The structure of Philadelphia and its neighborhoods helps explain the city's rates, said David Metzger, director of the HIV prevention research division at the University of Pennsylvania School of Medicine. It also makes comparisons tricky.
Old cities in the Northeast, for example, tend to have fixed boundaries. Cities such as Atlanta and Houston periodically "annex" surrounding suburbs. While that practice has no effect on who actually gets HIV, it may lower a city's rate - as if, say, Philadelphia were to annex Lower Merion.
Neighborhood structures may actually cause infection to spread faster, said Metzger, who began studying HIV in the late 1970s, before it had a name.
In the mostly poor, black and Hispanic communities with high rates of HIV in Philadelphia, there is a greater chance of coming in contact with the virus "even if you are not doing practices that are considered particularly risky," he said. Once high levels of virus are circulating among the heterosexual population, it is harder to control.
That's how Lester Faison, the recovering crack addict, believes he was infected. And while he hasn't gotten over the diagnosis - the "tough guy" and one-time drug kingpin says he is now afraid to pursue a woman for fear of being rejected - he is taking classes at the Lax clinic, which diagnosed and got him treated for a heart condition he never knew he had.
With the human immunodeficiency virus slowly weakening his immune system, Faison started on anti-retroviral drugs yesterday. But he expects to be around for quite a while.
"The drug use and the way I was living could have killed me," he said. "God brought me out for a reason.
"Maybe this is the reason," he added. "To teach others about HIV and AIDS."
Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.
