HIV: Don’t Be Nicer, Be Smarter

Be honest: Would you have sex with someone you knew had HIV? And if you would, would you feel anxious about it?

Words: Shawn Malone

It feels like the end of the world

For the past three years, I’ve been part of a team working to reach more men in South Africa with HIV testing and treatment. We’ve talked to more than two thousand men about their thoughts and feelings around HIV and what factors make HIV testing and treatment easier or harder.

Among the men we’ve talked to, the biggest barrier is the association of HIV with death, both literal and figurative. Many men believe an HIV diagnosis is the beginning of the end.

A surprising number of men still think that having HIV will mean gradually becoming weak and sick, leading eventually to an early death. Many avoid testing because they believe that confirmation of an HIV positive status will trigger or hasten that decline, so it’s just better not to know.

We found that even more men associate HIV with social—and sexual—death. They anticipate taking on pariah status, viewed by those around them dirty, damaged, reckless and risky. They fear that their current partner will leave them and that no one else will want them. They fear that their friends will no longer want to share a drink. They fear that their family will be worried and disappointed.

In too many cases, their fears are not misplaced. Forty years into the epidemic, ignorance and stigma are alive and well.

One pill a day and you’re back to normal

In the past, HIV campaigns have largely told us to be more understanding and compassionate to people living with HIV. That message is no longer relevant, if it ever was. What we need is to be more educated.

In 2020, HIV can be fully suppressed by one pill a day, to the point that it cannot even be detected in the body and cannot be passed to anyone else, even if condoms are not used. Most people achieve viral suppression within a few months of starting treatment.

In other words, if you are worried about getting HIV, someone with HIV who is on treatment and virally suppressed is your very safest sex partner. Far safer than someone who tells you they are HIV-negative but might have had their last HIV test a year ago and might have been exposed to HIV multiple times since then. Far safer than someone whose status you do not even ask for fear of killing the vibe.

Someone with HIV who is virally suppressed is the only person you know for sure will not give you HIV. That means if you are passing up the opportunity to date someone with HIV, you’re not just being unkind or unsympathetic. You’re being dumb. You’re making a deal-breaker out of something irrelevant and inconsequential.

Creating spaces for intimacy and growth

Once you know better, do better. You can start by talking openly about HIV with the people in your life, especially current or potential sex partners.

Some of them might be ‘in the closet’ about living with HIV and wondering whether you are about to unload ignorance and judgment on them when they tell you. Some might be living openly with HIV but being the one to broach the topic every time they meet someone feels a bit exhausting and unfair, and they wish the other person would take a turn. Some might not be living with HIV but are still living with outdated attitudes and beliefs about it.

No matter who they are and whether they’re living with HIV or not, the message about HIV is the same:

Don’t be nicer, be smarter.

Shawn Malone lives in Johannesburg with his husband and their eight-year-old son. He has worked for more than 20 years in the public health sector, primarily on HIV. He wrote this article in his personal capacity.

 

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