NAIROBI -- Warren W. ''Buck" Buckingham, 53, believes he has been living with HIV for more than half his life -- 27 years -- and he has been pointing this out to every HIV-positive African he's met over the last 3 1/2 years, as part of his job for the US government fighting AIDS in Africa.
He is the only one of 250 American government health specialists battling the virus in Africa known to have HIV and to be speaking out about his status.
''I can talk to people who are on antiretroviral medicines for three months, who have made it through the first side effects, and I'm able to say to them, 'Look at me, I've been here all these years. So instead of leaving your children as orphans, you are able to dance at their wedding,' " he said.
For Africans who hear him, first there is disbelief, then hope.
''When I first met Buck, I had to open my eyes wide to see the HIV in him -- he was the first white man I had met to tell me he was HIV-positive," said Elsa Ouko, 50, head of the Kenya Network for HIV-Positive Teachers. ''And when he said how many years he has stayed with the virus, it made me accept my status more than I had before."
Said Ouko: ''It gave me courage that I could live like Buck for so many years."
At the beginning of the AIDS pandemic more than two decades ago, the virus often brought death swiftly. But the distribution of triple-combination antiretroviral medicines in 1997 greatly extended the lives of many HIV-positive people, although at first almost entirely in Western nations.
Only in the last two years, thanks in part to the multibillion-dollar US government program, has access to the drugs broadened to large numbers of poor Africans. Roughly 1 million people in developing nations are taking the drugs daily, although the need is estimated at more than 6 million. Across Africa, healthcare providers say they are grateful for the United States' contributions -- the billions of dollars, the millions of condoms, and the hundreds of thousands of daily doses of antiretroviral medicines. But they say another integral part of the program is the people running it: scientists from the Centers for Disease Control and Prevention; veterans of the battle against the US epidemic from the Department of Health and Human Services; and prevention specialists from the US Agency for International Development and Department of Defense, among others.
Buckingham had worked on the domestic epidemic for 15 years, starting with a Dallas-based center and continuing with the Clinton and Bush administrations in Washington. It was in those early days that Buckingham, who is gay, learned he was infected. He said his doctor told him at the time that ''if I'm really, really lucky, and if I'm really, really careful, I might live for two or 2 1/2 years."
He paused. ''I'm well past my expiration date," he said. Nearly four years ago, feeling burned out on the domestic epidemic, he turned to Africa for a new challenge. More than two-thirds of people living with HIV are in sub-Saharan Africa.
''It's absolutely his passion," said Miguel Gomez, a close friend and director of Health and Human Services' leadership campaign on AIDS, a domestic initiative that encourages minorities to speak out on HIV. ''He loves his work because he understands the pain personally, but he also just knows -- and this sounds corny, but it's true -- that you can make a difference."
Buckingham coordinates the President's Emergency Plan for AIDS Relief at the US Embassy in Nairobi, the Kenyan capital, but his job, like many of his peers', is hardly just a bureaucratic one.
On a morning late last month, he joined the Rev. Edward Phillips, a native of Brighton and graduate of Boston College. Phillips runs the Archdiocese of Nairobi's Eastern Deanery AIDS Relief Program in city slums that are as horrid as any in Africa. In just a little over two years, Phillips's program has expanded from just a few hundred people on AIDS treatment to more than 3,300 patients attending nine clinics. Of his $1.9 million annual budget for next year, $1.8 million comes from the US government.
Buckingham peppered Phillips with questions about numbers of people taking HIV tests (25,000 in the last year), children receiving treatment (only a little more than 100), the youngest child on treatment (age 3), and security precautions in handling large deliveries of antiretroviral drugs (the clinics have ''strong rooms," complete with steel doors, steel bars on windows, and steel bars underneath the ceiling in case thieves try to break through the roof.)
Phillips took Buckingham to a clinic, where he met a patient, George Otieno Audi, 28, who started on antiretrovirals a year ago and almost stopped because he said that God told him he no longer carried the virus. Audi asked for another test, which verified he still was infected.
''You're just starting the drugs -- I've been taking them for 18 years," Buckingham told him. ''So keep taking the medicines. You'll be taking them when you have gray hair."
Audi smiled. His weight has risen to 132 pounds from 106 pounds since he started the drugs, and he was back at his old job as a mechanic. ''I think my life will go on, too, because God has helped me," he said.
''God and medicine go together well," Buckingham said.
He left Audi and walked into the Mathare slum, down narrow alleyways, sidestepping children playing in streams of raw sewage. ''When we started treatment in the States," he said, ''we used to call what we were seeing the 'Lazarus effect' -- people were coming out of their graves. Now it's happening all over Africa as well."
After meeting a few more patients, Buckingham traveled across the city to another US-funded project -- the Hope Clinic at the Coptic Orthodox Hospital, where Buckingham patient No. 531 and Buckingham the AIDS worker melded, for a few moments, into one. Dr. Michael H. Chung, Buckingham's personal doctor, told him that he now has diabetes, a complication related to his long-term HIV status and family history of diabetes.
Buckingham took it in stride. He was diagnosed with HIV in 1988, although he was infected years earlier, and a football-sized bag of medicines at his side was evidence living with the virus was all about making adjustments.
Buckingham went through meetings with specialists supervising his health -- his blood pressure was 130/80, slightly high; he promised a nutritionist he was eating fairly well; and he told a social worker, in response to a question on a form, he had no intention of getting married.
''Are you proposing?" Buckingham playfully asked Antonia Wanjiru Mburo, the social worker.
''No," she said, laughing.
She asked him for a favor, though.
''We have a support group of HIV-positive patients meeting every Saturday," she said. ''We are waiting for you."
''I'll try to make it," he told her.
''Please," she said, ''it's most important for us."
John Donnelly can be reached at email@example.com.