Among all the fallout from Charlie Sheen's recent announcement that he is HIV positive, I got stuck on the fact that TMZ -- a publication no one should expect to be a bastion of medical literacy -- put quotes around the word "undetectable," as in: Sheen claims "the virus has been 'undetectable' in his system."
I seethed over that one, when there were easily a hundred other things to seethe about.
Undetectability has a real medical meaning -- that the amount of HIV virus in an individual's bloodstream is below the ability of a test to detect it -- yet TMZ was treating it like Sheen had made it up to fast track getting to the sex. As if undetectability is a con.
Oh, but then it came to me what the quotes were really about: Sheen's female partners -- his ex-wives, long-term partners, regular hookups and one-night stands. The assumption is that anyone who slept with Sheen, a man living with HIV, was either a dupe or too stupid to realize the risks. They must be victims of a lying Lothario, dumb enough to get involved with someone with many past partners or "promiscuous" women who should have known better. According to some media narratives, some of these women are, puzzlingly, all three.
I can't speak to if Charlie Sheen really disclosed to every partner or not. However, any of Sheen's partners who slept with him after he disclosed to them made an absolutely reasonable choice and are most likely uninfected. And any of Sheen's partners who didn't know his status are also are most likely uninfected.
I Owe Bree Olson an Apology
As an HIV activist, I know the new bottom line of HIV in 2015: A person on effective antiretroviral treatment (ART) with an undetectable viral load has a close to zero risk of transmitting HIV to others. Plus, HIV negative people can take a daily dose of Truvada (tenofovir/FTC) as pre-exposure prophylaxis (PrEP), once again reducing the risk of infection up to 100%.
So when I heard that Bree Olson was on Howard Stern, upset by the possibility that she'd been exposed to HIV, my first response was "UGH Bree Olson."
But Olson probably didn't know her risk of exposure was low to nil. Most of America didn't, and even with the wealth of information online and in the news over the last few days, most still don't.
Nevertheless, as a former porn actress and well-documented ex-"goddess" of Sheen's, Olson has a high risk of receiving the public's infinite scorn for being a sexually active sex worker -- because that surely means she should expect whatever she gets.
So I'll apologize to Bree and upgrade my response to "UGH, world."
As Jennifer Power recently wrote in "Charlie Sheen and $10 Million Worth of Stigma": "Like no other illness, there tends to be an implicit (and often explicit) differentiation between the 'innocent victims' of HIV -- children, people who acquired HIV through blood transfusions, women infected by their husbands -- and those who presumably invited HIV through their choices and actions."
Here's the game:
As media cycles turn and the Sheen story persists, those women who come forward as his former sexual partners have some chance of retaining innocent victim status. However, those women who don't are at risk of being scorned as unknowns who somehow deserve to get HIV from him or, conversely, as the the "unsavory" sex workers Sheen spoke of on the Today show, implying that his association with them led to his HIV infection.
There's No Protection From Hysterical Headlines
If I had a magic keyboard, I'd fix all the "unprotected" headlines in the articles on Amanda Bruce's recent interview with Dr. Oz about her relationship with Sheen.
Bruce, a nurse, relates in her interview that Sheen informed her of his HIV status when they started dating. He was undetectable, she explained. She began taking PrEP to have even more protection against infection. They sometimes had condomless sex. Sounds like a grown woman making some sound choices.
The stigmatizing headlines say she had unprotected sex with Sheen despite his HIV status. Again, the stigma and shame of HIV are paired up to paint a picture of Bruce as either starry-eyed or in denial -- because, by the way, she was in love with him. Because you know how women are.
But there was no denial in her voice as she explained that "many people with HIV don't die from AIDS," and that she was told that the risk of transmission from her undetectable partner was minimal even without PrEP. Bruce most certainly was protected by Sheen's and her own use of medication, but no one protects readers from inaccurate headlines.
With unusual clarity amidst the blamefest of recent days, Bruce deftly explained that the fear surrounding HIV is connected with the social stigma that began when there was no treatment. Put that in a headline -- even though a woman said it.
Will the Real Terrordome Please Stand Up?
Unmitigated fear and "concern" seem to be the order of the day for the women who knew Sheen and the public that judges them.
Reportedly, "many" of Sheen's former sex partners have met with lawyer Gloria Allred to understand their rights. One reportedly said she found the situation "terrifying."
Even Jenny McCarthy, who only shared a fictional sexual relationship with Sheen on his sitcom, got in on it. No stranger to anti-science, she's now incensed that she wasn't told his status and finds it "scary" that they fake kissed.
While all can play the hysteria game, sex workers are in a particularly acute place in the public imagination both on HIV generally and in this media moment. Desiree Alliance co-director Cristine Sardina notes that "there can be no blame of exclusion because the combination of words like 'sex' and 'work' terrify people, terrify groups, terrify agencies, terrify governments. Add the word HIV into the mix and you now have a trilogy of brutal systemic histories that sex workers can't seem to climb out from under this deathly weight of stigma and shame."
Meanwhile, an 18-year-old woman in Cincinnati -- a high school senior -- has been arrested, charged and had her mugshot posted online for allegedly not telling a sex partner her HIV status.
When it comes to women and HIV, there is indeed much to fear. For those who are ready to take a break from the Sheen media roller coaster, the recent flashblog from the Positive Women's Network -- USA is a crash course in the realities of HIV stigma, trauma and violence in the lives women with HIV.
Rather than continue to fear what we do not understand, how about we prioritize the actual facts and challenges of women's lives and health? We could start by understanding that we can think for ourselves and put sound science to use when it comes to our decisions and bodies. But in order to do so, we need information instead of hysteria. While we're at it, we could come together to tackle those factors that increase the chance of HIV acquisition among women, including poverty, experience of trauma, mental illness, substance use and vulnerability to assorted social stigmas.