|Hot to tell others of HIV status (DISCLOSURE, 2009)
Feb 4, 2009
Dr. Bob, I have been told I am HIV positive with a cd4 count of 569. I do not kow how to tell my children in their 20's, my sister, or the woman whom I love who resides in Asia. She is most likely infected and I do not know how to approach it, espcecially witht he distance factor. I want to go back there to be with her. Please help. Thank you.
| Response from Dr. Frascino
Despite the title of your post, it appears you, like most HIVers, are anything but "hot" to tell others your HIV status!
Disclosure is never easy. I vividly remember disclosing my HIV-positive status to my parents, siblings, friends and colleagues. The best advice I can offer is to be direct and ready to address their questions as well as their fears. Hopefully your children will have a healthy working knowledge of HIV, because they've essentially grown up with HIV all their lives. Unfortunately, Bush's abstinence-only sex (mis)information campaign in our schools for the last eight years has set HIV/AIDS awareness and prevention back considerably. As for the woman in Asia, if possible it would be best to tell her in person and then support her through her HIV testing. I'll reprint below some information about HIV disclosure from the archives. Also, you could suggest your kids, friends and family members consult this Web site for accurate science-based information about HIV/AIDS.
Good luck! I'm here if you need me.
How to ask certain questions? (DISCLOSURE 2008) Jul 30, 2008
Hi Dr. Bob,
I recently started dating this guy and I know that we should have a discussion about our status. How do I bring up the subject of his HIV status? I don't want to sound weird, but I know it should be discussed. Thanks, Katie
Response from Dr. Frascino
Perhaps start by talking about the necessity of safer sexual practices as a general rule. Then you can volunteer your HIV status. If negative, you can say you always practice safer sex to protect your negative status. If positive, you can say you always practice safer sex to protect your partners. Your partner should get the hint and then talk to you about his status. It's best to have this discussion well before climbing between the sheets. If you need a way to bring the topic up, say you saw Magic Johnson (or Dr. Bob) on a television show or in a magazine. That should allow you to segue into a discussion of HIV in general. Then you can bring the conversation down to a personal level.
I'll reprint some information about disclosing one's HIV status below. We also have a whole chapter devoted to this topic in the archives. Have a look!
Feeling a bit flat (DISCLOSURE) (REJECTION) Apr 21, 2008
Dear Dr Bob It's been a while since I have written to you. Things have been going well - drugs still work and I feel fine. However recently I met a man with whom I wanted to get to know better... I told him my status and I now feel a bit crap. He was so shocked and lacking in information that I felt as though I'd just let an elephant in to the room! I'm not sure I am disappointed that he didn't want to take things further, or the fact that even after all these years (16 of diagnosis) that I can't deal with the feeling of rejection and pain of the stigma attached to HIV. I know I did the right thing and I should be proud that I was strong enough to tell him before we got too intimate. I think I am also in shock because he didn't know how he could contract HIV!! I reassured him that kissing was ok (where has he been hiding for the last 20 odd years!). He thought I was leading him on - I explained it wasn't something you share needlessly and I needed to be sure I wanted to be with him. But I feel so low, depressed and ashamed of my status. Dr Bob - please give me some words of inspiration and help me through these dark days.
Response from Dr. Frascino
I'm willing to bet that ultimately it will be the other guy, not you, who will be singing "The One that Got Away Blues!" If he's so clueless that he knows next to nothing about HIV, it should be a major red flag that either: 1) he's an alien who has just landed here on earth from the former planet Pluto or 2) he's another victim of Dubya's abstinence-only-until marriage sex education curriculum or 3) he's such a mental dunce that he probably voted for Dubya in 2000 and 2004! Consequently, maybe he was doing you the favor of breaking things off before they even got started. Clearly he was not your Mr. Right. (He's certainly not Mr. Bright either!) The important thing to remember is that if someone dumps you because of your HIV status, he's rejecting the virus, not you!
Buddha was once asked how to brave his critic's insults and anger. Buddha replied, "If someone offers you a gift and you decline it, to whom does the gift belong?" I think this is very wise advice. Put in a less contemplative way, if someone blows a load of rejection your way because of your HIV status, I say, "Spit, don't swallow!"
Your happily-ever-after is out there waiting for you just as you are, "virally enhanced" or not! Don't settle for anything less than true happiness, OK?
He fucks me without condom! Dec 6, 2005
Hi - i am a 38 years old gay guy, been hiv positive for 2 1/2 years. 9 months ago i started an (on and off) "relationship" (read fuck-buddy) w a guy who later tested negative. He always tops me (had sex about 10 times in 9 months) and never wants to use condom. I am afraid to tell him my hiv status, afraid this incredible sex stops. Also i've been telling him again and again we MUST use condoms, he answers yes, but always wants without. And, yes, i am not able to stop the sex when we are at it.
How do i get out of this mess? Now i have been avoiding him for 2 months, because just not seeing him helps me keep away sexually. That leaves me w a rotten sex-life (sorry, but this guy totally outperforms any one else i have had sex with, the passion is also incredible...).
I am sure we will end up in bed again and i am going through in my mind everything of how to make sure the condom is on, how i will myself put the condom on him. Even though i know the probability is huge that he will take it off and just fuck me. And not 10 crazy horses are able to separate us than.
I also look at questions about chances of hiv-transmission (6,5 in 10.000) from bottom to top, but it really doesn't bring me any comfort. He could still get it (although i probably, according to my doctor, am going to start medicines within some months, and hopefully get the virus level down from todays 20.000 to undetectable, under 50).
Whish i never met this guy. Help, please!
Response from Dr. Frascino
You are not alone in your quandary of how and when to disclose your positive HIV status. I've addressed this point multiple times in the past and you can review those comments by checking the archives. (I'll repost one question and answer below.) It's important to point out it takes two to do the Mattress Mambo and the ultimate responsibility of maintaining one's health (avoiding infection, reinfection, STDs, etc.) is up to each and every one of us. In other words, you are not solely responsible for this situation. That said, obviously all of us that are "virally enhanced" want to prevent further spread of this dreaded scourge whether it be to a "buddy", lover, spouse, pizza delivery guy, pool boy, hot bi-curious but clueless Mormon missionary boy wearing Jesus jammies or whomever! Consequently I agree you should disclose and the sooner the better. And certainly before those "10 crazy horses" show up trying to pry you two rooting wombats apart. I'd suggest you plan a meeting somewhere where it's highly unlikely you'll have nookie a meeting of the Young Republicans, a lesbian teahouse, almost anywhere in the State of Texas you know, somewhere like that. Then tell your stud-muffin sex machine what he needs to know. If he says it doesn't matter, that he's a top gun and enjoys going commando on your butt and that he is willing to take the risk, advise him you are not. It's important for you to realize he's not the only one at risk here. If he barebacks you, he most likely barebacks others. That means he's placing you at risk for STDs or even HIV reinfection if he contracts another strain of the virus elsewhere. Are you willing to take that risk? I certainly would strongly advise against it. You know what is right and you know what you have to do. I'm quite confident you'll do the right thing for both you and your cocky buddy
What a way to disclose. Oct 24, 2005
I have known of my HIV status for about four years now, however I sometime have this issue of disclosing to my patners at the right time. Sometimes I feel I disclose to early and sometime I feel I disclose too late. On October17, 2005 my current boyfriend and I had intercours and the condom broke. As he got up he annouced the news of " the condom broke" and he thought nothing of it. I immediately felt scared to the point that I cried. I notice on the bed sheets there were blood ( just slight but it was blood). I went to work and thought about what should I do. I made a few calls and before you know it we were on our way to the ER for PEP perscription. On the way there I had to disclose to him that he has been exposed to the virus and we are on our way for you some help. My question is, what is his chances of contracting the disease and how can I keep this man in my life, I love him so much and I don't want to lose him. Oh we have been together for about a month in a half now.
Response from Dr. Frascino
When to disclose is a question many of us wrestle with on a continual basis. I'll repost below some responses from the archives that address this topic.
Regarding your questions of the risk of acquiring HIV from the broken-condom experience, you did not mention if your partner was insertive (top) or receptive (bottom). So I'll give you the estimated risk statistics for both. The estimated per-episode risk for acquisition of HIV from unprotected (including broken condom) insertive anal intercourse is 6.5 per 10,000 exposures to an infected source. This estimated risk increases to 50 per 10,000 exposures for receptive unprotected anal sex with a positive partner. These risks would decrease if PEP is taken. How can you keep this man in your life? Communication is key. Why not show him this post? Your concern and compassion for him are clearly evident in your comments.
I wish you both good luck.
Feel Really Bad Jul 12, 2005
I am an HIV poz male of five years, I try to make sure I have safe sex for the most part. I placed an ad, where it asks you if you are neg or poz, or you do not have to answer, I choose not to answer, and instead have that conversation with a person when sex is a possibility. However, I met this guy, we had dinner and a few glasses of wine, and I spent the night, however during the night he started to have aggressive sex with me that lead to unprotected sex, this is someone I do not know his status. I am a wreck, he stated he had diarrhea for a few days, and a pain in is throat, I was tested two weeks ago, have not had sex with one else, and don't have any std's... I know I have to bring this subject to the table, please help me out..
Response from Dr. Frascino
The subject of when and how to disclose your HIV status is not an easy topic to address, as there is no easy (or correct) answer for everyone's unique situations. Jim, I think you already know what needs to be done, and I would add the sooner the better. I'll post several of my responses from the archives that address the disclosure issue.
When to dislcose Mar 28, 2004
Hi Dr. Bob,
Thanks for your helpful insight for us pozitoids. I have been positive for a little over a year now. I have only dated one guy since and he was also positive. That lasted for about six months as I was not ready emotionally to be involved with someone so soon after my diagnosis. Well here it is a year later and I have met a great guy. We met at a club a few weeks ago. We have not had sex yet. We have however kissed passionately on several occaisions. I am going to be spending the weekend with him next week and it will definitely be time to perform. We have not even broached the subject yet of HIV. I am very interested in this guy and am wondering when I should tell him. I know it will be before we get in the sack. But I am wondering if it would be best at dinner, after dinner...This is the first time I have had to disclose to a guy since my diagnosis, not knowing what his status his, his feelings about HIV etc. (I met the guy I dated immediately after my diagnosis through a positive group). So I am totally new with this disclosure thing. Any insight you could give me about what to say and when to say it would be greatly appreciated. Your experiences as a fellow positoid are refreshing and greatly reasurring.
Response from Dr. Frascino
I recently posed the "when do you tell a potential bed partner you're positive" question to a group of pozitoids. The answers ranged from "pre-smooching" to "pre-heavy petting" to "before the money shot" to "afterward" to "I usually don't even tell 'em my name!" so, you can see, there really was no consensus here whatsoever! As for my personal opinion, I addressed this topic recently in another question, so I'll just re-copy that post and hope it helps your decision process.
help,i feel like a deadly weapon Posted: Mar 18, 2004 Dear sir, several times i foloowed your forums and answers you have given to many other people here. I'm really in crazy mood and i beg you tell me something about the follow situation.I'm very sad because after 1year and a half of non sex (i've been teste poz 1 1/2 year ago) i have found a guy that a really like. I had sex with him and, protected anal sex, but we have kissed (we liked very much to kiss each other) but i was streesed about the risk. Secondly,i let him make me oral sex for 1,2 min. What is worse is that we like each other very much and i think we've just falling in love (i didn't disclosed my status). I have such bad feelings and i'm scared for him. What are the risks for him to become +? i know, there are different opinions but could the kiss be such a risky way and is it so risky that i let him 2 min to provide oral sex, i didn't come into his mouse ( i interupted him because i was scared for him) . Sorry for the language. i'm from an eastern country and i cannot find here too many advices. As you can imagine i care so much about him that i'd rather be dead than to hear that he become infected. Please, i would be grateful if you could find 1 minute to answer me. Kindly yours,
First off I must remind you and our readers that questions like these should be posted to the Safe Sex/HIV prevention Forum, not the Fatigue and Anemia Forum. I'll post this reply in both forums, but folks if you've asked a question here not related to Fatigue and Anemia, I'd strongly suggest you re-post to the correct forum to increase your chances of a reply. Thanks! OK, now back to your question. I'm glad you didn't "come into his mouse" as many mice aren't very happy about getting their tonsils spunked. Sorry I don't mean to make light of your situation. I'll be serious now. To disclose or not to disclose, and exactly when to do so are very difficult questions for us HIV pozitoids. Some folks live by the "don't ask, don't tell" rule, but always play safe. Unfortunately what one person considers "safe," someone else might consider too risky. Some folks prefer the "do ask, do tell" philosophy. Sure, this may result in getting dumped before you get humped, but wouldn't you rather know sooner rather than later that this guy is never going to be your Mr. Right? I know you are from an eastern country, but I thought I would mention that here in the US, 24 states have passed HIV-specific laws regarding disclosure. Merely exposing someone to HIV you don't have to have actually transmitted the virus can land you in jail! So in these states, as long as you know you're HIV-positive, you can be arrested just for having sex and not disclosing. These laws, as you can imagine, are extremely difficult to enforce. OK, regarding the risk of HIV transmission in your particular situation, kissing is not considered a significant risk. Oral sex carries an extremely low risk. Alex, at this point, I would strongly suggest you be honest with your new boyfriend. Waiting longer is not going to make things any less awkward. His response may surprise you, and could range from a caring heart-to-heart discussion to a cranial meltdown and wall-punching. Hopefully, he won't say either "See ya later" or "What's HIV?" also, it's probably worth noting that at this point, you don't know your boyfriend's HIV status either. It's possible he too may be positive. At any rate, if the relationship does end because he can't accept your positive status, please realize the guy is rejecting the virus, not you!
How and when to tell a boyfriend im hiv+ Jan 20, 2005 I have just found out i am hiv+. I am already informing past and present sex partners of this so they can be make sure they are alright. One of these guys I believe could be "the one" ive been looking for. How do I tell someone of my status and how do I deal with being rejected solely on me being hiv+?
Response from Dr. Frascino
Sorry to hear about your recent positive diagnosis. There are no easy answers as far as exactly when and how to disclose your HIV status to your sex partners and to "the one." There are various strategies to consider, some of which I've discussed in the archives. The one strategy that I certainly don't recommend is waiting months and months to break the news. I don't believe good relationships withstand such secrecy. Consequently, I'd advise disclosing all to your honey now. If his/her status is different from yours, there are a variety of common immediate reactions that might ensue, including:
1. a caring heart-to-heart with lots of hugging and perhaps a few tears
2. "What's HIV?" (most likely if you are dating a graduate of an abstinence only sex education program)
3. a cranial meltdown and wall-punching
4. silent shock and awe
5. "See ya later." (most likely if you are dating one of those compassionate conservative Republicans)
Let's hope it's #1, but even if it's #5, just remember they are rejecting the virus, not you! Perhaps some advice form Buddha is in order (and isn't it always?): Asked how he braved his critics' insults and anger, Buddha replied, "If someone offers you a gift and you decline it, to whom does the gift belong?" I'm a bit less contemplative. If someone blows a load of rejection your way because of your HIV status, I say, "Spit, don't swallow." I wonder if I can put all that on a fortune cookie fortune?!?
Good luck! I'm here if you need me.
Im recently diagnosed HIV . . .May 21, 2004
I was recently diagnosed as HIV +. Im 99% sure from whom I got it from and this person new their status and did not bother to disclose that information to me but after I told them I just found out Im HIV positive. They admitted they knew prior to having unprotected sex with me and failed to tell me. Ive questioned my local authority and I was advised that if I press charges it will be for assault and they will arrest him. But I have to prove he is HIV + and he knew about it prior to him havig sex wih me if I plan to make a case for felony attempted murder. How do I do that? I want to make him pay. But how do I prove he knew about his status? I have not proof about his admission. My life is ruined and I take a large part of the blame but I dont think I should be the only one to pay for this demise. What to do from here.
Response from Dr. Frascino
Although there is no doubt that the person who knowingly placed you at risk for acquiring HIV is indeed a scumbag, I agree with your statement, "I take a large part of the blame!!!" Blaming others for our own lapses in judgment is not helpful. One in every 250 Americans is HIV positive; however, only one in 500 knows it! Consequently, whether your scumbag knew or not, the primary responsibility for your staying safe and protecting your health is really yours and yours alone. We must all assume our sexual partners could be HIV positive, and take the appropriate precautions. Even if a partner slapped a lie detector on his Mr. Happy and claimed to be negative, I wouldn't believe him.
When and how to disclose one's status has always been a challenging issue. Now that you are positive, have you decided whether, when, and how to disclose your status to the dreamboat hottie you have lined up for next Saturday night? Will you bring up the subject over dinner with some Beyoncé in the background? Maybe over a light lunch? Some guys insist on telling pre-smooching (before even saliva gets exchanged) while other guys don't even tell tricks their name, let alone their status.
If you play safe, do you even need to tell? Well, legally that depends on where you live. Twenty-four states have passed HIV-specific laws regarding disclosure. The threshold for prosecution in these states is exposing someone else to HIV. You don't have to transmit the virus to land in jail. In these states, as long as you know you have HIV, you can be arrested for having sex and not disclosing, whether you intended to infect someone or not! I believe these laws are misguided. Prosecuting these cases is of course very difficult, and these laws, although on the books, for the most part are not enforced. Here in California, the law has a "specific intent" clause.
So, your final question is "What to do from here?" My advice would be to stop focusing on "him" and refocus on you. HIV is now your reality and your problem. Blaming others and making someone "pay" will not help you cope with your new reality. The scumbag has to live with the reality that he may have been responsible for passing HIV on to someone else. It's a painful realization, and one which, most likely, will cause him considerable guilt and angst. Hopefully, it will also make him reconsider his actions and change his behavior in the future. You need to consult a competent and compassionate HIV specialist. A period of adjustment as you learn to cope with your new reality as an HIV-positive person is to be expected. Hopefully, you will soon realize your life is not "ruined." It's merely changed. I've been positive since January 1991. HIV has not "ruined" my life. It has redirected it, refocused it, and in some indirect ways, improved it. It has afforded me a new appreciation for my existence, however long it lasts.
Write back anytime. We are all in this together, and together we'll see it through, OK?
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
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.)
You cant be cavalier... "Homophobic single father" Jan 28, 2007
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.
Response from Dr. Frascino
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.
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
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.
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