Dear Dr. D,

I am a healthy 38-year-old gay man and have been HIV-positive for six years. I’ve never told anyone but my sister about my condition, but recently she mentioned it to a friend of hers who happened to know my best friend. When he later found out, he called me very angry and told me I was dishonest for not telling him myself. I’m not afraid he’s going to tell anyone else, but I’m thinking maybe it’s time for me to be honest and come out about my condition to my friends and family. How do I do this?

Anonymous
Fresnaye

Dear Anonymous,

What you are asking has no cut-and-dry answer. But let’s begin by putting aside judgment and word like “honest.” Sure, your friend might be angry, but one should never pretend that coming out about one’s HIV status is anything less than difficult. It’s not.

Even among (and some might say, especially among) well-to-do gay men, people identified as positive are still prone to stigmatisation. Being that you’re from Fresnaye, I can assume that you may not necessarily have the same level of vulnerability as, say, a gay man in Nyanga. But there are always repercussions – sometimes social, sometimes economic – that one has to consider when deciding to come out. The trick is deciding which are real, and which are based on our sometime unreasonable fears and anxieties.

Let me put it to you this way: In the U.S., I once attended a “Coming Out Day” celebration in West Hollywood. It was an annual event where gay celebrities from Frasier to Married With Children stood on a podium and called for all closeted gays to “stop living a lie” and join the family-at-large. Sure, it was fun. Here we were in the safe haven of a gay American capital, immersed in the warming embrace of our gay brothers and sisters. And come out many did, enraptured by the belief that they could finally stop “living the lie” and begin a new, happy life as an openly gay man or woman. And yes, many did. On the other hand, some returned to their small-town homes and were they were immediately confronted with alienation from friends, discrimination in the work place, and attacks in their churches and communities. Some were even disowned by family. Where were their West Hollywood brothers and sisters then? Who was really living the lie? Coming out, therefore, is never a party. It’s a choice. And a highly personal one.

That’s not to say we should simply surrender to our fears. Not at all. All I’m saying is that no one can live our lives but ourselves. We have to make our decisions honestly and truthfully to ourselves, and no one else.

So what are the advantages of coming out poz? Firstly, if you are on antiretroviral (ARV) treatment, it is nearly impossible to be 100% adherent in secrecy. Therefore your chance for maximal ARV response can be greatly diminished if you constantly have to hide your pills, or change your schedule to sneak in a dose. Fear and anxiety about hiding your status can also affect your ability to maintain adherence. You and you alone end up being your own support system, and that’s rarely a good thing. Having supportive friends and family has been shown to not only greatly increase ARV efficacy, but the extension of life itself. And in the end, you have to ask yourself – is it is your friends and family that you doubt… or yourself? Truth is, we are often strait-jacketed with our own fears. We become our worst enemy simply because we’d rather stand still than move into an unknown.

That’s not to say that all fears are unfounded. Stigmatisation and discrimination do persist, and we often are unable to find recourse, even legal, when faced with such adversity. And some of us are simply unable to find the strength, either emotionally or spirituality, to face the sometimes harsh repercussions of disclosure. It could mean having to come out about gay, or having to reveal how one “got it” in the first place. Disclosure builds on disclosure. It’s rarely an easy proposition.

So let’s put aside words like “dishonest” for the moment, and focus on creating a safe haven for those in our own community living with HIV. Oscar Wilde once said that a measure of a society is not in how it supports the strong, but how it supports those in our society who are not strong. Who are the most vulnerable.

So good luck with your choice, dear Reader. I think you’re extremely brave for asking the question. Please keep me posted on your progress. I send,

Kind regards,
Dr. D

Please submit your questions, comments and criticisms directly to EXIT or to denniss@netactive.co.za