The Winners: Profiles in Courage, Compassion and Fortitude

Troy Duke

In fact, several HIV Leadership Award winners are current or former members of the military, or care for HIV-positive officers and veterans. Troy Duke, for instance, is an HIV-positive active Navy officer in Virginia who is also a peer counselor. He is getting ready to appear in an educational film on HIV that will be shown to military personnel.

Research nurse Tari Gilbert sees a significant population of active military personnel in San Diego. She says, "There is a silence that accompanies being in the military in the first place: Don't ask, don't tell." That silence makes her job much more challenging, particularly when caring for active-duty personnel. "There is the difficulty of seeing your patients be sent off to war," she says. "I know they're not supposed to be placed in a war zone when they are positive, but sometimes this detail seems to slip through."

HIV in Prisons

While the Veterans Administration seems to be delivering high quality care to the many HIV-positive veterans, the exact opposite is true about another government-run entity -- prisons.

"Up to 15% of the 11 million people who spend time in jail every year are thought to be HIV positive."

Up to 15% of the 11 million people who spend time in jail every year are thought to be HIV positive. Joseph Bick, M.D., one of the United States' leaders in this area, provides care for more than 500 HIV-positive prisoners at the California Medical Facility, a healthcare state prison facility. He's a passionate advocate for their care.

"Whether you care about prisoners or not," says Dr. Bick, "you should understand that we can't have a healthy society unless we provide them the best medical care possible -- especially with regard to HIV." He notes that 20% of HIV-positive Americans and a third of those with hepatitis C or active tuberculosis have been incarcerated at some point in their lives. "They're still human beings," Dr. Bick adds pointedly, "and most of these guys are going to get out of prison someday."

The Spread of Crystal Meth

Finally, many of TheBody.com's HIV Leadership Award winners work in urban centers, where HIV first began to spread in the 1980s and where, today, wildly divergent facets of the epidemic -- the powerlessness of women, drug use, poverty, immigration -- come together, making effective care an extremely complicated affair.

Urban areas are also where you can now see more of the much-talked about crystal methamphetamine epidemic, which isn't only leading to a rash of new HIV infections; it's also impacting HIV-positive people, some of whom are so hooked on meth that they can't remember (or be bothered) to take their meds.

	Eric Daar, M.D.

People like Eric Daar, M.D., of Los Angeles, can speak to this. As an investigator for large research trials, he sees a growing number of gay, white men testing positive because of crystal methamphetamine. It's an incredible, frightening trend for a population that was torn apart by HIV in the 1980s and 1990s; for many long-time AIDS advocates and healthcare workers, it's the worst kind of déjà vu. Other healthcare workers note that meth use is becoming common in rural areas as well.