Photo of Tye Fortner playing pool by Alessandro Simonetti
I am writing in response to the very polarizing article “The Men Who Want AIDS—And How it Improved Their Lives.” The first natural response that most people may have to this story of men who seek out HIV to acquire housing and other entitlements is one of outrage. How could the system be built to let people take advantage of services designed to help people living with HIV? How could someone risk their lives to get housing and services? Is this con worth acquiring a potentially deadly, and at best, chronic infectious disease with potential significant complications?
As someone who has worked in the HIV/AIDS field for many years both clinically and embedded in one of the foremost AIDS service organizations in the country, this was not my response. My response was…we told you so. It is not the final product that is the problem…it is how people got there.
When we look at this story we should not look at the rare outcome of someone seeking disease to have a better life, but the complex and often times painful decisions made to survive. This article demands that we look at the root causes of this problem rather than the solution sought out by this small minority of disease-seekers. HIV prevention is not just about PrEP, condoms and behavioral interventions alone. It is about looking critically at the institutionalized homophobia, racism, poverty and sexism that may provide HIV a comfortable home to decimate a community. Like tuberculosis and other social infectious diseases, HIV is built to find the poorest and most marginalized individuals who may put themselves at risk to either numb their pain or make it through the day with food in their bellies and a roof over their heads.
Let’s face it—this story is about the exception and not the rule.
This is not a common approach to a better life, but it highlights how we as a modern society need to eradicate the real plagues of stigma, homelessness and poverty that continue to fuel new HIV infections. Don’t stop providing people with HIV supportive services; rather look at how those services can be expanded to envelop the populations at risk.
Bean counters will say that this costs a lot for money. On the surface it may, yet when looked at as an intervention, preventing one HIV infection may save the system over $500,000 or more. I ask, 'Can we afford not to fix this?' Social justice is HIV prevention. You may judge the man chronicled in this story, you may judge the system. However, I say that we need to judge ourselves and our society. Let’s look at the root cause of this sad story and strategize as a community how we can fix it.
Demetre Daskalakis, MD
Member of the GMHC Board of Directors