I was infected in Africa after an affair with a married man when I was working there. We continued the relationship and were making plans to reunite in my country. He was mid-divorce and looking into a student visa, etc.

Last weekend, he died suddenly while still in Africa. I am very sad about my lost future with him but also very confused about what to do about the knowledge that I alone had of his HIV -- like whether I have a responsibility to tell his family (who are very confused about his sudden death) and his wife who may or may not know and/or have been tested. I know he did not want to tell his family, and while I encouraged him to talk to his wife, I don't know whether he did or not before his death. The stigma associated with HIV in this part of Africa is very serious (complete social isolation, etc) and I don't want to "out" him (or even his memory for family) or his wife carelessly. But I also want her to be well and seek treatment if she is also infected which I suspect she well may be.

There are two separate issues here. The first is your own feelings about your very real loss. You are experiencing a kind of mourning known as "disenfrnachised grief." This is a term first coined by psychologist Kenneth Doka that pertains to a death where the loss is unacknowledged by others for what ever reason. You need to talk to trusted people about what you are going through, or find a grief group where you can get some support while you are mourning the death of your beloved.

You raise a difficult and serious ethical issue about whether or not to tell the deceased's wife. At this point it really does not matter what he would have wanted since it was his responsiblity to have told her in the first place. It was only cowardice on his part not to have informed her that he might have infected her. If she lives in a country where antiretroviral treatment is available, then I believe it is your ethical obligation to inform her that you were a friend of her husband's and he shared this information with you and spoke of wanting to tell her and for her own good you are letting her know. Not to tell her is to condemn her to death from AIDS. Since that is now a preventable death, I do not see any other moral position than to let her know that she may be living with the virus. This will obviously not be an easy thing to communicate, but ultimately I believe that it will be easier for you to share this with her than for you to live with the knowldege that you never told her and what the consequences of that will almost certainly be --- a protracted and painful death for this other woman.

Michael Shernoff, MSW