. He had HIV.
The weeks since the virus invaded him have brought despondency, regret, guilt, "a lot of fear and anxiety." To talk to him now is to hear him look back on his own recent life as though across a gulf. Three combatants now struggle to control him. One is the earnest and chastened young man who is going on to graduate school in psychology, and who says: "I guess I'm just wishing that I'll be able to find some kind of peace and happiness before I die. And contentment of some sort."
Another is lust, a demon that still roars and rages and breaks its bonds. Thirty-seven days after his positive diagnosis, Jim lost his self-control and had another unsafe encounter with the man who he thinks may have given him the virus. And 37 days after that, he went to a park for sex, and a condom broke. "I haven't been able to get past this barrier of 37 days," he says, sheepishly.
The third combatant is the human immunodeficiency virus. Jim is obtaining treatment through a clinical trial. The enemy is brutally stupid and brutally cunning. HIV is, yes, easy to avoid. But viruses are ingenious exploiters of vulnerabilities. One sort of vulnerability is an open sore or a compromised immune system; another sort is neurosis, folly, or the intoxicant of lust.
At the margins of neurosis, folly, and lust, human self-destruction is restrained not by self-control but by the embrace of institutions: the stabilizing influence of family, the calming influence of church, the settling influence of a sexual culture in which marriage is legal and expected. To Jim, those institutions all seemed, or were, vanishingly remote. They failed him and he failed them. Because his story is not so very rare, the virus will survive and even thrive. So, I hope, will Jim.
At one point in a long telephone interview, Jim asked leave to wash his face. Later I asked: Were you crying? No, he replied. "I feel like I've already cried a lot." One scarcely knows whether to hold Jim or to hit him. In the end, one simply cries, and hopes.