Shared responsibility is key to reducing HIV transmission
To the editor:
In his February letter to the editor "When it comes to HIV - do ask, do tell," Chuck raises very important issues.
Unfortunately his correspondence is rife with false assumptions and misconceptions. It also seems to reflect a marked lack of compassion and a propensity to blame.
The writer claims to know how most men in our community became infected but cites no evidence. In fact, people become infected in a variety of circumstances that may involve simple lust or be complicated by poor or impaired judgment, dysfunctional relationships, substance use, or other factors. We become infected because we are human.
Of course the goal is for HIV positive persons to disclose their status. A realistic consideration of the difficulties of disclosure, however, should inform others‚ decisions about the risks they take. Those who disclose often experience enhanced rejection and stigmatization piled upon what they already suffer as men who love men. Disclosure may also result in other kinds of discrimination from family, employers, and landlords, to name but a few.
Chuck characterizes his stereotypical HIV negative transmission partners as a "victims," concedes they "fell prey to lust and let their guard down," yet has no compassion whatsoever for their HIV positive partners who did exactly the same. He states the "heat of passion is not an excuse for passing this virus." It takes two individuals to transmit. Applying this to only one partner seems to enforce a double standard for responsibility. Outside of rape, most HIV negative people have it within their power to reduce the chances of infection to nearly zero without forgoing sex.
Not all of us consider ourselves victims, by the way. Most eventually become aware of and accept our own responsibility for being infected - and doing so is often critical to our emotional health. We are not a mindless, monolithic herd. The writer's premise that we all think and act the same is an act of stereotyping that borders on bigotry.
The writer proposes to chastise our community for not insisting HIV positive gay men quit spreading the virus, discourage HIV positive men from having sex, hire internet police to monitor positive people who do not disclose, count on laws that make it a crime to engage in sex with others without disclosing their status.
Sadly, there's no evidence that any of these strategies will reduce HIV transmission.
Our sexual orientation is considered by many to be an offense in itself. We have enough people chastising us without doing it to ourselves. After years of breaking the law whenever we had sex, we defeated those laws. Moving beyond decades of clandestine meetings, we‚ve come to recognize and embrace our sexuality as healthful and "normal." Laws that criminalize exposure are considered by many to be counterproductive and a disincentive to being tested. (If one doesn't know he's HIV positive, one doesn't have to disclose and doesn‚t have to be responsible.) We cannot police sexual activity without putting everyone under constant surveillance, something those who've fought for freedom won't consider.
With all his rhetoric, the writer places the responsibility for the epidemic and for prevention solely on the "others," the HIV positives. This is neither rational nor effective for basic scientific reasons. The United States Centers for Disease Control and Prevention reports that approximately one in five HIV positive persons do not know they are positive. In the weeks just after being infected, persons are more infectious than they will ever be in their lifetime, yet most do not realize it. While the exact proportions are unknown, it is believed both groups are significant sources of new infections.
The correspondent assumes that positive persons who don't list their HIV status openly in online profiles do not disclose to their partners before having sex. He can't possibly know this. For very real social, emotional, and survival reasons, some individuals don‚t wish to broadcast their status. They responsibly disclose later as needed. Others limit actual, in-person sexual interactions to activities with little or no risk. Studies indicate that most men who have sex with men work hard to protect their partners after they are diagnosed. Those who are successfully treated dramatically reduce their potential to transmit the virus.
I dispute Chuck's assertion that we "do not engage smart protection for the gay community." HIV prevention programs have historically urged folks who were engaged in behaviors associated with obvious risk to behave as if all of their partners are positive. That's realistic and simple - but it"s not enough. Today's prevention programs try to reduce transmissions by engaging communities in more nuanced conversations. Significant effort is placed on discussions with those who are already infected, and empowering them to disclose is always a goal.
We are not "more concerned" for HIV positive men than HIV negative men. Our methods are not backwards. They are constantly being improved based on the experience and research of highly dedicated professionals and volunteers.
The answer to our struggle is not pointing fingers, is not segregating the community, is not placing the responsibility on one group's shoulders. The answer is for all of us, HIV negative and positive alike, to assume the shared responsibility for reducing HIV transmission by:
Getting screened and encouraging our friends to get screened regularly for HIV and other sexually transmitted infections, according to the risks we take.
Using known methods to reduce the risk of transmission of HIV (AND hepatitis, herpes, syphilis and other sexually transmitted infections.)
Talking to each other frankly about our sexual history and health before we have sex.
Honestly assessing the reliability of these conversations and our own vulnerability in situations that entail risk.
Supporting those who test positive, encouraging them to get into care, and expressing our love for them.