Would you tell?
Ok, so I have a serious question for everyone. This is something that happened to me a while ago and I often look back upon it with very mixed and often uncomfortable feelings. I have only shared this with a select few and I am now wondering what you guys think – so here goes . . .
One night when a friend of mine (let’s call him Doug) wanted to chat with me about something he was going through I was all ears. We got to talking and Doug started to tell me about someone new that he was exploring. He had recently started dating a guy and it had started to become serious. Doug has been trying to find Mr. Right for ages and he thought that he might have found him. Of course I was happy for him. When he told me who it was, I was even happier because I knew the guy and thought that they would make a good match. But then Doug did something that caught me off guard. He asked me if I knew whether his new boy was HIV positive. I didn’t know what to say. Truthfully, I knew that Mr. Right was indeed HIV positive. But it certainly wasn’t my place to disclose. Or was it? I felt uncomfortable that Doug had even thought that it would be appropriate to ask me. I told him of course that I didn’t know and that I didn’t know why he didn’t ask Mr Right for himself. Since Doug seemed to think that the relationship had serious potential, I was also curious as to why Mr. Right hadn’t disclosed anyway. Knowing Doug for years I knew that he made it a habit of practicing safer-sex. But being a close friend, I also knew that Doug had a tendency to slip up every now and again (especially when he thought he had found Mr. Right). Having convinced Doug that I really didn’t know, we changed the subject.
I sat with this uncomfortably for weeks. It turned out that Doug and mister right broke up a while later and that in the process Doug did find out about Mr. Right’s status. I felt relieved that I was no longer carrying this weight. It’s been a few years now and Doug and I have lost touch. I still see Mr. Right every now and again. But when I look back at this experience I still have a lot of unconformability and unanswered questions. I happened to know Mr. Right and truly believe that if there was reason to disclose (significant risk) he would have. But when it comes to the ones we love, and want to protect what do we do? Although the ethical part of me thinks that I have done the right thing, the friend in me still feels a little unsure.
If I had disclosed (lets forget for a moment that as member of an AIDS Service Organization I would be breaching my oath of confidentiality something serious) would I be contributing to the difficult and stigmatizing reality that is making it difficult for Mr. Right to disclose in the first place? And if Mr. Right for some reason never disclosed and my friend became HIV positive, had I really done the right thing? I would really like to know what you guys have to say about any of this.
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January 14, 2009 08:34 PM
I understand your need to protect your friend, but then again your responsibility of working in an ASO and respecting that confidentialy is foremost. Everyone is responsible for their own actions
December 14, 2008 12:15 AM
“That being said, I don’t think that it should be up to the poz person to disclose, but they should reach for a condom during sex out of common courtesy.”
To turn Scott’s comment around, because it goes both ways though not everyone thinks about that, it’s just as true that a neg guy has an obligation to grab a condom to put on during sex as a common courtesy. Especially if the other guy is or might be poz. As Scott points out, there are other STDs and those STDs can often be much more damaging to people with HIV than they are to other people. You should be valuing protecting poz guys from your STDs just as much as you value protecting yourself.
December 13, 2008 08:20 PM
IMHO, anyone i’m sleeping with is poz, until the prove otherwise, and I’m treating them accordingly. I’m a neg guy who currently has a poz bf. He disclosed when we first met. It didn’t change how I felt about him, nor is it an issue.
That being said, I don’t think that it should be up to the poz person to disclose, but they should reach for a condom during sex out of common courtesy. HIV is not the only STD out there. If someone is willing to act “unsafely” during a sexual encounter, then in my books they are automatically positive or can possibly have any other STD. The weekend a friend of mine contracted HIV, he also got Gonorrhea , Syphillis and Chlamydia, what a party weekend.
December 12, 2008 09:27 AM
Wow what a great discussion and some really great thoughts however, though I can’t agree with Jason at all. My personal experience being in a sero-opposite relationshiup for over 8 years disproves his kind of thinking to me. I’m single again now and I always disclose before there is even the possibility of sex. I find it more difficult then ever these days, with constant rejections even in bathhouses. So I love this kind of discussion it really really helps.
There’s a guy who I had sex with who afterwards told me he had Herpes. Fortunately I didn’t catch if from him, but it really freaked me out. I really wanted to warn people for a while because I felt he didn’t disclose properly and infact engaged in risky Herpes behaviour…lol. I had honestly disclosed my HIV status to him before we had sex. I can tell you I feel it is my duty to warn my friends if they say they might or are having sex with him, because he with held it from me. If he had disclosed before we had sex, I would have respected his privacy. The same is true with my HIV infection. I was infected with HIV by a man who deliberately infected me and at the time of the “accident” I asked him his status and he played innocent to exposing me and his status. I’m not so innocent as a result of his act, but I can tell you I also warn people about him because what happened is too likely to happen to someone else, and I consider him a predator. It’s all about respect and protecting our community. If people have the integrety to be honest in the situations they enter, then no one else has to play policeman, but if people are not acting with a conscience and honsetly, I beleive others have a right to do it for the people they might indeed hurt. I sure wish someone had warned me.
I wish I could say someones privacy comes first, but if an idividual has proven to me that they can’t be trusted, and I see a friend relying on their trust, I will always speak up to my friend to warn them of my experience. That is the ethical thing to do and it’s the truth - not lying through ommission to protect someones lie through ommission.
December 8, 2008 11:52 AM
I think Jason’s response misses the point about the consequences of disclosing a poz guys status to others. He describes the fallout as that “they ultimately won’t sleep together”. If only it was just that. Frankly, I think that, like it or not, most poz guys can handle the “not sleeping together” bit. It’s life. What they - or at least I - have difficulty with is the prospect of the kind of damaging consequences AA mentions here, PLUS a poz guys’ civil rights being trampled on by third parties.
Seems to me those friends are skating on thin ice here anyway. They seem to THINK, but don’t know, that this poz guy is a danger to his “neg” partners. Partners, incidentally who seem no strangers to risky behaviour themselves, or this wouldn’t even be much of an issue. In fact, it sounds like there’s a distinct possibility that those partners are amongst the 30% of poz guys who don’t know they are poz. So perhaps we should share their names with others too, just in case they are poz? I don’t think so.
I can see that it may be an ethical quandary if loyalty to friends is seen as all-important, so I’m glad that folks like David and Vijay are thinking this through rationally, and inviting discussion. But a discussion which sees the neg guy as the victim here doesn’t strike me as helpful. Poz guys tend to be highly respectful of the health of others, but what’s equally important in this context is that poz guys have rights too, which are pretty important in a civil society. And those rights can be quite adequately protected if the responsibility for safer sex is a shared one, involving both sides, not just one. There are many ways for a) poz guys to protect their partner and b) neg guys to keep neg without breaching the basic right of all of us to confidentiality of medical information. If that process doesn’t seem to be working, outing people to the world seems way less attractive than friends and others who know what’s happening - and I stress “know” - suggesting behaviours perhaps need to be changed.
Murray I think is saying that the danger here seems to me in letting the emotional reaction to a friend or a client who is perceived to be in danger getting in the way of a response which tries to balance the interests of everyone. At the risk of knocking emotional responses - because I’d argue that in nine times out of ten they serve us well in other situations - I’d agree.
December 8, 2008 12:56 AM
I THINK IF SOMEONE MEETS SOMEONE THEY SHOULD BE HONEST WITH EACH OTHER IF ONE HAS HIV HE CAN STILL BE SAFE BE IN A LTR WITH SOMEONE NEGATIVE IN BOTH PLAY SAFE ALONG THE WAY JUST BECAUSE SOMEONE HAS AIDS DOESNT MEAN U TURN YOUR BACK ON THEM INSTEAD BE A BIG FRIEND AND EVEN A LOVER SOMEDAY MAYBE COULD END UP BEING THE BEST LOVER OF YOUR LIFE.
December 7, 2008 07:24 PM
thanks for such an interesting and intense question Vijay. Interesting conversation to say the least. One of the things that I and a colleague have been doing for a while now is working with health care providers (primarily in AIDS related work) to help them recognize and think about this at a much deeper level than is usually the case. If you are asked to provide services to someone how is positive and you know that they have infected another client that you are working with, it impacts you. We can pretend that it doesn’t but it does. Even when the situation is unintentional and the newly infected person doesn’t blame anyone, it’s virtually impossible for us not to have an emotional response of some sort. The thing is that regardless of our emotional response, we are obliged to provide the best service in the most respectful and non judgemental manner that we can. It would be interesting if members of the general public who have no work or volunteer connection to our kind of work could have the same level of knowledge and training. Ultimately, we will have an emotional response when someone we know could theoretically be at risk (I had this knee jerk emotional response when someone I knew to be struggling with addiction started dating an acquaintance who I knew to be in a fragile state regarding addictions) but the bottom line is to know what is your business and what is your “shit” that you need to work through yourself.
December 7, 2008 07:31 AM
Roger, are you sure you don’t know me? As to “overlay[ing] their own opinions as which sex acts require disclosure,” I’m basing that on what I’ve read elsewhere on hivstigma.com. Did I say that I was worried about you personally? No, I didn’t. I think a partner has the right to know whether his partner(s) have any STIs, including, but not limited to, HIV.
Of course, I agree that everyone should practice safe sex. But what if Mr. Right is really Mr. Wrong? What if Mr. Right displays sociopathic traits? Say my friend is bowled over by the fact that Mr. Right is going out with him? What if my friend suffers from depression and gorgeous Mr. Right tries to pressure him into having unprotected sex?
Probably neither party should be having sex, but they do.
http://www.aidsmap.com/en/news/513F7A90-F018-4AC8-9A92-57D439A9E8F0.asp Chronic low-grade depression means gay men more likely to have casual unprotected sex
http://www.chicagopride.com/news/article.cfm/articleid/4154256
Report Links Gay Men’s High-Risk Behavior to Depression
http://www.upi.com/Health_News/2008/11/28/Undesirable_gay_men_may_have_riskier_sex/UPI-34881227916074/
Undesirable gay men may have riskier sex
December 7, 2008 01:38 AM
I’m glad I don’t have friends like Jason who would make all my life decisions for me, and who overlay their own opinions as which sex acts require disclosure onto the lives of their friends as some kind of self-appointed moral arbiter. I always take other people’s lives and health into huge consideration, I am way more careful about safer sex than most neg/unknown-status guys. Thanks for assuming the opposite, and dictating that outing me is worth it to protect your friends who don’t need to be protected from me at all.
December 6, 2008 10:50 PM
Some interesting responses.
Jason says he’d tell someone, which means he makes the assumption that Mr. Right wouldn’t disclose before unsafe (bb) behaviour, and he doesn’t know the guy. I think I’d approach it by at least raising the concern about many people not even knowing whether they are positive or not, and also suggesting that his friend ask his sexual partner. Or, are you willing to take the risk that the guy is a liar and says he’s HIV-?
Why do we want to find out “secretly” from a 3rd party about someone’s status, when we’re about to jump into bed with a guy and get very intimate? I think it’s because guys feel uncomfortable when they find out someone is positive, and then respond by avoiding sex, even safer sex, and having that guy know that the immediate reason is his hiv+ status. It helps them avoid uncomfortable situations. I think if you’re not ready to get through that conversation, then maybe you’re not ready to have sex in today’s world.
Anyone who accuses someone else of “social working” them denies the amount of careful thought & work that social workers do to have an informed and ethical opinion on their own behaviour and the counsel they give others. It means that person is, in some sense, is abdicating their own responsibility for their behaviour.
The micro-chipping situation in Malaysia is a challenge. They are the 4th most populous nation on earth, yet I don’t think their social climate is as understanding of GLBT issues as ours is, for which we’re fortunate. They face a much “larger” (in terms of # of people) transmission issue than we do. On the other hand, once such a program is in place, it’s very difficult to guarantee ethical privacy. Also, the method would likely further stigmatize hiv status, so that hiv+ people would go underground & disclose even less often, for fear of reprisal, which could limit the effectiveness of the program.
If someone asked me about someone else’s HIV status, I think I’d fall back to the same tactics I used when people asked me if someone else was gay, years back: I’d say ” do you think if I knew, that person would be comfortable with me telling you?” Remember there were real consequences - perhaps not disease, but perhaps gay-bashing, prejudice at work, exclusion from social circles, etc.
I’m glad this conversation is happening. It’s kind of like our “coalition government” political situation that is unfolding - a lot of people are starting to talk about & learn about something that is important to them but don’t necessarily know all the facts or even have a fully-formed opinion about how our government works - people are taking an interest, and learning, which is good.
December 6, 2008 09:04 PM
Well, I seem to come down on the minority side here, but speaking as an individual, who is not a social worker and would not come to know someone’s status in a client-patient setting, I would definitely tell my friend. I would hope that the two of them will have already negotiated safe sex, but I know that’s not always the case.
If my revealing the guy’s status means they ultimately won’t sleep together, then they probably shouldn’t have been sleeping together in the first place. Yes, everyone needs to practice safe sex; however, if safe sex is not negotiated and you know you have a contagious disease, then it is incumbent upon you not to spread it to others. And, if you’re having anal sex, I think you should disclose because there is the risk of the condom breaking. If you don’t want to disclose, then don’t have anal sex. There are plenty of other things two people can do to get off that are of lower risk.
HIV is the only disease that I know of where people pussyfoot around because we’re afraid of offending someone or hurting someone’s feelings. Obviously, microchips are not the answer, but neither is not speaking up because you’re afraid of hurting someone’s feelings.
December 1, 2008 02:53 PM
Thanks for all of the feedback guys. I have read what you have written carefully and there are a few things have come up that I have never thought about before. Rodger, to address your point that even contemplating this situation “implies the poz guys deserve a default position of mistrust,” - I think a light bulb went off for me. I agree; we need to stop assuming that poz guys don’t have a vested interest in HIV prevention. And it’s true, often times the needs, issues and rights of poz guys are placed secondary to those of negative guys. These hierarchies, though they may be implicit, feed into a culture of sustained inequalities.
Bob, I agree that in theory it is never EVER ok to volunteer information about someone else’s status. I think the point that I was trying to make is that as someone who has been working in the ASO realm and is well-versed in the ethics of HIV prevention for a few years now, this issues was still uncomfortable for me. I knew my ethical obligations (not only to my job but to the human person we were discussing) and so I chose to say nothing. But for many, I would even say most, of the gay guys out there that have never thought about the complexities of HIV stigma, this question is much easier to answer and I think that result would be to disclose. David and I have debated this issue and I came to a realization that there wasn’t a black and white answer when it came to people we loved. But my concern is that for the majority of negative gay guys out there (for whom HIV is still seen as a distant something far away and intangible) there is no dilemma because the automatic thing to do is tell.
I like Brian’s approach. My uncomfortability with being asked had silenced me from delivering the intervention required. I suppose what I can learn from this is that the responsibility is not on me to disclose but rather to make sure my friend is adequately equipped to have an honest conversation about HIV with his partner. And I think that the “what would you do if he is positive?” question is huge. I am going to think about this a little more.
December 1, 2008 02:29 PM
I’m with Bob on this one. I believe, even with me being so public, it is my right to disclose that information to anyone. Well at least before he or she sees me on TV or something. This says to me a few things. What kind of relationship or communication skills does this friend have if he thinks someone could be serious to approach a fundamental question such as sero status?
I do know that many positive guys may not disclose until they’ve gotten to know someone and feel there is trust and safety in disclosing. Personally, I hate this approach, so I don’t go that way. But I know many who do. However it becomes a even more basic question around trust. I don’t like people to keep secrets from me. I hate surprises. To date someone and find out even six weeks into it would piss me off, not because of feeling I needed to know for protection, but what else are you hiding from me, and is this how you deal with difficult decisions.
Then there is the issue of the friend and not always having safe sex. I think many of us, including myself want to jump and help or save others. Perhaps its callous of me, but the friend has to make his choices. We can off as much support and information, but if he slipped up with this guy, it’ll be someone else.
For me the point of intervention would have been when the guy asked for the other guys status. I’d jump right in there with, “Don’t you talk to this guy? Why is it that you can’t have this discussion? What would you do if he was positive? Do you see all your sexual partners as being positive?.
I know, it’s easy to say from a distance, but these things do come up and they can be difficult.
November 30, 2008 06:53 PM
“Because as a poz guy, it seems quite wrong for anyone to divulge my status, without my consent, to a third party UNDER ANY CIRCUMSTANCES.”
I SO agree with you, Bob, and I think sometimes it’s important for us to take a poz-centric position because we need to advocate for our interests, which are often (not by any of the moderators on this site, but out in the rest of the world) definitely considered secondary.
I do understand where David and Vijay are coming from though. They are afraid their friends could seroconvert, and they want to protect them from that. In the ideal situation, no one would go raw without a conversation — but we know sometimes things go differently, because neg and poz guys are both human. So they are stuck with trying to figure out how to deal with that situation, both in terms of their jobs and in terms of the people they care about.
All the same, I think there are ways we can talk to our friends about how to deal with risks they have taken that don’t necessarily involve outing someone.
November 30, 2008 05:12 PM
Bob, you are completely right in that there are obligations to keeping clients confidence. That much is clear, and hopefully neither of us has led anyone to feel that that isn’t the case. However, it doesn’t take away the dilemna of whether or not the “right” thing has been done. You voiced it perfectly Bob in saying that the things that sometimes sound good in theory, often become challenging in practice which have been a source of discussion on this site as it relates to some practice of the law surronding HIV. Rules and regulations are black and white, however they operate in a world of grey that involves real people, living real lives, that are subject to those realities. Vijay did the right thing, no doubt. But he’s brought up a thought that many people workers and not, Poz and Neg, ask themselves even with the ASO field. Is the ‘ethical’ choice, always the ‘right’ one?
November 30, 2008 04:16 PM
David and Vijay. I guess I’m a black and white kind of guy, but I dont share the sense of there being a dilemma here as much as you do. Because as a poz guy, it seems quite wrong for anyone to divulge my status, without my consent, to a third party UNDER ANY CIRCUMSTANCES. So Viyay, by keeping quiet, you did the right thing, in my book. I liked Rodger’s way of addressing this too - an ethical and helpful way of keeping the other guy safe while not breaching poz guy’s confidentiality.
Look at it another way, and admittedly it’s a bit of a poz-centric one (hey, a new word!) Disclosing a client’s status to a third party would likely get you fired as a social worker, because it’s recognized as unethical conduct. I dont think you should consider reverting to laxer ethical standards because the person involved is a friend rather than a client. The impact on the poz guy is exactly the same, after all. Having said that, I’ve neven been there, so what may sound good and untroubling in theory might really challenge me in practice. In fact I think that’s what your’e saying it’s done to you. And I can understand that.
November 29, 2008 09:37 PM
Hey Vijay,
you and I have both spoken about this position our friends often place us in, as if somehow we know the HIV status of all of Toronto. Goodness. I recently got into an heated interaction with a friend who was quite upset that I wouldn’t go out of my way to warn him about being with someone who I knew to be HIV positive. Now, I offered to him that I have always, and would always push condom usage no matter who his partner was. I do that with all my friends. He didn’t see this as helpful and saw me as social working him, unfortunately that’s what I do and like you’ve pointed out, we have professional obligations to consider. On the other hand, I have to be honest in saying that I’ve asked myself “how I would go about dealing with a situation where I knew for certain that a close friend was engaging in unsafe sex with someone I knew to be HIV positive without there having been disclosure.” You’ve brought up a really difficult ethics issue that we as workers sometimes grapple with. Good area for discussion my friend.
November 25, 2008 08:12 PM
Vijay Thanks for providing a link to that article on the Indonesian situation. There seem to be many unanswered questions, but what we can get a handle on is downright appalling The microchips are supposed to be implanted in “sexually aggressive patients”, whatever that means, but later we’re told that they’re intended to catch and punish ” those who deliberately infect others”. Trouble is that those “deliberate infections” aren’t happening - anywhere that I know of. It’s largely an imagined danger rather than a real one. It’s also known as pozphobia.
What a bizarre approach to stopping new infections though. It’s stigmatizing to the nth degree for those affected, of course - sounds like they haven’t even been charged with anything, but are implanted anyway. Plus of course it devalues the human rights of those impacted, purely because they are positive.
You could argue that acts of stigmatization like this, even abroad, only affect the people in that region. Or that they hurt all of us. I would argue the latter. Or is this case so extreme that most people, poz and neg, would see the injustice here and condemn the Indonesian authorities?
I don’t know. I think the general public, even in Canada, is pretty supportive of criminalizing HIV transmission in general. Perhaps we as a community need to do a better job in persuading folks that there are better solutions out there than the heavy hand of the law. And they certainly don’t involve micro chips.
November 25, 2008 07:02 AM
I hear you on the torn feelings on this one! From my own experience, I know at least one occasion when I was negative that I made really strong hints to a buddy of mine that someone they were interested in playing with was positive. I had heard that the poz guy was into getting barebacked. The problem with it was that it meant I didn’t respect my friend enough to believe that he could make adult decisions around protected sex without such a warning. And it wasn’t fair to the positive guy to almost-out him the way I did. Now that I’m positive I know how terrible that is. And it really is. It implies the poz guys deserve a default position of mistrust, and it disempowers by robbing us of the right to self-assertion around disclosure. If a person already knows about your poz-ness from someone else, they can consider you a fraud until the moment you out yourself — which is deeply, deeply stigmatizing.
Anyway, that was my experience, which is not exactly the same as what you are talking about. But I do think you did the right thing. If you wanted to improve your discussion with your friend because you had concerns about him around safer sex, I think the right thing to have added in would be a talk along the lines of “I don’t know that he’s poz, but you never know. In fact anyone can be poz without knowing it. I think you should both be careful till the point you decide to have a talk about status and safer sex, and either decide to keep things how they are, or get tested together and decide how to proceed from there.” All in all, I think you were right to say what you said though, and not to out the other guy.
November 24, 2008 05:55 PM
Hey Guys,
A friend of mine just forwarded me this article. It’s about plans to use microchips to monitor people living with HIV in order to “track and punish” them in parts of Indonesia. It’s shocking and sick but worth reading. What do you guys make of this?? Is there something that we as a community do about this?
http://ca.news.yahoo.com/s/capress/081124/world/indonesia_aids_tagging
Comments??