Running on Empty 

With the recent loss of a major grant, outreach workers across the state fight to keep HIV and hepatitis C prevention programs from disappearing.

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Shortly after Montgomery's death, Holman began losing weight and developed flu-like symptoms he couldn't shake. At first, he ignored it. When finally he succumbed to an HIV test in 1998, Holman had 27 T-cells; a healthy individual typically has more than 500. Doctors told Holman he'd contracted HIV and that he probably wouldn't live six months.

"The first thing the doctor told me was get my stuff in order," Holman says.

He immediately began taking the immune system boosting medicines prescribed by his doctors. Holman credits those drugs for his longevity. He still takes four pills a day, every day.

Now balding and with a paunch, Holman says his T-cell count is up to 500. He feels good enough, which is important because he keeps a busy schedule. As the executive director of Butte AIDS Support Services (BASS), Holman started conducting HIV outreach in Montana the same year he was diagnosed with AIDS. MTAP hired him as a subcontractor in 2000. He estimates that through MTAP he tested roughly 10 men for HIV monthly. As is the case with the Spotted Eagles, the Rudds, and the other MTAP outreach workers, Holman knows his demographic.

"So many of our clients are very secretive about their lives," Holman says. "A lot of married men test with us on a regular basis, bisexuals. It's just a very, very difficult population to reach."

Also like the other former subcontractors, Holman is watching his supplies run low. He doesn't want to charge for HIV tests and says he'll take measures to prevent any fee. Asking people to cover even the expense of an HIV test—about $15—would create yet another excuse to keep from getting tested.

Although the MTAP cut hurts, Holman insists BASS will persevere. The organization has to, he says. Thirty years after the virus emerged, decimating a generation of gay men, Holman worries that people are forgetting its impact. Despite the staggering statistics—25 million dead across the globe, 33 million more living with the disease—it's not talked about anymore, it's not on television and it's not discussed in schools like it was in the past.

"If we don't educate [young adults]," he says, "we are going to see deaths down the road."

HIV remains a threat in Montana. New infection rates have steadily trended up since 1985 and, as of last year, the state Department of Health and Human Services recorded 445 HIV-infected people in the state.

In 2007, only 35 percent of Montanans between the ages of 18 and 64 reported they'd been tested for HIV, according to the CDC's Behavioral Risk Factor Surveillance System.

Nationally, new infection rates have remained relatively stable, with roughly 55,000 new cases per year since the mid-1990s, according to the CDC. But gay men continue to contract the disease at an alarming rate. In fact, CDC charted a 12.4 percent annual increase in new diagnoses among men between the ages of 13 and 24 who reported having sex with other men between 2001 and 2006.

Health experts say the increase is likely a result of growing complacency fueled by the reassurance of improved HIV drugs. Medicines are becoming increasingly effective, switching a positive test from a death sentence to a life battling a chronic disease.

That's not to say living with HIV is easy. Antiretroviral medicines cause a range of side effects including heart, liver and kidney dysfunction. The meds can also trigger diarrhea, vomiting and lipodystrophy, or fat cell redistribution, which causes thinning of the limbs and an accumulation of fatty tissue at the base of the neck. The latter leaves a telltale sign of HIV—a hunchback.

At least one in five persons living with HIV does not know they are infected, according to the CDC. Forty percent of people with HIV are not diagnosed until they have already developed AIDS, meaning they have a seriously impaired immune system. That process can take up to 10 years from the time one acquires the disease.

click to enlarge Through his work with the Missoula AIDS Council, outreach worker John Neumann mingled among the population most susceptible to HIV: gay men. While at work, Neumann handed out condoms and educated people about the disease and the importance of getting tested. - PHOTO BY CHAD HARDER
  • Photo by Chad Harder
  • Through his work with the Missoula AIDS Council, outreach worker John Neumann mingled among the population most susceptible to HIV: gay men. While at work, Neumann handed out condoms and educated people about the disease and the importance of getting tested.

Newly infected people carry huge amounts of the virus in their blood. Health experts say that unknowing population—the one in five who don't know they carry HIV—is responsible for about half of all new infections.

"If you can get it stopped and get them tested right away, that's the key," Holman says.

John Neumann, MAC's Missoula MTAP outreach worker, echoes the same warning as Holman. Armed with MTAP-supplied condoms, lube and HIV tests, Neumann received an hourly rate—MTAP subcontractors earned, on average, $10.50 per hour—to conduct outreach in sexually charged atmospheres around Missoula. The longtime local regularly navigated porn stores, Internet chat rooms and favored queer watering holes, knowing exactly what to look for.

"I could quickly see when there was a couple that were new, and I also knew which of the young guys were really kind of spreading the oats all around the neighborhood," Neumann says. "Little did they know that that 20 year old that slipped into the bar that is playing the whole innocent Montana boy routine has been with everybody west of the divide. So, my job would be just to go up and introduce myself to these guys and tell them what I do. And, simple as that, it puts it in their head."

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