When doctors filed into her room at George Washington University Hospital a year ago this week to tell her the cause of the raging fevers, wracking chills, night sweats and exhaustion that left her too weak to walk, they confirmed what Sonia Sherman had suspected for months.
"They said, "Yes, you have AIDS,"" recalled Sherman, 34, a former legal secretary. "In a way it was a relief. Finally I had a definite diagnosis, which is a lot better than hearing, "You're a challenge, you're really baffling us.""
Sherman, the first woman in the Washington area to contract acquired immune deficience syndrome, represents both a medical rarity and the latest development in the course of a frightening new virus that has been targeted as the nation's number one public health problem.
Since its discovery three years ago, AIDS, which kills nearly all its victims within two years of diagnosis, has been largely identified with homosexual men, who represent the overwhelming majority of its 6,251 victims.
Largely overlooked in the search for a cause and cure is the fact that the number of reported cases of women with AIDS has nearly tripled in the past year. Statistics compiled by the federal Centers for Disease Control in Atlanta show that the number of women with AIDS has jumped from 160 to 428.
Doctors believe that about half of these women contracted the disease by using contaminated hypodermic needles to inject drugs. Sherman is one of about 50 women who develop AIDS through sexual contact with a bisexual man who may be an unwitting carrier. She thinks the carrier was a former boyfriend, whoshows no symptons of the disease.
"The incidence among women is higher than you would anticipate," said Dr. MargaretFischl, a Miami internist studying women with AIDS as part of a three-year research project funded by the National Institutes of Health. Women appear to get the disease through long, repeated contact with gay or bisexual men," particularly men who have many sexual parters.
There is no cure for AIDS, which progressively, destroys the body's ability to resist infections and cancer. Precisely how it is transmitted is unknown, but doctors believe it involves the exchange of body fluids such as semen or blood. For unknown reasons, the disease also strikes Haitians, who comprise 5 percent of AIDS victims.
There is no evidence that AIDS is transmitted through casual contact, such as touching a patient, or through the air. There are no documented cases of women transmitting the disease, of family members other than sexual partners developing AIDS or of health care workers who have contracted AIDS.
In the Washington are, 50 new cases have been reported since June, a larger number than for any previous four-month period. Area public health officials are not sure whether that is because AIDS has spread or because doctors are more aware of the disease and more conscientious about reporting it.
For women, the trauma of AIDS is not limited to female victims of the disease. Women who are wives, mothers, sisters or close friends of male victims simultaneously confront the anguish of death and the stigma of a disease widely regarded with horror and revulsion. Often it is the first time that they directly confront the personal implications of homosexuality.
Fearing rejection at the time they are most vulnerable, many female relatives of male victims hide the nature of the disease from friends, landlords, neighbors, employers and families.
"The wives really feel the stigma," said Gail Snider, a therapist at Whitman-Walker Clinic in Adams-Morgan. "The carry so much around because often they tell no one and to put on a certain front, even with their own children."
"Sometimes it's the first time people tell their families that they're gay and not only that they're suffering from a life-threatening communicable disease. It's a double whammy," said Deborah A. Newmark, a clinical social worker at NIH who counsels patients and their families.
Some women worry that they or their children may have contracted AIDS, which has an incubation period of up to three years. Others worry they might inadvertently expose a patient to germs that could be deadly, because AIDS victims have reduced immunity. That fear can create painful dilemmas.
A District woman whose older brother, a 37-year- old teacher, recently died of AIDS still wonders whether she should have allowed her 4-year-old daughter to kiss him. "I still don't know if I was right in that decision, but I just couldn't do that [forbid it] to either of them" she said.
For female victims, the fact that there are so few of them can cause additional problems. Because she has many close friends who are gay men, Sherman said, her adjustment has probably been somewhat easier. In addition, her family has been especially supportive and she is financially secure.
"Sonny is a remarkable person," said Barbara Baird, an NIH nurse who knows her well. "She's got a lot of spunk and lot of fight and that goes a long way."
Sherman, one of five women out of the 188 AIDS patients who have been treated at NIH, is also something of a minor medical miracle. NIH officials say she may be the only AIDS patient to survive a rare bacterial infection caused by everyday dust. However, the experimental drugs used to control the infection left her nearly deaf.
AIDS had not even been given a name in 1980, the year Sherman believes she contracted the disease from a former boyfriend. He is considered a high AIDS risk because of his numerous sexual partners, but it is medically impossible to determine whether he was the carrier.
Many of her friends are gay men, Sherman said, "because if you weigh 200 pounds, which I did, gay men still accept you for who you are, not what you look like. It was a way to have a social life and there was no sexual pressure."
Although she says she deeply loved her boyfriend, she ended the relationship after six months because he refused to stop seeing men. "Deep-down I think he wanted a normal, monogamous relationship," she said. "He couldn't do it an I couldn't take it anymore."
Sherman had relationships with other man but none was serious, and she had difficulty meeting straight men who might be prospective marriage partners. "At one point I decided "Okay, girl, you're 32 and it's time to get it together,"" she said. "Then I got sick."
In April 1983, Sherman said, she noticed a small, extremely itchy red rash on her forearm and legs. Her dermatologist did not think it was anything serious and gave her cortisone cream, which helped temporarily. Then, she said, her thick curly blond hair began to fall out in clumps and the imexplicable fevers, night sweats, chills and overwhelming fatigue began.
Tests for allergies and lupus, a degenrative skin disease, were negative. "After a few months I had the feeling I might have AIDS because of my life style and the people I went around with," she said.
For months, doctors assured her she did not have AIDS. She recalls numbing weeks in which she worked long hours at a Washington law firm, despite high fevers, often spending her lunch hours in doctors' offices undergoing painful and at times harrowing procedures.
For a long time she tried to conceal the severity of her illness in Montgomery County, where Sherman grew up. She spent a lot of time resting in her immaculate efficiency apartment in Northwest Wasington, which is decorated with colorful pottery and sepia-toned family photographs. "Once I had such a high fever I couldn't get out of bed to get a glass of water to take an asperin," she recalled. "I had to ask the maintenance man who came to fix the air conditioner to bring me one."
The pain caused by the infections and highly toxic experimental drugs used to treat them required frequent shots of morphine. Although her cheerful directness belies it, there were period of terrible emotional anguish worse than the physical pain.
One of the worst times occurred last Thanksgiving during a two-month hospitalization at George Washington University Hospital, where she was fighting to survive the rare pneumonia that is the primary cause of death among AIDS patients. "I just lay in bed all day and watched the Macy's parade on television and wept," she recalled.
In December, when she returned to work, Sherman told attorneys in her law firm of the diagnosis. "The firm's reaction was, "Don't come back and don't tell anyone why." That really hurt," she said, "because I feel okay and I would like to be productive and work part time as long as I can."
Sherman, who receives Social Security disability payment of $700 a month, does not want the firm's name disclosed because it paid part of her $20,000 annual salary after she left and continued her medical insurance, which has covered about $60,000 in medical bills. The cost of her treatment in several experimental NIH programs is far greaater but free because it is federally funded.
Breaking the news to her mother, who was recently divorced from her father, a commercial real estate salesman who lives in Florida, was difficult.
"We came back here and sat down at the dining room table," Sherman recalled, "and I told her. She handled it really well. I know she didn't want to cry in front of me so she started chain-smoking furiously. Even though I'm open about it, we really can't talk about death, I'm afraid of the emotions that will occur. . . . My mother is going to outlive me and I know that losing a child is a terrible thing."
Her father and two brothers are also supportive. "The hardest thing for my family was finding out that I had more of a relationship with homosexuals than they thought."
Sherman said she feels better than she has in a year, and she spends her days seeing a large circle of friends and working in AIDS-related programs. "I definitely want people to know that women do get this disease." Every two weeks she goes to NIH for blood tests. Her mother calls every day, and her former boyfriend, who was shocked by the news, telephones periodically.
Several months ago she wrote a will, dividing here possessions and leaving Nelson, her affectionate gray cat, to her younger bother. She also drafted a living, which she hopes will prevent doctors from using extraordinary means to keep her alive. "My biggest fear is not dying," she said, "but the process of dying."
She has a few regrets. Occasionaly she wishes she had married or that she could travel.
But, she adds, "I don't really want to be that far from home. I fear is that any time I could come down with an opportunistic infection. I always wonder when I'll feel lousy again. That fear is always lurking there."
At this point her reaction to her impending death is "sort of an administrative one that probably shocks a lot of people. I worry more about the people left behind." She is planning a "celebration of life" party on the anniversary of the AIDS diagnosis and is thinking about her funeral, which she hopes will also celebrate her life. "I definitely don't want a morbid, morose service."
She is especially conceerned about not squandering whatever time remains. "You don't waste energy on certain things," she said. "I appreciate things more like getting out in nice weather, driving through Rock Creek Park, seeing flowers bloom.
"People sometimes aske me if I blame anyone, if I blame God," she said. "I definitely do not. I have to be as responsible for contracting it as the person was who gave it to me. Being a woman with AIDS, I would give the same advice I have to a man. Have hope, have a good psychological outlook. Because if you just sit at home and wait for AIDS to take over, it will."