Robert Marquez was 18 when he got the news that would change his life forever.
He was HIV positive.
"I knew nothing about it outside of it being a 'gay disease' like my conservative parents and pastor said about it," said Marquez, now 20. "But now, I know that's not true. It can affect anyone. But it's also possible to live a long, normal life."
His case is one example of a double-edged reality that has raised concern among advocates as HIV makes an unwelcome comeback in Florida. While the stigma has lifted somewhat and effective treatments have lessened much of the danger, the disease no longer presses on the public consciousness like it once did.
That and a lack of public information have contributed to a rise in cases among a new generation of young people who never knew the fear that HIV evoked in earlier times.
Florida continues to rank at or near the top nationally for HIV diagnoses, with Pinellas and Hillsborough counties among the regions that are considered hotbeds of activity. And local health officials say they are seeing more cases among people in their early teens to early 20s.
"Yes, HIV is more manageable these days, but it's on the rise again. Younger people are being diagnosed and don't seem to understand the consequences or know the history of the stigma behind HIV and AIDS," said Lorraine Langlois, CEO of Metro Wellness & Community Centers, a network of health care facilities that specialize in LBGTQ services around Tampa Bay.
While state health officials typically don't release HIV data in real time, many available numbers support what advocates say they are seeing in their centers.
According to the Florida Department of Health, the number of HIV diagnoses:
• Increased 8 percent statewide among people of all ages from 2014 to 2016.
• Shot up 20 percent from 2007 to 2016 for people in their 20s across the state.
• Rose significantly over the same nine years for people in their 20s in Tampa Bay. The increase was 28 percent in Pinellas and Pasco counties, and 23 percent in Hillsborough County.
Nationally, people ages 13 to 24 accounted for 21 percent of all new HIV diagnoses in the U.S. in 2016, with most of those occurring among those who are 20 to 24, according to the Centers for Disease Control and Prevention.
Many of them are not using condoms, a problem that has only worsened in the last decade. In a CDC survey last year, only 54 percent of sexually active high school students said they used condoms the last time they had intercourse, down from 61 percent in 2007.
Health care groups and advocates around Tampa Bay say they are responding to the trend with expanded services and new public health campaigns focusing on HIV prevention, including the need to use condoms.
The AIDS Healthcare Foundation opened a new medical clinic this week in St. Petersburg's Skyway Marina District, where it will offer medical care and services to patients regardless of their insurance status or ability to pay.
"The need for medical care and services for HIV/AIDS patients in St. Petersburg remains significant, with both Florida and St. Petersburg repeatedly landing at the top of HIV and/or AIDS incidence and rates nationally," said Dr. Jeanette Cancel, AHF Tampa Bay medical director.
Also this week, the Foundation for a Healthy St. Petersburg announced a "Zero Pinellas" partnership and a $2.2 million grant that aims to reduce the number of new HIV infections in Pinellas County by 50 percent within the next three years.
"It's the millennial generation, living in this age of technology and social media, which can be difficult to grab their attention," said Imara Canady, regional director of communications and community engagement for AHF. "They're pulled in so many directions, and traditional academic ways of messaging just doesn't work anymore."
The way young people meet and engage with one another has changed the way sex plays a role in relationships, too.
"People can be dating online for two weeks, and when they're in the same room with someone for the first time, they already feel like they know them," Canady said. "Because that dating practice is accelerating, it makes sex a more risky experience."
It doesn't help that sex education has been reduced or eliminated in school systems because of a lack of funding, Canady said.
"People aren't dying anymore from HIV and AIDS, so there's no more sense of urgency around the epidemic," said Tracy Jones, national director for grassroots mobilization at the AHF. "There's a generation of young people who have lived with HIV their whole lives, which represents something different entirely than those who were diagnosed just hours away from death."
Treatment for AIDS and HIV changed significantly in the mid 1990s, said Dr. Stephanie Marhefka-Day, a professor at the University of South Florida who has studied HIV for decades.
"Medicine changed the outcome greatly at this time, but it was not a great time for quality of life for people living with HIV," she said, noting there were many pills to manage, which caused severe side effects.
That, too, has since changed. Multiple medications can be used to manage symptoms of HIV patients on an individual level without so many side effects, she said.
A controversial new prevention drug called pre-exposure prophylaxis, or PrEP, is becoming increasingly popular within gay and transgender communities to lower the chance of becoming infected through sex or injections.
"The benefit is allowing HIV-positive people to have a relationship, to realize their sexual selves again, and for it to be less stigmatized, which is amazing," Marhefka-Day said. "But from a research perspective, there are a lot of dollars going toward PrEP and a cure, which is great. But we could use more funding toward the behavioral side of prevention, like reminding people to wear condoms and to understand the risks."
While it may be easier to live with HIV clinically, the stigma behind the disease is still alive and well, especially in places such as Florida, Marhefka-Day said.
"It may be less so with young people, but unfortunately, there are still people who don't want to live with HIV-positive patients, or want to touch plates they've eaten off, or they're afraid to share a bathroom with them," she said. "People still don't understand how HIV is transmitted."
That's what Jonathan Hill remembers. He was diagnosed with HIV in 1998 while he was incarcerated at the Hillsborough County jail. While Hill was married to a woman at the time, he was taking drugs and drinking, and later would come out as a gay man.
"I thought I was going to have to call my family and prepare them for my death," Hill said.
Now 49, he sees his doctor twice a year and takes medicine daily. He uses condoms with his second wife, a transgender performer named Sierra. They have been married since 2016, and she is not HIV positive.
"She didn't know much about how you could catch it at first," Hill said. "But she was willing to learn more."
Hill likes to talk to young people who come into Metro Wellness and the Youth Clinic in Ybor about life with HIV.
"It's 2018 and I'm still here. I can eat what I want. I don't look sickly and frail," he said. "But young people need to stop trying to be Superman. PrEP is great, but it doesn't protect you from other STDs. So use a condom."
Robert Marquez wasn't sure which partner passed HIV onto him.
"I have two cousins with lupus, so I regularly donated plasma at a local clinic for them," he said. "One day, I was told I couldn't donate anymore because I was HIV positive."
He confirmed the diagnosis with a physician at the Metro Wellness clinic in Ybor City. When he knew for sure, he was devastated.
"I didn't know what I was going to do. But I started researching it to learn," he said. "It didn't make me feel better, but it gave me hope."
Marquez, who was born in Miami but grew up in Tampa, now works as a prevention specialist at Metro Wellness. He coaches young people by telling them what he went through, and he's healthy enough to pursue passions like playing piano, singing and dancing. Marquez's current partner is HIV negative, and he takes PrEP.
"I get to have goals, like plan for school and traveling the world and hopefully one day getting engaged and getting married," he said. "This was a wake-up call. I'm lucky I get to live a normal life, but it's taught me to be careful and to educate myself."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.