WASHINGTON -- As I was waiting for the results of my AIDS test, the health lecture from my counselor Anthony was calm, explicit and, um, informative. The five bodily fluids that can transmit the HIV virus. The proper way to open a condom package to avoid rips (I did it all wrong). Certain uses for Saran Wrap not specified by the manufacturer.
An AIDS clinic in Washington, D.C. -- a new ground zero in the American AIDS crisis -- is no place for the squeamish.
The test itself looks like a pregnancy test, in its small, white, plastic momentousness. The swab at the end is run across the gum line; no blood is drawn. The results take about 20 minutes and are 99.1 percent accurate.
I was visiting Unity Health Care in Ward 7, an outpost of tidy medical professionalism in a poor section of the city. Here the talk of epidemics has nothing to do with swine flu. The Centers for Disease Control and Prevention describes a health epidemic as "severe" when more than 1 percent of people in a geographic area are infected. The HIV infection rate in Ward 7 is at least 2.4 percent -- higher than the national rate in Ethiopia, Ghana or Burundi. Among 40- to 49-year-olds in the District of Columbia, 7.2 percent are HIV-positive.
If 7.2 percent of all 40-somethings in America were infected with anything, there would be no other topic of national discussion -- every alarm would ring, every clock would stop. In this case, the victims are geographically isolated, often poor, and thus largely invisible.
Unity Health Care provides services from dermatology to ophthalmology; due to stigma, few would come to a clinic that deals exclusively with HIV/AIDS. But Dr. Gebeyehu Teferi, the medical director of HIV services, sees the AIDS crisis in every form -- intravenous drug users, prostitutes, men who have sex with men, and middle-aged women shocked by their diagnosis and the infidelity of their partners. (Among African-Americans in the District, the single largest method of transmission is heterosexual sex.) "There are late, full-blown cases coming into the emergency room," says Teferi. "People who say, 'I don't use drugs, or even drink.' They forget about the sexual part of it."
The staff at Unity recommends three changes to confront the epidemic. First, AIDS needs to be discussed at home. In prevention, there is no substitute for uncomfortable frankness. Neither self-interest nor morality is aided by ignorance.