The woman and two men in the 19-year-old Winnebago could hear shots in the distance as they pulled up to a busy West Baltimore intersection at 9:30 p.m. They shrugged it off and got to work, readying the converted RV for its mission, checking their supplies: 200 bottles of bleach, several hundred condoms, blood-pressure cuffs, vials for blood tests.
The AIDS van was open for business.
Four nights a week, for 16 months, this white Winnebago with 123,000 miles on its odometer has taken to the city's mean streets, bringing a specialized health care to those who might not get it otherwise.
The city Health Department sees this as one answer to the AIDS problem in Baltimore, where more than 2,200 people have been diagnosed with the deadly disease in the past decade.
Today, black, female drug-users are the fastest-growing population with AIDS in the city.
The roving clinic, at a cost of a $48,000 a year, targeted this group with a prevention-based solution -- condoms for safe sex, bleach to clean shared needles. And, by making tests for the AIDS virus convenient, the program identifies infected people who may not go to more conventional clinics.
From 9:30 p.m. to 12:30 a.m., the Winnebago sets up shop at a busy corner in a poor neighborhood, then waits for clients to drop by. Paperwork and blood-pressure tests are done at the dinette table. In the rear, emergency medical technicians draw blood to test for syphilis and the human immunodeficiency virus, which causes AIDS.
Initially intended as an outreach program for women, prostitutes in particular, the van has become a mobile community center, an odd, nocturnal version of the bookmobile. Some neighborhood residents look forward to its visits, stop by and chat with the workers, note when it fails to show up.
Others simply stick their heads in the door, ask for condoms and bleach, then disappear into the night. Or they come by for an AIDS test, then never return for the results.
And then there was that time in Hollander Ridge, when angry adults surrounded the Winnebago and began banging their fists on it, incensed because the workers were talking with a 15-year-old boy who said he was having unprotected sex.
"They said they didn't need us there," said Sandra Wearins, a city Health Department worker and consultant who counsels the clients. Ms. Wearins believes that young people in the neighborhood are more sexually active than their elders may think.
Since the van began touring city neighborhoods and homeless shelters in April 1991, it has served more than 2,000 clients and administered 600 tests for the AIDS virus, about 5 percent of which came back positive.
While the city Health Department, which runs the Winnebago, can hand out bleach for cleaning needles, state law prohibits needle exchanges, in which addicts receive sterilized needles for used ones.
A similar mobile program in New Haven, Conn., the first legal needle exchange in the country, has been able to demonstrate that it gets HIV-tainted syringes off the streets. Other cities, including Washington, have approved exchanges, despite condemnation by the Bush administration.
Kevin, 26, was bleeding from his latest heroin injection when he climbed into the Winnebago last Thursday night.
"What's wrong with your arm?" Ms. Wearins asked sharply. He looked down at his arm and grinned sheepishly.
"You haven't been sharing needles, have you?" she persisted.
"Yeah," Kevin said, and Ms. Wearins shuddered involuntarily.
"I know, but I rinse them in bleach," he said. "I had a birthday since I last saw you. I pray out there. I pray I see another birthday."
Kevin relies on the Winnebago for bleach and condoms but goes to a clinic for testing.
On this particular night, dozens of people will drop by, but only five will be willing to wait 15 minutes for blood to be drawn. The fifth, a woman, is sent away after emergency medical technician Joe Graham fails to find a usable vein.
"She had no veins at all on her arms, and when you tried to use her hand, the vein collapsed," said Mr. Graham, who wears street clothes because his blue uniform makes him look like a police officer. "She said they take it from her neck or her groin at the hospital, but we're not allowed to do that here."
The van's workers often encounter people with collapsed veins, a common condition among chronic IV drug abusers.
Lying also is common, as some who decide to be tested give false names and addresses. Ms. Wearins knows they lie because she tries to visit anyone with a positive test result.
"I've gone to laundromats, to sub shops, to the house of a 74-year-old man who refused to let me in," she said, rolling her eyes.
Results are available within a week, but some people never come back. Or, when they do remember to check results months later, they no longer have the card with their control numbers, which Ms. Wearins matches to a computer printout. In those cases, she checks the files at her office and brings the results back the following week.
"I took it three months ago!" one young man told the workers during Thursday's outing, indignant that his test results weren't available. "Don't you have it yet? You told me you were going to send me a letter. I'm sure I don't have it, but I want to take another test."
While Ms. Wearins told him how the confidential system works, a neighborhood resident and self-appointed volunteer, Charles Dorsey, worked the intersection of Pennsylvania and Fremont avenues and Bloom Street, practically dragging people to the Winnebago.
"It's a good program. We need it around here," he said, as he shoved one woman through the door. "Nobody says no to me."
So far, this West Baltimore neighborhood has had 15 positive AIDS test, accounting for about half of the positive results at the 20 sites visited. The Health Department briefly dropped the neighborhood, but decided to return because the highly transient population means there are always new people to reach.
At first, residents thought the health-care workers were "narcs," street slang for narcotics detectives. In some neighborhoods, the unit is still fighting that rumor.
But they have no problem attracting clients at this West Baltimore site, which Mr. Graham describes as a "24-hours-a-day neighborhood." Prostitutes come by between jobs. Others come by after visiting the clubs and sandwich shops along Pennsylvania.
The workers know not everyone uses the fistfuls of condoms they take away. Ms. Wearins figures some people sell the foil packets, while others just want someone to think they're sexually active. Pre-pubescent boys ask, too, but Ms. Wearins says the service is limited to those 12 and older.
Recently, the U.S. Centers for Disease Control evaluated the program, officially known as Ujima, which is Swahili for "communities collaborating." The Atlanta-based agency is considering a grant for the program.
It could use additional money, Ms. Wearins said, if only for a new Winnebago. Mechanical breakdowns have kept the unit off the streets several times this summer.
By midnight, the rush of clients was over. Sometimes, the crowds keep coming until 3 a.m. But this had been a fairly quiet night for Ms. Wearins and her crew. No one wired on cocaine. No one staggering in with a stab wound, or blood pressure so high the workers had to call 911.
But the hardest part of any shift is talking with those who have tested positive. These people often become regulars at the mobile clinic, coming back just to see Ms. Wearins.
"People test positive, they need someone to talk to," she said simply.
When the RV pulled away from the curb shortly after 12:30 a.m., the neighborhood was still going strong. A young woman was working the corner of Pennsylvania and Bloom, in a tight skirt and black-and-fuchsia blouse. In her purse, she had about 20 foil-packed condoms, courtesy of the Winnebago.