In a recent interview, Charlie Sheen disclosed his HIV+ status. I think it takes a lot of courage to do this because, despite science to the contrary, the disease is still stigmatized, both socially and legally, in ways that it shouldn’t be. However, I have to reprimand the reporter for asking questions such as, “Have you knowingly, or even unknowingly, transmitted the disease? Have you ever had unprotected sex since your diagnosis? Have you told each of your partners about your status before sexual intercourse? What risky behaviors did you pursue? And do you know how you contracted the disease?” These are invasive questions that, to me, are just as bad as asking a trans person about genitals and surgery, or maybe even worse.
So let me just say a fast few things about sex, safety, and HIV.
1. Safe sex is a two- (or three- or four-) way street.
It’s the responsibility of every sexual partner to discuss their health and safer sex habits, regardless of their status. Just because you think (and unless you’ve been tested and abstained since then, there’s never total certainty in anybody’s status) that you’re HIV-, it doesn’t mean you have any less responsibility–to yourself or your partners–to ask first.
Because, really, if you don’t care enough to ask, why should they tell?
In this case, it really is a “do ask, do tell” sort of situation. Sure, it might be hard and awkward, but do it anyways. Say things like, “I always use condoms and get tested regularly. When were you tested last?” or similar lines to get the story started, and if you don’t plan on asking, use condoms consistently, get tested regularly, and you won’t have much to worry about.
(But beware: condoms don’t prevent all STDs/STIs, and not all of these infections have observable symptoms, so testing is always important.)
2. Transmission happens. Deal with it.
It’s a bit harsh, but let’s face it: most people infected by HIV today are infected by partners who aren’t themselves aware that they’re HIV+.
If you didn’t learn anything from Number 1, let me repeat that the prevention of transmission is just as much the responsibility of HIV- persons as it is of HIV+ persons.
That said, it probably won’t surprise you that in many states, infecting others with HIV is still a crime. Yes, HIV is a terrible disease, and it kills a lot of people, but we don’t lock people up in jail for infecting people with the flu, with tuberculosis, or other diseases, so why should we criminalize people living with HIV? It just makes no sense to me.
However, treatment is prevention. A person receiving proper treatment with an undetectable viral load has practically zero chance of passing on the virus to partners. A friend of mine who has HIV put it to me like this: In order to infect somebody, he’d have to transfuse a gallon of his blood into the other person to pass along enough virus to infect them.
And ain’t that ridiculous?
Yes, I’ll admit, the actual risk of transmission among positive-undetectable people is not known precisely, but the point is that many HIV educators agree that having sex with someone who’s undetectable is safer than having sex with someone who doesn’t know their status. So why are we still stigmatizing those least likely to transmit the virus?
3. Unprotected sex isn’t always “unsafe” sex.
There’s a widespread belief that the only safe sex is protected sex, but it’s also a misuse of words to call any sex “safe” in the first place. There are “safer” practices, but no sex is ever 100% risk-free.
When it comes to unprotected sex, a lot of factors need to be considered, and it’s often a very personal decision. Yes, if you’re hooking up with random partners, condoms are always a good idea, but with trusted partners, and with partners tested regularly, there are ways to have “safer” unprotected sex. It’s a nuanced conversation that could be its own blog post, but the point I’m attempting to make is that unprotected sex should not be used as a way to shame or attack anybody, regardless of status.
Yes, I encourage people to have protected sex, but I recognize that isn’t always possible for some people, so I accept when people don’t.
4. There’s more than one way to prevent HIV.
There’s a drug on the market called Truvada, in a class called PrEP, short for pre-exposure prophylaxis. It’s a once-daily pill believed to be up to 99% effective in preventing new HIV infections when taken as directed.
This is amazing.
And the drug manufacturer, Gilead, even offers a coupon card that can bring total costs, after insurance, to zero dollars per month!
(Certain cities, like San Francisco, recognize the public health benefits of PrEP and work to make it even more accessible for high-risk groups.)
Yes, it isn’t a vaccine (not yet), but it’s an extra form of protection that’s available, and more people should know about it.
5. You don’t know someone’s positive until they tell you.
Sure, there were rumors, but the truth of the matter is, for most of us, until Charlie Sheen made his announcement, we didn’t know he was HIV+. And the glaringly obvious fact is that until anybody tells us they have HIV, there’s no way to know. Hell, they might not even know themselves.
So this is a reminder that we all need to first get tested ourselves, to know our status. Then we need to talk openly with our partners about our status, our testing habits, and our sexual practices. Honesty is key, and if you can’t enjoy talking about sex with someone, are you really going to enjoy actually having sex with that person? Really, just think about it for a moment.
Next, we need to be educated on the facts. We need to learn about things like PrEP, undetectable status, current treatments for the disease, and the fact that HIV, when managed properly, is no longer a death-sentence, nor a public health risk worthy of criminalization. Armed with this information, we need to bring others into our circle of awareness, and together fight to eradicate outdated policies that stigmatize this disease and those living with it before they’ve even been diagnosed. With so much hatred toward the disease built into our laws and our culture, there’s a barrier to knowing our status and talking openly about how to prevent and manage HIV.
This needs to change, because when people are informed, have access to testing and other resources, then HIV can be controlled, even eradicated.
I look forward to a world without HIV, but I know my world would be a lot lonelier if not for the people in it who are living with HIV every day. We can all work toward creating habits and shaping public policy that will prevent new infections, and we all should, but we shouldn’t let the fight against this epidemic discolor our compassion toward those who are HIV+. They are no more or less human than either you or I, and they deserve to be treated with the same respect and value as everyone else.