To hear him described, Nushawn Williams was an old-fashioned charmer -- a man who seduced girls and young women with shopping sprees, flowers, music tapes, jewelry and home-cooked meals. "He made me feel special," said one of his young partners on the Montel Williams show. Now this woman and eight others are HIV positive, and prosecutors in New York are investigating whether they can charge the 21-year-old man for knowingly spreading the virus that causes AIDS.
As more information emerges about Williams and the women he had sex with, health officials fear that this may be just the beginning of an epidemic. Williams, who may have a history of intravenous drug use, has provided New York City health officials with the names of 19 recent sexual partners; health officials in Chautauqua County, where he lived the last two years, have identified 110 who had sex with Williams or with partners of Williams.
Ironically, it was not his sexual reign of terror that brought Williams to authorities but an arrest for selling $20 worth of crack cocaine to an undercover police officer in a sting operation. A member of the Bloods and an ex-con, Williams is being held in a New York City prison and has also been charged with the statutory rape of a 13-year-old girl, who is also infected.
Williams' wide circle of partners -- and the fact that he preyed on teenagers and young women -- brings to light new questions about the particular vulnerability of young people to the AIDS virus. One out of four new infections are in people under 22 years old, according to the Centers for Disease Control and Prevention. Salon spoke with Dr. Jeff Birnbaum, head of the adolescent HIV clinic at Kings County Hospital in Williams' hometown of Brooklyn, about why teens are more vulnerable to HIV infection -- and why, once infected, they can be more dangerous.
Nushawn Williams reportedly slept around without telling his partners he was HIV positive. Is this an anomaly or is it common for young people?
This was anything but an anomaly. There are thousands of people like him out there. This past week everyone has been talking about Nushawn Williams and I just think, what's the big deal? I see kids like him every day -- or I see the girls he has infected every day. Williams is an easy target: He's a young black male, a drug dealer, having sex with 13-year-olds, and now he has infected them all with HIV. He's Public Enemy No. 1. But he could be any color. There are lots of guys out there like him.
Is it hard to get teenagers to divulge the names of their partners?
I'm not defending Nushawn Williams, but if anything he was actually much more cooperative than most young people. He voluntarily gave the health authorities the names of 20 sexual partners when he was initially tested.
On "Nightline" a week or so ago, they presented Williams as being very proud of this, that these girls were like his 20 trophies. But the bottom line is it's very hard to get somebody that young who tests positive to give up the names of their sexual partners for contacting, for partner notification. It's very difficult to get teenagers to trust health-care providers in the first place.
Why don't HIV-positive teens tell their partners?
A lot of them are not symptomatic for the disease. The fact that they're HIV infected is not a concrete thing to them. There's no daily experience of feeling sick that makes it real to them. Also, many infected teens live with an older guy, maybe 10 years older than them, with a history of violence or drugs. Since these guys are basically their sugar daddies, their financial providers, these girls run a lot of risk disclosing their HIV status.
How are most teens infected?
Nationwide it's through unprotected sex, whether or not it's opposite-sex or same-sex behavior. At my clinic, the majority of the patients are heterosexually infected teenage girls.
The media has made a lot of the fact that Williams seduced young women with jewelry and money. Do you think that makes teenagers more vulnerable
Teenagers are very sexual beings, so a lot of it might be experimentation. Sex is more about someone holding them. It's one of the few things in life that makes them feel good. It's not like they are going to start negotiating a condom just because you tell them there are health risks without them.
What's the average number of sexual partners that the teens you see have had?
It varies from some who have had two or three to those who have engaged in prostitution for survival -- "survival sex" as we call it -- and have had hundreds. Most of those infected have had less than 10 partners.
What is the law for partner notification? Are you allowed to contact the people possibly infected?
A person's HIV status cannot be given over to someone without the written consent of the person who is being tested. I could not, if I was testing some teenager, just go out into the waiting room where their sexual partner is sitting and say, "I think you need to get tested because your friend in the next room is HIV positive." That teenager would have to give me written permission to discuss it with that person. But if a teenager gives me the names and phone numbers of their sexual partners, I can contact the local health department authorities and give them names of those sexual partners, and then they go out and knock on their doors and say, "We have reason to believe you have been exposed to HIV through sexual contact and we recommend you get tested."
When a patient tells a psychiatrist that he might murder someone, the psychiatrist is required by law to break confidentiality because another person is at risk. Do you think the same principle of life endangerment should be applied in HIV and AIDS cases?
You certainly could make a case for that. I have had people attack me, saying, "How can you sit back knowing that one of your patients is having unprotected sex with someone and you don't disclose their HIV status to the sexual partner because they've asked you not to?" It makes people angry that people can "get away with it." But this is different than the scenario of the loaded gun, the duty of a psychiatrist to warn. For years it's been no secret that people can get infected from HIV when having unprotected sex. The responsibility is on individuals to protect themselves, to look at every sexual partner as being potentially HIV positive.
Do teens have to get their parent's permission before they are tested or treated?
In most states, an adolescent can sign their own consent for HIV testing and treatment without their parent's knowledge. The only time it does become somewhat problematic is when hospitalization is required, then the hospital may require the parent's consent.
Are there a lot of HIV-positive teens who live at home and their families don't know?
Not only is that true, but some go for several years before their family finds out. They go about their everyday business and, since most teens are recently infected and don't yet have HIV-related symptoms, it's not readily apparent they have a disease. So the parents don't know. Many disclose to their parents when they become really ill -- and sometimes, as a result, they get thrown out of the house.
What are some of the reasons why they don't tell anyone?
Most of them tell somebody. A couple of them keep it to themselves, only talking freely about it in the clinic or with other kids who are HIV positive. They think, "Hey, this person is like me," and they can compare notes about their secret lives. We're always urging them to disclose to their sexual partners, but quite often when they do, it doesn't guarantee that the boyfriend will start using condoms to protect himself. More often than not, he remains together with the girl and continues having unprotected sex.
Do they realize the consequences of unprotected sex? How much do they know about HIV and AIDS?
They are all very smart; they know the facts. If you ask any teenager on the street, "How do you prevent yourself from getting HIV?" they'll tell you, "Use condoms when you're having sex." If you walk into a teenage pregnancy clinic and ask, "How many of you use condoms all the time?" they'll all raise their hands. Well then, how come you're all pregnant? So the knowledge and the behavior don't always match up. It's just teenagers being teenagers; this is the way teenagers behave, and did long before HIV came on the scene.
Do you think the confidentiality laws will change in the wake of the Nushawn Williams case?
I think a lot of society's anger is going to be vented on Nushawn Williams, even though he wasn't arrested for infecting someone with HIV; he was arrested for the statutory rape of a 13-year-old. So public opinion might change the laws. The other thing that may cause change in confidentiality laws is that when they were written in the early '80s, there was absolutely no treatment. AIDS was a fatal disease. So why identify people without guaranteeing them confidentiality if there's nothing you can do to cure it? But nowadays we have combination therapies and the use of protease inhibitors, which may change the way people look at HIV and AIDS. They could end up looking at HIV and AIDS as they do syphilis, and go after all the sexual partners and treat them and cure them.
One of the reasons the confidentiality law was passed was to encourage people to come in and get tested. One of the potential downsides of the law being changed is people might be frightened to come in and get tested; they may avoid health care all together.
Do you think the privacy rights should be different for minors, who often don't exercise the best judgment? Should it be mandatory to tell parents?
Given the cards that are dealt against a lot of the kids -- with families that are not model American families by any means -- it's not a good idea. You would be literally asking the question, should teenagers be allowed to make up their mind on anything? And I would not be successful in adolescent medicine if I took the attitude that teenagers didn't have the intelligence or sense to make their own decisions -- they definitely can make decisions. They don't always make the right decisions, but I think when they make really bad decisions, it's not because they didn't ask their mother or father -- it may be because they don't have a mother or father they can ask.