"I think my wisdom teeth are loose," Julio says as he leans back in the dentist's chair. "The teeth aren't really hurting me or nothing. I just don't want to wait a few months and have to get them taken out in the emergency room."
Julio (not his real name) has full-blown AIDS, and he comes to the Ryan H. White Clinic at the University of Illinois at Chicago's dental school because it's the only dental clinic left in the city that serves exclusively HIV positive patients and because he's ashamed to go anywhere else. "I'm afraid I might run into people," he says. "My mother, father, brother--I haven't told anybody. They would just be hurt."
Dr. Mario Alves, the Brazilian dentist who's run the clinic since it was founded, knows how strong the stigma still is. "We had another Ryan White clinic at 47th Street and King Drive on the south side, but we had to shut it down because it only served HIV patients," he says. "People knew that the patients who went there had HIV, and they started to discriminate against them in their own communities. It's a politically charged issue."
That's why the White clinic at UIC is tucked away in the back corner of the much larger general dental clinic at Polk and Paulina. Its six chairs aren't in a separate room, and there's no sign, so a healthy person who goes to have his teeth cleaned has no way of knowing who's an AIDS patient. That, says Alves, is the only way his clinic can work.
The clinic's story began in 1985, when patients started trickling into the UIC dental school with a mysterious immune disease that nobody was sure how to handle. Alves, who'd been doing postdoctoral work at UIC for two years, had once worked with lepers, who have some of the same symptoms as AIDS patients. So he agreed to take on the new cases.
Alves wanted to stay in the United States. "I liked the patients here, and my wife and kids liked living in America," he says. In 1986 UIC gave him a permanent faculty position.
The early years at the clinic, he says, "were very frustrating. We got a lot of patients with very severe gum disease. Most of them were dying before we could see them three times. After 1989 they were developing more drugs, so things got a little better. We also got our first outside funding that year."
The money came from the Chicago Department of Health and the Ryan White Foundation, the organization named after the hemophiliac boy who wrote a memoir about living with AIDS. They still help fund the clinic, giving it grants of about $350,000 a year, enough to pay a second dentist (a rotating position) and two assistants and to provide most routine dental care free of charge--most of its 3,500 patients are poor and have no regular dentist. "This is a vital and necessary service," says Daniel Ash, of the health department's STD and AIDS division. "Individuals with HIV need to have a place that understands where they're coming from. This clinic does just that. We wish we could give them even more money."
The demand for Alves's services is great, and it's increasing. The health department says about 30,000 people in Chicago are known to be HIV positive and an estimated 60,000 more are infected but don't know it. After the introduction of advanced protease-inhibitor cocktails in the mid-1990s, AIDS patients started living longer, which made them more interested in finding dental care. The number of clients seeking care at the White clinic jumped five years ago, when Loyola University closed its dental school, and again last May, when Northwestern University shut down its school. "We've been overwhelmed since the close of NU," says Alves's wife, Marilda, who was hired eight years ago to oversee the clinic and its research division. "We are the only dental school in the area. The patients are coming in flocks. We don't have enough dentists to see everybody."
The clinic is always busy--Alves and the other dentists spend most of their day moving among five or six patients at a time. They make a point of talking to the patients as much as they can, and they tell plenty of dumb jokes. "We play a lot," says Alves. "I tease them because going to the dentist is a bad experience for all of us. I have bad teeth, so going to the dentist was horrible for me in Brazil. I talk to them a lot to keep their minds off the future. I want them to be comfortable and relaxed."
Every day four or five new patients walk in off the street. They spend about two hours filling out paperwork, answering questions about their general medical history and about their HIV history, including how they got infected. "I deal a lot with the behavioral and cultural differences between the white, black, and Hispanic populations," says Alves. "It's funny--Hispanic men never know how they got it. They just say, 'I don't know.' But most of them got it through prostitutes."
New patients often won't write on the forms that they're HIV positive. Everybody who comes to the clinic has to be HIV positive, which lets them qualify for its reduced rates--they pay nothing for routine or emergency care and half for optional treatments such as crowns and dentures. Alves says it can be hard to find a sensitive way to broach the subject. "I am always very careful asking them if they have HIV," he says. "Maybe I will ask them if they are seeing a specialist for any particular disease or something, but I never ask them directly."
Alves says his clinic wouldn't be so burdened if more dentists would take on HIV positive patients. "There's no real reason for this clinic to exist," he says, irritably. "AIDS is not nearly as dangerous to dentists as tuberculosis or a slew of other diseases. All dentists have to do is follow standard safety precautions they would follow with anyone. There has never been a reported case of a dentist who contracted HIV from a patient."
Alves wasn't always so sure. "In the beginning I had a lot of problems," he says. "I was very afraid. I used to test myself every six months, but after ten years I gave up. Too many poking needles and drawing blood for no reason." He now spends about two weeks every year traveling to dentists' conventions to speak about the issue.
For years Alves found it difficult to persuade dentists to volunteer at the clinic. He still relies mostly on students and foreign dentists to come in one or two days a week, and there are now usually at least two volunteering at any time. "It's much nicer to be a specialist and work with people who are more educated and have more money, like doing cosmetic dentistry or putting on braces," he says. "But this is very fulfilling."
AIDS patients do have special problems. They often have open sores in their mouths, and because their immune systems are weak, they're more prone to fungal infections, gum disease, and tooth decay than other patients. They get extra fluoride treatment, and Alves tries to get them to come in for checkups every three to four months instead of every six. He has to be especially careful with hemophiliacs, because bleeding gums can be fatal. "I like this clinic because I can do everything from oral hygiene to biopsy of tumors," he says. "It's fun to do it. I feel like I am doing something much more important than ordinary dentists--I am treating the whole body of the patients."
Alves works about 70 hours a week and is on 24-hour call. "We have very little time for ourselves," says Marilda. "Most of the time we work seven days a week preparing papers and taking care of patients. But we find time to entertain ourselves." She met Alves in high school in Brazil, dated him in college, and married him in 1966. She taught high school, but started volunteering at the newly opened clinic because she wanted to spend more time with her husband. "His life has become my life," she says.
She too enjoys working at the clinic. "We get letters and presents almost every day," she says. "People send us chocolates all the time." Posted everywhere around the clinic are notes from sick or dying patients.
"In the beginning I was afraid of doing it," Alves says. "Then I was very stressed, tense, and worried about things. Now it's different. I know that what I do makes their lives better. This is why I do it."
Yet he knows he can't do it forever. He's 61, and he worries that the clinic may disappear when he retires. "I am getting old," he says. "There are only four or five more years that I can keep up with the things I'm doing now. I work 10 to 12 hours a day. I need to find somebody to take my place."
Art accompanying story in printed newspaper (not available in this archive): photo/Eric Fogleman.