I recently wrote about the need to disabuse ourselves of the need to create monsters from viruses, after watching episode three of the fifth (and final) season of the acclaimed Oprah Winfrey Network (OWN) series Greenleaf. And after viewing episode four, which picks up on the HIV reveal in the previous episode, it was also disappointing to see that the writers were completely unclear about the basics of HIV testing or treatment, or the ways to help someone who has experienced a diagnosis after sexual assault. The show is a real missed opportunity to educate the audience and to demonstrate what should happen to a person dealing with these circumstances. If you haven’t seen episode four, consider this your spoiler alert.
Episode Four Picks Up the HIV Storyline Post-Hospital Release
At the end of episode three, AJ Delajae, the son of Grace Greenleaf, shares that he contracted HIV after being raped in prison. Episode four opens with Grace, Noah (AJ’s father), and AJ’s hospital physician discussing post-release care for AJ. The doctor suggests inpatient therapy at a facility that focuses on HIV. But the way the care facility is discussed, it seemed to me like a sort of HIV camp—the camera even jumps to show a brochure with the word “HIV” in bold letters during the scene. But they don’t clearly discuss exactly what kind of care he needs—is it for the sexual trauma? Is it for the HIV diagnosis? Both? It almost seems as though when a person tests positive they need to go to a sanitarium for treatment.
AJ ultimately decides to go with his father Noah and returns to the Greenleaf residence to gather his belongings. As AJ and his father are leaving, Grace, in her concern for her son’s health, stops Noah and whispers, “He’s not asymptomatic, Noah.” This highlights another jarring failure: What exactly is Grace Greenleaf suggesting about AJ and his HIV? “Asymptomatic” doesn’t make sense in this context and is not how HIV health or illness is discussed. The following is an offering to the writers of Greenleaf and to others like Tyler Perry, to help demonstrate the five key ways this storyline missed an opportunity to educate viewers about HIV.
Show Us How AJ Was Tested for HIV
HIV testing has advanced significantly since the beginning of the epidemic. Currently, there are fourth-generation tests that can detect antigen and antibody response to HIV as early as a month after exposure, which is different from the antibody tests that screen oral fluid and only test for the presence of antibodies, which take 90 days to show up in this form of testing (which is often called a “window period”). Given the disproportionate burden of HIV in Black communities, wouldn't it have been useful to see the process by which AJ comes to be made aware of his status? We know that he tests positive for HIV after being raped in prison. Based on what we’re given, we aren’t sure when he tested, but could this have been a moment for the writers to explore how incarceration prevents adequate and holistic care? I’m sure he wasn’t tested with a fourth-generation device, so was it a blood draw? Or did he get sick before the prison would test him—which happens very often when prisons don’t want to be responsible for the care of people with HIV who are under their control?
How and When Does AJ Get Introduced to an HIV Treatment Plan?
I tested HIV positive in 2008. This was before the mantra and science of “Treatment as Prevention,” and I had to advocate for myself to start medicine, because at the time, the recommendation was not to start medicine until someone’s CD4 (also known as “T-cell”) count dropped below 500 or they had been diagnosed with AIDS—defined by a CD4 count under 200 and usually presenting with two opportunistic infections associated with a weakened immune system. This was done largely because of the toxicity of earlier treatments and the impact they had on kidney function. So, when I went to my first HIV appointment in late January 2009, I was told that I didn’t need to start meds right away. I interrupted the medical provider and exclaimed that I wanted a script that day. I was put on Atripla (efavirenz/tenofovir disoproxil fumarate/FTC). Everyone’s journey to treatment isn’t the same, but wouldn’t it have been useful to see a Black HIV-positive person exploring treatment options on an acclaimed show that reaches so many segments of the community?
Any HIV Portrayal That Doesn’t Deal With Viral Suppression Isn’t Worth Doing
Grace Greenleaf states that AJ is not “asymptomatic” in her exchange with Noah on episode four of season five, and this was such a missed opportunity. Does that mean he’s progressed to an AIDS diagnosis? The show doesn’t make this clear. Almost never are people with HIV talked about as being symptomatic or not, and the show really misses the very basics of HIV and its symptoms, treatment, and care.
As I stated earlier, I was diagnosed at a time when we were made to wait until our CD4 count was dropping or we were beginning to show signs of illness.
Activists and medical providers over the past several years observed, researched, and documented that if someone’s HIV is well treated and their viral load is undetectable, they can’t transmit HIV sexually. This new movement is called U=U, meaning “undetectable equals untransmittable.” This was a cultural, medical, and legal revelation. Studies were conducted, and there is science to back up this new language—and this has been used to update or modernize laws that criminalize HIV status, which of course disproportionately target and incarcerate Black and Brown communities.
Now we know that starting medicine right away (even if one has a high CD4 count) is the best way to treat HIV-positive people and can help prevent transmission, because sustained treatment can render HIV undetectable in someone’s body. In other words, we now know the amount of HIV present in the body also matters to the person’s health and their ability to transmit the virus to others. So if a person is on treatment and achieves an undetectable viral load, this means they can’t transmit HIV to anyone, even without condoms or other prevention methods, during sex.
I want to be clear that this isn’t the reality for many people, who—because of many barriers—have difficulty sustaining consistent care. Due to lack of consistent health insurance or other issues, some people (particularly Black and Brown folks, transgender folks, and poor people) are often unable to attain an undetectable viral load. Sometimes, people may acquire a strain of the virus that is resistant to certain medications, or due to gaps in treatment, some may develop a resistance to some treatment options, making their treatment journey more complex. But Greenleaf just glosses over and provides a misleading characterization of HIV treatment by reducing it all to AJ not being “asymptomatic.”
People With HIV Who Survive Sexual Trauma Also Experience Desire
Greenleaf writers could’ve used this story as a beautiful opportunity to share some new information and a new way to view HIV status with their viewership. This storyline could have really shown what it means to be HIV positive in 2020, to explain viral suppression and even how people who are HIV negative have prevention options like pre-exposure prophylaxis (PrEP), and the process of negotiating consentual sex between poz and negative partners. Part of the inhumanity of of these kinds of depictions of people with HIV is that it constructs us as sad, depressed, angry, and even malicious figures, and refuse to engage with the idea that AJ’s character could have any sexual agency and desire while also working through his trauma. His character is running from himself—and as an HIV-positive person who had experienced rape before my seroconversion, it does a disservice to not show survivors of sexual assault exploring desire after a traumatic experience. They could’ve strived to make AJ a whole person and not just a traumatized HIV-positive person.
This Depiction Creates More Stigma Than Understanding or Compassion
Creating a character who was raped and then tested positive for HIV, in the final episodes of the final season, with little place to go further into his story, is not OK. It tangles violent sexual assault with HIV in a way that creates more harm for HIV-positive people. There is already a narrative that exists that not disclosing your status is in and of itself an assault, and this is backed up by state laws that criminalize HIV non-disclosure even when transmission doesn’t happen (which is true more often than not). In tying non-disclosure and rape together, Greenleaf is participating in a pop culture that already creates bizarre narratives of people with HIV, further othering us and not holding the nuance of what prevents people from fully disclosing HIV status, all the time.
I truly hope more shows like this speak to people living with HIV and hire HIV-positive writers and consultants who can help shape more realistic stories.