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When am I required to disclose my HIV status?

Q: I am HIV-positive, but after taking HIV 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, is it OK for me to keep it to myself?”

A: 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 for novices 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 such information.

Not surprisingly, some 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 the Sero 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 it through criminal laws or are pursuing such cases in court 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their status to a sexual partner, and these cases are hotly contested among (HIV) advocates because they are based on outdated science,” says Mark.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Among the concerns about these laws are not just that they are based on outdated or wrong-headed science – for instance, that biting or spitting can transmit HIV – but that they are strengthening anti-HIV stigma.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 as well. (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 HIV advocate Tyler Curry wrote in the Huffington Post: “(It’s) 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,” says 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 forego it. Telling my negative now-husband gave him a sense that he could trust me and made our dating relationship stronger.”

Rodrigues’ 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 first-hand 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’s 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, for discussing safe sex or for 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.

Petrow, the author of Steven Petrow’s Complete Gay & Lesbian Manners, addresses questions about LGBT and straight etiquette in this Washington Post column. Follow him on Twitter: @stevenpetrow.



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