May 6, 2014
Tim Lahey, M.D., M.M.Sc., is an HIV doctor at Dartmouth-Hitchcock Medical Center where he is the chair of the clinical ethics committee. He is also associate professor at Dartmouth's Geisel School of Medicine, an HIV and tuberculosis researcher, and a contributor to The Atlantic, Scientific American and The New York Times.
I saw Steve* in clinic a few weeks before his marriage to Marty. They were knee deep in wedding planning. Had they ordered enough irises? Could they squeeze in one more belated RSVP? Would the best man be funny without being too embarrassing? As we chatted, about weddings and then about Steve's medications, I remembered our last several years of clinic visits. Knowing Steve for years now, I've been honored to see him change and grow. And I've grown to like him.
At an early meeting, I diagnosed Steve with pharyngeal gonorrhea, and later he contracted chlamydia and syphilis, too. Each time we discussed safer sex and HIV disclosure while arranging antibiotic therapy. Steve would roll his eyes when I asked him about condoms and whether he disclosed his HIV status to men he met online. This was not Steve's favorite part of the visit. I tried to be upbeat and nonjudgmental, and focus on education and empowerment. I asked him to reflect about what responsibilities he had to his partners without being judgmental.
At first Steve said, "Hey, they're consenting adults. What gay man doesn't know HIV is out there?" In time, though, Steve's take on things changed. He started to say things like, "I'd hate to infect someone else the same way I was infected. Not knowing the risk, I mean."
Steve changed the kinds of sex acts he did with anonymous dates, and even put his toe into the HIV disclosure water. On Manhunt.com, for example, he changed his HIV status to "Ask me." He described a time when a partner came out about his HIV status after Steve did, and then, "It got pretty hot."
Once I asked Steve how it felt to approach things differently now, and to have fewer partners. He said, "Well, it's a hell of a lot less fun." He laughed and then paused. "Actually, doc, I don't miss it at all. I was getting tired of it all." He said previously he had felt bad walking away from an unprotected encounter with a man to whom he had not disclosed his HIV status. "I have more fun now, being open about things."
Years passed. Steve got a good job and got promoted. He met Marty and fell in love. Marty, too, has HIV. "He didn't freak out when I let him know. Actually, he made fun of me for waiting so long." Steve and Marty had both been around the block a few times, as Steve would put it, so Steve felt he could tell his story and be understood, and even loved.
A few years ago, Steve started HIV therapy. Initially afraid of side effects and the burden of taking pills, he found neither was really a problem. "I don't understand what the big deal is," he said, after getting into the habit of taking his medications nightly. "It's one little pill. It makes me live longer. And I don't transmit as much. What's not to like? Okay, labs. I could do without those needles."
In time, our focus in clinic shifted from sexually transmitted diseases to eating right and -- as he entered his 40s -- keeping his weight down. Steve's cholesterol rose, and sometimes his sugars were a little high, too. We talked about portion control, low salt diets, and finding time to exercise amid a busy work schedule. But in the end, Steve loves food and wasn't willing to cut back. "I used to think you liked to ask indecent questions about my sex life," Steve said once. "Now I understand you just like to nag me." We laughed.
Sitting with Steve and Marty that day talking about their wedding plans, I felt really proud. I was glad Steve found love. I was relieved our state made same-sex marriage legal so they could get married. I felt honored to have seen Steve through the last several years of change, and evolution. Sure, we talked about antibiotics, and antiretrovirals, and cholesterol, but that all seems like window-dressing for the real story of his 30s and 40s -- the story of him falling in love and making a good life for himself.
I hope Steve and Marty have a great honeymoon. I'm sure there will be plenty of irises and just enough great food for the guests. But they better look out for that best man: They've both lived full lives and so that guy has a lot of stories he could tell. I look forward to hearing all about it.
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