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City of Night 

Homeless gay youths in San Francisco run an extraordinary risk of HIV infection, according to city statistics. On the street, safety is a matter of economics -- and hope.

Wednesday, Feb 21 1996
At night, the cars are like blood cells -- white headlights, red taillights, a glistening stream of motion and life. Steven isn't watching the traffic, though. He is telling a story.

"This guy, he picked me up," Steven is saying. At 21, he's tiny -- waiflike, childlike, dressed in a Windbreaker, a polo shirt, an undershirt, jeans, and sneakers. He looks gentle and sweet, like a Deadhead, which is what he was, for a while, before he came here. His golden-blond hair falls over his face in long bangs, but even through his bangs it is possible to see the dark, pooled pupils of his light-blue eyes. He's smiling as he speaks, which is funny, in a way, because the story isn't. The guy who picked him up, Steven says, "his thing is, he wants to fuck you. I don't usually do that."

"I don't either," his friend interrupts. "Unless I need the money real bad." His friend is named Stephen, too, and the two Steves look out for each other. They take care of each other when they're sick, sleep together on the sidewalks, in doorways, on the streets, for warmth, for company. Sometimes they date together -- that is, have sex with men for money -- but not usually. Usually, they figure out a place they'll meet up again later, after their dates, to get well. Getting well is the reason they're out here. Getting well means injecting themselves with heroin, or a combination of heroin and cocaine. Stephen carries his needles in his backpack, along with a copy of the Bible and Jane Austen's Pride and Prejudice.

"Well, I needed the money bad," Steven continues, "and so I let him do it, and in the middle of it -- me screaming, 'Ow ow ow' -- he took his condom off without me knowing it. I didn't really know until it was done."

Steven stops speaking, and rolls his eyes, and laughs. He's been eating a bagel with cream cheese and tomato as he talks, with a voraciousness that seems impossible in such a small frame. Two older men come by, and Steven leaps up to embrace them. "They're regulars," Stephen explains. Behind them, the light changes, and the cars take off.

"Were you worried about HIV?" I ask him, when he sits back down.
"Not really," Steven says. He shrugs.
But according to the Department of Public Health's (DPH) "HIV Seroprevalence Report," issued last November, the rate of HIV among homeless young men who have sex with men is high. Decisively high. Between 1990 and 1994, 45 percent of self-identified gay and bisexual homeless youths tested in city clinics were HIV-positive, according to the DPH statistics. The numbers might not be precise, due to the complications of compiling them, but there is wide agreement that they reflect the scope of HIV infection among the specific group of homeless youths they describe. And other studies have shown similarly high HIV rates: In 1994, an assessment of homeless youths conducted by Health Initiatives for Youth found that 57 percent of gay and bisexual homeless youths who were also injection drug users were HIV-positive.

If you compare these statistics with those for gay and bisexual youths in the United States in general -- young people who have homes, who have steady places to sleep and eat -- you will begin to understand how high the numbers are. According to a federal Centers for Disease Control report issued this month, 7 percent of gay and bisexual young men in America are HIV-positive. Obviously, any percent of HIV seropositivity is too high, but 7 percent pales against the much more daunting realities stacked against the young gay men who live on the streets of San Francisco -- some of whom have come to this city because of its reputation as a benevolent place to be openly gay.

And it might be tempting to think that the reason the HIV rate among homeless young men who have sex with men in San Francisco is as high as it is is because San Francisco doesn't have the proper programs in place. But in fact, in this city, where some 2,000 youths are believed to live on the streets, the range of programs and services available to homeless young people -- queer and straight alike -- has expanded steadily over the last five years. These days, there are shelters, drug treatment centers, housing, needle exchanges, gay foster families, condom distribution programs, educational services, vocational training -- even paid-for bus tickets home -- available for youths up to 23 years old.

Out on the street, you see, on the narrow, virulent, and violent stretch of Polk that is stained with the blood-cell taillights of circling cars, it isn't so much a question of not being able to get help. It's a question of being able to believe anything will make a difference.

Statistics, of all things, are infinitely malleable -- and, at times, controversial. The 45 percent positive rate among gay and bisexual homeless youths is one such number: Not everyone agrees that it is accurate, and not everyone agrees that, even if it is accurate, it means anything at all.

Consider Eric Rofes, for example, the former head of Shanti Project, an AIDS outreach organization, and author of the just-published Revitalizing the Tribe, about the AIDS epidemic.

"It doesn't seem so shocking," Rofes says.
Similarly, Michael Kennedy, who is program director at the Larkin Street Youth Center, which directly serves the homeless youths of Polk Gulch, disputes the statistic.

"Those numbers are misleading in a big way," Kennedy says. "We don't control the data. It comes out of the Department of Public Health."

But others, including local public health officials and AIDS activists, say the number is accurate -- and intensely troubling.

"It's outrageous," says Antigone Hodgins, executive director of Bay Positives, a support organization for young HIV-positive people, and a member of the Health Department's HIV Prevention Plan executive committee.

About The Author

Ellen McGarrahan


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