By Justin Hayford
As the man at the far end of the gym adds another weight to his rack, his upper arms bulge so that the skin seems ready to tear. His shoulders seem armor plated, giving him a permanent menacing hunch. His chest bulges out of his blue tank top, as though copied from the pages of a comic book.
If you've spent any time in east Lakeview, Chicago's gay ghetto, you've seen him, or someone who looks just like him, turning heads on the street, fawned over at the bars. And if you believe the ads in every gay publication and bar window, he's the person all gay men aspire to be.
But in this Boys Town health club, known on the street as the "steroid gym," he's a dime a dozen. The place won't be busy until after dinner, but already several men as monstrous as the blue-tank-top guy lumber about the cavernous room packed with workout machines and free weights. No one smiles. You can almost smell the testosterone--and it's a good bet much of it came streaming out of large-gauge needles jabbed into these men's thighs. Scoring steroids and syringes on Lakeview's thriving black market isn't cheap; according to one source, a bottle containing two shots of testosterone goes for $150, five times its pharmacy price. And it's not uncommon for muscle men to reuse and share needles--a more efficient way to transmit HIV than sex without a condom.
As the man in the blue tank top begins lifting a huge stack of weights, Richard (not his real name) begins his workout. He last injected himself with testosterone and Deca-Durabolin seven days ago, and he's due for another shot when he gets home. Although he has the bulky upper body typical of someone on steroids, he'll never achieve the size of the other guys in the gym. Richard is battling HIV-related wasting syndrome, and the steroids he injects are prescribed by his doctor to help him maintain the weight HIV would otherwise drain from him. He comes here every day; if he doesn't work out, the steroids will just add fat to his frame. Like many gay men steeped in a muscle-crazed culture, he admits that using steroids was a great temptation before he had a medical excuse to start. "I was glad to get a diagnosis of wasting syndrome," he says, without a hint of irony. "I could finally use steroids. I could look like everybody else. Except when you think about it, that's not everybody else. It's wanting to look like the A crowd."
Since his insurance pays for his steroids and his syringes, he doesn't need to share. And since he knows his HIV status and understands the risk, he wouldn't anyway. "But there are a couple of guys in my building who don't know their status, and I know they're shooting up," he says. "When I lived in New York it was very common to see guys shooting up in the locker room, sometimes sharing needles. I once saw four guys inject off the same needle."
Since the epidemic started almost two decades ago, HIV-prevention messages targeting gay men have for the most part suggested that their risk comes from only one source: unprotected sex. Needle sharing, if mentioned at all, is typically discussed in the context of narcotics use. The mainstream media's incessant use of the strung-out street junkie as the icon of needle-related HIV infection further obscures the risk many steroid users face.
Trying to figure out how many men share needles and how many have been infected as a consequence is next to impossible. Although the Chicago Department of Public Health keeps track of patients' HIV risk factors in its AIDS case reports, the form merely asks if "this person injected nonprescription drugs since 1977." Jim Murphy, an epidemiologist with the department, says, "They could be shooting heroin or cocaine or steroids. Our record keeping doesn't break it down any further." However, the department's records do show that in 1998, for the first time, injected-drug use became the largest risk factor associated with new AIDS cases, accounting for 45 percent of those cases. Men having sex with men, which had been the predominant transmission mode since records started being kept, accounted for 40 percent.
To make matters worse, steroid use among gay men in Chicago is a well-guarded secret, despite the bulging evidence. As Richard discovered when he moved here from New York last year, "No one here will talk about it. Many times I've talked to friends and said, 'You know, your body has really changed a lot over the past year. What are you doing?' That's a pretty common question in New York--I heard people asked that all the time and answering, 'Oh, my combination is Deca-Durabolin and testosterone' or whatever. But I don't hear that in Chicago. This one guy I met here was probably 150 pounds six months ago. Now he's topping 200. I'll say to him, 'What are you using these days?' And he'll say, 'Oh, nothing, nothing, nothing.' The only time someone has admitted it to me is when we shared the same doctor and we were prescribed the same thing. But otherwise, all these guys want you to think their muscles are totally natural."
Richard estimates that three-quarters of the guys at his gym are using. "You can tell when a body is on steroids," he says, pointing at guys as they move from exercise machine to exercise machine. "It's a different muscle type, a different skin type. And testosterone makes the nipples protrude--the whole areola sticks out and points down a little bit. They call it 'bitch tits.'"
The silence about steroid use may prove deadly. Ann Sanders, community-outreach coordinator at the north side's Test Positive Aware Network, says, "HIV-prevention messages haven't begun to touch upon steroid use. And somebody needs to start--because this is happening."
Every Wednesday at 5 PM, Sanders makes a modest attempt to break the silence. In TPAN's large conference room--with its mismatched chairs, old stereo, and uncovered insulation on the ceiling--she sets up a card table lined with alcohol swabs, tiny cotton balls, drug cookers, and, "just for something nice," breath mints. Next to her table is a large biohazard container, and behind her is a green plastic tub containing several hundred syringes, ready to be handed out to anyone who happens to come in with dirty needles to trade. She has two types of syringes on hand: little orange ones for narcotics and big green ones for steroids.
This is Chicago's newest needle-exchange site and the first ever in Lakeview, where HIV-infection rates have always been among the highest in the city. It's a joint venture between TPAN and the Chicago Recovery Alliance, which started exchanging needles in January 1992. Today CRA operates 19 office- or van-based needle-exchange sites around the city, as well as two "cell-phone delivery areas," in Maywood and Chicago Heights. People in Evanston and Joliet can also page CRA and have needles delivered.
CRA's success has been impressive. Its research shows an almost 90 percent reduction in disease-transmitting injection practices among people who use its service, while the average number of times a syringe is used has dropped from 9.14 to 1.41. According to Dan Bigg, head of CRA, a yearlong study of 99 Chicago injectors conducted in 1994 found that the rate of new HIV infection among those who'd never exchanged needles was 14 percent, while the rate among those who had exchanged was zero.
This new site opened a year ago. "We've known for years that a group of needle users that is often overlooked is the steroid users," explains TPAN's executive director, Dennis Hartke. "We realized that here we are, we've been here 11 years, they trust us, they come to us for safer-sex information--maybe now they will come to exchange their needles rather than sharing. And we felt that these are people who are probably comfortable walking into our office building--but might not be comfortable walking into a van in an alley to get needles." Without the TPAN site, the nearest needle-exchange location would be in Uptown, where the CRA's silver van parks every Sunday afternoon at Wilson and Clifton, a decrepit corner known to the locals as "blood alley."
"We knew about the gym boys," Sanders quickly points out. "But we also knew that homemakers, bankers, schoolteachers, grandparents--these people also inject. It's not just a problem that affects people who are homeless, or 'the junkie,' the people you see on Law & Order. That's just not reality. People who don't believe that should drop by any Wednesday and see who walks in our door. We're also reaching transgendered people who are probably not working with a doctor and [who are] shooting up black-market [female] hormones."
There's no limit on the number of needles people can exchange. The first five are exchanged one used for two new; after that it's one for one. "We had one person bring in 2,000 needles," says Sanders, laughing incredulously. "Another brought in 600. Some bring in bags and bags, making a run for several people. We don't count them--we don't want our people touching them. We just have the person dump them in the sharps container and trust what they tell us. We have one person who, bless his heart, brings in his five needles every week. He knows he could get ten, but all he wants is his five."
In its first eight months of operation, the site served only 49 people. "Unfortunately we haven't been as aggressive as we'd like to be in promoting this among the gyms," Hartke says, adding that for the most part, area gyms have been receptive to their outreach efforts. Still, those 49 clients exchanged more than 6,500 needles. Sanders estimates that 30 percent of them were steroid needles.
Last fall a nurse from Sinai Family Health Centers began working at TPAN's exchange site, offering to help anyone who had an abscess that needed attention or who wanted an HIV test or simply needed basic health care. "But it's not just the needles and the nurse that are important to us," Hartke says. "It's getting people in here and presenting them with information. We don't lecture them, but I think that picking up needles at an HIV service agency highlights the risk they take if they share needles. It's a subtle but powerful message."
It's also a message Hartke thinks too many people--and not just the gym boys--have missed. "I'm not sure that the, shall we say, upscale illicit-drug injector sees that risk. Because the risk is always associated with people on the street, with 'dirty' people. It's the same way we were led to believe that only 'promiscuous' sex spread HIV in the early years of the epidemic. So the businessman who shoots up can think, 'The person I'm sharing needles with, he's an executive. He couldn't possibly have HIV or hepatitis.' The real problem with the crowd we're trying to reach is that they don't understand that they should be reached."
Steroid use also poses health risks such as liver damage and malignant tumors. Yet gay social-service agencies and health organizations have remained largely silent on that issue as well as on the risk of sharing needles used to shoot up steroids. As one official at Horizons Community Services says, "We're still at the stage of trying to figure out how to address the problem."
The biggest obstacle to getting the message out may be the infatuation in gay culture with muscle mass, an infatuation that has been exploited to market everything from dance music to advances on life-insurance policies. The muscle man--buff or ripped--is everywhere in gay culture, the mute spokesman offered up for public consumption and community approval. That Richard sees his diagnosis of wasting syndrome--once the most horrifying news a gay man could receive--as a boon to his quest for the body beautiful gives some indication of the depth of the obsession in gay culture. Social workers and nurse practitioners with two-color pamphlets don't stand much of a chance against decades of cultural programming.
And given the addictive rush steroids provide and the ongoing misinformation campaign about the new benign nature of AIDS thanks to protease-inhibitor therapy, where will gay men find reasons to stop shooting up, let alone sharing needles? If almost two decades of aggressive safe-sex outreach to gay men hasn't stopped a resurgence of bareback sex, how will the steroid users, largely ignored until now, be persuaded?
Art accompanying story in printed newspaper (not available in this archive): illustration/Andrew Epstein.