Super Infector: With the U.S. Epidemic Larger-And Blacker-Than It's Ever Been, the Growing Consensus among Health Officials and Community Activists Alike Is That the Only Way to Stop the Spread of AIDS Is to Control the Behavior of Those Who Already Have It
Wright, Kai, Colorlines Magazine
Garry Wayne Carriker had a pretty promising life ahead of him. He'd graduated from the Air Force Academy back in 2001 and at age 26 was prepared to graduate from Emory University's prestigious medical school this past spring. He probably never dreamed he'd instead spend most of the year sitting in an Atlanta jail. But at summer's end, that's just where he was, awaiting trial on three counts of a sex-crime that could get him 30 years behind bars.
Carriker's not a rapist or a child molester, but many consider his alleged crime equally horrific. The Atlanta attorney who is representing one of Carriker's seeming victims in a civil suit compared his actions to "shooting bullets into the crowd." Carriker is charged with having consensual sex with a guy he was casually dating without telling the man he is HIV positive. He was arrested and released on bond, but then two additional men came forward with similar charges. So a judge locked him back up, where he remained at this article's writing.
Publicly, it's still unclear when or how Carriker found out he was positive. It's also unclear exactly what sex acts he and his boyfriend, John Withrow, engaged in together, or if they used protection when doing anything in which HIV could have been transmitted. Not that any of those details matter much to the law. Nor does it matter that Withrow never actually contracted HIV. All that matters is that Carriker had sex without telling. In Georgia, as well as in dozens of other states, that's a prosecutable offense.
Carriker, who is white, is the latest in what has been a steady, if small, stream of such prosecutions across the country since the late 1980s. The most agressively pursued cases--both by prosecutors and by news media eager to cover the action--have been those involving Black men, often who have migrated to rural areas and have had sex with white women. They represent the extreme end of a once-derided perspective that is gaining considerable currency in the world of HIV prevention. With the U.S. epidemic larger--and Blacker--than it's ever been, the growing consensus among health officials and community activists alike is that the only way to stop the virus' spread is to control the behavior of those who already have it.
An increasingly popular quip bouncing around the halls of AIDS conferences sums up the new zeitgeist. Every instance of HIV transmission, one knowingly remarks, involves someone who's HIV positive. This truism ignores its corollary: There's always a negative person in the mix, too.
From tuberculosis to syphilis, Western public health has long employed a straightforward and largely successful formula to controlling communicable diseases: find the carriers, treat them, determine who they may have already infected and repeat. Confine those who can't or won't cooperate. Why not adopt this "screen and treat" approach to HIV? Science can't expunge the virus from folks' bodies, but it can suppress it to low enough levels that it's harder to transmit. And there's at least some research that shows people who are engaged in treatment are less likely to do things to risk exposing others to the virus.
But HIV has never been just another communicable disease; it's passed on by used needles and sex, often of the taboo sort, be it between men or just outside of marital monogamy. So for years, HIV prevention considered the complicated emotions that drive sexual behavior, from the quest for intimacy to the urge for adventure, to be far too layered for single-bullet solutions. Health educators held transmission's duality as their guiding principle--it takes two to do the AIDS tango--and crafted campaigns that urged every individual to take personal responsibility for his or her own health.
But after 25 years of this approach, the epidemic is still raging out of control. …