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The brown teddy bear on Metko Irson's bed stares mournfully with crooked eyes and no nose or mouth. It's a reminder of his mother, who died in a car accident when he was 6 years old, shortly after she gave him the bear. He used to cling to it while he slept, but he's not afraid in the dark anymore.
It's hard to be afraid of anything when you're HIV-positive.
Metko, age 19, didn't have sex without a condom. He didn't get HIV from using needles. He was simply born, rubbing HIV-infected amniotic fluid out of his eyes. He didn't find out until he was 13 years old.
"Children like Metko were born at a time when we didn't know how to prevent perinatal transmission," says AIDS pediatrician Dr. Diane Wara of UC San Francisco. (For reasons of confidentiality, the names of the children in this story -- Metko, Ricky, and Maria -- have been changed.) "There really wasn't much we could do, even if we knew."
Wara notes that most children born with HIV live with foster parents, since their natural parents usually die from AIDS by the time they are teenagers.
"I'd say with about 90 percent of our kids the natural parents are dead," says Estrella Manio, the clinical trials nurse practitioner at UCSF. Metko's father, divorced from his mother when Metko was a baby, died of AIDS-related pneumonia shortly after her death. "At least Metko is lucky, because it's his grandparents who take care of him."
Metko's grandmother, a bustling, white-haired, full-blooded Russian, rations Metko's cigarettes over the course of each day. He counts to see how many he has left before lighting up.
"To me, AIDS is mundane," he says, puffing out a cloud of smoke. It's his ninth cigarette today. His years on the street have carved dark circles under his penetrating eyes. His bushy, dark eyebrows and crooked smile dance across his pale white skin. He's 5-foot-3 and thin -- his mother's addiction to heroin and his premature birth stunted his growth, he says.
"It's not like some soap opera," he says bitterly without breaking eye contact. "If I have HIV, then I have HIV. All that means is that I'm probably going to die a little sooner than somebody else. I don't have mortality issues, not anymore at least. You just learn to live with it, like anybody with cancer, or only one leg. And I hate pity. It makes me feel awkward. I mean, this is my life. If I can handle it, you should be able to."
Metko's lack of fear is not unusual. Wara says children diagnosed with HIV/AIDS handle the news in one of two ways.
"Some of these kids really grow up fast and take responsibility for their disease," she says. "Others handle it just as you'd expect: They figure they're not going to live to be 40, so it doesn't matter what they do. They go out on the streets, do drugs, have sex, and they don't tell anyone they're HIV-positive."
Metko admits he snapped when he found out he had HIV.
"It was pretty awkward how they told me," he says, grimacing. "They brought in all the nurses that knew me, like Estrella, and the doctor, and they said, you know, "We have to tell you something.' I felt like it was entertainment. They all just sat around watching me. It was really embarrassing. So then I'm like, "OK.' It didn't hit me until a couple of months later."
That's when he got angry.
"I thought I only had about five more years left to live, so I should go out with a bang," he says, adjusting the black Raiders hat angled on his head. "I'd get drunk, come home late just to fuck with my grandparents, wouldn't go to school. Stopped believing in God, I was like, "Fuck God, why would God punish me, what have I done to anybody?' There was a lot of self-pity, like "I don't deserve this.'"
He has stepped into the rain outside Starbucks for another cigarette break and watches the passing cars spray sheets of water. Nearby, a mother shields her four huddling children from his drifting smoke. As soon as he notices her irritation, he winces and grinds his cigarette out on the ground, apologizing.
"My two New Year's resolutions -- to stop smoking and to read more." He shakes his head grimly. "But then, maybe I won't stop smoking -- I'm obviously not too worried about cancer."
Metko started smoking when he was 14, about the same time that he ran away and started squatting in abandoned houses with other homeless people. He hopped freight trains all over the country and Mexico, following punk rock bands and wearing the same clothes until they fell apart.
"I didn't like being dirty all the time or being strung out on heroin," he says, swirling the cinnamon on his latte contemplatively. "But it wasn't so bad. The worst thing that ever happened to me was I'd catch a cold, or I'd overdose and the other junkies would have to resuscitate me. We'd eat the leftover fries in thrown-away bags outside McDonald's."