Maximum-security prison, USA, 2010
“James, you know how we did those tests two weeks ago?”
“Yeah.” James was about my age. He’s African American. Though he was dressed in the denim and orange typical of prisoners, and had no access to real makeup, he managed to look pretty feminine. His mannerisms and speech were very effeminate—a sharp contrast to the leg cuffs, handcuffs, and lengths of chain that bound him.
“Well, I’m really sorry to have to tell you this, but the HIV test came back positive. You have HIV.”
His jaw dropped. Silence.
“You mean, like, I’m gonna get AIDS?” Tears began to flow.
“AIDS is what we call it when the HIV virus makes you sick. I don’t know if it’s ever going to make you sick. We are going to do some more tests, and figure out if you need to take medication now or if it’s better to wait. If you take the medication, it might prevent the virus from ever making you sick. You might even live a normal life span. We don’t know yet. But lots of people that are HIV positive are living with it—living fairly normal lives—for decades. We will just have to see. Whether you start on the medicine now or later, we are going to have to do blood tests to check in on how your body is handling it. We will do those about every three months.”
“Well, how’d I get it? I mean…” he trailed off.
I was kind of hoping he wouldn’t ask—that it would be obvious to him. I guess it was, but he asked anyway.
James continued, “I mean, yeah, like I have had a lot of
partners in here… But I just… I just didn’t think I would get it. You think that’s how I got it?”
I nodded. “Most likely.” I was grateful I had not had to say it.
His tears burst out afresh. “How am I gonna tell my mom?!” He bit his lip. “She doesn’t even know about me… that I have sex with men!”
I had no answer. I answered a few questions about whether the test was reliable and other medical minutiae.
“I tell you what. You’re gonna need some time to think about this. Take half an hour. The nurses have a room back here where you can sit and think. Maybe pray, if that’s something you do. And I’ll be back in half an hour and answer whatever questions you have. And I wanna see you back next week too. You’re going to have some more questions. And I want to check in on you and see how you’re doing. If you want me to pray with you when I come back, just say so. You OK if I go now and talk to you in about half an hour?”
I tried to make sure that the nurses wouldn’t be able to tell that I’d been crying a little bit. Prisons are not places where doctors typically cry with their patients.