She comes in, won’t make eye contact with me. I have to hold my breath so I can make out what her mumbles mean. But before I’ve had time to process the low tones of her language, I know why she’s in my office: She wants to get tested for HIV.
There’s definitely shame in the eyes of the people who come here looking to exchange their used syringes for new ones, but oftentimes they’re so desperate to be done with me that there’s nothing halting about their speech or presentation. The folks worried they’ve got the granddaddy of sexually transmitted diseases well, they have a reason to put off the potential certainty of a diagnosis. Those exchangers are all too anticipatory, and it is a readily accessible difference that I can assess inside of five seconds.
No matter the need of a given individual, I put on my most reassuring face. Get professional, avoid any hint of judgmental snark or attitude. In most engagements, they’ve spent copious amounts of time beating themselves up for their behavior, their mistakes, their bad decisions. I’m not one for piling on.
I ask this latest sorrowful woman to fill out a form, over here at the table, and I’ll be with her in a few minutes. She shouldn’t have to face the questions about her drug use and sexual history with some random guy watching her. I’ll be all up in her business when we do the cheek swab, so I give her a moment to get herself together.
I’ve turned many people away, or referred them to someone else, because an HIV test was not what they needed or not appropriate. They often come in too soon—I can’t test anyone within six weeks of exposure—or they may describe something that never would lead to HIV transmission. One young woman, developmentally disabled, was certain she had AIDS, but she’d had no sexual contact with anyone. Some men come in having checked the boxes for unprotected sex with men, and then scribbled them out so intensely they ripped the paper form, or stormed out, lest I think they were gay.
Other people are not so timid, or horrified at themselves. One man came in every other month for a test. I suggested he make his visits to me quarterly. Now I see him every three months, always gently suggesting that this retroactive check on his health is not as helpful as using a condom would be. (Note to parents of sons: Tell them as early on as possible that condoms are important, and don’t focus on their sensation. Sensation and protection are two different things, and one should not be deprioritized for the other.)
I test strangers. I test people I’ve seen around town. I test people I know, reminding them that I am bound by law not to tell anyone else they came in, what their result was, or anything they said to me during the test. If the county Sheriff came in wanting to know who I tested on a given day, I would not be able to tell him. Sometimes this total, unshakable confidence makes my testing room something of a confessional, and people blurt out all kinds of things about their sexual practices and relationships. I’ve slipped domestic abuse hotlines into women’s palms, even though they’re printed up as hair salon business cards. I’ve answered questions about sexual positions and times of the month, penis size, and on and on.
This woman has checked off enough boxes that she is at high-risk in terms of practices. Walla Walla, for its part, is a low-prevalence area, but we had four new positive cases last year, so there is a quiet nervousness among a few of us as to how many other undiagnosed people are here who are playing a terrible waiting game with their immune systems. I’m currently looking for a long-term former partner of one of my clients—they broke up two years ago—who apparently seems sick. She lives somewhere in Walla Walla but works over the state line, so getting different jurisdictions to find her and get her tested has been onerous. I think about her often.
I suggest we do the rapid test so we can have results in 20 minutes, and my test subject agrees. Her foot taps the tiled floor. We’ve only been in this office since last July, but at our old office the carpet was worn in two spots where people did what she is doing. I guess that at some point the finish will be worn off that tile square.
The good old boys of Walla Walla like their perspective on the city—it’s clean for the most part, often sunny, with some grand brick buildings from when it was the capitol of the territory of Washington. They see white families in nuclear family model, meter-free parking, a thriving farmer’s market, an annual rodeo, lots of chuch-going folks on Sundays. I know this is all present in town, but there are also teenagers having secret sex with their peers, bubbling pockets of meth and heroin use on the outskirts of town, a revolving door at the district court because we have so few resources for people with chemical dependency issues, and whirlpools of poverty that snag generation after generation of people here.
I watch the blue dye climb up the window of the rapid test. Five minutes. I need to see one line to verify the test is valid. If I see the second line, then I know she has antibodies to HIV—a sign of exposure. I would have to follow up with a conventional test, sent to the state lab in Olympia, and if that was positive, she would need to get a blood test from a doctor’s office, and she would have an official diagnosis, with which she could get state insurance coverage. She’d also feel like her life was never going to be the same.
Instead it’s negative, and like I’ve witnessed with so many others, she exhales in relief. There’s a moment, just a flash, where she seems to process all of the anxiety and angry thoughts she’s had about her choices, where it looks like she’s trying to promise herself she’ll be perfect from here on out. It’s similar to what I used to do in confessionals with the priests at my school, back in my practicing Catholic days. I know what happens after that moment, because I’ve done it too. She’ll find a way to laugh off the tension, dismiss her worries, and slip back into her habits so effortlessly it’ll be like this experience never happened.