Elsie Smith, who is HIV-positive, lives in the tiny tribal community of… (Barbara Davidson / Los Angeles…)
GALLUP, N.M. — 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.
For The Record
Los Angeles Times Sunday, January 08, 2012 Home Edition Main News Part A Page 4 News Desk 1 inches; 34 words Type of Material: Correction
Navajo and HIV: An article in the Jan. 5 Section A about HIV infections among the Navajo said that HIV patient Emerson Scott tested positive for the virus in 1989. The year was 1999.
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.