For many years now, the focus of prevention has been on trying to get society as a whole to adopt condom use as a way of life. Perhaps this approach was successful early in the epidemic, but today the mood has drastically changed. AIDS is no longer perceived by the general public as a "crisis," and many people in the HIV community (after 20 years of being ultra-conscious in their safer-sex practices) have become more relaxed as well. As people live longer with this disease, the focus is on improving quality of life.
A loving, passionate, emotionally and physically satisfying sex life is not something that can be denied to us. It is a fundamental basis of our human nature. Many +/+ couples and even some +/- couples have chosen to practice unprotected sex within the context of a monogamous relationship. This is a very personal choice for them, and comes from doing their own assessment of risk. For two HIV-positive people to have unprotected sex together, obviously the risk of transmitting HIV is not an issue, so the worry here would be more related to transmission of other STDs or "reinfection." (Currently, the jury is still out on the issue of reinfection, so this is arguable). For some +/- couples, particularly where the woman is positive and her male partner is not (or if the sero-different couple happens to be lesbian), the risk of transmission from the woman to the man (or woman to woman) is lower so they may choose to take a calculated risk.
Whether or not a couple practices safer sex is not the issue at hand. What is most relevant, is that they have established a line of communication regarding HIV. The fact that they have disclosed their status to each other before engaging in sex, and educated themselves about their options, is what is most important.
The Dating Scene
For other individuals who are not in an established relationship or are doing the dating scene, disclosing their HIV status to another person is often difficult and requires quite a bit of courage. In a perfect world, of course no one would have HIV or AIDS. In a semi-perfect world everyone who had HIV would:
Know their status (because they took the test).
Be willing to disclose that to another person (before they have sex with them).
Use protection if that person so desires.
Also in this "perfect world," our society would look at a person with HIV no differently than it looks at someone with any other chronic disease. Reducing stigma is key to opening lines of communication.
But hence, we do not live in a perfect world, so we often have to make choices based on instinct, trust, and in some cases, our own conscience.
Other than an obvious moral and ethical dilemma related to this statement, there are many legal issues that need to be taken into consideration. Before making any judgments ourselves, we must keep in mind the fact that we, as HIV infected individuals must take on a certain level of responsibility if we are ever to stop the spread of HIV in this country. Although there does not appear to be any hard data published regarding the numbers of people here in the US who became infected with HIV from a partner who knew that they were HIV-positive and chose not to disclose, the stories that we hear in the HIV community are astounding. Why do people continue to put others at risk? And, better yet, how can they continue to get away with it?
For the most part, people living with HIV have a very strong sense of the burden that they bear, and are extremely concerned about the possibility of transmitting the disease to someone else. Often, even to the point of depriving themselves of much needed emotional and physical intimacy.
There are a few individuals, for a host of reasons which may consist of selfish desires, economic hardship, denial, drug abuse, or even sociopathic behavior, that throw aside the moral rules of fair play and make a conscious decision not to disclose their status before engaging in unprotected sex.
Currently about 27 states have established criminal penalties for knowingly exposing or transmitting HIV to someone else. In California, the "Willful Exposure" law (although narrowly written and difficult to prosecute), makes exposing someone else to HIV (whether they become infected or not) a felony punishable by up to eight years in prison. In Alabama, you can be prosecuted for "Conducting yourself in manner likely to transmit the disease." (Just the thought of that is scary).
Many of these laws were written early in the epidemic, and were fear driven. Even though we know that HIV is not transmitted in saliva, there are still people sitting in prison for spitting on a police officer. Deciding who should be punished, and for what offense, often lies in the hands of politicians and court systems that base their decisions on old data and personal prejudices. For HIV-positive women, the scales of justice have been weighted in unfairness since the beginning. Unfortunately in many situations women are still looked upon as "vectors of disease." California was one of the first states to adopt policies of mandatory HIV testing for sex workers, which has in turn, been used to prosecute women for crimes such as attempted murder and manslaughter. There is no such mandate for their male customers.
One thing that furthers this point is the issue of where do some of these men's HIV infections originate. Although women have been blamed from the beginning, there is not much hard data to show how many men really became infected with HIV from sex with a woman. There is no real way to tell if the men are telling the truth about their sexual experiences. We just have to take their word for it. It is much more "macho" and socially acceptable for these men to say that they got it from a prostitute. Again the blame falls back on the women. The ironic part of this whole issue is that time and time again research has shown that it is much more difficult for a woman to transmit the disease to a man (especially in a one-time encounter).
Besides the risk of criminal penalties for putting someone at risk of contracting HIV, there are civil penalties that could be leveled as well. Imagine what a sympathetic jury might do in a case where you failed to disclose your HIV status, and the other person became infected (or perhaps pinned it on you?). What if they infected others in turn? It could get very ugly.
There are emotional repercussions, too. In appealing to those with an altruistic nature (meaning: doing no harm to others), think about how you might feel if the other party became infected by you. Think about how you felt when you were diagnosed.
The bottom line is sex while HIV positive is risky business unless you know where you stand. Learning how to protect yourself and others will save you a lot of heartache, and quite possibly protect you from bigger problems.
Disclosure is not easy for everyone, and in certain situations is not an option (such as where disclosing could cause physical injury to yourself). When considering your options keep in mind: In California, you cannot be prosecuted criminally if you use a condom (whether you disclose your status or not). You cannot be prosecuted criminally for oral sex. Men and women can be prosecuted equally whether on the "top or bottom" for vaginal or anal sex. (The person does not have to become infected by you).
If you tell the other person that you have HIV before insertion, you cannot be prosecuted criminally. It would have to be proven in court that you had "specific intent" to infect the other person in order to be prosecuted criminally. In a civil case, the specifics to which you could be found guilty are much more flexible -- so be careful. Check with your local ASO (AIDS Service Organization) or legal services to find out what the laws are in your area.
Disclosure will continue to be a difficult part of life for many with HIV. In recent times, more and more HIV-positive people have turned to each other for help and support regarding issues of disclosure. Some have chosen to avoid the whole dating scene all together. Many are using Internet chat rooms, support groups, and dating services to meet others like themselves. This is one way to avoid the stress of disclosure and helps build a strong community of people who understand. But keep in mind, it is important in any situation to never assume someone's HIV status. Always talk about it before you have unprotected sex. In addition, don't expect that just because someone is also HIV positive that they will want to have unprotected sex with you.
As we all try to overcome the devastation that HIV has brought on all the different aspects of our lives (particularly our sexual lives) and as we try to move on toward an uncertain future, let's keep in mind a few important facts. We as HIV-positive people are in a very special club, with a very exclusive membership. The price of a membership in our club is almost more than anyone can bear. The initiation into our club is HELL, and once you are in, you can never get out. There are already way too many of us in this club. We have lost so many of our friends along the way, but still people continue to flood through the door. I say, Let's close it off to new memberships now! Let's make sure that we don't inadvertently invite anyone else into the club. OK?
Should you disclose your HIV status? Absolutely! If you are going to have unprotected sex, you must tell. Let's take the necessary steps to protect ourselves and our fellow human beings. Talk to your sexual partners and protect them.