Five years ago, the man Elsie Smith loved told her calmly from his hospital bed that it was time for him to go. He died with a hushed goodbye and a squeeze of her hand.
Smith herself had been feeling ill for a while. Her bones ached and she vomited often. She soon mourned him from her own hospital bed.
A doctor explained to the Navajo woman that her lover had died of AIDS. It was important that they check her blood, he said. She agreed.
Two days later, the doctor told her that she had HIV. Her tired mind became flustered with questions, but she asked only one.
“What is HIV?”
Smith learned of her diagnosis at the Indian Medical Center in Gallup, where Western medicine and traditional healing converge to treat members of the Navajo Nation and where a ceremonial hogan -- or sacred structure -- sits on hospital grounds.
It is where Jerry Archuleta and Emerson Scott, partners who are both HIV-positive, go for their monthly checkup and where Danny Morris nearly died from AIDS before receiving care from both doctors and medicine men.
The hospital has become a leading force in the effort to quell a rise of HIV transmission among Navajo, a troubling development at a time when HIV infections are holding steady or declining in other groups across the country.
Most of the infections are occurring in the Navajo Nation, a vast expanse in the Four Corners region where poverty, poor education, alcohol abuse and the hardships of reservation life cultivate an environment in which the virus can spread.
Like Smith, some Navajo learn of HIV and AIDS upon diagnosis. Others believe it’s a white man’s disease. Doctors, meanwhile, must explain the virus and disease in round-about ways because, in traditional Navajo culture, to speak of death is to bring it about.
Larry Foster, the Navajo Nation’s sexually transmitted disease coordinator, said health professionals had encountered resistance when giving presentations on the disease.
“They didn’t want to listen because they thought we were bringing a curse, bringing death into their communities,” Foster said. “Nobody cares until they have seen an AIDS death in their family.”
In sheer numbers, the amount of infections is small among the 173,600 people who live in the Navajo Nation. The Indian Medical Center and its clinics scattered across the reservation log about 35 new cases a year. But that’s about three times the number recorded a decade ago.
Signs of trouble emerged in 2001, when about half a dozen patients trickled into the Indian Medical Center with severe fevers, rashes and headaches.
They appeared to have mononucleosis, but their symptoms did not completely match that diagnosis. Dr. Jonathan Iralu, the hospital’s infectious disease specialist, called for HIV tests.
HIV was rare among Navajo then. The first documented case surfaced in 1987. Typically, Iralu said, the carriers were gay or bisexual men who contracted the virus in big cities and returned home for treatment or to die.
The results of the tests Iralu ordered were alarming. The patients’ viral loads, the amount of HIV in their blood, were extremely high and their bodies had not yet produced antibodies to fight the virus. This indicated they had contracted the virus within a few weeks of being tested.
Navajo were infecting Navajo.
Along with her two sons and three granddaughters, Elsie Smith lives in the tiny tribal community of Iyanbito. The name means “buffalo water,” a place where herds of once-bountiful bison gathered to drink from a natural spring.
Only 17 miles from Gallup, it feels a world away, where Smith’s small hogan sits at the foot of a brilliant red rock bluff.
Her infection was born of tragedy. In 1997, her late husband was killed during a gunfight with Navajo Tribal Police after he shot and killed an officer.
Her brother-in-law provided comfort, helping with the children and paying some bills. Eventually, they became a couple. They were together only a few months before he died.
They had never worried about sexually transmitted diseases. Smith, 47, with limited schooling, knew little of such things. After her blood test, the doctors explained everything.
“I felt like crying and I felt like I wanted to commit suicide,” Smith said. “I was mad at myself.”
Preparing meals for her granddaughters -- Keyanna, 7, Keira, 3, and Kariann, 2 -- is a daily torment. “I’m scared of cutting myself and giving it to these kids,” Smith said.
One morning Smith whipped dough swiftly between her palms, the white powder caking her fingertips and filling the wrinkled crevices on her hands. She gently placed the dough into a frying pan.
Smith served herself a bowl of deer and corn stew and added to a growing pile of fry bread on the table. Keira swooped in to grab a warm piece and mumbled a “thank you” between nibbles.
Smith’s eight brothers and sisters rarely call. Sometimes they invite her to get-togethers, but she is not allowed around her nieces and nephews and is told not to handle food.
“They’re afraid of me,” she said.
But at home, there is family. Her oldest son, Julius, 28, drives her to appointments at the Indian Medical Center and the girls remind Smith to take her many pills.
In the living room, Keira and Kariann began bouncing and pirouetting to a Justin Bieber DVD. They collided mid-dance and tears flooded Kariann’s hazel eyes and ran down her plump cheeks.
Keira, also crying, bolted for her grandmother sitting on the couch and Smith engulfed the little girl in her arms, the toddler’s tears falling on her grandmother’s face.
At 52, Danny Morris still has the boyish grin of the 19-year-old who escaped Gallup for Phoenix, where he attended Arizona State University and quickly discovered a bustling gay club scene.
Morris had been drinking since he was 8 and loved alcohol. At the clubs, he rarely had to buy his own.
“I was pretty wild. I thought I was invincible,” Morris said, as his cellphone rang to the tune of Lady Gaga’s “Born This Way.”
He eventually returned to Gallup and found work. By 1990, he began feeling fatigued, would break into sweats and dropped weight. He had heard about AIDS on television but refused to be tested.
“I felt like I might have it, but I was just afraid to go in,” Morris said. “I was still drinking, still partying, still having unprotected sex.”
By 1995, he was back in the Navajo Nation, and doctors at the Indian Medical Center told him he had advanced AIDS. They gave him six months to live.
Morris chose to fuse modern medicine with traditional Navajo healing. It’s not only a frequent choice at the hospital, but one encouraged by the Indian Health Service out of respect for Navajo culture and to make patients feel more optimistic about their treatment.
Medicine men came to his hospital room, offering ancient prayers and blessings. He drank healing herbs.
In three months he was well enough to go home. There, medicine men conducted an Enemy Way Ceremony, a rite often performed for Navajo soldiers who have returned from war. It’s a days-long ritual of prayer, dance and offerings intended to rid a person of evil spirits and restore harmony.
Maintaining harmony is the driving force in Navajo life, a concept captured in hozho, a complicated word that can be translated as harmony, balance but also beauty.
“I was off-balance. I had to re-harmonize, reconnect with the creator and with Mother Earth,” Morris said. “The holy people were there for me.”
Today, Morris lives with his father in Naschitti, 51 miles from Gallup and many of the vices of his past.
“I’m living in harmony here,” he said.
Still, there are a few men on the reservation who call him every now and then for sex. Some have girlfriends or wives, some have children. “The only time they call is when they aren’t with their wives,” Morris said. “They still tell me that they aren’t gay.”
He uses protection, he said. He does not tell them that he has AIDS.
Emerson Scott sometimes stands outside the Gallup city library to hand out condoms and pamphlets to encourage people to get tested for the virus he’s lived with for 13 years.
So far, not one person has agreed.
“People just don’t want to change here. They are so stuck in their ways,” said Jerry Archuleta, Scott’s partner, who wore a shirt with an image of a horse that read: “If you’re going to ride the pony, throw a blanket on it.”
They are among the small number of Indians trying to warn Navajos about the dangers of AIDS, and as they make their way around Gallup together, their appearance sometimes draws puzzled looks.
Scott struts a bit when he walks, his lean arms often carrying a purse, his crown-shaped earrings gleaming in the sunlight. Archuleta is heavyset with salt-and-pepper hair often matted under a U.S. Navy veteran cap.
They’re in love. They have been since they met 17 years ago outside a bar in Gallup.
Archuleta, who was separated from his wife, didn’t know that Scott was a prostitute when they met. They shared a six-pack and their first night together was chaste.
“It was an instant connection,” Archuleta said as he glanced at Scott, who smiled shyly. “We talked all night.”
Scott, then 20, had fallen into prostitution after running away from the reservation community of Black Hat.
“I did it just to get the money, to drink and to have a place to stay,” Scott said. Archuleta, a Pueblo Indian with a daughter, had decided to come out as a gay man as his marriage fell apart. The two moved in together.
After a routine physical in 1989, Scott tested positive for HIV. Soon after, another test showed Archuleta was infected.
“There was no blame. No pointing fingers at each other,” Archuleta said. “We just went on from there.”
They now avoid alcohol, try to watch what they eat and never miss an appointment at the Indian Medical Center. And should Archuleta forget to take his medication, he can expect a stern lecture from Scott.
Both volunteer with the Navajo AIDS Network and work with several support groups for HIV and AIDS patients and gays and lesbians.
They’ve recently befriended a young gay man who is HIV-positive. He struggles with thoughts of suicide and they spend hours and hours with him, on the phone or visiting his home.
They’ve done as much for many friends over the years; several have died of AIDS, others committed suicide.
On a recent morning, Archuleta and Scott did what might be called a breakfast waltz. They moved effortlessly about the kitchen, Scott gliding around Archuleta to tend to the scrambled eggs sizzling in the skillet.
Archuleta, wearing his favorite blue camouflaged pajama pants and blue slip-on shoes, dashed pepper on the hash browns. Scott, wearing the same ensemble in green, set the table.
Archuleta opened the oven door and they both bowed, as if to each other, to peek at the biscuits. Without a word, they agreed the biscuits needed a bit more time.
“We’re not perfect, but we make it work,” Archuleta said. “That to me is harmony.”