Chicago Tribune - September 1, 2004
Connie Lauerman, ctc-woman@tribune.com

They didn't serve up platitudes. It was gritty, real life with no sugarcoating.

They talked about sex: Men who will say anything to get it and women who crave it, without regard for the threat of sexually transmitted diseases.

They talked about how women of color are demeaned and devalued in music videos. They told the students it's OK not to have a boyfriend, to wait until you're ready and have a stable partner who is honest about his sexual history.

Most of all they talked about HIV/AIDS, a growing threat for teenage girls.

In one skit, a young woman visited a friend to dish about a neighbor, "Cyn," who she heard had AIDS.

The gossip was enamored of a guy called "Mookie" (the gossip didn't know his real name or too much about him). She also had a lot of misconceptions about HIV, such as thinking mosquitoes can spread it.

She found out from her friend that "Mookie" also had been involved with "Cyn."

"Mookie" would never use condoms. He told the gossip that condoms weren't big enough for him. Her friend disabused her of that notion. She unwrapped a condom and stretched it over her whole hand and forearm.

The gossip finally got the message: She had been exposed to HIV/AIDS from unprotected sex with the feckless "Mookie." She was stunned into silence.

In another skit, a young woman told her boyfriend that she was pregnant. He didn't believe it, said she had the 24-hour stomach flu. He also had news: He got a promotion at the fast food restaurant where he worked. Overjoyed, she was ready to buy "a real couch" and formula for the baby. But that wasn't all: He found out he's HIV positive. It was, he said, the result of "that situation when I was locked up."

After the skits and the equally frank, often angry, poetry and rap, Debra Fleming, a Chicago woman who has AIDS, told the students more.

She talked about living with AIDS, herpes, genital warts, and hepatitis C, and the medicine and doctor visits, and the discomfort all of that entails. She told them about her past: getting high, selling her body and even taking extra money from clients to have sex without a condom.

"You can get more than HIV," she said. "You can get herpes, syphilis, chlamydia."

She told them that the herpes virus can infect fingers, hands, lips, mouths and faces as well as genitals.

There was some snickering at one table.

"It's funny till you wake up that way in the morning," Fleming said sternly. The snickering shut off like a faucet.

She told them more, then the questions came.

"Don't people have symptoms so they know to get tested?" asked a girl in a red jacket.

"Your first symptom is risky behavior," Fleming retorted. "Step into the doctor's office now!"

"Could you go for years without knowing you have HIV?"

"If you're pregnant, is the baby born with opportunistic infections?"

"Don't vitamins protect you?"

"What do they do to test you?"

At the end, Fleming sounded a final alarm: "It only takes one time. You can get HIV, pregnant and chlamydia all at once.

"Abstain from risky sex, drugs and drinking. If you can't talk to your partner, you shouldn't be with him."

Imani Nia trouper Stephanie Haynes summed up:

"AIDS is a disease of behavior. Are we scared, you all?"

"Yeah!" the girls shouted.

They should be frightened. A recent federal study showed that between 1999 to 2002, 64 percent of new HIV infections occurred in women--and girls age 13 to 19 account for the majority of new heterosexually acquired HIV cases.

Not getting the message

"On any given Monday two years ago, we might have gone for two months before we had a new HIV patient," said Dr. Lisa Henry-Reid, chair of the division of adolescent and young adult medicine at Stroger Hospital of Cook County. "Now there are two or three new patients every Monday.

"Young people aren't getting the right messages and they suffer from the myth of invulnerability, very prevalent among 14- to 19-year-olds."

Gender and power issues also are a factor, Henry-Reid said.

"A lot of adolescent women are engaged in sexual relationships with much older men, 25-, 26-, 27-year-olds. And trying to negotiate safe sexual practices in that context can be very difficult.

"Date rape occurs, and it doesn't matter what socioeconomic level you are, what color you are, what ethnicity you are.

"Sometimes girls don't feel they can ask their partner to use a condom. The first response [to the girl] might be, 'Well, what do you have?'" The answer, Henry-Reid said, should be, "'Well, I don't have anything but I don't want to get pregnant and I don't want HIV.'"

Or the guy could say, "'Well if you loved me, you would do this.'" Henry-Reid noted, "If a young woman does not have a good sense of self, she will fall for that."

The adolescent clinic at Stroger has close to 200 young people under care. Henry-Reid said the majority contracted HIV as the result of sexual activity.

Meanwhile, teenagers may or may not be receiving adequate sex education in their homes or in schools.

"We've had fits and starts in terms of mass general education" about AIDS, said Mildred Williamson, administrator of the Woodlawn Health Center on the South Side. "Not all communities were reached with accurate education for youth. How much comprehensive information is provided varies from school to school."

The Kaiser Foundation's national survey of adolescents and young adults, released last year, showed that an alarming number of sexually active adolescents and young adults engage in unsafe sexual behaviors, and 1 in 4 contracts a sexually transmitted disease every year.

For example, 70 percent of females ages 15 to 24 consider using forms of birth control other than condoms to be "safer sex," and 80 percent consider oral sex safer.

However, oral sex exposes women to syphilis, gonorrhea, herpes, genital warts--and HIV, despite common misconceptions.

Cynthia Tucker, director of prevention for the Chicago Women's AIDS Project, said teenage girls think oral sex is "like a kiss. They figure they can prevent pregnancy and still please the guy," without regard to the risk of disease.

Part of the problem, Tucker said, is that "the community doesn't know how to deal with the problem of HIV. People don't know how to talk to their kids about a very sensitive subject.

"For some kids, one parent is in jail, one is on drugs, and they're being raised by a grandmother, who is dating."

At the same time, young people are "bombarded by media that is very sexual--music videos, movies, teen shows--and they're not addressing safe sex," said Staci Bush, a physician's assistant who deals with adolescents and young adults with HIV at Howard Brown Health Center on the North Side. "Young African-American women are having sex for acceptance. I don't think they even feel like they have a choice. It's part of the dating process at a younger age. If you're unmarried and pregnant, there is no stigma."

If there is any sex education, she said, "it's about abstinence and it leaves them ignorant of what the real threat is."

A report released in March at a National STD Prevention Conference in Philadelphia showed that public virginity pledges do not reduce the rates of sexually transmitted diseases. In fact the study concluded that among teens who took a virginity pledge, the sex that they have is more likely to be hidden and more likely to be unsafe.

Just saying no without understanding the risk of disease and how to protect oneself from risk turns out to create a greater risk for STDs.

Bush added, "A 30-year-old today grew aware of AIDS when they were hitting their sexual maturity. AIDS was in the media daily. It was on MTV. This is just a different generation. They're more sexually active but ignorant."

As a result, adolescent and young women with HIV feel isolated, fear disclosure and stigmatization, and remain silent about their status. Bush said that if they were infected by their mothers at birth, they probably have been told repeatedly to keep their HIV status a secret.

"I am more concerned that [young women infected at birth] are not practicing safe sex, because they are out there infecting others," Bush said.

Need for constant vigilance

Even being informed and playing by the rules may not help, if vigilance is relaxed on any occasion.

A 25-year-old college student, who began dating at 19, was infected by her first boyfriend during their four-year involvement.

All it took, she said, was a few instances of sex without a condom, either after an evening drinking alcohol at a nightclub or because there were no condoms handy. She asked that her name be withheld because of privacy concerns, saying "it's not in my interest at this time" to be public. By the time she received the "devastating" news that she was HIV positive, she and her boyfriend had broken up. When she informed him that she had HIV, he told her he didn't know how she could have gotten infected. She sent a public health worker to his home to convince him that he needed to get tested for HIV.

Her family members, she said, "were hysterical. My mother was wailing down the hallway. But eventually everybody came around. The first thing my family said was, 'Well, this was your first real boyfriend and you were a good girl, we don't see why this happened to you.' But it's not the person you are. This could happen to anybody."

After one of her siblings spread the news that she was infected, she could hear people in her West Side neighborhood laughing at her when she went to the store. "I thought, 'How can they be judging me? They have five kids each. They had unprotected sex somewhere, unless the stork brought their kids.'"

After the diagnosis, she faltered for a while, wondering "what's the use of going back to school if I'll be dead in a few years? That's what people were saying to me, and for a while I kind of bought into it."

Eventually, she decided to return to college and continue with her plans.

"I see [HIV-positive] people who are doing great things, who are moving on with their lives. If they can do it, I can do it too."

After she adjusted to the reality that "my life will never be normal again," she had a tiny heart with wings tattooed on her upper chest. It's an important symbol for her. "I have a brave heart," she said.

It's a little awkward on dates when it's time to take her pills. Usually, she will tell men about her HIV status after the first date, if she is interested in them.

She focuses on the future. After completing her bachelor's degree, she wants to open day-care/tutoring centers and, after that, to work as a teacher.

"If I die at 35 or 40, I want to have lived," she said.

"Some people can live to be 90 and never do anything. I don't think it's about how long you live but what you do with the life you have.

"I would like to live until I'm 90. But who knows?"

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