LETTERS From CAMP Rehoboth |
CAMP Safe |
by Salvatore Seeley |
Great Expectations
"I'd expect a man with HIV to tell me he was positive before we had sex." So said nearly 70% of men in the 2000 National Gay Men's Sex Survey conducted by Sigma. The whole business of disclosure is something with which the HIV sector hasn't come to grips. And I'm not sure that we can. The who, why, when, if and how all depend on the situation, perceived need to disclose, personal beliefs and abilities, trust and consequence. It's damn near impossible to take all these things into account when working on a population level. But the flip-side to disclosing is being disclosed to. Now, in the good/bad old days of the epidemic, disclosure wasn't such an issue if you were negative. There were only two things you had to bear in mind: assume that every single person that you had sex with was HIV positive, and always wear a condom when you had sex. And this delusional, status quo was made easier by positive men being disempowered so that they couldn't disclose their status nor acknowledge that sometimes they wanted sex without condoms. We cottoned to the fact that most gay men were negative, some positive men rightly got pissed off that their HIV status had to be guarded like a guilty secret ranking alongside wearing your mother's underwear. There are now more gay men who answer that in the last year they had sex without condoms. This will inevitably be seen by the media as recklessness on the part of gay men or the failure of health promotion programs. But I believe what's really going on is that gay men have become knowledgeable about HIV transmission and are finding ways other than "a condom every time" to protect themselves. As the number of new infections being diagnosed each year in gay men is going down, it would seem that the gay community is having some success with new strategies. But many of these new strategies depend on knowing both the status of your partner and yourself, and this is where things can start going pear-shaped. To successfully apply new strategies we need to test for HIV on a regular basis and honestly disclose the result to our partners. These are things which we don't do consistently. But, while we seem comfortable about not doing this personally, we do seem to have expectations that other people should. What expectations? The exact meaning behind "I'd expect a man with HIV to tell me..." is unclear. It could mean any one, and probably a mixture of three things. 1. It is the duty of a man with HIV to tell me his status before we have sex. Being 'honour bound' to disclose a positive status has recently been brought into focus by the successful prosecution of a man in Scotland for "reckless and culpable conduct" because he did not disclose his status and had unprotected sex. When I talked to gay men about the case, there was more agreement with the verdict than I had expected. And people were very clear that it was the combination of unprotected sex and non-disclosure rather than just non-disclosure that formulated their opinion. The question this raises for me is: if a positive man doesn't disclose his status, has sex without a condom, but practices harm reduction (pulls out before ejaculation or is the receptive partner) would the same value judgment of "reckless and culpable conduct" be levied against him? I know that some gay men believe that we should not publicize harm reduction techniques at all, but is there a significant number of men who accept harm reduction interventions, but only if those interventions also advocate that men disclose their status? I suspect there is. Now a word of warning to anyone reading this that believes it is a man's duty to disclose his positive status. You are probably the least likely person to ever be told. Very few positive men disclose their HIV status every time and one of the factors which influence men's decision to disclose is who they are disclosing to. Usually positive men are very good at picking up vibes from men who would treat them differently if they found out their status. As such, they don't disclose to them. 2. I believe that all men with HIV disclose their status before they have sex. This is probably the meaning that most men had in mind when they answered the question. And while this view is a tad naive it isn't necessarily going to do any harm in itself. However if a man goes on to twist this logic into a belief that not discussing status is the same thing as someone saying that they have the same status as himself, then this could open the door to HIV transmission. But only if you change the kind of sex you have depending on the HIV status of the person you are with. The problem now is that more gay men do change their strategy depending on the status of their partner, and so a flaw in the logic around an undisclosed status is usually the reason for most episodes of sero-discordant unprotected sex. The fact that so many men expect positive men to disclose but not negative men, illustrates how, as a community, we have placed all the responsibility onto positive men. And I have mixed feelings about whether or not this is right. On the one hand the HIV sector preaches that everyone should take responsibility for themselves and so it would follow that if I have unprotected sex on the basis of someone's HIV status I should take personal responsibility for disclosing my negative status and ask my partner theirs. Shared responsibility between negative and positive men around disclosure sounds good. On the other hand, if I were positive and a negative man disclosed to me, I would really be under pressure to either disclose my status or lienot so good. A response of, "that's nice for you," really wouldn't cut it. Furthermore, if a negative man discloses to another negative man it may be hard to know what to do with the information. I'm HIV negative and only once had a pick up disclose his negative status to me in the hope of sex without condoms. Maybe because it had never happened before, or because he was a barman in San Francisco, or maybe I'm just cynical, but I've never felt more certain someone was HIV positive. 3. At some point in the future a man with HIV will tell me his status before we have sex. Ok, I'll admit that it's my sloppy command of the English language that made me believe that this is what I was being asked when I read the question. But I did feel that way and I 'strongly agreed'I'm sure others did too. I believe all negative men should get used to the idea that positive men will disclose to them at some point. And I believe positive men have the right to be treated the same as before they disclosed their status. But all too often that's not how things turn out. |
LETTERS From CAMP Rehoboth, Vol. 11, No. 9, July 13, 2001. |