Should HIV status ever be disclosed?

This is a question often debated among therapists in situations where an identifiable potential partner can be identified. For instance, here is a case where a husband’s sexual activities will be made a part of an action by an ex-wife where the husband may have (alleged by the ex-wife) infected her with the virus.

If you were a friend of this couple and you knew one of them had HIV, would you tell the other? If you were their marriage counselor? Recently, on the BoxTurtleBulletin blog, Daniel Gonzales said that HIV status should never be disclosed. His advice was in contrast to advice given on a gay dating website (although I don’t fully agree with the advice columnist either) Essentially, the question posed by the scenario was this: If a friend knows the HIV+ status of someone who might be a dating or sex partner, should the knowing friend warn the unsuspecting friend? The gay dating website published advice suggesting that the friend should be warned. Daniel said the unknowing friend should not have been told.

I disagree with Daniel. I would probably inform a friend about much less, if I knew it. And certainly in this case, I believe that such disclosures should be made where there is a clearly identified partner. I sometimes link to Box Turtle Bulletin when Jim and the gang discuss research since he often provides thoughtful commentary and analysis of research on gay related issues. However, I strongly disagree here. While I do not think that HIV status should always be disclosed, and I am sensitive to the issue of stigma, but, in a case like this, I cannot understand why privacy should trump safety. I do not believe it does.

UPDATE: Jim Burroway posted a lengthy response to the dust-up over the advice on his blog regarding HIV+ disclosure. I still disagree and left a comment about it there:

Bottom line, if I knew two friends who might hook up and I knew one of them had a disease that could be spread via intimate contact, I would tell my unsuspecting friend as well as the friend who had the condition that I was going to do so. Sure, I might have to deal with fall out; but I believe I might have to deal with a different kind of fall out if I say nothing.

28 thoughts on “Should HIV status ever be disclosed?”

  1. An HIV positve result is being processed by you,and you realise it is the partner of one of your friends who is unaware of thie partner attending. What are the issues for you and how will you deal with them?

  2. Mary,

    You sound very angry.

    Not particularly. I am, however, stridently aggressive toward bullies. The only way to get a bully to stop abusing you is to be more vicious to the bully than they are toward you. And when someone states or intimates that I deserve to die of a “dirty sex” disease, or that I am prone to maliciously infect someone with a “dirty sex” disease, then I get mean.

    That said, it looks like I misread you, so I apologize for my harsh words. You deserve a good life, too.

  3. J. James,

    You sound very angry. There is no hidden meaning behind what I wrote. And my friends were engaged in the same kind of activities as myself. That I am alive and healthy is – a fluke.

    I hope you find happiness in your endeavors and someone to love you as you love them – whomever that may be.

    I too have been mistreated by evangelical christians and I assume the same has happened to you. I hope you are able to meet people that are kind, encouraging, supportive and most of all true.

    You deserve a good life, too.

  4. Mary wrote:

    You may not believe what I wrote. That is your choice. I cannot force you to believe anything.

    What an obvious thing for you to write.

    I do not approve of gay sex for myself. As for others – that is their decision to decide what is acceptable to them and what is not.

    You’re holding back, Mary.

    Would you prefer that your gay friends not have gay sex? (Yes/No)

    Is gay sex impure? (Yes/No)

    My friends did not deserve to die anymore than I deserve.

    I suspect you are an evangelical, for your words sound suspiciously like the “We’re all trash and deserve to die!” misanthropy that evangelical Christianity imposes upon people.

  5. I thought Mary was simply pointing out that we’ve reached a point in our society when someone would be conflicted over a choice between ‘betraying a friend’s secret’ and ‘risking another friend’s life and future’. In my day, that was a ‘no-brainer’.

    I believe Michael mentioned the sense of conflict but I don’t think the conflict was about telling or not. In reality, at the bottom line…if it hadn’t slipped out, Michael would have compelled the HIV positive guy to tell or Michael would tell him that he would. The conversation where the secret was revealed was about high risk behavior. I think Michael’s only conflict was knowing that the positive guy was going to be mad when, in fact, it was Michael and the naive guy who had the real right to be angry.

  6. J. James,

    You may not believe what I wrote. That is your choice. I cannot force you to believe anything.

    I do not approve of gay sex for myself. As for others – that is their decision to decide what is acceptable to them and what is not.

    My friends did not deserve to die anymore than I deserve.

  7. Mary wrote:

    I don’t relish the idea I abhor it!

    I don’t believe you because you wrote, “Makes you go hmmmm?” which is awfully snide. What exactly were you trying to convey with that comment? I read that you were enjoying the fact that a gay man would murder someone else with his dirty sex disease because that proves how evil you think gay people are. I don’t buy your “a person” defense. You know we’re talking about gay people.

    Do you approve of gay sex? (Yes/No)

    Two of my very best friends died of AIDS.

    And some of my best friends are black. If your best friends were gay, did they deserve to die of AIDS because of the dirty sex they had? Did they deserve it more than a hemophiliac who gets AIDS from a blood transfusion?

    The Christian right loves AIDS because they see it as a just desserts for the dirty sex that gay men have, who they think deserve to die of a painful and humiliating disease because of the dirty sex that they have.

    HIV does NOT cause AIDS. I will NEVER have another “HIV test” again as long as I live.

  8. J. James,

    I don’t relish the idea I abhor it! Two of my very best friends died of AIDS. And I am appalled that anyone would give consideration to a friendship over the life of another person.

    My inuendo was that it makes a person wonder what kind of thinking goes into that action of allowing a person to assume a sexual interest of theirs is HIV- when you know otherwise.

  9. Mary,

    You seem to relish the idea of gays being murderers. Do you also enjoy the idea of gays dying of a gay disease? This is a long-standing Christian view of gays (“Christian love”).

  10. Wow – a person more concerned about a friendship than the life of another person! Makes you go Hmmmmmm?

  11. Wow…

    In Michael’s scenario, David is described as naive…

    More accurately, Mark lacks integrity, or worse. His anger at Michael suggests nothing more than someone who was fearful of being frustrated in his pursuit of manipulative self-gratification.

    This whole notion of “consenting adults” has it’s limitations when one of those adults is lied to or important information is willfully withheld.

  12. It was about a month ago that my best friend accidentally leaked his partner’s HIV status to me. His partner still doesn’t know that I know and I spend time with them at least once a week.

    I can appreciate Norm!s (is that a Cheers reference, BTW, if so I only now just got it) concept of revealing behavior without revealing status. Knowing the behavior should warn any thinking person to take all the necessary precautions. If someone took the additional step of revealing their HIV status, that info could spread unneccessarily to ears that don’t need to know. But, there will be those who have been HIV positive–and celibate for a time. Saying “I used to be sexually active and not always safe” would infer being positive–or an indifference to being tested.

    Hey Michael!

    Good to hear from you. Thanks for the vivid illustration.

    Like several of the others, I, too, was struck by the audacity of this guy not revealing his status. And, I agree with Ann, that this is the only time when disclosure is required.

  13. It’s also troubling (if not criminal) that Bussee’s HIV-positive friend Mark would engage in unprotected sex without disclosing his positive status.

    I completely agree. I also think this is the only time a person is required to disclose this information – when two consenting adults are contemplating sexual activity. If a person is witholding this information from a potential sexual partner, then it is wise and ethical (IMHO) for another person to intervene and suggest further information might be needed. Otherwise, it is not required, nor should it be assumed.

  14. I probably would have handled Michael Bussee’s situation similarly. I would have also felt conflicted about disclosing a friend’s HIV status versus protecting a naive, risk-taking friend. Unfortunately, Michael’s friend Dave seemed to be relying on word-of-mouth and other unreliable methods to unwisely determine whether a sexual partner was HIV-negative.

    It’s also troubling (if not criminal) that Bussee’s HIV-positive friend Mark would engage in unprotected sex without disclosing his positive status.

    Warren, I’m not sure why a “duty to warn” would be limited to just friends. If you’re going to argue that HIV-positive folks should be involuntarily outed, then such disclosures should not be limited to only those you happen to be friends with.

    Instead of encouraging friends to play the guess-who-has-HIV/STD game, I think it makes more sense to make sure they assume any sexual partner has HIV or an STD until proven otherwise.

  15. Michael’s scenario, to me, is a great example of why I would disclose if I knew. Now, it all seemed to work out, but it certainly didn’t have to go that way. Thanks, Michael for sharing that.

    Norm – You are talking theory, I am talking about ethics among friends. I would not broadcast HIV+ (or whatever if it can be spread via intimate contact) but I would tell a friend if I knew. I suppose an exception to the not broadcasting scenario would be if the person had a habit of being intimate with people and then disclosing. At some point, isn’t there a duty to warn?

  16. I have two friends, Mark (HIV+) and Dave (younger, a bit naive and HIV-). A few months back, Mark and Dave “hooked up”. Dave told me it was “nice to be able to not use condoms since Mark was HIV negative.”

    Dave must have seen a hint of surprise or confusion on my face since Mark has always been very open with me (and others) about his HIV+ status. Dave asked, “He is HIV negative, right?” I urged Dave to always be safe — and to talk with Mark.

    I called Mark immediately to let him know that I may have “let the cat out of the bag” with my inability to keep a completely straight face. Mark was furious with me. He told me I had “f****d-up” his chances with Dave, Mark would not talk to me for weeks.

    Eventually, the two men talked honestly and in-depth with each other about staying healthy. Mark told Dave he was indeed HIV+ and Mark “forgave” me for not keeping his secret. Dave thanked me for the lecture on safety — so it all turned out well.

  17. Warren said:

    Why should sexual activity be disclosed and HIV+ not be? You have just asserted this without rationale. I would like to know how privacy trumps life and health.

    My point is that it should always be assumed that potential sex partner is HIV-positive or has some other STD. Engaging in a whisper campaign that someone is HIV-positive implies that others are HIV-negative. I would be more concerned if I believed a friend were planning on engaging in risky sexual activity.

    Also, if it truly is a “life and health” issue, shouldn’t someone’s HIV-positive status be publically announced and not simply disclosed to your friends? In the scenario Manhunt scenario, would you not disclose someone’s HIV status all of their potential sex partners?

  18. From my reading of the passage, the author was concerned that Steve dropped Adam from his life after only knowing him for a few hours. The two could have gone to a movie, gone out to dinner, gone on any number of dates, even be in a committed relationship without being sexually active at all. Maybe their relationship would not have worked out anyway…

    But if it, did they could even wed and either decide to abstain from certain practices or take measured precautions.

    Being in a relationship with someone who has a (potentially) fatal illness is certainly not easy and I would imagine *starting* rather than merely *sustaining* one would be even harder especially if that illness is communicable. That being said, people–gay and straight–do it all the time.

    In my life, I *try* to withhold snap judgments both from friends and potential romantic interests. I’m imperfect of course, but I try my best.

  19. There is no moral dilemma here – when an individual willingly and purposefully chooses to withhold information from another, thus putting that person’s health in jeopary, they are acting in a negligent and pernicious manner.

  20. Norm – Why should sexual activity be disclosed and HIV+ not be? You have just asserted this without rationale. I would like to know how privacy trumps life and health.

  21. I’m not sure why the question is limited to HIV. The implication is that it would be okay to NOT tell a spouse their are being cheated on because it’s safe to assume the cheating spouse is HIV-negative. A more appropriate question would be: “Is it ever okay to tell a spouse their are being cheated on?”

    No, a person’s HIV status should never be disclosed. However, a spouse should be notified that their partner is sexually active outside of their supposedly monagamous relationship.

    Another assertion is that by not telling a friend about a potential sex partner’s HIV-positive status, the friend will automatically assume their potential sex partner is HIV-negative. It’s never safe to assume a sexual partner is HIV-negative or STD-free. Always assume a new sexual partner is HIV-positive or carries some STD until tested period.

  22. It has been pointed out that at some point HIV status (or any other disease status) stops being a private concern and becomes a public health issue when the lives and well-being of others are at stake. I don’t want my co-workers coming in if they have the flu, I don’t want my friends contracting HIV. A person has the right to keep his or her HIV status private. Another person has the right to make informed decisions.

    But for me, most importantly, a person has the right to share his or her status with others. The infected individual (Dave) has the right to share that information in his own way, on his own terms so long as it remains a private issue and not a health concern.

    If “Steve” were my uninfected friend was considering starting a sexual relationship with Dave, who I knew to be HIV+ and knew had not disclosed that to him, I would make sure Steve found out before that relationship began. Either by making sure Dave told Steve directly, or by telling Steve myself it that did not happen. Don L provides a real-life example of what can happen if we remain silent.

    Honest discussion, not silence, is what will end the stigma surrounding this disease and ultimately end it. The columnist put it succinctly: “[Steve] gave up a night or maybe a life with an awesome guy just because he’s HIV+? What a schmuck.”

  23. David G said: “A person’s HIV status is their own business and their on [sic] business only.” Yes, but not when they are sleeping with others it’s not; then it becomes a public health issue, and they have a right to be properly informed.

    BTW: Manhunt: “Your guide to hunting, stuffing, and mounting the man of your dream”! Should we even give credence to such so-called “dating” site? Sounds more like bestiality. By this being a gay-identified site, it sure lives up to the stereotype.

    David also says: “This bogus “advice” has no place on Manhunt, a site which appears to be concerned with promoting socially responsible sex practices.”

    Yes, “concerned” all right! Again, why give credence to a site that demoralizes people by inferring them as animals to be hunted, stuffed and mounted?

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