Antonio Cox is not ashamed. He doesn’t mind if you know his full name, see his photo, are aware he was homeless on the streets of Chicago and slept in Grant Park. Nor is his medical status a secret.
“Four or five years ago, I got really sick and got diagnosed with HIV,” he says. “The doctor was really scary: You might die, your medications might not work.”
But drugs to keep HIV infection from manifesting itself into AIDS do work, astoundingly well, although they have a nettlesome requirement common to medications: You have to take them.
Which can be a challenge even for those who have jobs and homes and ordered lives. For those on the street or unemployed or coping with mental illness, remembering to take their medicine can be a challenge. That’s where organizations like Heartland, which introduced me to Cox, are important. We met in their Uptown clinic, on Lawrence Avenue.
Some 20,000 Chicagoans live with HIV, according to the Chicago Department of Health. About two-thirds have what is known as “viral suppression,” meaning there is no detectable virus in their bodies.
To achieve this, Cox takes just a single pill a day — Triumeq. Not too long ago Cox would have to take up to 18 pills a day.
“It’s always changing,” said Dr. Firas Mahdi, senior manager of clinical operations at Heartland. “It changed five years ago when they started to produce one pill with three medications combined; it was easier for everyone.”
My view of HIV was formed in the 1980s, when AIDS was a death sentence, and for that reason I imagined just knowing you have HIV, even under control, would be a burden. Cox, 34, doesn’t view it that way at all.
“I’m glad I got HIV,” he said, contrasting his former life with his family in Palatine with now, enfolded in the embrace of social services. “I’ve been surrounded by these angels, I got an apartment during the pandemic. I’ve gotten the best care, I have beautiful teeth because of their dentist. I could go on and on. I could care less that I have HIV, only I care is that I’m among these beautiful people. Most of the time I forget I have HIV.”
Cox is “an ideal person” when it comes to taking his pill, and about a three-quarters of the 300 people receiving HIV care from Heartland are virally suppressed. The other quarter have issues with taking their medicine.
For some, the routine of taking a daily pill challenges their organization skills. For others, it represents difficult aspects of their lives they’d prefer not to think about. Being in good health can ironically present an additional challenge.
“For people who don’t have a home, the stigma of having the bottle, with a label that many people know, is a big issue for many participants.” Mahdi said. “Sometimes they get rid of the medication without taking it. This is a big concern, because if you don’t take your medicine there is a lot of consequences of what will happen to your health.”
Does Cox tell sex partners he has HIV?
“I tell them,” Cox said. “I definitely tell them. It’s very important. But since I got the apartment, four years ago, I’ve only had sex with two guys. Before I got the apartment I was having sex with everybody. I just decided to take a break. It’s been great.”
Since readers like to pigeonhole unhoused persons as a class apart from themselves, their reasons for not taking medication are not so distant from those who are better situated. People don’t take medications as prescribed about half the time, according to the American Medical Association.
“Social determinants are big causal reasons of not taking medications,” Mahdi said. “Housing, transportation, financial, education. There are different kinds of reasons why.”
I don’t often find myself sitting across from someone like Cox, and I took the opportunity to get to know him better. His mom was a crack addict, and he was given up for adoption, but he clashed with his new family and ended up on the streets. He also had “severe mental illness” and still has autism, he said. But he is rising, phoenix-like, into a new life.
I asked him what pronouns he uses.
“Male,” he said. “But next year I want to be a girl and have long blue hair down to my ass and black lipstick and thigh high boots. I made my decision to be a girl, and that’s going to bring me so much happiness. There’s no words to describe the happiness that it’s going to bring me.”
Why is being female going to be better?
“Because I have all the equipment already,” he said. “I don’t have to go on hormone therapy. I’m 6’2, 110 pounds. I’m naturally like this. I just have the facial features. The body. I’m going to be sexy as hell, 100%. As a guy, I’m bald, I’m skinny. Guys are less attractive who are skinny. But girls who are super, super skinny are hot as hell. It goes without saying I’m going to be the hottest girl on the block.”
Besides becoming a girl, any other goals? Where do you see yourself in five or 10 years?
“Just getting a job,” he said, though that is a long way off. “I can’t even be a cashier. Even making sandwiches, I can’t do. I’ve quit so many jobs. I’m looking for a job bagging groceries right now.”
Since I know that readers can take a Victorian view of philanthropy — those benefiting from social service agencies ought to somehow earn their support by cleaving to a hazy puritanical ideal — it worth pausing to ask how the city would be better if Cox were being ravaged by AIDS in Grant Park rather than living his best life, healthy in an apartment in Forest Park?
He’s certainly better this way. And, it’s fairly clear, so is Chicago.
