Civilities: When am I required to disclose my HIV status? Plus, an update on Mx. as a title

Speaking up about your HIV status is better than not, Steven Petrow says. (Ivan Bajic/iStock)

By Steven Petrow Columnist, Civilities-August 31

Dear Civilities: I am HIV-positive, but after taking medication for the past few years, my viral load is undetectable, which means it would be almost impossible for me to pass the virus on to a sexual partner. I wonder if you think I should be required to disclose my HIV status to a partner, or if, because I’m undetectable, it is okay for me to keep it to myself.

Name withheld, Los Angeles

You know it. I know it. Speaking up about your HIV status is better than not. If you’re asking for permission to avoid disclosing it, you’ve come to the wrong guy. But the reason I’m giving you this advice may surprise you. It’s not about medical science or disclosure laws; it’s about personal responsibility.

Before delving further, let me sketch out what HIV researchers mean when they say someone’s viral load is “undetectable.” In a nutshell, it means “the amount of HIV in the blood is below the limit of detection . . . [it] is not reproducing at a level that causes ill health and that the likelihood of sexual transmission is approaching zero when adhering to HIV treatment,” said Jeffery Meier, the director of the University of Iowa HIV Clinical Trials Program.

This is all excellent news for those infected with HIV, not to mention their sexual partners. But it is not a license to withhold information about HIV status.

 

Not surprisingly, some people disagree. “The degree to which there is a moral or ethical obligation to disclose is, in my opinion, commensurate with the degree of risk of harm present,” said Sean Strub, executive director of theSero Project, which fights HIV stigma and injustice. “That is a function of viral load, whether other protective measures are being used by either or both parties” — he mentioned condoms and PrEP, the acronym for preventive HIV medicine — “and the specific sexual behaviors in which one engages, etc.”

In addition, when it comes to disclosure, there is a legal imperative. More than 30 states either directly mandate disclosure of HIV status throughcriminal laws or are pursuing cases in court to require it by other means.

“Many people are in jail right now after being prosecuted for not disclosing their status to a sexual partner, and these cases are hotly contested among [HIV] advocates because they are based on outdated science,” said Mark S. King, who has written about his life with HIV for decades.

Among the concerns about these laws are not just that they are based on outdated or wrongheaded science — for example, that biting or spitting can transmit HIV — but that they are strengthening anti-HIV stigma. This results in frightening people away from HIV testing and treatment. (You can’t be prosecuted for failing to disclose if you don’t know you’re HIV-positive in the first place.) This raises public health risks, of course, instead of decreasing them.

Still, the law is the law.

Whether your viral load is undetectable or not, my advice is to talk about your HIV status with potential partners not because you fear transmitting the virus or prosecution, but because, as activist Tyler Curry recently wrote: It is “your opportunity to protect yourself . . . and to make sure you have no lingering regrets after the sexual transaction is over. It’s also your chance to find out if he is the type of guy who would have a visceral [negative] reaction to your status.”

“I’ve always told, and I’ve always been undetectable,” said my friend Timothy Rodrigues, who has been HIV-positive for 17 years. “I found that it changed how people wanted to have sex, including some negative people wanting to forgo it. Telling my negative now-husband gave him a sense that he could trust me and made our dating relationship stronger.”

Rodrigues’s sentiment resonates with me. More than 30 years ago, I had testicular cancer, which, like all cancers, can’t be “caught.” While I didn’t always reveal it in the most casual sexual situations, I did otherwise and always within the first couple of dates. I wanted boyfriend candidates to know me, to understand me.

My cancer “experience” was a part of me, even after I was cured. I had regular blood work and scans to attend to; I worried about health insurance; and I hated watching TV medical dramas! It was much easier to explain all of that having disclosed my situation early on. (Not that I didn’t learn firsthand about cancer stigma when I was summarily dumped after talking about my health history.)

Coming out about a health condition — whether cancer, diabetes, depression or HIV — negates the secrecy and the shame. And it is past time we put both of those behind us when it comes to HIV.

The truth is that sexual situations of all kinds require personal responsibility on both sides. No one partner, whether infected or not, is more responsible for disclosure, discussing safe sex or bringing condoms. If you’re sexually active, get tested regularly so that you know your HIV status. We’re equally in this together — positive or negative.

Update: Using Mx. as a title

A month ago, I answered a question about using the honorific Mx. as a gender-neutral alternative to Mr. or Ms. Now comes an update from Oxford Dictionaries that Mx. (pronounced “mix”) has been added to the mix. Good news for many, including Scrabble players who have a new two-letter word.

Agree or disagree with my advice? Let me know in the comments section below.

Join Steven for an online chat Sept. 8 at 1 p.m. at live.washingtonpost.com. E-mail questions to stevenpetrow@earthlink.net. Follow him on Twitter:@stevenpetrow.