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At 2 a.m. on an unusually warm Saturday in November, Hadley sat in the back of a taxi, his head leaning on the windowpane. He was sobbing. It was an anniversary of sorts -- it had been one year since he tested positive.
That night, like many others, Hadley had anonymous sex with another HIV-positive man he met at a bar. But it wasn't the man or the experience that brought Hadley to tears. He was struggling to quell an anxiety attack, fueled by a doctor's appointment he'd had earlier that day.
At a regular checkup with his physician, Hadley broached a subject that had become the source of his recent paranoia -- HIV superinfection.
"I hear about it all the time. But I wanted real answers," he says.
Superinfection is said to happen when someone who is already infected with HIV is later reinfected with another strain of the virus. Recent studies suggest that becoming superinfected could speed up the progression of HIV to AIDS. The possibility also exists that someone responding well to medication may subsequently acquire a drug-resistant, untreatable strain of the virus.
Hadley has battled anxiety and hypochondria for years. And the recent talk of superinfection among his peers triggered the darker side of his imagination.
"I became obsessed with thinking about it. I'd imagine new viruses attacking me while I was in the middle of having sex," he says, rolling his eyes at himself. "It got to me more than I'd like to admit. I'm terrified of superinfection."
That morning when Hadley asked about the dreaded superinfection, his doctor emphatically warned him not to have unprotected sex for fear of acquiring another virus. "He said, 'You are very at risk for superinfection because you've been recently infected. You could get a new strain [of HIV] that is drug resistant. Your HIV could become untreatable. Don't put yourself at risk for that,'" Hadley recalls.
But when Hadley asked for more details, the doctor had none. "It was like, 'You're at risk and you're screwed if you get it, but I don't really know what it is.'" (Hadley declined to name his physician.)
That night as he rode home in a taxi, Hadley was gripped by a new fear. He had just come to terms with his life as an HIV-positive man, but what if he had been superinfected? What if tonight's handsome stranger carried a drug-resistant strain of HIV that at that very moment was preparing to attack his already weak immune system? The unanswerable questions were too much for Hadley; all he could do was cry.
"When I tested positive, I knew I had options. I knew HIV was treatable, and I knew my life wasn't over. But superinfection scares the shit out of me. It's like the great unknown."
Hadley is right: Superinfection is still a mystery. Many doctors and scientists warn that superinfection can lead to a worse long-term prognosis and limited treatment options, but those warnings are premature. And Hadley's fear of superinfection is far from justified. In the annals of science, even the existence of superinfection is yet to be explicitly proven.
Hadley is waif thin and nearly 6 feet tall, with unruly wavy brown hair and bright hazel eyes. When he moved to San Francisco from Tucson in 2003, he says, his sexual habits changed. "I got a ton of attention all of a sudden," he says while absent-mindedly spinning a lukewarm cup of cappuccino in a downtown Starbucks.
Hadley says he had at least 100 sexual partners in his first six months in San Francisco. Many of those encounters were unprotected. "That's when I got it," he says of his HIV infection, shaking his head and pausing to pet his Chihuahua, Lady Layla, who has popped her head out of the lavish Louis Vuitton pet carrier Hadley totes everywhere he goes.
After Hadley found out he was positive, he says, he went through a period of "extreme promiscuity," racking up an estimated 300 more partners in his first year of infection. He says he did not know the status of many of those partners.
He knows he may have put a lot of people at risk for HIV, especially because in the initial period of infection HIV is extremely contagious. Hadley later learned that emerging theories suggest that in the first years of infection he may also be more at risk for superinfection.
But the debate is still far from settled.
"Some of my friends say it doesn't exist. But my doctor seemed to think it was going to be the end of me," he says.
Hadley is certainly not the only gay man in San Francisco to get mixed messages about superinfection. It is a frequent topic in doctors' offices, among friends, and at meetings around town.
Brian Gonzales, 28, who hosts AIDS support-group gatherings at his home, says the topic of superinfection often leads to frenzied meetings. A few months ago someone came with printouts from Internet sites that warned about the dangers of superinfection. "Most of it was total BS, but he was screaming and yelling about safe sex and how superinfection was going to be the thing to wipe us all out," Gonzales recalls. "His information was from random blogs and Web sites, but he was repeating it like it was the word of God. I think he scared the shit out of all of us because we didn't know better and no one else out there is telling us what the truth is."