Tim Barrus: The New York Times Health Section
I work with teenage boys at-risk who have HIV. It is much more difficult for the teenager who is endemically entrenched in intractable poverty than the teenager who is middle class. In the field of HIV, we often, and wrongly, refer to them as the hard to reach. They are not hard to reach. But they have to have something to reach for.
Anecdotal impression. Suicide. The boys I work with are often profoundly depressed before infection, and almost always, after. Psychiatry is not helpful, and it can render the kid into a zombie. The tools it uses are sledge hammers, and poverty never makes its way into the discussion. AIDS orgs want to know why the boy isn’t participating in the advertising gimmick of the healthy, robust lad, playing frisbee in the park with the dog. AIDS orgs are in touch with funding.
Boys will flush their antiretrovirals. The issue is hope. Being here is too difficult. Their lives are a curse and a nightmare of repeated physical examinations that are both invasive and abusive. The medical paradigm of one size fits all is irrelevant and ineffective. Staying in care is far more arduous than anyone in the field wants to admit to. What do you say to the kid who is living on the street and doing sex work to survive. What do you say to the kid who can get his $200 pill that day, but he’s hungry, and hunger plays a huge part in his attitude that articulates the idea that things do not necessarily just get better, and, in fact, he knows they can always get far worse.