On a cold Wednesday night, David (name changed at his request), a 21-year-old Wharton senior, pounds beers, smokes weed and scouts potential hook-ups at a fraternity party. After several rounds of drinks, he abandons a game of beer pong and strolls into a dark bathroom to relieve himself. A girl he does not know eyes him and follows him in. They start to make out while the party continues on the other side of the wall. By the time David leaves the bathroom, he will have known her quite intimately, while still unsure of her name. Throughout his education, David has been bombarded with statistics about the risks of unsafe sex and the prevalence of sexually transmitted diseases. According to the Centers for Disease Control and Prevention, more than 65 million Americans are living with an incurable sexually transmitted disease. Two-thirds of all new STD cases every year occur in people under the age of 25. For the first time in ten years, the infection rate of HIV has risen. These numbers may scare David, but not nearly enough. He rarely uses protection -- despite having multiple sex partners. It has been two weeks and a day since David had unprotected sex in that fraternity bathroom. Early on this Thursday morning, he heads to 1201 Chestnut Street to get tested for sexually transmitted diseases at the Philadelphia Community Health Alternatives. After spending four years worrying about grades and internships, he is now motivated enough to find out if his sexual habits have in fact impacted his physiological health. "I actually wanted to do it right now because I had slept with a girl unprotected, and I feel like if the girl would let me do that, well then, maybe she has been having a lot of intercourse on her own," David says. While his worries are specifically about the sexual history of this one partner, he is less concerned about his own past. "If she's been having a lot of intercourse on her own, you know, before me, then I just feel like that kind of increases the chances because she wouldn't make me wear a condom. And I was a little nervous about that. I feel like that might have been kind of slutty on her part and so I wanted to get tested." While her failure to ask him to wear a condom makes him think that she might be a "slut," he excuses his own carelessness by saying that he just got caught up in "the heat of the moment." As David waits in the sparse reception area of the clinic, he tries to remember what he did the night before. His head hurts, his memory eludes him and he does not think that he hooked up with anyone, but is not certain. Eventually, a counselor motions for David to follow, leading him into a tiny room furnished with only two chairs and a table covered with safe-sex pamphlets. Of the experience, he says, "They put me in a room all by myself with an STD counselor, and she just started talking to me about STDs and asked if I had any questions. She made me feel really comfortable. She asked me about my sexual life, how active I am." But soon the counselor began to highlight the realities of his sexual negligence. David recalls, "She sat me down and said, 'I want to ask you a question. What would happen if your results came back HIV-positive?' I first blew that question off, but we got back to it, and the first thing I said was, 'I know I'll be able to live a normal life, but then again, any girls I sleep with, they could get the disease from me, and I would never want to do that. I wouldn't want to give someone a disease like HIV. If I was positive, I would like to think that my life wouldn't change, but inevitably, it would.' It's just one of those things that you don't think about, you don't talk about, but you've got to face. It's just reality. I need to escape from this invincible world." Being young and feeling untouchable sounds a bit cliched, but David has taken this as truth. "I kind of feel that at my age, that I'm invincible and nothing can hurt me or bring me down. Nothing can stop me. And also, the whole notion that I'm at Penn, what goes along with that is that the girls I've had sex with, I know they came from a good background, good families, good neighborhoods." If David is at all representative of Penn students, they assume that because everyone here is smart, they can make a stupid decision without risk. But now, David is facing the error in his thinking. While he has had unprotected sex with multiple partners in the past, the fact that those partners may have done the exact same thing is what makes him feel vulnerable. After speaking with the counselor, David is brought into another room where a doctor draws his blood to test for syphilis. It is during this step that he may bring a friend, partner or family member for support or company. The blood sample is followed by a urine sample which tests for for chlamydia and gonorrhea, a less painful method than the previous one of inserting a swab in the penis or cervix. For the HIV test, David is given a choice between another blood sample or an oral swab. He chooses the swab, which picks up the mucous membrane from the walls of the mouth, offering a less intimidating, painful way for those nervous about being tested. After all the samples are taken, David drops his pants so the doctor can check if there are any visible signs of herpes or genital warts.
While David has gone through these first steps, he is forced to leave the center without any answers. "It usually takes about two weeks to get the results back for STDs and one week for HIV," explains Courtney Wilburn, an HIV counselor at the PCHA. "All the samples are sent to a lab, but the lab does more STD testing than HIV so STDs take longer." To get the results of the STD tests, David can call the clinic. But for the HIV results, he must return to the testing site. According to Wilburn, "HIV testing is totally anonymous. You can say you're Ronald Reagan if you want. But all STD testing in Pennsylvania is not anonymous -- it's confidential -- which means you must give your name. With HIV testing, you're assigned a number to your specific test. You must bring the card in, with that number on it, to get your results." HIV test results are only given in person. The patient can choose to see the lab report, but may not leave the clinic with a written copy of the results. The reason for this, Wilburn says, is so that "no one else can claim that the results are theirs." For David, coming in to get tested was not easy, and he finds the long wait for the results stressful. But facing the truth could be much more difficult. While contemplating the possibility of testing positive for HIV, he finds some comfort in the support and care that the center will offer him if he needs it. "We have a program called Early Intervention. We make sure that there's an Early Intervention specialist there to talk to [HIV positive patients]," Wilburn says. "They don't have to speak with the specialist, but we give them the choice. The specialist offers them support and information about treatment and care." And while David hangs in balance awaiting his results, Wilburn believes that college students overall are at lower risk to contract an STD "because there are so many resources, that's really an advantage students have over the general population. You don't see nearly as many cases. But that's still no reason to go unprotected, obviously." Those resources, like the free condoms, dental dams and lubricant offered at Penn's Office of Health Education, located at 3609 Locust Walk, are available to any student who seeks them out. As David leaves the clinic, the doctor makes a similar gesture, offering him a bag of condoms and lubricant -- though they are of little use if he fails to change his habits. After this experience, David likes to think that he will be smarter the next time around. "I would probably just start carrying a condom around with me. I'd like to say that I wouldn't do it again. Men are susceptible, and women, to spontaneous sex. And the best sex is spontaneous, just right there and then. And I hope that I'll be able to hold back. I say that now, but when I'm in the moment, I hope my conscience will be thinking with the right head. I think I will, after going to this clinic. And I really hope that I will wear a condom when that time comes about." David is anxious as he waits for the results; yet he is optimistic that they will reveal a clean bill of health. "Am I nervous for the results? Well, I had the doctor check me, there's nothing there. My piss doesn't burn. And I feel good. I feel like I sort of am invincible, but I know that I'm not. I'd like to live in this false reality until I get the results and know that. But then, after that if I find out I'm clean, then I'm definitely going to start wearing condoms, just because I know the risks involved." It seems as though the precarious situations in which he has put himself have motivated David to map out a safer future. Or maybe this experience has not taught David anything at all. "I'm going to wait until I get the results 'til I start wearing condoms"