Cover Image

Not for Sale

View/Hide Left Panel

“The counseling and testing numbers for January, February, and March.”

“What’s the matter with them?”

Ruth was a meticulous person who carried the day-to-day activities of the clinic on her shoulders. She took pride in the counseling and testing program. No other clinic for the homeless had one, and she had developed it from scratch. She stopped making copies at the Xerox machine and came into my office. If there was a problem, we needed to fix it immediately.

“The numbers testing positive seem awfully high. Seven out of 40 for January, 10 out of 53 in February, 12 out of 42 in March. That’s going to average somewhere between 15 and 20 percent.”

“That’s what we’ve been averaging since we started testing. Is this the first time you’ve read my report?”

“I must have made a mental error with my decimal points. But could this really be true? Nobody has numbers this high. Fifteen to 20 per thousand is high, but 15 to 20 per 100? Could there be a bias? Do only those who feel sick ask to be tested?”

“I don’t think so, since the Centers for Disease Control gets pretty much the same numbers from their seroprevalence study. The interesting thing is that it’s pretty much all heterosexual transmission. I’ll show you.” She got up, went to her office, and returned with more data. “You see, we have very few gays, and surprisingly few IV drug users. The prevalence in men and women is essentially the same.”

“What’s this ‘sexual assault’ category?”

“Oh, those are guys who had nonconsensual sex in prison. But even if you factor that in, it’s still mostly heterosexual sex.”

“How do you explain it?”

“Crack cocaine, sex with prostitutes, lots of unprotected sex. The price of a ‘basic service’ by a street prostitute is the same as a ‘nickel bag’ of cocaine—$5. That’s not an accident. For the drug dealers, crack is literally money that grows on trees. They give a huge discount for volume. Sex and crack, the opiates of the homeless. I saw oral sex performed for bus fare—75¢—right on the sidewalk in front

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement