Paces’ lights were low and Lady Gaga lyrics soared through the alcohol-tinged air. Students crammed together in the café-turned-club to dance away the stress of the week. The young man, 21, was feeling a little tipsy when another guy caught his eye from across the room.
They spent the night together thinking the Swarthmore bubble would protect them from infection or disease. Not that they talked about any of that—neither before nor after their encounter.
Months later, a fear lingered. “What if I have something and don’t know it?” thought the student. “I was pretty sure I didn’t have anything but you can never be certain, so I got tested,” he said.
More than 30 years into the HIV epidemic, about 50,000 people in the United States still become infected each year, according to the most recent data from the Centers for Disease Control released last August.
While the number of new infections has remained relatively stable over the past few years, the number of new HIV infections has increased at an “alarming” rate among young gay, bisexual, and other men who have sex with men, the only group in which infections are increasing, according to the CDC. Their data were based on direct measurement with a laboratory test that distinguishes between recent and long-standing HIV infections.
In an interview, the young man described a recent conversation. He found himself relaxing in the armchairs of Shane Lounge and having a casual conversation with a friend last week. The occasional hum of the printer was their only accompaniment during the late night hours. “Do you think anyone at Swarthmore is HIV-positive?” she asked him. “Do you?” he responded. “No, absolutely not,” she said without hesitation. The certainty of her reply surprised him.
“I feel like there’s this general trust in the community—people think ‘Oh, I know they don’t have anything’ and kind of assume people are clean—but you really don’t know,” he said in an interview. “It’s not like sex is just contained to campus—and Philly has a really high rate. Plus, people go abroad and do stuff,” he added. In fact, Philadelphia’s rate of new HIV infections is five times higher than the national average, CDC data show.
Although gay, bisexual and other men who have sex with men are disproportionately impacted by HIV, the majority of new infections in Philadelphia are now transmitted through heterosexual contact, according to the data.
Beth Kotarski dealt with HIV firsthand as a nurse practitioner working in a practice with pregnant women in West Philadelphia during the late 1980’s.
“It was a different time—it was a scary time,” said Kotarski. She recalled the difficulty in telling a woman she had tested positive for HIV. “It was very hard to tell her because there wasn’t much we could do.”
At the time, there was only one drug to slow the progression of HIV to AIDS—it had brutal side effects and medical professionals did not yet know it could prevent transmission from mother to child, Kotarski said. About 20 years later, there are over 25 medicines available to treat HIV infection, but the disease has certainly not disappeared—over 34 million people worldwide are currently living with HIV/AIDS, estimated the Joint United Nations Program on HIV/AIDS last month.
Kotarski has served as the Director of Worth Health Center at Swarthmore for the past four years. “It’s not an overly frequent occurrence, but I’m sure there are students who are HIV-positive,” she said. “We’ve had, in the past, students who have come HIV-positive: one from an exposure through a blood transfusion and one who was from a different country,” she explained.
As a Sexual Health Counselor, Ariel Finegold ‘13 has talked about sex with a lot of students over the past two years. Earlier this year she received a question from a student asking how to convince his or her sexual partner to have anal sex.
“We get lots of questions about anal sex but no one asks about HIV or AIDS—not one person ever in my experience,” said Finegold. While she has also fielded questions about lube and other sexually transmitted infections such as chlamydia, she thought that many students do not believe there is much risk at Swarthmore.
“We’re in a bubble so people think that everyone around them has had the same experiences they have had and knows the same amount they do, and if you haven’t had any experience with HIV or AIDS or you haven’t had that many sexual partners, then you assume the person you’re with hasn’t either,” she explained.
Zack Wiener ’12 remembers the coolness of March when he decided to get tested. The warmth and sterile smell of Worth Health Center greeted him when he went to make his appointment. He returned the next day to talk with the nurse who specializes in sexual health.
“We went over my sexual practice and my sexual history, and she was not judgmental at all,” he said. They went over the CDC guidelines together. “I came back a few days later to get counseling along with my results and got a clean bill of health,” he said, feeling proud. He described getting tested at the student health center as “the easiest thing in the world” and considers it an important part of his yearly routine. “It’s just like going for a check-up,” he said.
Wiener has served as a Sexual Health Counselor for about a year. He expressed concerned about the CDC’s recent figures showing increasing rates of HIV among young people. “We are either forgetting the lessons of the past or they’re thinking they don’t apply anymore,” he said. Like the other students, he agreed that students think HIV infection does not happen at Swarthmore.
“Young people should be absolutely concerned about HIV,” said Kotarski. But HIV infections can be prevented, she added. “Getting tested, reducing risky behaviors such as unprotected sex with multiple partners, and getting treatment are all ways for people to protect themselves and their loved ones,” she said.
Students with health insurance through the college can get tested at the health center for free once a year without any bill or notice going home to family, she said. Students who have other private insurance can also use it to cover the costs of testing, or they can opt to pay a $20 out-of-pocket fee per test.
“We do a lot of testing,” said Kotarski, estimating that they conduct 100 to 200 reproductive health visits each month. “But students often think it’s safe to hook-up and don’t use protection,” she said, noting “it was the same way at Haverford, too.” She worked for six years as the associate director of Haverford’s Student Health Center before coming to Swarthmore.
“When nobody knows their status, it’s a very concerning public health matter,” she said. Although she thinks the rising rates of HIV among young people are cause for concern, she said the most common sexually transmitted infections on campus are “herpes and human papillomavirus and chlamydia, probably in that order.”
Without a test, it’s easy to unknowingly spread infections because people may remain asymptomatic for a period of days to several years. “Anyone who’s being sexual with a partner needs to be tested and it should be an annual affair, just like going to the dentist or doing anything else,” said Kotarski. “You can encourage people to get a test, but ultimately the onus is inside.”
The young man who recently decided to take the test rose to that challenge. And with the knowledge of his HIV status, peace of mind has replaced his nagging worries.
Today, December 1st, is World AIDS Day, an opportunity for people worldwide to unite to address HIV, show their support for people living with HIV and commemorate people who have passed away. World AIDS Day was the first ever global health day and was first observed in 1988.