Sabrina Heard was lying in her hospital bed numb on crack cocaine when she received her HIV-positive diagnosis. It was 1989. She'd just given birth to twins and a bright pink sign taped on the wall outside of her room warned doctors and nurses to beware of bodily fluids. The nurses scowled and scolded Heard upon finding out that she had HIV. "You killed your babies," they told her.
"I heard the nurses debating about who was going to take my blood," Heard said. "That wasn't very nice at the time. I didn't have the education and knowledge to even fully understand the diagnosis I had just been given."
None of Heard's five children have HIV, but the state did eventually take all of them away. Still addicted to crack, Heard said she was in a mental and physical fog, a numbness that she couldn't shake until deciding to get clean.
"I've got to get these babies back," Heard one day realized.
She hit rock bottom in June 2000. With her children in foster care and her addiction spiraling and controlling every aspect of her life, Heard visited a detox center in Washington D.C., where she began to make small goals for herself that would eventually lead to larger ones.
Heard has now been clean for 13 years and works as a community HIV health worker with Women's Collective, a D.C.-based organization that seeks to meet the health needs of low-income women, girls and those living with HIV/AIDS by reducing the barriers to care and strengthening networks of support.
While it looks like most other office buildings, Women's Collective contains a room with free children's clothes, and another offers free food. An improvised altar with candles and funeral programs sits at the back of the office. Photos of clients who died of AIDS fill the room.
Washington D.C. is one of the areas hardest hit by HIV in the U.S., with 2.7 percent of the district's population infected. More than 80 percent of those diagnosed are black.
But D.C. is also a microcosm for what is seen happening throughout the country in these types of hot spots: Small, densely populated communities with overlapping sexual networks fuel transmissions. The aspects of many of these cities with hot spots, including D.C., New York, Baltimore and Atlanta, often have unique health care access challenges, a significant low-income area, high drug use and significant rates of other sexually transmitted diseases, according to the Kaiser Family Foundation.
Heard creates relationships in order to educate women in her city about HIV, and she often travels with Women's Collective mobile unit that offers free testing and information. Along with the tote bag filled with coupons for free food, condoms and a variety of hygiene products, Heard gives out her personal cell phone number to anyone who needs guidance. And she sometimes joins clients in the doctor's office at their appointments regarding HIV diagnosis and treatment. One of the biggest issues in her community, like many impoverished HIV hot spots in the U.S., is education and access to care, she said.
There can be a real lack of compassion, which only deters people from getting tested and potentially test positive, a "character assassination," she said.
"There has to be a common language within the community," said Heard. "You have to relate to the patient, and not just have someone who lives across the river in a condo talk at you about your disease from behind a desk."
There are more than 780,000 people in the U.S. who have HIV/AIDS, and nearly one in five HIV-positive people are unknowingly living with the virus. Many of those people who carry a positive diagnosis do not have proper access to testing or follow-up care, leading to greater transmission of the disease and much sicker patients when they actually do go to see a doctor about symptoms. Rates of HIV in the U.S. have held steady at about 50,000 per year, the highest rate out of any developed country in the world.
By having candid discussions about sex and drugs and STD status that present the topics with a level of comfort and camaraderie, Heard has helped countless women into treatment and toward a healthier life.
"We have pretty provocative talks," she said. "Often times, people aren't using scientific terms for body parts. They're using words they hear on the street."
And that's OK. Her main goal is to create a haven for girls and women to talk about their health concerns in a way that they may never have before.
"We're dealing with a lot of people who have bad information from the start," said Heard. "Black men don't want to be considered gay and women don't want others to think they've had a lot of partners or they'll be considered a slut. This is the reality of people's thoughts."
People in impoverished communities are hit with many more barriers than those who do not live in such areas, said Dr. Mary Paul, chief of retrovirology and global health at Texas Children's Hospital in Houston.
"Taking daily HIV treatments, transportation to appointments, problems with insurance and coverage, coverage for co-pays, having pharmacies in convenient locations, staying organized enough to take medications every day -- these are things that need to be accounted for once diagnosed as HIV positive."
Paul said it is programs like Women's Collective and people like Heard who are going to make a difference in getting to the heart of these HIV hot spots in the U.S.
"None of this happens overnight," said Heard. People don't just open up to her, but after continued sessions and helping them to understand that Women's Collective wants to help them live healthier lives, "once we get some confidence in them, then you can talk with them about their status, and help them advocate for themselves," said Heard.
This story is the second of Mikaela Conley's four-part series on HIV Hot Spots in America. Her reporting is supported by the California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School of Journalism.