ABSTRACT
Mark was sentenced to a two-year prison term following arrest and conviction for possession of heroin. It was during these years that he met the infectious disease doctor who would later see him in the outpatient immunology clinic. On release from prison he followed through with the clinic appointment. His self-confident, friendly attitude was reflected in the way he swaggered into the examination room and said to the physician, "Hey, John! How ya doin' man?" At 6'6" and 240 pounds his physical presence alone was intimidating. He would soon become well known to the clinic staff as a master of manipulation. He would also use intimidation to accomplish his objectives and to try to direct the outcome of a clinic visit. Mark was diagnosed HIV positive six years prior to his first clinic visit. His CD4+ count remained above 500. He appeared to be a healthy, thirty-two-year-old black man.
