the District's HIV infection rate -- already the highest in the country, with one in 20 adults HIV-p

By Anne Hull
Washington Post Staff Writer
Tuesday, December 16, 2008; A01

The last of the boxes were hauled away yesterday from the Whitman-Walker Clinic at 1407 S St. NW. The moving truck made its final run. The rooms were empty. The heat was off.

A

Hundreds who walked through the doors of the building in the 1980s and 1990s died. And then hundreds more began to live.

If a physical space can capture the arc of an epidemic, the Whitman-Walker Clinic, at the corner of 14th and S streets, occupied the front lines of AIDS in Washington for 21 years. It was there when the average life expectancy for someone with AIDS was two years, and it was there when new drugs became available that made HIV infection a manageable disease to live with.

Whitman-Walker sold the property for $8 million to beat back mounting debt. The nonprofit community health organization will continue to operate from consolidated quarters two blocks south on 14th Street.

In one sense, the sale of the property was just another real estate deal among many in a neighborhood where lofts replace bodegas and galleries overtake graffiti. The developer plans a mixed-use retail and residential space.

But the move was a kind of requiem. In the weeks leading up to it, people showed up to say their goodbyes to a building where every room held a thousand stories. The medical exam room was bare except for the old blue Midmark 119 table upon which a generation of bodies had settled on crinkly paper.

The boxes in the hallway packed with old reports and binders also told a story. The cover of the clinic's 1987 annual report, titled "A Fighting Chance," featured three handsome young men on the cover. All of them died.

Upstairs were the paper shredders, kept at the ready in case the feds showed up with a subpoena for the names of HIV-infected patients.

"Names were very important in those days," said Patricia Hawkins, a psychologist and social worker with Whitman-Walker since 1984. "We lived in fear of raids."

When the names became less volatile, patients painted them on a mural downstairs in a bit of bright art expression. The wrecking ball will take the wall down soon, but as of yesterday it was still standing:

Here we are again

Back to where we've already been

See you soon, my friend.

* * *

Whitman-Walker bought the property for $1.25 million in 1986. The AIDS epidemic was in its fourth year, and the clinic had desperately outgrown its quarters in Adams Morgan.

Jim Graham, now a D.C. Council member, was Whitman-Walker's executive director for 14 years, witnessing the first cases of AIDS in 1982, when gay men were getting sick with mysterious fatal infections. By the summer of 1984, the Washington area had recorded 125 AIDS cases and 56 deaths. In what was a prescient forecast of the growing plague, Graham brokered the purchase of a bigger building. Formerly the Evelyn Towers Apartments, the property had been renovated but still sat in the neglected blight of 14th Street.

Some fought Graham on moving the clinic to a neighborhood known for drugs and prostitution, but the building had the space to offer the services he sensed would be necessary to launch a full-scale defense for AIDS patients: medical, dental, psychological and legal services.

The definition of "legal services" in those days meant that Graham, a lawyer, would sit at his IBM Selectric in the clinic and type up wills and power-of-attorney forms. Graham would leave the clinic and take the legal forms to the hospitals for signatures, often arriving at the patient's room greeted by food trays stacked at the door. Food service workers, afraid of exposure, would not enter the rooms.

Or Graham would take the forms to the homes of the sick. A partner or an aging mother would let him in, and he would be led to a bedroom where a dying man lay in his boyhood bed, surrounded by sports pennants from junior high.

Because many local doctors and dentists would not treat a person with AIDS, the afflicted came to the clinic. Some were going blind from cytomegalovirus, tap-tapping with their walking sticks up the sidewalk on 14th Street. Others were speckled with Kaposi's sarcoma lesions, and they arrived like gaunt snow leopards in bluejeans.

"You took great satisfaction in doing what you could do, but you knew the suffering was horrific," Graham said. "It affected everything you did."

Whitman-Walker desperately needed money. Then-Mayor Marion Barry and the Meyer Foundation were Whitman-Walker's earliest financial supporters when other institutions wanted nothing to do with AIDS. Even the city's ball-loving philanthropists turned a cold shoulder.

"I asked everyone," said Robert Alfandre, a wealthy board member at Whitman-Walker who approached a local socialite for help. "She asked all the grand dames in town whether they would sponsor a fundraiser. They wouldn't touch it."

The gay community filled the void, giving donations that accounted for nearly half of Whitman-Walker's operating expenses.

By 1987, Whitman-Walker had a staff of 34 along with 700 volunteers, had opened a food bank and hired a full-time lawyer, but it could not provide the most elusive antidote: medicine to stop or cure the virus.

The chandelier in the foyer hung over a grand marble staircase, a holdover from the old Evelyn Towers apartment days. The elegance belied the degrading reality of diarrhea and incontinence. The bathroom on the first floor was a place of wasting and humiliation. A washer and dryer were installed to launder soiled clothes. For infection control, the staff used a ratio of one part bleach to 10 parts water.

Touch was often all that could be offered. Staff member Barbara Chin remembers leaving the clinic to visit a client at Washington Hospital Center. The dying man had terrible KS. Chin put her hand on the man's hand. "Oh, that feels good," he told her. "Please don't take it away."

Chin was hired to run Whitman-Walker's new housing program, created because so many people with AIDS were being evicted by landlords or relegated to the family basement to eat off separate plates.

When the clinic purchased an old house on Park Road NW and hired contractors to fix it up, crew members abandoned the job when they learned who would be living there, but not before scrawling "AIDS" on the walls.

Washington was no San Francisco, but the Whitman-Walker Clinic on beat-up 14th Street was gaining a national reputation. One day, a young man from Kansas came to take an HIV test. The attention also drew others. The clinic was once tipped off by a gay-friendly Pentagon employee that naval investigators were doing surveillance on license tags outside.

The first medical breakthroughs began in 1987. Aerosol pentamidine and Bactrim tablets were shown to help treat and prevent pneumocystis pneumonia, an often fatal opportunistic in AIDS. Next came the antiretroviral known as AZT, the first drug approved by the FDA to treat HIV and AIDS.

Still, the new drugs could not offset the high mortality rate that began to build by the late 1980s. The names of deceased clients were kept in a binder called "Book of the Dead."

Countless memorial services were held inside the clinic. A renegade atmosphere pervaded in those days. Some funeral homes refused to handle AIDS deaths, so when a funeral home that Whitman-Walker did business with donated a casket to the clinic, it was used in five different services. The practice violated every public health regulation. When staff members were notified of a federal on-site inspection, they hid the coffin under a large dropcloth, but unfortunately someone left a phone inside, and it began to ring during the inspection.

In a single week in 1989, Barbara Chin attended four funerals.

The clinic began seeing a new demographic: women who were being infected by HIV-positive male partners who were either having sex with other men or using contaminated intravenous drug needles.

Several blocks from the clinic was the White House, where President Ronald Reagan had barely uttered the word "AIDS" in his eight years in office. In 1989, the Centers for Disease Control reported 22,082 deaths from AIDS.

* * *

That same year, a square-jawed guy walked into the clinic and introduced himself as Hank. He said he wanted to volunteer. Freeland H. "Hank" Carde III was a retired Navy commander who had done three tours in Vietnam as a river intelligence officer working with Navy SEALS and Army Special Forces units, for which he earned two Bronze Stars. Carde's partner had just died of AIDS, and Carde, though strapping and fit, was HIV-positive.

Whitman-Walker's newest volunteer was assigned to the bedpan brigade at a group house for AIDS patients.

Within two years, Carde was holed up in offices at the clinic helping to write grant applications that eventually netted $3 million. When the District spent so little of its federal AIDS grants that the U.S. government threatened to yank the entire subsidy unless city officials filled 15 federally funded jobs, Carde staged a hunger strike in front of the District Building, sitting in the pouring rain for three days until the city promised to fill the jobs.

Whitman-Walker employees marveled at the irony of Carde's forcefulness: The same military that spied on and isolated people with HIV had given Carde the training and determination to get the job done.

By 1992, a decade into the epidemic, Whitman-Walker had treated 2,600 clients: 1,600 were dead, a thousand more were still living. AIDS education had calmed some of the paranoia but not all. A D.C. Council member called Hawkins to float the idea of holding HIV-infected patients at a juvenile facility in Maryland with barbed-wire fence.

Race was a tricky complication. Barbara Chin noticed that African Americans were more nervous to be seen walking into the clinic.

"The white boys had gotten to the point where they said, 'I'm gay and to hell with you,' " Chin said. "African Americans were afraid that someone would label them HIV. This was their home town."

Clients were trying all sorts of unproven remedies to stay alive, and Whitman-Walker saw it all, from the egg yolk lecithin craze to flying to Europe for ozone therapy. Clinical research trials were underway, and some were terribly painful. One called for heating the blood. Hawkins was in her office at the clinic when a client called to say he wanted to participate in a trial at the National Institutes of Health. The man had already lost his partner, and he was also sick.

"You are going to cut in half your life expectancy by going on these trials," Hawkins told him. He said he understood but wanted to help others. He died four days after starting the trial.

"These are the unsung heroes of the epidemic," Hawkins said. "It was all about the people who would come later. And they were right."

More women were becoming sick. More mothers and more fathers would not live to see their children grow up. Audiotapes and videotapes of the parents were made, to be watched by the children.

The questions were basic. What would you want to say to your daughter the day she graduates from high school? What would you want to say to her the day she gets married?

The tapes were supposed to be watched later, but sometimes, out of necessity, they were watched sooner.

"The kids wanted to see that their mother didn't want to leave them," Hawkins said.

First lady Barbara Bush made the short but symbolic trip to 14th Street to visit the clinic in 1991. By 1994, Whitman-Walker bought more property two blocks south and expanded operations. One year later, the FDA approved drugs known as protease inhibitors that helped stop the replication of the virus. A new test also became available to measure an infected person's viral load.

It was too late for Hank Carde. He was down to 80 pounds, "a flickering light . . . being kept alive by some invisible energy," Jim Graham told a Washington Post reporter. Carde was sunken and spindly, his teeth too big for his face. He died in 1998 at the National Naval Medical Center and was buried at Arlington National Cemetery.

* * *

"Be Here for the Cure" was the message on the poster at the bus stop in front of the 14th Street clinic. There is still no cure, but each year since the advent of more advanced drugs, the death rate for AIDS has dropped significantly.

The clinic that used to represent death adjusted to caring for people living long-term with HIV. But financial troubles beset Whitman-Walker. When HIV became more of a poverty issue, fundraising dried up. In the past two years, the clinic cut its staff from 252 to 173 employees, and more restructuring is anticipated to help the organization weather the tough financial climate. The clinic serves about 10,000 patients, of whom 3,400 are HIV-positive.

At a recent public forum organized by young men to discuss HIV, one of the panelists, a young HIV-prevention specialist, said he often has to quell the panic of newly infected men who do not realize they can take medication and be relatively fine. "Why does it have to be, like, all sad? Because it's not like that anymore," he said.

But Hawkins said she expects to have data soon that will show that the District's HIV infection rate -- already the highest in the country, with one in 20 adults HIV-positive -- is again on the rise. "I wake up every day fearing that a new, faster, more virulent form of this virus will hit us," Hawkins said.

Yesterday, as the last of the items at the clinic at 14th and S were tossed into a truck from Junk in the Trunk Removal Services, the chandelier still burned in the foyer. Down the hall, the old blue medical exam table was still in the empty exam room, but someone had taped a handwritten sign to it:

"Trash."

Staff researcher Julie Tate contributed to this report.