Dan Savage's column recently addressed the morality of HIV-poz folks, and the responsibility they have to notify potential partners. The topic is more pertinent, given the recent (and mostly debunked) revalations in NYC, though that's another topic for discussion entirely. I have my own views on his response, but I'm a little curious to hear yours first. The first comment response is from a listserv here in India where I first was notified of the ariticle. I'll say I disagree, but I'll leave it there for now.
"
Q. One of my best friends was recently diagnosed with HIV. Since college, he's been on an unending sex conquest, hooking up with countless guys he meets online to engage in risky activities. My concern is that he doesn't seem fazed by his HIV diagnosis, and he says he has no intention of giving up his online sex crusades. I worry about his mental and physical health, but also about his seeming willingness to infect others just to satisfy his sexual appetite. I'm pretty sure he doesn't disclose his HIV status to potential partners, and barebacking is what got him into this mess in the first place.
I don't know what to do. He's a pretty clean-cut, attractive, A&F- wearing young guy, which doesn't match the stereotype that many in the homosexual community have about HIV-positive guys. So what am I obligated as a friend to do? Should I tell the group of friends we share, even though they are straight and are not connected to the pool of people he is sleeping with? Should we arrange a time to get together for some sort of intervention? I want to be a good friend, but I don't want to just stand by and watch him continue to hurt himself and possibly others. Any advice is appreciated.
—HELP ME DO THE RIGHT THING
Dan: Would you be friends with a guy who went out at night and mugged little old ladies? Or a guy who beat his girlfriend? Or a guy who ran around raping people? Of course not, HMDTRT, because you're an ethical guy and ethical guys don't hang out with violent, abusive assholes. So why on earth are you wasting your time with this guy? Knowingly exposing other people to a potentially fatal disease is an act of violence, HMDTRT, and there's just no excuse for it. Your college buddy obviously doesn't care about his own health any more than he cares about the health of his sex partners. And you know what? If you were an attractive, naive stranger he met on a website, he'd be more than willing to imperil your health to satisfy his own selfish sexual appetite.
So here's what to do, HMDTRT: You're going to drop this guy. You're going to refuse to have anything to do with him anymore and you're going to tell him why. And if anyone in your circle of friends asks why you aren't friends with this asshole anymore, you're going to tell him or her the truth. Will you be violating your college buddy's privacy? I suppose so, kiddo, but someone who violates other people so casually isn't in a good position to complain about having his precious privacy violated.
Speaking of new HIV infections, an apparently deadly strain of the virus that causes AIDS surfaced in New York City last week just in time for Valentine's Day. This new strain doesn't respond to the antiretroviral meds that hold most infected people's HIV in check and, even more worrisome, it appears to induce a rapid progression to full-blown AIDS. The new HIV strain was discovered in a New York City man who told health officials he had had sex with hundreds of men in recent weeks while using crystal methamphetamine. Nice. The news about what could be a deadly new stage in the AIDS epidemic broke less than a week after public-health officials began warning gay men about a rare form of chlamydia known as lymphogranuloma venereum, or LGV, that's spreading among gay men. Symptoms of LGV include a painful, bloody rectal infection, genital ulcers, and exploding lymph nodes in the groin. Six cases of LGV have been confirmed in the United States, all among gay men, and most of the men infected with LGV reported having multiple sex partners and engaging in unprotected anal sex.
For some, the HIV/LGV one-two punch was the last straw: "Gays Debate Radical Steps to Curb Unsafe Sex," read the headline on the front page of The New York Times on February 15. And the radical step that's being contemplated? Partner notification, or tracking down, testing, and treating the sexual partners of people who have been newly diagnosed with HIV. As radical notions go, partner notification is about as radical as suggesting that surgeons wash their hands before they operate. Public-health officials have used partner notification to combat other sexually transmitted infections for decades and it's past time that they started using it to combat HIV too.
If people are looking for a truly radical step—something that might actually curb unsafe sex—I've got a suggestion. But first some context: When extremely promiscuous gay men assess the risks and benefits of unprotected sex, most assume that if they get infected, or if they infect someone, an AIDS organization or state health agency will pay for the AIDS meds they or their sex partners are going to need to keep themselves alive. It seems to me that one surefire way to curb unsafe sex would be to put the cost of AIDS meds into the equation. I'm not suggesting that people who can't afford AIDS meds be denied them—God forbid. No, my radical plan to curb unsafe sex among gay men is modeled on a successful program that encourages sexual responsibility among straight men: child support payments. A straight man knows that if he knocks a woman up, he's on the hook for child support payments for 18 years. He's free to have as much sex as he likes and as many children as he cares to, but he knows in the back of his mind that his quality of life will suffer if he's irresponsible.
If the state can go after deadbeat dads and make them pay child support, why can't it go after deadbeat infectors and make them pay drug support? Infect someone with HIV out of malice or negligence and the state will come after you for half the cost of the meds the person you infected is going to need. (The man you infected is 50 percent responsible for his own infection.)
"I don't think there's anything inherently illegal about it," said Jon Givner, director of the HIV Project at Lambda Legal Defense and Education Fund, when I called to bounce the idea off of him. "It's just a matter of whether you think it's good public-health policy." Jon doesn't. "I don't want to play the role of the apologist for irresponsible behavior [but] whatever public-health policies we develop should not be based on blaming the person with HIV first."
Ana Oliveira, the executive director of Gay Men's Health Crisis, was more receptive to the idea. "We find ourselves at a time where the idea of holding people accountable, of building consequences into behavior choices, may be needed to help change the paradigm," Oliveira said. "We certainly appreciate the element of justice in your idea. It could act as a deterrent, and that would be helpful. The difficulty is that it would be impractical to implement . . . and the pitfall would be a lot of he said/he said situations."
Still, Oliveira thinks everything should be on the table right now, as do many other frustrated HIV prevention educators. So I'm tossing my idea out there.
"
Flown by mariposa at 06:42 PM on February 23, 2005
Comments
[Khush] from Dan Savage, a modest proposal
Date: Wed, 23 Feb 2005 11:44:04
The story of the new drug resistent AIDS strain from a gay guy who was into unprotected multi-partner sex and crystal meth usage is developing in interesting ways. There are indications that the scare has been a bit overblown and the reaction excessive, particularly some of the more draconian measures suggested to tackle it.
But except for the most extreme gay and AIDS rights activists, commentators, not least from the gay community, acknowledge that it does raise questions of the extent to which the behaviour of some gay men is contributing to the persistence, even resurgence, of the virus and what can be done to tackle it.
Dan Savage has just come up with a characteristically vigorous and thought provoking suggestion, which I'm giving below. The practical problems with are obvious, particularly in a country like India where so much infection happens through anonymous and even unacknowledged sex (meaning guys deny they are having it), and anyway most of them wouldn't be able to pay for their own treatment let alone that of the people they infect.
Still, its interesting in that it attempts to fix responsibility which is something AIDS activists have tended to shy away from because of fear of stigmatising people. I can understand the practical reasons for this, since stigmatising makes it harder to reach out to people. But it does seem to me that the reluctance to assign responsibility also stems from the sort of moral position that says "every is guilty, no one is to blame" and that I think is rubbish.
In many cases people may truly not be guilty, but in some cases - as in the one that Dan is responding to - the people who infect are guilty and should be subject to some penalty. And when, as Dan suggets, its a financial penalty with the benefits going to the victim it just seems neater than the rather gruesome option of putting them in jail.
What would be interesting is to hear how people on these lists feel about the dilemma the person asking the question is in? Because its a question more and more people on these lists will be facing. More and more gay guys are testing positive, but will continue to lead normal lives in the community. So what happens if they see that 'normality' as continuing to have unsafe sex?
Khush is the oldest online forum for lesbian, gay, bisexual and transgender people of South Asian origin.
Read online: http://groups.yahoo.com/group/khush-list
Posted by: Vikram at February 24, 2005 06:52 PM
WELL this is a interesting topic. One that I can relate to personally. While I am choosing not to name names, I recently ended a 12 yr friendship over this exact issue. Mr. X to my knowledge, has yet to succeed in contracting HIV, despite 2 close calls after unsafe sex with HIV pos partners. Mr. X has as many sexual partners per year as possible, and unsafe sex as often as the other person will allow. His “boyfriend” has also decided his life has no value and continues to sleep with Mr. X without the benefit of condoms. After many long discussions where I encouraged Mr. X to seek counseling regarding his self esteem and unethical behavior, followed by his refusal, I explained that I could no longer be friends with someone who took his own life and the lives of so many others with such disregard.
Do I feel Mr. X who refuses to be get HIV testing with any regularity need to divulge his unsafe promiscuity to his partners before sexual contact? Sure. Will it happen? No way. I did persuade him to tell “boyfriend” the extent of his promiscuity, and he did so with disappointing results. Boyfriend accepted the risk.
I think the problem isn’t getting Mr. x to divulge his bug chasing behavior OR believing you can inhibit him spreading disease by making him financially accountable - but to get Mr. X to value his own life, where using a condom is how he chooses to have sex based on the value he assigns his life.
I don’t think it’s realistic to think you could ever prove with whom you had sex, and the odds are he wouldn’t have been the only person for years you had contact with. There is not to my knowledge a DNA test to find out who infected another person. You also have the anonymous sexual encounters, where you would not be able to track the individual down for compensation. And what if the person was attempting safe sex and the condom broke? Do you have varying penalties depending on intent/disregard?
I do feel both unsafe parties take equal responsibility for what they may pass/contract in the way of disease. One should assume every partner has something and adjust your behavior accordingly.
Posted by: Eric at February 25, 2005 08:45 PM
Eric's final para summarizes an approach that many organizations use. After working in a community of people who were possibly infected with a variety of communicable diseases the recommended behavior was "Take proper precautions in every encounter. Assume you are being exposed to something".
My belief is that the responsibility lies with both (or all) parties.
Posted by: Jeannine at February 26, 2005 04:39 PM
You have both echoed my sentiments exactly with your final points.
It may be the onus of the lingering over-sensitive liberal in me, but it seems grossly irresponsible to place the blame of the spread of any disease to the present carriers. I believe this for a few reasons.
First, it is a way to largely over-simplify the current situation by placing blame where it doesn't necessarily belong. Sure, there may be problems with some "bad apples" or "bug chasers" that are causing proplems for public health policies, but I would certainly expect that this is the exception and not the rule.
Second, as already stated, is the simple fact that it takes two to tango. Both parties have a responsibility for their own health and safety. While the behaviour described in the article may be negligent and dangerous, the other parties have a choice to elicit the sexual history of their partner before engaging in sexual activity, and to engage in such activity in a way that negates much of the problem. It is the responsibility only of that individual to ensure his or her own safety. That's just human nature.
Finally, the question must be asked of why things have come this far to find ourselves in this quagmire. It can't be constructive to completely demean the already stigmatzed group of poz folks out there. Behaviour comes with some causes, and I believe that even in these extreme cases, this behaviour is not intended as malicious, merely consequential. I have a hard time believing that Joe Poz leaves his house on Friday night thinking, "who will I infect tonight?" Instead, I wonder what he is actually thinking: "would anyone even talk to me if I tell them I'm positive, or will I be entirely rejected by my own community?"
In the end, I wonder, how are positive people treated in society and in our community? How does this impact behaviour that could be viewed as constructive? What holes exist in current outreach and information campaigns that create both the negative stigma for poz folks and the lingering misconceptions about transmission of HIV? These questions need to have answers before a narrow-minded policy like the one Mr. Savage proscribes are thought through any further.
Posted by: Mark at February 26, 2005 08:57 PM
I owe my health if not my life to outreach programs. Ignorance contributed to some very risky behavior in my early sexual experiences. Finding a forum that discussed sex without an overlying tone of judgment or shame allowed me to ask things never permitted in my “sex after marriage only” upbringing.
I agree education is lacking about HIV-pos people, and their value. It’s unfortunately common to merely categorize them as a health threat. I have recently, and belatedly, joined the statistic of having a close friend contract the disease. It has changed my perception considerably.
Posted by: Eric at February 28, 2005 04:47 PM
Mark asked me to comment on this. We chatted back and forth and I needed time to think about it.
It seems quite strange to me that we can sue people for crashing into us on the freeway, for workers' comp, or for child support, but we can not sue someone for giving us a deadly disease.
However. I am leery of letting the gov't into our bedrooms even more than it's already there. Child support is where I'd allow the gov't because the child should have support. But in the case of HIV/AIDS infections...?
I know that there have been cases of infected individuals suing their infectors for manslaughter (I think?) or malice. In order to prove that, you'd have to prove that the infector knew s/he was infected AND that s/he lied to the infected. So this means that the infected would need to prove that s/he asked for and saw test results on the infector, etc.
And there lies my other issue. Sex is dangerous, no matter whom you're rolling around the sack with. Each person needs to take responsibility for the act. I don't understand why it's a big deal to ask for HIV results before you strip to your undies with someone. I understand lust, I understand drive, but if humans are supposed to have rational thought, why not rationally demand to see papers? Yes, they could still be wrong--your partner could've been infected since then, and even in monogomous relationships someone could be unfaithful, but when I tell friends that I refuse to sleep with someone without seeing a recent HIV test, they look at me like I'm nuts. They think just discussing sexual history is enough.
I don't think I'm nuts to want paper proof. My ex showed me his results and didn't begrudge me. I just had this conversation a gentleman I'm currently dating, and we both decided to get new HIV/STD workups. We both know nothing's changed, and we both have old paperwork, but it's a sign of respect to each other and OURSELVES to know our statuses.
Partner notification sounds great to me. I know, I know that there is client-doctor confidentiality, but we're not talking about putting giant "quarantine" signs on homes. We're talking about notifying people that they are at an esp. high risk of being infected since a former sex partner is infected. I don't see anything wrong with that.
And I agree with Dan Savage in that I wouldn't remain friends with someone who was acting in such a manner.
Posted by: Amanda at March 3, 2005 06:54 PM
| 