Box Turtle Bulletin

HIV and Friends, Part 3 — Where Ignorance Rules

It’s strange how sometimes we see a convergence of related topics coming within a few days of each other. In our discussion of the ethics of revealing someone’s HIV status, I wrote at length on the pernicious effects that AIDS-related stigma continues to have within the LGBT community as well as the larger society. Of course, that larger stigma has had more than twenty-five years to fester.

But then yesterday, we had a mainstream news report from Switzerland, in which health experts suggested that people with HIV/AIDS with an undetectable viral load may not be contagious. (While their hypothesis makes a lot of sense logically, I’m not aware of any research to support it just yet.)

But now, we have shocking news out of Canada — you know, that country that is so much in the grip of the “homosexual agenda” — that a judge believes that HIV/AIDS is so contagious, one can be infected just by sharing the same courtroom with someone. According to the Toronto Star:

An Ontario judge is at the centre of a misconduct investigation after insisting a witness who is HIV-positive and has Hepatitis C don a mask while testifying in his courtroom.

Three groups have complained to the Ontario Judicial Council about the conduct of Barrie judge Justice Jon-Jo Douglas, who later moved the case to a bigger courtroom in order to create more distance between the witness and the bench.

… “The HIV virus will live in a dried state for year after year after year and only needs moisture to reactivate itself,” Douglas insisted, according to a transcript of the Nov. 23 trial proceedings.

At one point, court employees donned rubber gloves and placed documents touched by the witness into plastic bags.

Judge Douglas’ ignorance is downright appalling. I have no idea where he gets his medical information. Maybe from the same source as Mike Huckabee. You may recall, he recently defendd his call to quarantine everyone who’s HIV-positive (while saying it wouldn’t be called a “quarantine”). Instead, Judge Douglas should probably acquaint himself with what the experts at Health Canada has to say:

HIV cannot be transmitted through:

— Casual, everyday contact;
— Shaking hands, hugging, kissing;
— Coughs, sneezes;
— Giving blood;
— Swimming pools, toilet seats;
— Sharing eating utensils, water fountains; or
— Mosquitoes, other insects, or animals.

Meanwhile, complaints have been filed against Judge Douglas:

Ontario’s Criminal Lawyers Association has also lodged a complaint with the judicial council. The lawyers’ group contends Douglas did not bring a judicial temperament to trial proceedings and treated a witness differently on the basis of irrelevant personal characteristics. … The complaints are being investigated by a judicial council subcommittee, which will determine if a public inquiry into Douglas’s fitness to remain on the bench is warranted.

Judge Douglas however remains obstinate:

Douglas refused the Crown’s request to grant a mistrial, declined to recuse himself from the case and refused to consider granting bail to the accused, Lee Wilde, when it became clear the trial would have to be adjourned until the judge’s concerns were addressed.

A new trial will begin Feb. 14.

See also:
HIV and Friends, where we discuss the ethics of revealing someone’s HIV status and the pernicious role stigma plays in the assumptions surrounding those living with HIV/AIDS.
HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?, where we examine the hypothesis of Swiss health officials who suggest that an undetectable viral load renders one virtually non-contagious.

HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?

The Swiss seem to think so:

The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others. …

The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood. The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

“The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy,” said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St.Gallen in eastern Switzerland and one of the authors of the report.

I have seen a few references to this hypothesis in medical journals — I call it a hypothesis because I haven’t ever heard of a study to test the hypothesis — but I’ve never before seen anyone go out on a limb to say that unprotected sex with someone with an undetectable viral load is safe. And I won’t. As I understand it viral loads can fluctuate for a variety of reasons, including if the person has the cold or flu or any other temporary illness.

I normally wouldn’t even comment on this hypothesis except it has now appeared in the mainstream media. If I were you, I’d demand a whole lot more proof before changing any behaviors. My advice here still stands.

Update: The CDC has responded to the Swiss actions by reiterating their previous recommendations.

See also:
HIV and Friends, where we discuss the ethics of revealing someone’s HIV status and the pernicious role stigma plays in the assumptions surrounding those living with HIV/AIDS.
HIV and Friends, Part 3 — Where Ignorance Rules. If the Swiss believe that HIV isn’t contagious under certain conditions, a Judge in Ontario believes HIV is so dangerous it can be transmitted simply by sharing the same courtroom with someone.

HIV and Friends

This commentary reflects the opinions of the author, and is not necessarily those of the other contributors of Box Turtle Bulletin.

Last Friday, BTB contributing author Daniel Gonzales wrote a controversial post objecting to some advice given on the gay male hookup site “Manhunt.” (By the way, I think that post marks the first time an author on this humble site has ever linked there, but that’s beside the point.) The advice was in response to this question:

So, my friend “Dave” has HIV and when he met my other friend “Steve” sparks flew. I debated if I should tell Steve that Dave was positive but decided not to. Later that night Dave and Steve went home together and when Dave told Steve he was positive things came to an abrupt halt and now Steve is no longer speaking to me because he thinks I should have said something. Was I right to keep my trap shut?

Manhunt’s sex-advice columnist Michael Alvear’s responded:

I would have told “Steve” that “Dave” was HIV+. Why? When philosophy meets reality, logic flies out the window. If I’m asked to choose between an abstraction like personal responsibility and the well being of a close friend, I would rather be intellectually inconsistent than emotionally tortured. I’m not passing judgment on you because there are good arguments on both sides. The only person who needs a wake-up call is negative Steve. He gave up a night or maybe a life with an awesome guy just because he’s HIV+? What a schmuck.

Daniel called that advice “bogus”:

Remind me never to make friends with Alvear if I contract HIV.

A person’s HIV status is their own business and their own business only. I’ve been in situations similar to this and never for a second considered disclosing someone else’s status.

The response in the comments was quite varied. And privately, I’ve gotten a few e-mails from readers who are very puzzled by Daniel’s reaction. One asked if we’ve lost our collective minds. Well, yes and no. The topic of HIV/AIDS tends to do that. Since some have questioned our credibility because of that post, I want to take some time to address this question in detail and throw my two cents worth in.

This particular situation calls for everyone to examine this from three sides: Steve’s responsibility, Dave’s responsibility and Bob’s responsibility. Who’s Bob? Well, the letter writer doesn’t have a name, so I’ve named him Bob.

Steve’s Responsibility

Let’s recap. In a nutshell Steve is Bob’s friend, but he’s mad at Bob because Bob didn’t tell him that his other friend Dave was “poz,” or HIV-positive. Steve’s furious that because Bob didn’t warning him ahead of time, Steve didn’t know until Dave was “poz” until Dave told him, bringing everything to an “abrupt halt.”

I think we can all agree with Michael Alvear on one point at least: Steve is a schmuck, but for a more serious reason that Alvear cites. Steve’s a schmuck because he’s denying his own irresponsible behavior while trying to make Bob the scapegoat.

Look at what happened. Steve was about to have sex with a someone he had just met that night, and he was going to do so without having “the conversation.” And it appears that Steve decided to call everything to “an abrupt halt” only because he got the “wrong” answer from Dave when Dave brought it up. Ironically, the “wrong” answer just happened to be the honest-to-God truth about Dave’s HIV status.

If there ever was a case of playing with fire, this is it. What if instead of honest Dave, Steve had found another really hot guy that he decided to go home with, someone who Bob didn’t know. And what if no conversation took place? I have a sneaking suspicion that nothing would have come to “an abrupt halt.”

But let’s say that Steve is only slightly less than a schmuch and initiated the “the conversation,” and in that conversation Steve got the “right” answer because this hot guy lied about his status? Would Steve have brought everything to an abrupt halt then?

Or what if that hot guy just assumed that he’s negative because he’s never been sick and never been tested? According to the CDC, nearly one million Americans are infected with HIV, but about a quarter of them don’t know it.

Or what if that hot guy was honest and thought he was really HIV-negative because he just got a negative test result last week? That negative result may not mean he’s actually HIV-free. The truth is, it can take from a few weeks to several months before an infection leads to seroconversion in some people, and it’s that seroconversion which produces a positive result.

All we know is that Steve changed his behavior because Dave gave him the “wrong” (but honest) answer. But given all the possibilities in this situation, Steve is playing a dangerous game no matter what anyone else might say or do. Before anyone casts any stones towards anyone else, we really need to place the responsibility for Steve’s health squarely where it rests: with Steve.

Dave’s Responsibility

But just because the primary responsibility rests with Steve, it doesn’t mean he’s the only one who should be concerned. And in this story, it turns out that Dave is the hero in the story. He made sure “the conversation” took place and gave Steve the information he should have asked for. At least we know that there’s one responsible person in this whole scenario. He deserves a heaping helping of recognition, and everyone who is in this situation needs to follow Dave’s example. It’s tough though for a lot of reasons, so I have a whole lot more to say about Dave. So stick around, because I’ll come back to Dave after I deal with Bob, since he’s the focal point of the whole controversey.

Bob’s Responsibility

So now we come to Bob. The guy caught between his two friends, Dave and Steve.

I wish Bob had explained why he decided not to tell Steve about Dave’s HIV status. I’ve thought about it, and can only come up with three possible legitimate reasons: 1) that he was confident that Dave was a stand-up guy and would do the right thing, or 2) that he thought that Steve was a stand-up guy and would do the right thing, or 3) that it wasn’t any of his business.

On the first point, Bob was right. Dave is a man of integrity who did the right thing. Maybe that’s why Bob and Dave are friends.

But on the second point, Bob was seriously wrong. Steve was a complete idiot. Does that mean Bob should have spoken up? Maybe so, and he can do it without disclosing Dave’s HIV status. But given Steve’s reckelessness, Bob might be taking on more responsibility that he can reasonably handle, since he’d probably feel obligated to speak up regardless of who Steve is about to go to bed with. With Steve’s dangerous calculation, how on earth is Bob going to keep him out of trouble?

So what about the third point? Is it any of Bob’s business?

My view aligns somewhat with Daniel, that it is none of Bob’s business — generally.

We all know that matters of health are very sensitive, so much so that we demand confidentiality between the patient and his or her doctor. I think we can all instinctively understand that this confidentiality is important. And so as a general rule, I think we can understand that maintaining confidence about someone’s health status is generally wise.

It’s the party line in the poz community that one must never ever ever never reveal someone else’s health status. But that’s the thing about party lines. Party lines which leave no exceptions, generally speaking, aren’t always wise. There needs to be room for exceptions.

The question has been asked, does privacy trump safety? I think the question sets up a false dichotomy. If I were Bob and I believed that my friend Dave would actually lie about his status, and I believed that my other friend Steve was too much of an idiot to take care of himself no matter what Dave might or might not say — then yes, I would probably feel obligated to say something. But that doesn’t mean I have to reveal Dave’s HIV status.

But if Steve were such a complete idiot there was no other way of getting through his thick skull, then yes, if pressed, then I might. But remember, in this very limited scenario, I believe that my friend Dave would lie about his status (and why would I protect that behavior?) and that Steve is stupid and utterly irresponsible. Which means that I’d also have to dump both friends and look for a much better class of friends.

I know that’s crossing a party line, but sometimes party lines beg to be crossed. But in the end, I’m no more capable of protecting Steve than anyone else. Ultimately, it has to be up to him.

But there’s another point to be made here. The issue has been raised that Bob had no business discussing Dave’s health status. But I’d also point out that Bob had no business assuming that serodiscordance between Dave and Steve should be a deal breaker.

Serodiscordance in couples — where one partner is HIV-positive and the other is negative — is not terribly uncommon. There thousands of couples all across the country, both casual and serious, who are “poz/neg” (I hate the term “serodiscordant”; it sounds too, well, discordant). The fact that Dave and Steve are of a mixed serostatus doesn’t mean sex is inherrently dangerous for Steve. It just means that they need to take measures to keep from passing HIV on. This isn’t always easy, but thousands of couples somehow manage. Besides, the fact of this particular couple’s being poz/neg shouldn’t trigger any change in behavior on Steve’s part anyway, since Steve needs to protect himself no matter what anybody says or doesn’t say.

But if Steve considers serodiscordance unacceptable — and he has every right to establish whatever boundaries he chooses (again, I’m treading on another party line) — then that just means he has a special obligation to raise “the conversation” as early as possible. After all, doesn’t Dave have a right to know he’s about to waste an evening with someone who considers it a deal-breaker? If Bob knew that serodiscordance was a problem with Steve, then if anything he probably should have pulled Dave aside and told him, “hey, Steve’s not going to go for this.” But I don’t see anyone making that argument for some reason.

I think Bob did the right thing in this particular scenario. With a different scenario, maybe Bob might feel compelled speak up. Since this is something of a judgment call, I wouldn’t come down too harshly on Bob if he had said something — although I’d be very critical if he unnecessarily disclosed Dave’s HIV status. But I strongly disagree with the notion that Bob bore a moral responsibility to do so.

So to those who say “I would want to be told”: if you really want to be told, then ask — and take the answer with the appropriate grains of salt. That’s the only way to protect your health. No one else can protect it like you can. Even if Bob were inclined to freely blab about who’s poz or not, he won’t always be around.

Let’s Talk About Dave Some More

Remember Dave? In the responses to Daniel’s post, both public and private, few seemed to notice that it was Dave — the poz guy who posed such a terrible threat to poor unsuspecting Steve — who showed responsibility by forcing “the conversation.” For some, it’s almost as if the poz guy is virtually guaranteed not do the right thing. That because he “did something wrong” to get infected, then he’s going to keep doing something wrong to pass it on.

Ever since five gay men died in Los Angeles in 1981, people with HIV/AIDS have been a frightening abstraction. AIDS is certainly frightening. It’s commonly believed to be a fatal condition, but that’s no longer true. Thanks to modern medicine, AIDS has moved from being a fatal disease to a chronic one, much like diabetes. It is still a very serious, complicated and life-changing condition (like diabetes), it still causes a lot of health problems in virtually every organ of the body (like diabetes), it still ultimately results to a lot of deaths for too many people (like diabetes), and it remains incurable (you get the picture). And like modern-day diabetes, AIDS is often acquired due to poor choices that one makes in life — but also like diabetes that’s not always the case.

AIDS differs from diabetes in two distinct ways. First, AIDS is communicable and diabetes is not. And secondly, unlike diabetes, AIDS carries a very special stigma more than twenty-five years in the making.

Well there’s a dirty secret we’re not supposed to talk about, so I’ll cross yet another party line. It’s the stigma that surrounds HIV/AIDS within the LGBT community. In February 2006, Cari Courtenay–Quirk and colleagues published a study in the journal AID Education and Prevention titled, “Is HIV/AIDS Stigma Dividing the Gay Community?” In short, the answer is yes. One poz participant talked about the taboo that has developed among some:

I think people support you to a certain extent, and then they kind of back off from you. It’s like taboo to them. So on the one hand, they’re always there to help and they’re concerned, but when it comes down to getting to know you, if they’re not HIV–positive, then it’s different. There’s some sort of block there.

The stigma surround HIV/AIDS often keeps HIV-negative men from talking about it, much like Steve in our story. Another study participant noted:

They are afraid of being involved with somebody who has it or being attracted to somebody who has it and then risking getting it themselves. And it’s a lot of just not wanting to think about it, and so please, don’t bring it to my attention. Let’s not talk about it, and, you know, we’ll be fine.

That very same stigma can reach everyone regardless of HIV status. Several years ago, I decided it was time to shed a lot of excess weight. When I did, I experienced reactions similar to this one:

Nobody knew his status. And he chose not to tell anyone. And I would hear like a lot of little remarks because he started losing weight, you know. And it wasn’t in a sort of nice way. I don’t know, but catty gossip, you know? Like, so yeah. I think that sometimes you can find prejudice among your own people.

There is considerable stigma surrounding HIV/AIDS, and it’s not just heterosexuals who are responsible for it. The difficult truth is that it is alive and well within the LGBT community. And because of this stigma, many people with HIV/AIDS remain in a second closet, fearful that if their secret gets out they will lose friends and family and even their homes and jobs. The stigma also affects people who are not living with HIV/AIDS, including even AIDS volunteers and health care workers. People living with HIV/AIDS who have experienced this stigma are more likely to be non-compliant in mantaining their health regimens, and they are less likely to reveal their serostatus to their prospective partners and friends. Stigma has even been cited as a critical factor in why some people put off getting tested or treated.

I’ve personally seen the HIV/AIDS closet in action. In cities where there is less stigma attached to HIV/AIDS, people talk more freely and openly about themselves and their health. They have come out of that second closet. But in other places, having HIV/AIDS is treated as a deep dark secret which can be disclosed to no one. Not even to their close friends like Bob.

As long as HIV and AIDS are the topics for gossip, intrigue and condemnation, there will always be those who would just rather hide than make themselves known. That’s human nature, and as gay men you’d think we’d be more sensitive to this dynamic that we’re creating. All of us, positive and negative, have been there with regard to our sexuality. Yet we are setting up the same forces with HIV/AIDS.

No matter how responsibly Dave carries himself for the rest of his life, it appears he will still judged by his HIV status. He is often looked upon as a dangerous predator out to infect the poor innocent Steves of the world. This notion that Bob needs to go around warning all the Steves of the world about Dave just provides more fuel to that attitude. It’s time for Steve to finally grow up and be a man.

So Steve, leave Bob alone. He can’t keep you safe. Only you can do that.

Schmuck.

See also:
HIV and Friends, Part 2 — Is an Undetectable Viral Load Safe?, where we examine the hypothesis of Swiss health officials who suggest that an undetectable viral load renders one virtually non-contagious.
HIV and Friends, Part 3 — Where Ignorance Rules. If the Swiss believe that HIV isn’t contagious under certain conditions, a Judge in Ontario believes HIV is so dangerous it can be transmitted simply by sharing the same courtroom with someone.

Michael Alvear & Manhunt – Remind Me Never To Be Your Friend If I Contract HIV

The gay hookup site Manhunt.net has an in-house sex advice columnist, Michael Alvear. Here’s my summary of this week’s question:

So, my friend “Dave” has HIV and when he met my other friend “Steve” sparks flew. I debated if I should tell Steve that Dave was positive but decided not to. Later that night Dave and Steve went home together and when Dave told Steve he was positive things came to an abrupt halt and now Steve is no longer speaking to me because he thinks I should have said something. Was I right to keep my trap shut?

Columnist Alvear replies by quoting an exchange he had with NYC-based psychologist Dr. Brad Thomason in which Thomason takes the position it’s never ok to disclose someone else’s status. Alvear, however ends by stating:

I would have told “Steve” that “Dave” was HIV+. Why? When philosophy meets reality, logic flies out the window. If I’m asked to choose between an abstraction like personal responsibility and the well being of a close friend, I would rather be intellectually inconsistent than emotionally tortured. I’m not passing judgment on you because there are good arguments on both sides. The only person who needs a wake-up call is negative Steve. He gave up a night or maybe a life with an awesome guy just because he’s HIV+? What a schmuck.

Remind me never to make friends with Alvear if I contract HIV.

A person’s HIV status is their own business and their on business only. I’ve been in situations similar to this and never for a second considered disclosing someone else’s status. This bogus “advice” has no place on Manhunt, a site which appears to be concerned with promoting socially responsible sex practices.

For those interested here are some contact emails, support@manhunt.net, cruisedirector@manhunt.net, info@online-buddies.com

And if you’re so inclined, Manhunt’s phone number 866-424-9999, and the phone number for the company that owns Manhunt, “Online Buddies Inc” is 617-225-2727.

What’s In Your Future?

How about a spray-on condom:

The system works a bit like a car wash. The man put his penis in a chamber and presses a button to start the jets of liquid latex, sucked from a detachable cartridge. The rubber dries in seconds and is later rolled off and discarded like a conventional condom.

The aim is for the process to take just 10 seconds but at present the latex drying time is around 20 to 25 seconds. “We’re working to shorten that time,” said [Jan Vinzenz]  Krause.

Jenna Bush Advocates Safe Sex to Prevent HIV/AIDS

Last month, BTB contributing author Timothy Kincaid mentioned Jenna Bush’s new book based on the life of a young woman in Latin America living with AIDS. Ana’s Story: A Journey of Hope also represents a key break from official White House policy on HIV prevention:

Safe sex is encouraged through-out her new book, even though the Bush administration’s hotly contested HIV-prevention campaign was built around a staunch “abstinence only” message. “In Africa my dad’s policies are pretty much in line with mine, but not domestically,” says Bush, referring to her father’s ABC (abstain, be faithful, use a condom) policy in Africa. “But it’s a personal decision. All of us want our kids to be safe, and there’s no doubt that condoms make our kids safe. And many girls don’t have the choice—they are exploited sexually. It’s important they stay protected and protect others.”

The First Family’s rowdier twin was once known for her hard partying ways. Now it seems that she’s taking a hard look at the world around her and drawing her own conclusions — as are many others of her generation.

PBS Frontline Examines True Cause Of Uganda’s Success In War On AIDS

Religious right groups often point to success in Uganda in fighting the AIDS epidemic claiming a religiously based abstinence-only campaign is the cause of such dramatic results. PBS’s Frontline program takes a look at the impact of American policy on Uganda’s war on AIDS. Click here to watch the entire segment.