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Bob I thin k you are wrong on this one... (DISCLOSURE)
Feb 7, 2007

Your social and professional circle no doubt afford you many luxuries. But for many of us out there is it not the face and ignorance is a fact. Quickly stated, there is nothing ambiguous about HIV, but disease progression can be. I was diagnosed when my son was 9 months old. when do you think he had the right to know?

I am sorry but I find you responses to be smug and disrespectful to the many people who live their lives in an environment fueled by ignorance and fear.

I most cases, it takes many people acting in concert to bridge the gaps between ignorance and acceptance.

Response from Dr. Frascino

Hello,

You may find my responses to be smug and disrespectful; however, that was certainly not my intention.

I believe your son should be told as much as he is able to understand and as soon as he is able to understand it. The "environment of ignorance and fear" is fueled by those whose actions perpetuate that environment! Social and professional circles, whatever they may be, do not make HIV disclosure any easier. Of that I am certain.

It may take many people acting in concert to ultimately bridge all the gaps between ignorance and acceptance; however, if no one is willing to come forward because of fear, how will we ever be able to work in concert? Please note my HIV/AIDS benefit concerts that have now raised well over a million dollars for crucial HIV/AIDS-related services worldwide are called "A Concerted Effort." I would welcome you to help bridge the gap as soon as possible. As the old African proverb states, "The best time to plant a tree is 20 years ago. The next best time is now." Had we been more open and less fearful 20 years ago, I believe there would be less HIV-related stigma, fear and ignorance today. Think about it.

(I'll repost the question you are referring to below for our readers.)

Dr. Bob

You cant be cavalier... "Homophobic single father" Jan 28, 2007

Dr. Bob,

Your comments to the single dad with HIV and a teenage son maybe a bit too reflective of the insulated circles where you travel. I too have a teenage son and have been insistent about diclosing my status in the right situation with the right level of support and counseling. However, after 2 years of a nasty divorce fight my ex decided SHE would tell our son "the dirty little secret!" She did it crying in bed one night... really doing a head job on the kid. Moreover the status of my HIV has been made in to the 2000 pound guerilla that the court system continues to evade. Secrets are one thing and disclosure is another. No child needs to comfront the ambiguities of HIV until there is a need to know. I suggest you advise this mother to encourage her son to talk to someone who has gone through this before you encourage a family meeting with the adults.

The one thing I have learned in dealing with HIV for 15 years is that timing is everything.

Peace.

Response from Dr. Frascino

Hello,

Sorry, but I have to disagree. And your personal story only lends further evidence to my argument. If you had disclosed your status earlier, there wouldn't have been a "dirty little secret," a "head job on the kid" or a "2000 pound guerilla in the courtroom!!!" There are no "ambiguities of HIV." You either have it or you don't! That you chose not to disclose while waiting for the "right situation with the right level of support and counseling" has complicated your life and your relationship with your teenage son. The real problem was not whether or not your son could handle the information; it was your delay in disclosing the truth.

I stand by my recommendation and will reprint it below.

Dr. Bob

Homophobic single father Jan 17, 2007

My 35 year old son is a single father with sole custody of his teenage son. 2 years ago after being hosp. for PCP he learned he was pos for HIV and had to move back home with his son from an urban area to our small rural town. His employer went bankrupt and he lost his health insurance. He planned to make no disclosure but his doctor's office inadvertently told me, his mom, of his HIV status during a phone call soliciting payment of their bill. He has told no one for 2 years, including his son; sends me to the pharmacy to get his HIV meds because he's afraid he'll be recognized and word will leak back to his son; is about out of money to self-pay for meds; has no local doctor and isn't getting scheduled blood tests and doctor visits; won't go to the excellent AIDS clinic we have in our town because someone will recognize him and "word will get out" that he's poz or his son will be negatively affected by it; the stress in our home is becoming unbearable because there is a huge elephant in the room we can't talk about. I respect his desire to keep his health condition confidential; however, he really needs medical and emotional counseling because this is too great a burden to carry all by himself, especially since he's homophobic. Dr. Bob, I've been reading your column for my emotional salvation and has helped by making me realize there's as much mental fatigue to this illness as there is physical. I don't want my grandson to hate me someday for knowing and not telling him but I so respect my son's need for secrecy. I find myself adding to my son's anxiety without meaning to do so by nit-picking because I can't even see a counselor myself without disclosing what my son asked me to keep quiet and I think I'm unconsciously punishing him for being poz and that's flat-out ridiculous since I love him greatly. Dr. Bob, I love your outlook on life and AIDS and your saucy responses have gotten me through a few dark moments. Any helpful ideas on how I can decrease tension in our home and make things better for my son and his?

Response from Dr. Frascino

Hello,

If you are a regular reader of the forum, you probably already know my views on honesty vs. secrecy. You can already see the consequences of your son's unwise decision to try to keep his AIDS diagnosis a secret. "He isn't getting scheduled blood tests and doctors' visits . . . . The stress in our home is becoming unbearable . . . ." Clearly this cannot go on indefinitely. Secrets (and/or lies) never do. You are not doing your son any favors by helping him keep his secret by picking up his meds at the pharmacy, etc. My advice is that it's time for some "tough love." Your son needs a reality check. Plan a very private family meeting (adults only). Advise your son you are very worried about his current predicament and the consequences his secrecy is having on his health and your entire family. Tell him directly you have respected his wishes up to now, but can no longer do so. You will not lie or cover up for him. You will not sneak around and get his medications to protect his secret. You will not shield your grandson from the truth. Be prepared for your son to have a "nuclear event" when you tell him all this, but no matter how angry he may get, don't get angry back at him. Tell him over and over again you love him and only want to do what's best for him, your grandson and your entire family. Offer to help tell your grandson the news about Dad's illness. Consider getting family counseling if your grandson has difficulty accepting the news. Encourage your son to get established with a local AIDS specialist and to reinstitute his regular visits and lab work. A benefits counselor might be helpful, if he's running out of funds for his medications. Offer to and, if possible, go with him to his doctor's appointments. There is no doubt your son could benefit from counseling. His secrecy about his AIDS diagnosis is worrisome. Counseling may also help him confront his homophobia issues, which may be linked to some of his HIV/AIDS psychopathology.

Chances are I'm not telling you anything you hadn't already thought of yourself. However, hopefully hearing it from me will help you act to save your son from further self destructive behavior.

AIDS stigma and fear can only be effectively confronted with rational thought, common sense and compassion.

Good luck to you, your son and your family.

Dr. Bob



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