Comfort Zone

Chapter 9

"I need a letter."

The patient looked tense but Miriam just nodded. She'd written countless letters for patients, all saved in one computer document, and it had become an easy chore: some cut and paste action, then substituting one name for another. Besides, Mr. Mayer was a good guy, an artist who cared for his autistic older brother, who usually came to his appointments smiling, with a small piece of his art for her. No art today though, and no smile.

"It's a legal matter." It usually was.

"No problem, Mr. Mayer, I'll be happy—"

"--here's the thing. I met someone and we had sex. Later he found out from a friend of a friend that I'm HIV positive." He anticipated Miriam's question. "We didn't use condoms, no one does. It's 'don't ask don't tell' out there. Everyone's barebacking. I didn't do anything everyone else isn't doing!"

Miriam kept a neutral face with difficulty. Others had confided the same, and while many did use condoms, she knew that what her patient was telling her was no lie. It was one reason the rate of syphilis had recently skyrocketed.

His defiant expression suddenly changed.

"But this SOB decided to charge me with criminal endangerment, a third degree felony! I could go to jail and be listed as a sex offender! I can't afford to hire a lawyer, so I got a public defender, and he thought a letter from you might help."

While it was unfathomable to some outsiders why people would risk contracting HIV, Miriam knew there were reasons for their behavior; some were deeply-seated psychological ones, but others just practical. People just weren't as afraid of HIV as they used to be; they knew it was often treated with one pill a day, a far cry from the "cocktails" of the past, complex mixtures of drugs with nasty side effects.

It wasn't so easy to catch HIV anymore, especially since many HIV negative people were taking PrEP, pre-exposure prophylaxis, which meant they swallowed one Truvada pill daily. Taking PrEP decreased the chance of getting HIV to virtually zero, though in terms of other sexually transmitted infections, it did squat.

"Condoms are still king," Miriam counseled her patients. "Gonorrhea, syphilis...do you really want to risk getting them? Sure they're usually treatable, if you don't mind a painful shot, but the bugs are getting stronger and soon the shots may not even work..."

But as impassioned as her counseling was, and as clever the campaigns from the Department of Health, there was no competition. Her patients were lured by the siren call of raw unsheathed sex. Against her will, she thought fleetingly of her ex-husband.

Hijacked by hormones, all of us.

Just wait 'til gay marriage catches up and enough pay alimony when they get divorced, she thought. That'll work. It's a great anti-aphrodisiac.

"How can he prove you didn't tell him?" she asked.

He looked away. "There have been others. They're all against me now! I hate them! We used to go to the same support group and now everyone's against me. They're all using crystal methamphetamine, all of South Beach is on crystal, and I'm not. The guy's a musician, he wants to be famous. He wants to get his name in the papers and he doesn't care how." He went on until Miriam managed to find a soft spot in the narrative to break in.

"I want to help you, Mr. Mayer, but how?" She was his doctor, his advocate. Still, full disclosure was the only ethical way to live. It was hard not to judge someone who wasn't honest, who endangered others, and yet—

"Have you been taking your meds?" she asked abruptly.

"Every single pill. Always," he said.

Miriam clicked on the lab section and verified that about this her patient was upfront. Numbers don't lie, though people might say anything to please you. The so-called "viral load" of the HIV in his blood was undetectable on all his recent tests, indicating that he was taking his medicine , and it was working. Undetectable viral load, the gold standard in HIV management. The virus was still present in his body, but below the level the lab could detect it, currently 20 copies per milliliter of blood.