I don’t look as the nurse slides the needle under my skin. She moves quickly, her fingers snapping new vials onto the syringe. Three tubes on the formica countertop are filled with purpley blood, still bubbling.

“Are you OK?” she asks.

“I just don’t like to watch,” I say, keeping my voice low and even and sane-sounding. In movies, I’d rather watch a beheading than an injection. Something about the metal slipping into skin, into the vein. Mom once told me she was glad “because at least I know you’ll never start shooting up.”

“All done,” says the nurse, and opens a small circle of plastic band-aid. “Press hard on it, or you’ll get a bruise.” I get my bloodwork done here regularly. I listen to her voice, trying to tell if she is more careful this time, seeing HIV on the lab request.

“When was the first time you heard about AIDS? Back before it was even named that, back when it was GRID and only fags could get it? Back when men fucked monkeys and one evil guy flew all over the world and spread death in creamy bullets? Back when people died, all the time, like Paul, who I hardly knew even before he became unrecognizable, taking up a third of a hospital bed, a face full of bruise-coloured sores. Back when everyone was scared, of everything, everywhere, crack heads, drive-bys, kissing. Did you read Newsweek cover stories about Africa, AZT, or the poor hemophiliacs who didn’t deserve the disease? Did you take your kids out of school or stop drinking from fountains?

Everyone is so enlightened now. Everyone knows hugging is OK. Everyone knows that latex condoms, when used effectively, have an over 90% chance of preventing transmission of the HIV virus. Oh, yeah, it’s universal knowledge. So why is condom use down? Why are new cases of HIV on the rise among heterosexual women? Let’s face it, people are tired. You don’t believe your partners are Positive, because they would tell you. You haven’t been tested yourself for so long because you feel fine, and everyone you’ve been with looks fine too. So HIV can lie dormant for 10 years. You still don’t think you’re at risk. Not really. And if you were, would you really want to know?

Have you ever thought about the word 'tolerant'? There are things out there that are different from you, but you can tolerate them. You can put up with them, foreign as they may be, misguided as they may seem to you. Oh, leather queens, squeegee kids, sex trade workers, heroin addicts, male to female transsexuals: it’s OK that they exist. You don’t mind at all, though maybe it would be good to help some of them out, help them out of their situations. Right? Nothing wrong with helping people. There’s nothing wrong with the people; it’s just the behavior. And people with HIV? Well, you would never discriminate against them. Though if you were hiring, it might be nice to have someone healthy around, someone you could count on for the long haul. Or if you were sending your kid to school, it might worry you a little if the nurse was Positive. And when you meet someone amazing, attractive and funny and down-to-earth, someone you could really fall for, it could ruin everything if they had HIV: everyone knows that safe sex is only for when you don’t know someone’s status, not when the results are back and the death warrant signed.”

J.’s eyes are sharp, dark, bruised around the edges. Through them I am female, attractive, and distant. He is half-Cree, half ghost, walking into the needle exchange where I volunteer. He wears the same red plaid flannel and jeans whenever he comes in. He only takes a couple of rigs at a time, never seems happy about it. When we go outside for a smoke, he asks me for a hug. “You’re real pretty,” he says. I always laugh, because I like him, but not that that way. He’s 38 years old, and he doesn’t think he’ll ever have sex again, and that can get to you. J.’s hands are always clenched. He has long, slender brown fingers. “Once I went after a guy with a hammer,” he says, thinking he’ll warn me off. He’s been locked up before; now he’s only trapped. I consider sleeping with him, to show him someone would, that all this safe sex stuff isn’t just talk. I want someone to sleep with him, to ease his pain. He may never be inside someone again, bare, unless he lies. I don’t even kiss him, because then I’d be lying.

When I met J., he was clean. The first time he came into the needle exchange, he winced when he saw me. I tried to show him I didn’t think there was anything wrong. If I were him, maybe I’d use too. He’s not sick, not yet. Once you get really sick, you never get all the way well. He’s so thin, though. “I just got a new computer,” he tells me. He sends me emails with punctuation-smiles. When he doesn’t write back, I worry. The drugs or the disease, it’s hard to know which one is more dangerous. I’m not so scared of needles anymore, but I won’t shoot drugs because I know I would like it too much. I wish the world gave him something that seemed to matter more.

J. is a typical victim of an epidemic-- he comes from a ‘disadvantaged population.’ It seems like cultural Darwinism in a virulent form, socially manufactured biology. When it emerged as a public health concern, AIDS was a disease of gay men. IV drug users, especially those affected by poverty, were the next casualties. Now AIDS in North America is increasing in Native and other non-white populations, as well as in heterosexual women, especially among the poor and working-class. Most people know that AIDS has affected many regions in the third world severely, especially in Sub-Saharan Africa, where women are the worst-hit population. Getting treatment can still be difficult here in North America. So many times I’ve heard about HIV+ people going to the doctor for something unrelated- a broken bone, for example- and being treated like a walking pathogen, with nurses who refuse to touch them and doctors who speak about them as though they couldn’t hear.

Worldwide, the spread of AIDS and other epidemics has overwhelmed the supply of specialists, even GPs and nurses, and the cost of drug therapy is out of reach for many third world governments and inhabitants. In many cultures, including North American, women and girls often rely on their male partners to provide protection, and that leaves them vulnerable. Physiology puts women at a much greater risk of contracting HIV through heterosexual sex.

In a presentation at the York House private school for girls, Stephanie and I do a YouthCO presentation for a group of 16 tenth graders, asking them if they know how to put on a condom and which body fluids transmit HIV. “HIV lives in all body fluids, but only a few contain high enough concentrations to transmit,” Stephanie says. “The big four are blood, semen, breast milk, and vaginal fluid.” I write them on a flip chart with a blueberry marker. “Spinal fluid has it too, but that’s getting pretty kinky.” A few girls giggle. “You’d have to drink 18 gallons of saliva to achieve transmissible levels- one looong kiss. You’d have to ingest a bathtub full of urine.”

“Eeew,” some of the girls squeal. Mostly they’re pretty unfazable, though when Stephanie mentions something about having sex “up the bum,” there is a little ripple. Then one of the more outspoken girls proclaims that there is nothing wrong with it if that’s what people want to do. “It’s just different,” she says. When I was in school, I had not one day of sex education, except the basics of reproduction in biology. The logistics were never discussed. These girls seem totally frank; talking to their teacher after our speak, there is no sense of judgement about the girls’ sexual activity. “Some of them aren’t really ready for it,” she says, “but several of them are there.” Most of the girls take condoms at the end. The kids at the alternative schools we visit are rarely this comfortable.

YouthCO, the organization that we volunteer for, has two mandates: education, which is our department and “first-step” services for HIV+ youth, including peer counseling. Educators don’t have to identify as Positive. They don’t even have to practice safe sex. Stephanie has a girlfriend, and I’m what my friend Matt called an “equal opportunity sweetheart.” A lot of the women who work around AIDS are queer, and we know just how to employ a dental dam or how to keep toys safe. We even have easy access to the paraphernalia. But how many of us actually walk the walk? Lesbians in this field have told me that women who only sleep with women who only sleep with women (etc.) do not get HIV. Putting aside the fact that very few women never sleep with a man or at least a woman who has, we spend all this time teaching that HIV is in vaginal fluids. I’m not sure we really believe it, or else we’re in denial. It’s worse for me, I guess. I’m the girl that fucks it up for the rest of them, sleeping with men. Doubly incautious. In a film I saw at YouthCO, produced by young people with HIV, one of the subjects says, “I was careful, I took all the precautions. Except for one or two times.” When that needle was in my arm collecting the test material, I was thinking of those one or two times. I haven’t been reckless. But I can’t say I’ve never taken risks. Isn’t that what being young is for?

It helps me to imagine how it works. The HIV virus looks kind of like the Expo dome with little feet sticking out of it all over, only so very small it’s not visible under a microscope. It enters the bloodstream, finding a CD4 cell, so named because the outside protein layer of the cell contains CD4 receptors, to which the HIV feet attach. (These are also called helper T-cells). Then the protein layer of the virus melds with the protein layer of the cell, and the insides of the virus, the RNA (ribonucleic acid) and some enzymes, enter the cell. HIV is an RNA virus, which means the information it carries has to be transcribed into DNA within the host cell. Because an RNA virus relies on a duplication process to make DNA, mistakes, or mutations, are frequent. Mutations in the virus make treatment and prevention hard, because different strains may be associated with different drug resistances, and effective vaccinations are nearly impossible. (The viruses that cause the flu are also RNA viruses, and their tendency to mutate is why you have to get a new flu shot each year).

HIV belongs to a relatively rare subset of RNA viruses called retroviruses, which ingeniously alter the cell to manufacture more virus. For HIV genes to get into the host cell's DNA, the viral RNA has to be converted to DNA. One enzyme makes a single strand of DNA from the viral RNA, and also acts like a kind of offset Xerox machine, producing a partner strand of DNA to match the initial single strand. Another enzyme breaks down the RNA once it has been copied. The result is a double-stranded DNA replica of the original RNA template.

The new viral DNA is inserted into the cell’s DNA by yet another enzyme. Then the combined DNA produces messenger RNA (mRNA), which tells the cell to make new sets of viral RNA and enzymes. The viral components gather at the edge of the cell and push themselves out, taking part of the cell membrane with them as a wrapper. The cell usually dies, either by losing strength from this “viral budding,” or by being attacked by the body’s own immune system. Since the CD4 cells are themselves important immune system components, their annihilation alone seriously compromises the health of the infected person. The amount of virus in an HIV+ person’s blood has been shown to be proportional in many cases to how sick the person gets. Sometimes talking about all the numbers and proteins and functions makes it hard to remember the Human part of HIV.

There’s something beautiful and strange about a virus: angular, active but not quite alive. A protein-coated plan, no nucleus, no cytoplasm. One theory proposes that they’re from outer space (not a widely held theory, but Fred Hoyle was knighted in 1972 for originating it). A more popular theory contends that viruses are “rebel human DNA.” Viruses change the evolutionary course of ecosystems, and might be credited for the otherwise inexplicable synchronicity in any given environment. For example, a butterfly and the flower it feeds upon may have the exact same shade of yellow in their colouring. The slow process of evolution seems an unlikely explanation. Viruses keep the large-scale environment healthy by keeping the gene pool from stagnating.

On the smaller scale of humanity, and the micro level of people I know, this theory isn’t wildly comforting. HIV is a fairly efficient virus, allowing the carrier to live long enough to pass the virus to new hosts. But a really efficient virus would never kill the host; the influenza virus collective is a powerhouse because it never really reaches a dead-end. The Ebola virus, on the other hand, is ‘powerful,’ in that it kills horribly, but is “weak” because it kills too quickly to allow the virus to travel any great distance and is easily contained. HIV also suffers from its transmission method; it is a fragile thing out of the body. It depends on sex or drug use to be passed along, behaviors that are surrounded by social stigmas. It’s hard to avoid the why of HIV.

Back when HIV was new, the evangelists got on TV to say gay people deserved AIDS and HIV was the modern version of the burning of Sodom and Gomorrah. Then when the IV drug users became the fastest-growing infected population, the blame got more inclusive. Teaching people about safe sex sometimes makes me feel like I’m telling women not to wear short skirts if they don’t want to get raped. In a perfect world, sex wouldn’t be about responsibilities and protection; it would be about pleasure and engagement. By telling people how they should have sex in order to protect themselves from HIV and other STDs, I feel as though I’m saying the people who got HIV screwed up, failed somehow. Young people live in a world where sex has the overtones of death and has during the whole time they’ve been sexually active. Even though other STDs are far more common for young people (in the US, one in five people between the ages of 18-40 has genital herpes, for example), the emotional resonance of AIDS underlies every sexual act. And as youth have always done, young people today want to make their own rules. They feel the risk but think they, the individuals, will escape harm.

I’m no different. Getting tested has always scared me. “I know I’m not Positive, but what if I am?” I ask my friend. I feel like I can’t tell anyone from YouthCO or the needle exchange, because I really should have known better than to take risks. Not just with myself, that’s the part that scares me. You know, going in for results, that your whole life could change, and somehow it seems like it’s the knowledge itself that will change you, not the disease. And I haven’t gotten the results yet. They say people get tested all the time and never come in for the results. I know I’m not Positive. I’m too healthy. None of my former partners are Positive, they would have told me. I get my bloodwork done so often, wouldn’t they have checked already? I’m not Positive, but I’m not sure.