I don’t know why I gave Howie such a hard time. Sure, I was pissed at him for what he had done, but when it came down to it, we were in the same situation. We’d both been unfaithful, gotten infected with HIV, and potentially passed it on to our partners. When I thought about it that way, I realized I was no better than him. But that still didn’t stop me from hating him.
When I saw him outside the AIDS clinic in Century City, I wanted to hit him. But that would happen later. As it was, I almost didn’t recognize him. It was Lauren who elbowed me in the ribs and whispered, “Is that Howie?”
I stared at the small man who was coming out of the clinic as we were walking in. It was Howie alright, but he was wearing a baseball cap pulled down low over his forehead, which was weird because Howie hardly ever wore hats. Normally he cared too much about his hair, but I guess he didn’t want to be recognized. I had considered wearing a cap myself for the same reason, but changed my mind when I realized it made me look like Tom Hanks in Philadelphia. I just hoped we wouldn’t run into any paparazzi. Running into Howie was somehow even more awkward.
I probably would have just walked past him without saying a word, but Lauren was too nice to do that. She cleared her throat and said, “Hi, Howie.”
Howie’s head snapped up, his eyes widening under the brim of his hat when he saw us. “Hey!” he exclaimed, his voice going higher than usual as he looked from Lauren to me. I could tell he felt just as uncomfortable as I did, but it didn’t take away any of my anger.
“What are you doing here?” I asked him, none too nicely. “I thought you were in Florida.”
“I came back here to start treatment,” he said. “This clinic is supposed to be one of the best in the country. But I guess you already knew that, or you wouldn’t be here.”
“I got a referral,” I replied, through gritted teeth.
He nodded. “How are you guys doing?” he asked, glancing at Lauren again. “Have you... gotten tested yet?”
She shook her head. “Today.”
“Oh.” He gave her a grim smile. “Well, I hope everything turns out okay. Let me know, will you?” He looked back at me.
“Come on, Lo, we don’t wanna be late,” I said loudly and put my arm around Lauren, steering her away from him.
“That was rude, Nick!” she hissed in my ear, as I hurried into the clinic, but I didn’t care. I had bigger worries on my mind, like whether or not I’d given my girlfriend HIV.
We met with the specialist, Dr. Usako, who drew blood from both of us and sent the samples off to the lab for a battery of tests. A few days later, we were called back to the clinic to go over the results.
“Let’s start with Lauren,” said Dr. Usako, as we sat down in her office on that second visit. “Fortunately, there is good news. The HIV test came back negative.”
I let out the breath I’d been holding in a huge sigh of relief. Lauren and I had been holding hands as we waited to hear the results, but when I heard the word “negative,” I let go and threw my arms around her instead. Holding her close, I could feel her body go limp against mine, as all the tension she’d been feeling for the past few days finally left her. She had stayed strong and held it together, for my sake, but I could tell now how scared she’d been.
“Thank god,” I whispered, stroking her hair. “Thank god.”
Lauren couldn’t even speak. When she finally straightened up in her seat, there were tears in her eyes. Thinking they were happy tears, I smiled at her and squeezed her hand, but she just shook her head and mouthed, I’m sorry.
My smile faded into a frown. “What are you sorry about? We just dodged a bullet, babe. I’m the one who should be sorry for putting you in this position in the first place. God, I don’t know what I would’ve done if you’d tested positive.” I shook my head, trying to imagine my reaction if we had received different news. “I’d wanna blow my fuckin’ brains out. I don’t know how Howie lives with himself, after what he did to his family.”
“Don’t say that,” Lauren said softly. She was right. Those words would come back to haunt me.
“This is very good news, but we’re not quite out of the woods yet,” Dr. Usako interjected. I’d almost forgotten she was still sitting across the desk from us. “Although the preliminary test was negative, it can take up to three months for a person who’s recently acquired the virus to build up enough antibodies in the blood to test positive. Just to be on the safe side, I would suggest getting tested again at the end of February. In the meantime, make sure you use a condom during intercourse to lower the risk of transmission.”
We both nodded - not that we needed that last piece of advice. We hadn’t had sex since finding out I was positive, and I wasn’t sure when we would again. The threat of HIV was a major turn-off.
“Now let’s talk about you, Nick,” Dr. Usako continued. “As you know, we ran a battery of tests to determine a baseline for where we’re starting before treatment. We wanted to see how far the virus has progressed and predict how your body will respond to different drug regimens. One of the tests we’ll do each time you visit is a CD4 count, which measures the health of your immune system by counting the number of T-cells in your blood. T-cells are a type of white blood cell that help fight bacteria and viruses by triggering your body’s immune response. Generally, the higher the number, the better. A normal CD4 count is between 500 and 1,500 cells per cubic millimeter of blood. Your count was 470.”
“That’s not too far off, then,” Lauren put in hopefully, and I nodded. I was struggling to follow everything the doctor was saying, but I did understand basic math.
“No, it’s not. That’s the good news. The not-so-good news is that your viral load, which measures the level of HIV in your blood, is very high, over 100,000.”
I swallowed hard, hating the sound of that. “What’s normal?” I wanted to know.
“Well, ‘normal’ would be nothing. An HIV-negative person would have no viral load.”
“Oh.” Duh, I thought, feeling stupid.
“Our best hope with treatment would be to get your viral load down to an undetectable number, less than 50.”
“I have a ways to go then, huh?” I said, licking my lips. My mouth felt so dry.
“You do, but it’s typical to have a high viral load shortly after the initial infection, when your immune system is still trying to figure out how to respond to the virus. Once it does, that number will drop,” Dr. Usako replied, her voice reassuring. “If you choose to start treatment, it should drop considerably.”
“I have a choice?”
The doctor smiled. “Of course, you have a choice. In fact, some experts recommend waiting until your CD4 count is below 350 to start treatment. Others feel it’s best to start treatment as soon as possible after infection to keep the CD4 count from dropping that low. HIV drug regimens can cause some serious long-term side effects, but so does advanced HIV infection and AIDS, so it’s all about finding a balance between keeping you healthy and preventing side effects.”
“What would you recommend?” Lauren asked.
“Given Nick’s lab results and medical history, that’s a loaded question,” said Dr. Usako. Looking at me, she elaborated, “Your history of substance abuse, along with your previous diagnosis of dilated cardiomyopathy, will make finding the right medication regimen a more complicated process. HIV drugs are notorious for damaging the liver, and your liver enzymes are already slightly elevated, likely from alcohol abuse.”
Her tone wasn’t judgmental, but still, I swallowed hard, feeling like a screw-up.
“On the other hand,” the doctor went on, “HIV itself can cause or, in your case, worsen cardiomyopathy and other heart conditions. There are many other illnesses associated with advanced HIV and AIDS, including opportunistic infections and certain kinds of cancer. Given your high viral load, I would suggest starting treatment now. If you agree, we’ll start you on a modified regimen of medications that have fewer drug interactions and serious side effects than some of the standard regimens. We’ll monitor your viral load and CD4 count, as well as your liver function, to see how well the medication is working.”
My heart was pounding, and my head was swimming, but somehow, I managed to nod and say, “Okay.”
Dr. Usako looked at me seriously. “I must warn you,” she added, “if you do choose to start treatment, you should expect to stay on it, probably for the rest of your life. Stopping treatment will make you sick. It’s very important that you stick to the regimen and take your prescribed dosage of medication daily.”
“I can do that,” I said.
“I’ll make sure he does,” Lauren agreed, squeezing my hand. I gave her a grateful smile, glad she seemed willing to stick with me, at least for now. In the back of my mind, I wondered what would happen now that she was negative and I was positive, but I tried not to worry about it then. There was too much else to think about.
Dr. Usako wrote me a prescription for three different drugs, explaining what each one did and how often I should take it. Two of the pills only needed to be taken once a day, but the other had to be taken twice daily, twelve hours apart. “When you go to the pharmacy to fill these prescriptions, pick up a pill organizer with an AM and PM compartment for each day of the week,” she suggested. “You should take your medication at the same time every day. Set your cell phone alarm to remind you until it becomes part of your daily routine.”
That was going to be tough, I thought, since my schedule varied depending on whether or not I was working, but the doctor’s suggestions were good ones. Once Lauren and I left her office, we went straight to the pharmacy and brought home a pill container that matched her description, along with a bulging paper bag filled with my prescriptions. When we got home, we laid everything out across the dining room table, and Lauren helped me fill the pill organizer with a week’s worth of my medication. It was only four pills a day, but for a guy who wasn’t used to taking anything except vitamins, it sure looked like a lot. I wasn’t looking forward to a lifetime of taking medicine, but if it kept me healthy, it would be worth the hassle.
I wondered briefly about Howie and whether his meds were the same as mine, but I wasn’t about to call and ask him. Instead, I sent him a one-line text: “Lauren tested negative.”
He responded right away with, “Oh thank goodness! That’s great! Tell her I’m happy for her,” to which I did not reply.
That night, as I lay in bed next to Lauren, thinking back over our appointment at the clinic, I remembered her strange reaction to finding out she was negative. “Hey, babe?” I said suddenly, my voice breaking the silence of our bedroom. “What did you mean earlier, when you said you were sorry?”
“Huh?” asked Lauren sleepily.
“At the doctor’s office. After you found out your test results, you started crying, and you mouthed ‘I’m sorry.’ What was that about?”
Lauren rolled over to face me. “Really, Nick? I have to spell it out for you? I’m sorry that you’re sick and I’m not. Not that I wanted to test positive,” she added quickly, before I could call her crazy. “Obviously, I’m relieved I didn’t. But somehow, it just seems like it would be easier if I did.”
I shook my head. “Why would you say that? I would never wish this on you.”
“I know. I don’t want you to be sick, either. It’s so unfair. How could you have gotten it from that one time, when I’ve slept with you so many times since then and still haven’t? I just don’t understand.”
“Me neither,” I said bitterly, hating Howie some more, “but I’m glad you got lucky. I guess I’m just the unlucky one.”
She sighed. “Well, the doctor said I’m not out of the woods yet, remember? I could still have it.”
“I think you’re gonna be just fine, babe,” I said firmly. I wrapped my arm around her and held her close. “Try not to worry about it. And don’t worry about me, either. All those meds are gonna do their job, and I’m gonna be all right. And who knows: maybe in a few years, they’ll find a cure for this, and we’ll all be fine.”
“I hope so,” she whispered, hugging me tightly. “I love you too much to lose you. I want us to grow old together.”
“Me too,” I murmured back, but a lump had risen in my throat, making it hard to speak. Even before I had proposed to her, I’d envisioned us growing old together - in fact, that was what finally made me want to pop the question. But now I realized I had taken our future together for granted. With my diagnosis, there was no guarantee we’d get to enjoy a long life together. “Until death do us part...” It might happen a lot sooner than either of us would have anticipated when we got engaged.
Lauren was right. It wasn’t fair. Not to me, and definitely not to her.
I hated Howie even more for messing up my marriage before it had begun.