Gay Men and African Women

"Come on, don't be scared, just say it! FAGGOTS. That's the highest risk group in Vancouver." My preceptor spat out the words as he egged me on with a grin. He is a tall, ridiculously good looking, tanned and muscular gay man with salt and pepper stubble on his ever smiling face.

"I won't say it, so don't even try." Was my determined response.

For someone who sees herself as fairly open-minded and worldly my assumptions and stereotypes have been given a good beating this week, which is fantastic! I'm working at a clinic that functions as a family practice but focuses on the HIV+ population and specifically gay men. There have been both funny anecdotes and serious ethical questions that I've stumbled across which at week's end I find hard to process coherently.

There was the diagnosis I nearly missed because I didn't ask about nipple bitting . . . of course, silly me. Next I had a young businessman who skipped all pleasantries as he rushed into the room. "I have a rash." In a second, shirt and tie were off and he dropped his pants to show me the distribution. On the bright side, my choice of obstetrics has been confirmed. Although I love the HIV medicine, seriously folks, scrotal rashes are gross. I was also recruited to do a pap smear on a transgender young man who was going through gender reassignment but still had his uterus. So many fascinating and complex medical issues. Heck, not just medical issues.

A well-educated man in his 70s divulged to me just as he went out the door that he wouldn't even shake hands with 'them', he hadn't realized that the majority of the patients here were gay. He had even ignored the hand the doctor I was working with offered him. "You never know how you might catch it." Before retirement he had worked in a microbiology research lab. I was shocked by his views and told him that he should know better . . . with my usual undertone of humour of course.

The fashionista-shop-a-holic-I'm-in-love-with-Justin-Timberlake nurse shared his frustration with me after meeting with someone who had just found out they were HIV+. The patient is in his early thirties, as is the nurse. "There's just no excuse, I don't understand it. In this day and age we know about the disease, we know how prevalent it is and we know how to prevent it. I don't want to judge, but I just don't get how people go ahead and do what they do." My reaction was a bit of surprise I suppose. I thought that this nurse, having worked in the area for several years, with first hand experience would have some insight into why people are still getting infected. Even though HIV is no longer a death sentence and is treatable, it still turns lives upside down.

Perhaps it was similar to the shock I felt when on returning to Tanzania I ran into the husband of the head nurse I had worked with in Uha. We were waiting for transport out to the village. He was returning from her funeral, having died of the unspeakable disease and leaving two young sons. She knew all there was to know about the disease. We led HIV/AIDS seminars together for women, she counseled people to get tested and tell their partners, she delivered the babies of women we knew were infected and saw their fear and pain. But still, with all her education and experience she could not completely control her own health. Was her husband sleeping around? Had she been cheating on him? It doesn't matter, does it? Disease doesn't take a moral stand.

That's the conclusion I've come to. Several people asked me this week that it must be so different working with HIV populations here compared to Africa. More resources? Yes. But the loneliness is the same. Sickness and suffering unite us in our humanity. To look in the eyes of a middle-aged white professional man or to hold the calloused hand of a young mother from Uha I feel the same heaviness is my chest. That this world is not as it should be, and in the depth of our suffering there is inexplicable hope when we realize we suffer together.