(rape tw) Can you explain why you don't think HIV+ people have a moral responsibility to tell potential partners their status, if that is indeed your position? I understand that if they have an undetectable viral load and they practice safer sex, the risk of transmission is very low, but it still exists, no? I'm just trying to understand. I have HPV and I feel guilty for not telling the man who raped me beforehand, and that's not even a potentially fatal illness, just an inconvenience. (1/2)
(2/2) I want to support HIV+ people and not make their lives harder, but I’m having a really hard time with this perspective from an ethical standpoint.
(anon sorry, i answered this but forgot it in my drafts)
anon, i’m not really sure where this is coming from since i haven’t posted about this in a while [since this came in before my other post got resurrected] but i’ll try to explain (and forgive me, this got so damn long but i’m quite swamped lately and have no time to edit)
i don’t think i’ve said that there’s no responsibility to disclose, and i wonder what made you think i did, but the main point i want to get across is that it doesn’t really matter what i think about the morality of nondisclosure in any given situation — what matters is whether i think it should be a serious crime. this is a separate question because the law isn’t about morality, in this case it should be about public health.
and these laws are a resounding failure from a public health perspective, especially since as written they penalize testing and usually completely fail to take into account the risk level of the activity (including condom use) or even whether transmission actually occurred (even when the charge is “criminal transmission”!). these laws were born out of stigma, not science or real ethics. but you don’t have to take my word for it; this is the accepted position among HIV/AIDS and sexual health advocacy organizations, and even the CDC is recommending that they be reviewed. i really recommend reading what these organizations have to say about it. from a quick search UNAIDS’s policy brief (pdf) seems pretty good and clear but there is much more out there.
i’m so sorry about what happened to you and i want to know that you’re not at fault at all. no rape survivor is at fault for their rape or for the consequences of the rape for the rapist. he chose to do that to you, and he accepted the risks that came with that. that is entirely on him!
i think a major problem with the debate about disclosure is that, as the UNAIDS brief says, it “places […] responsibility for HIV prevention exclusively on those already living with HIV and dilutes the public health message of shared responsibility for sexual health between sexual partners.” this applies to other STIs as well. we all have to take responsibility for our own sexual health, at least when it comes to acts we consented to.
even if it may seem to make sense on a moral level, placing the entire responsibility on people who know they’re positive for HIV or any other infection just doesn’t work. there will always be people who don’t know their status or can’t know their status for sure because they were exposed too recently. these people can’t disclose, yet if they are HIV+ they pose a much greater transmission risk than people who know they’re positive because they can’t possibly be accessing treatment, because transmission risk is highest in the acute infection stage when they’ve first contracted HIV, and because they’re less likely to be taking the additional safer sex precautions that they’d take if they knew.
there is still a profound stigma against people living with HIV and other STIs. when we’re influenced by this stigma, we’re likely to focus on finding someone to blame for transmission (or even the possibility of transmission). when we reject the stigma, we can focus on effective methods of prevention which involve helping everyone accurately judge their risk level and make informed choices to protect themselves.
you mention that safer sex with someone with an undetectable viral load is very low-risk (so low-risk, in fact, that i don’t think there’s ever been a documented case of transmission under these circumstances) but that any risk is too much. it’s fine if you feel that way; you set your own boundaries. but sex with someone who doesn’t know their status is much riskier. so is it morally permissible not to disclose to your partners that you don’t know your status? and should not disclosing that be a crime?
i don’t think most people think so, or they haven’t thought about it. to a lot of people, not knowing their status is normal, because their sexual choices are governed by assumptions: they assume that they are negative, for HIV, HSV, etc., and they assume that everyone they have sex with is negative, unless they say otherwise. they assume this partly because of lack of education, and partly because of stigma. we think of people with STIs as dirty, reckless, less than virtuous. we don’t want to think of ourselves or the people we’re intimate with that way. but of course, people with STIs are not those things — having an STI is an entirely morally neutral characteristic of a person. and these assumptions about ourselves and others aren’t sound. they are actually an obstacle to STI prevention.
so these debates trouble me because they obscure the fact that the best practice for everyone is to get tested regularly, disclose what you know about your status (including whether you know it!), and ask about your partner’s status, making it clear that it’s safe for them to be honest. and when we place all responsibility on people who know they’re positive, we validate our assumptions that everyone is negative, but we have to challenge those assumptions if we want to protect ourselves and each other. we have to acknowledge that when we decide to have sex based on the assumption that our partner must be negative, we are taking a risk. even in a world where everyone who knows they’re positive disclosed — and i believe most do — this would be a risk.
the sooner we can accept this and reject stigma, the sooner we can take steps toward more honest and open communication in our sexual lives and make healthy, fully informed choices, the sooner we can stop the spread of HIV.