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Manio says she often lectures off the clock, encouraging donations to the UCSF Quality of Life Fund to support children like Metko. Sometimes the money comes out of her own pocket.
"I don't give too much," she says. "I'm not rich. But I give a few dollars whenever I can. I mean, if you can make it better for them, then why not?"
Nearly two out of three women of childbearing age who participate in the California AIDS Drug Assistance Program have annual incomes of less than $7,500.
Shirley Bellano is one of those women. She slumps over her green vinyl tablecloth and stares at the blank wall next to her. She coughs frequently. The Samoan woman's dark hair shrouds the tired eyes within her gaunt, wrinkled face. The blinds are closed throughout the three-bedroom, one-bathroom rented apartment in South San Francisco. The upside-down skeleton of a broken bike lurks in the corner shadows. Outside, a siren wails.
Bellano, mother of four, sighs as she talks about her 10-year-old son Ricky, who was born with HIV. She left him at a neighbor's house so he wouldn't have to talk about his illness.
"He's so angry," she says, closing her eyes. "Once, at the hospital he said to me, "I hate you, because I wouldn't be sick if it weren't for you.' That really hurt, but I can't blame him. Sometimes he says, "I don't want to take the medicine, I just want to die.'"
Twice a day Ricky takes a liquid medicine and seven pills.
Bellano, 43, guesses she may have contracted HIV in 1985, possibly from sharing needles or from her bisexual partner. After she had her second baby and finished serving her jail time for heroin possession in 1986, she got a checkup for pneumonia.
"The doctor told me I was positive with HIV, but at that time I didn't know what that was," she mumbles. "I didn't get no counseling or nothing. I didn't know I could give it to anybody."
She married her husband, who contracted HIV from her and died of AIDS in 1998, and she gave birth to Ricky.
"He was so sickly and he had some kind of bleeding disorder, so we took him to the doctor," she says, her voice controlled. "After that he had to go to the hospital once a month until his immune system got stronger. And now he knows he'll die sooner if he doesn't take his medicines."
Bellano was already five months pregnant with Lucas when Ricky was diagnosed with HIV. Fortunately, she agreed to participate in a study on the effects of AZT on pregnancy, and Lucas was born HIV-negative.
Bellano says she has felt a lot of guilt while raising Ricky.
"It kills me, every day," she says. "I let him get away with so much growing up because I felt bad, but now he's using it to his advantage."
Bellano says her other children resented Ricky while growing up because he got all the attention.
"One of my daughters couldn't wait to get sick because she thought that's what it was all about."
Bellano developed AIDS in 1991.
"When you first hear, you're expecting to die any day. I was so depressed," she says. Now, however, she just feels fortunate that she has lived so long, especially since she doesn't take medicine.
"When I was faced with all those pills I had to take, I just couldn't do it," she says. "I forgot to take them a lot."
Bellano doesn't acknowledge that the pills could extend her life.
"If my time comes, it comes, with the medicine or without," she says. "I could take all the medicine in the world, but if I'm going to die, I'm going to die."
UCSF's Manio notes that mothers like Bellano cause her the most frustration.
"If they can't take care of themselves, then how are they going to take care of their kids?" the nurse asks, her voice grave and irritated. "For instance, one of our patients is dying, but whenever she gets the chance she does drugs. She has two kids, one is infected, and that child keeps saying she doesn't want to outlive her mom. So she refuses to take her meds, her viral load is sky high. What do you do with that?"
Bellano, who is now in drug rehabilitation, says she may start taking medicine soon if doctors find her a more realistic regimen. She feels guilty making her son take medicine even though she doesn't.
"The only reason I'm living now is my kids," she says. "It would be selfish to leave my kids to face the world alone."
Bellano, who got hooked on drugs immediately after finishing high school, doesn't have a job, but she takes a computer class on Saturdays hoping it will eventually lead to a part-time job. She receives state disability money and welfare for her children. Altogether, the four-person family lives on $1,700 a month, and the San Francisco AIDS Foundation pays 67 percent of the rent on the apartment. The family manages, she says.
"I chose to live the life that got me here, but kids who are born with HIV don't have a choice," she says, her face cracking. Her next words echo slowly. "Like my son ... like my son."