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Mar 31, 2000

Dear Dr. Remien, I am a recently diagnosed 30 y.o. woman with no visible signs or effects of hiv infection. I am not on medications either. Being very outgoing, smart and attractive, I know that men would like to form friendships / relationships with me but I feel unsure how to approach the hiv issue. I would like to know what do you think is the best way of dealing with this: 1) if I am to have a brief sexual encounter, would it be morally acceptable if I do not disclose my status but make sure that sex is safe (condoms, no oral, etc), and 2) if I am to date someone seriously, should I tell about my hiv+ status just before sex (well, on the second thought, maybe not just before), well before sex, in the beginning of dating, or when?? I do not want to make too many mistakes before I learn how to behave in such situations. Also, is there a good literature that I can read about these issues? All that I read on the net is very controversial and not very helpful. Thank you. Alice.

Response from Dr. Remien

Deciding to tell, and when to tell, others about your HIV status is a very personal choice. My advice comes from the perspective of what feels right and healthy for you, considering all factors. I believe that each person bears responsibility for their own, as well as the health and well-being of their intimate partners. Bottom line, it takes two for HIV transmission to take place. Therefore the responsibility cannot be placed on one member of the dyad over the other.

Many people living with HIV are challenged by issues of disclosure in sexual and dating situations. I encourage people to think about how it really makes you feel when engaging in sex with someone when protection is not used and HIV is never discussed. Most people do no feel good about it which usually diminishes the pleasure of sex and leaves the person with "bad" feelings afterwards. Many people however are able to enjoy sex, and feel okay about it afterward, if disclosure does not occur, as long as the sex was "safe." Others do not feel okay and have a personal need for disclosure to take place -- for their own sense of well-being. Again, this is an individual choice, and both members play a role in what occurs.

For most people it becomes even more challenging when there is an ongoing relationship. One's HIV status is very personal information. Most pieces of personal information typically get shared over time as two people get to know and trust each other. For many people, the longer a relationship continues, without disclosure of HIV status, the more difficult it can feel. I think the challenge is to find a time when it feels comfortable and "safe" to share, but before too much time has passed. This is not always an easy thing to know and to do. Some people never want to deal with this discomfort and therefore always disclose right away, for their own sense of well-being. And if someone is going to walk away or reject them, they'd rather know that sooner, rather than later. Again, the choice is an individual one.

I think you are having trouble finding something written that is helpful because this IS a controversial topic. There is no one answer that will apply to all people and in all situations. Choices people make about this are not only personal but vary across different situations, in different contexts, with different partners. You can listen to the opinion and perspective of others, but will ultimately need to figure out what works for you. And keep in mind that the choices you make may change with time, depending on your own experiences. I do hope, however, that the choices you make will help lead you to feeling good about yourself, which usually includes considering your personal needs, as well as the needs of your partner, and the health and well-being of both of you.


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