‘Take a pew,’ said the doctor, scanning my medical notes. ‘Been to Africa and playing the field with the local beauties, have we?’ The tone was brisk, enthusiastic, conspiratorial, perhaps even a bit nostalgic. I nodded dumbly. ‘Right-ho, old man, drop the trousers.’
My underwear was a natty repeated pattern of the international warning symbol for radioactivity on a vivid yellow background (Top Man, £4.99). If he registered my little joke, he gave no sign. Instead, an impatient little wave of his hand ordered these down, too. The instant they were down he lunged forward, and without a word of warning assaulted me in an extraordinarily intimate manner with a cotton bud, causing me to jack-knife forward in pain and surprise. After twisting the bud this way and that, he withdrew it, I unbended, and then he whipped out a fresh one and did it again.
Another impatient little wave to pull up my trousers and we moved on to the questionnaire. ‘Did you have unprotected sex?’ ‘Yes.’ ‘Anal sex?’ ‘No.’ ‘Ever had unprotected sex with a foreign person before?’ ‘Yes.’ ‘Ever had a venereal disease before?’ ‘Yes.’ ‘What?’ ‘Gonorrhoea once and I don’t know what the medical term is for crabs.’ ‘Our little unwelcome guests, you mean?’ ‘Yes.’ ‘Do you have any piercings?’ ‘No. I mean yes.’ ‘Have you ever injected drugs?’ ‘No.’ ‘Snorted?’ ‘Yes.’ ‘Slept with a man?’ ‘No.’ ‘Are you taking any prescription drugs?’ ‘No.’ ‘Antibiotics?’ ‘Yes.’ ‘You mean your anti-malarials? Still taking them, I presume? Good man.’
The medical questionnaire completed, the doctor laid down his pen, sat back in his chair and said, ‘They were tarts, I suppose.’ I hesitated. He said, ‘Look. I’ve heard it all before. I was a naval doctor for many years before I did this.’ I didn’t immediately realise that he was referring to the Senior Service, and for a second I stupidly wondered why previous specialisation in the umbilicus should particularly inspire confidence. ‘So — how many?’ he pressed. He looked at me gimlet-eyed, bringing to bear all his years of experience with rough men on high seas to assess my honesty.
‘Two,’ I said primly. ‘They were cousins.’ ‘Related tarts, then.’ ‘They were musicians, at least that’s what they told me.’ ‘Brass section, were they?’ ‘One played the guitar,’ I said, remembering fondly. ‘She sang to me continually.’ ‘But why on earth didn’t you wear a condom, man? It says here you’re a journalist. Do you not read the papers? Don’t you know about the tragically high incidence of HIV in Malawi?’ His tone was more sympathetic than admonitory. He appreciated that not everybody has an abiding interest in epidemiology.
I did know, I said. And the number of funerals I’d seen in a fortnight in Malawi suggested the situation there was every bit as dire as the statistics suggested. But until I got back home and looked up HIV on the NHS Direct website, I said, I was under the impression that it was difficult to contract HIV from a woman, and that the virus could only pass through broken skin. (The doctor collapsed back in his chair, signifying despair.)
I then told him about the time, nearly ten years before, I visited a reformed sex workers’ collective in Zambia with one of my heroes, the late Ian Dury. He was promoting a Unicef drive to eradicate polio from the world. I was a reporter. The reformed sex workers sang for us, and then a spokesperson told us about how they had successfully reformed themselves via useful and profitable craft work. When she’d finished her account, she asked if any of us had any questions.
I had, I said. I understand that HIV is passed via broken skin, I said. Could anyone tell me, then, I said, why HIV infection in Africa is primarily a heterosexual illness? A painfully shy woman stepped forward and whispered, via the translator, that she couldn’t speak for all of Africa, but in that particular locality the men had a penchant for what she called dry sex, and that the women encouraged the men by priming themselves with sand and small pebbles, which caused abrasions to both parties. This arresting and surprising explanation, I told the doctor, was perhaps why the broken skin theory of HIV infection had remained fixed in my mind.
‘A moving story, but utter cobblers, I’m afraid, old chap,’ he said. ‘The virus can pass through soft tissue, damaged or not. Your urethra, for example. Know what that is? Course you don’t, you silly boy. The good news is that whatever the outcome of this test, and the one in ten weeks’ time, I can offer you another 30 years of life.’ ‘Without drugs?’ I said. ‘Don’t be daft. If you are HIV positive, then with, I’m afraid. You’ll be rattling with them. But at least you’ll be alive.’