God, AIDS, Africa & HOPE

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Moral responsibilities to disclose your HIV status?

Moral responsibilities to disclose your HIV status to partners aren’t so clear-cut

By Bridget Haire

Bridget Haire is a lecturer in ethics, HIV prevention at UNSW Australia.
This article was originally published on The Conversation. Read the original article.

Sexual ethics is an area prone to strongly felt moral intuitions. We saw this play out in the good, bad and sometimes ugly commentary following Charlie Sheen’s public disclosure of his HIV status. But just how much disclosure is it reasonable to expect from a sex partner, particularly if that relationship isn’t a serious and committed one?
Common morality
There is a “common morality” precept that for sex to be truly consensual, sexual partners need to disclose certain facts to their intended partner. This includes information about sexually transmissible infections, and whether the person is in a committed (supposedly) exclusive relationship such as a marriage. Identity is also relevant. It’s generally considered wrong (and often a crime) to have sexual relations with someone by means of deception such as impersonation.
Withholding material facts or deceiving a sexual partner deprives a partner of making an informed choice about whether or not to engage in sex, given the particular social and health contexts that apply. If consent to sex was dependent on an intentional deception, it was coerced rather than freely given. This “common morality” precept is also upheld from a sexual rights perspective. This decrees that every person has the right to freedom and to protection from harm, such as those harms that accrue from coerced sex.
But there are exceptions
These principles appear fairly straightforward but can become vexed when there is risk for the person disclosing, or it’s unclear whether the facts themselves require disclosure. Consider instances where transgendered people may seek to “pass” as their non-birth gender to a sexual partner. Under the sexual rights framework, all people have a right to non-discrimination and to enjoy fundamental rights and freedoms on an equal basis to others. These fundamental freedoms include the right to sexual pleasure. If the intended sexual partner of a trans person is not accepting of transgender concepts and is entrenched in gender binaries, he or she may react to disclosure by rejection or even violence. Arguably then, it may be reasonable not to disclose transgender status given that it could involve serious risk, foreclose the possibility of sexual pleasure and expose the disclosing person to discriminatory hostility.
From the condom code to negotiated safety
When HIV first erupted in the 1980s, gay communities emphasised condoms as a universal precaution, rather than relying on the disclosure of HIV status, which was not always known.
The condom code of the 1980s was also a community-building strategy that recognised the importance of sex for gay men who had fought to have laws criminalising gay sex removed. The stigma and discrimination that had been associated with homosexuality transformed into gay liberation and pride. The condom code emphasised mutual protection rather than a division along the lines of HIV status. This avoided some of the perils of HIV stigma at a time when connection and support were of critical importance in order to care for the sick. As the epidemic matured and treatment options developed from marginally effective drugs with difficult side effects to the highly effective and well-tolerated combination therapies used today, prevention responses also evolved. From the early 1990s, gay men in couples began to make strategic use of HIV testing to determine whether or not they needed to use condoms with each other. This strategy, dubbed “negotiated safety”, was one of several ways to reduce HIV risk that involved testing. Now, HIV treatment can reduce one’s viral load to undetectable levels and reduce HIV transmission to partners. This has raised questions about whether people with undetectable viral loads can consider themselves uninfectious, and whether they are legally or morally compelled to disclose their status to partners. Interestingly, some public health laws such as the New South Wales Public Health Act require disclosure. But taking “reasonable precautions” against transmitting the infection is cited as a defence. Whether or not such “precautions” may include maintaining an undetectable viral load, as distinct from using a condom, has not been tested.
Disclosing HIV status
At the moral level, does a person with HIV have a duty to disclose her or his status to a sex partner? That depends. While sex is a physically intimate act, sexual relationships have different levels of depth and intensity, ranging from the most seriously committed to the casual and transient. Duties to sexual partners must therefore sit on a gradient. Within the most trusting and committed relationships, non-disclosure of a serious infection such as HIV would undermine the intimacy of the partnership. In casual sex situations, however, HIV disclosure may not be morally required (though in many Australian states it remains legally required), so long as some form of safe sex is practised. Some communities have long recognised that using a condom could discharge the responsibility to disclose. Arguably, maintaining an undetectable viral load could also be seen as adequate, particularly if combined with further risk-reduction measures such as strategic positioning (adopting the receptive role during unprotected sex). With the many and varied relationships that fall somewhere between the two poles, degrees of trust need to be negotiated, and not assumed. All people have duties to their sexual partners regardless of their HIV status and all people have a responsibility to be moral actors in a sexual community. Stigmatising and rejecting sexual partners on the basis of an HIV status needs to be recognised as a moral wrong that works against creating a culture where HIV can be discussed freely and without fear. The response to Charlie Sheen’s announcement of his HIV status demonstrates we have a long way to go before banishing the discriminatory and offensive reactions to HIV-positive people. It’s time to recognise the role that every sexual actor plays in creating a culture where sex is safe for all

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Reflection, Religion and Ethics, Society and living environment, , , , , , , , , , , , , , , , , , , , , ,

HIV – curse or blessing?

For most people, on first side a pandemic is surely seen as a curse translating into sickness. In the case of HIV- without treatment – it turns into full-blown AIDS and consequently death. Who does not remember the eighties: a quick and cruel death for young people, killed in the prime of their lives.
HIV also means evolution: a small little bug jumps onto a different host and kills the host. Not intentionally of course and it will take a quite some time, maybe a couple of hundred years to develop into a symbiosis which lets bug and host live peacefully together. Otherwise it’s a dead-end for evolution and will at a certain point cease to exist.
HIV is a challenge: In the 1980’s the scientific world raced to find an answer what causes the syndrome. To isolate the bug, to find anti-bodies and consequently a test to determine infection and last but not least to develop first medications working to prevent full-blown AIDS took its time and toll. But HIV is also a challenge for every human being: transmission via bodily fluids means it touches on one of our strongest drive and urge: sexuality. And who controls this desire controls humans – just look into the history of religion and the significance of the control of sexuality via faith.
HIV mixes categories normally separated in society: youth and death. Death is anyhow so often hidden in modern society; now associated with youth and radical eradicating the beauty of it destroys the unspoken view how society works and develops. It changed the rules of engagement on that level dramatically and still does it in developing countries.
HIV means to open up to people living and loving in same sex relationships. Coming from the dark and hidden corners of social life gay people suddenly stood in the limelight of society. HIV and AIDS was part of a sometimes cruel outing process. In our days HIV is globally not anymore associated with homosexuality but the pandemic, almost as a side effect, opened up society to look at different life styles. And without any doubt the solidarity in gay circles in the beginning of the pandemic for their infected friends and partners was an impressive show of compassion and left traces which transformed into signs of normality and acceptance for gay love in the Western hemisphere. Obviously this triggers an antidote from the radical – fundamentalist side of society, mainly coming from the USA in an evangelical form even telling Africans what African culture means in Africa.
HIV is clearly a challenge for politicians and it was HIV which was put on the agenda as the first medical condition dealt with by the UN. This opened doors for other discussions on a global base like on Malaria or TB or all the other forgotten sickness of Africa and South America. We were reminded that they also kill millions a year and that they are in need of being addressed properly. The Global AIDS Fund was a first instrument of tackling a medical challenge on a global scale and not via bi-lateral negations which normally don’t’ see the full picture and are rather small –minded.
HIV means a challenge for society. While in Germany the campaign “Give AIDS no chance” with the commitment of the entire government prevented the pandemic to get into full swing, other countries and governments did not wake up to respond to the treat timely. The bible is right, that the sin of the fathers, in this case the sin of neglect comes onto the children and grandchildren. South Africa, but also Swaziland, is an example of failure with the result of hundred thousands of death and a generation born and plagued by HIV. What a challenge for the social coherence of society.
HIV translates into a challenge for religion, for our faith. Just a look at Ronald Reagan, who refused to act on the first reports of the new disease as it seemly “only” targeted gay people. His faith told him that they anyhow did not live according to God’s moral code; somehow no real action was needed. It reminds us also in this context of all those clerics calling the HIV pandemic the punishment of God for Sodom and Gomorrah in our times.
HIV is not a punishment but a clear sign of the time to reflect on our Christian theology – it has shown clearly that answering new questions with old answer do not serve humanity. The opposite is true: it endangers life. The question of protection cannot be answered with the reply given by authorities quite some time earlier on the question of procreation.
And how about the single human being infected with the HI Virus?
The challenges and reactions are as different as people are different: shock, disbelieve, despair, give–up mentality, defiance, hope….
What is indeed an almost general rule I discovered with people living positively is that after the balance in life is found again, there is a new sense for health and the value of life. HIV has shown how fragile life is and treatment has given almost the opportunity for a second chance in life. People infected mostly have a peace treaty with their boarder – always present even when tested undetectable. There is also the sense of gratitude and somehow, even if it sounds absurd, it changes from being a personal curse into a blessing. And I strongly believe that church should be and could be promoter of this transition, personal and in communities where stigma could be transformed into a blessing. The Catholic Student organisation of South Africa maintains in one of their publications that people living with HIV cannot live life to the fullest as stipulated in John 10.10.
They are wrong: God is giving everyone in his unconditional love the possibility to life their life to the fullest – for him, sexual identity or preference is not a hindrance nor is race or income or any other ability or disability or HIV or AIDS.
You will be a blessing for others – this promise of God applies to everybody who lives and loves with or without HIV.

Filed under: Catholic Church, General, HIV and AIDS, HIV Prevention, HIV Treatment, Reflection, Religion and Ethics, Society and living environment, Uncategorized, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

From Prevention, Polygamy and Crime…

As always in between posts I like to share some of the articles I am reading in between and they are ranging from the blue pill to criminal laws.

US Federal health officials recommended yesterday that hundreds of thousands of Americans at risk for AIDS take a daily pill that has been shown to prevent infection with the virus that causes it. If broadly followed, the advice could transform AIDS prevention in the United States — from reliance on condoms, which are effective but unpopular with many men, to a regimen that relies on an antiretroviral drug. Please read this article here.

In Africa, most people infected are female. In a modest public health clinic behind a gas station here in South Africa’s rural KwaZulu/Natal Province, a team of Norwegian infectious disease specialists think they may have found a new explanation. Not sure it will hold the scrutiny of sciences but it is worth reflecting on it. Read here.

In Kenya, a new law came into effect allowing for polygamy. Men can take several women as wives without the consent of the first or any of the others already married. Does it make sense? Well, questions are asked here.

Uganda was once the example of how to reduce the HIV pandemic. Then came complacency and PEPFAR rules, latter a curse and a blessing at the same time. Now Uganda has chosen to add to the draconian law regarding homosexuality also to criminalize HIV transmission. It is known that this has an adverse effect, but it seems that politicians in Uganda want to go the extra mile to do the wrong thing.  Click here to read the story.

Enjoy reading!

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Politics and Society, Reflection, Religion and Ethics, Society and living environment, Uncategorized, , , , , , , , , , , , , , , , , , ,

Worth reading..

Another look into the world or print today with worthwhile news and interesting articles:

The scares of Manhood tells the story of “proving manhood, alcohol and peer pressure of a South African youngster. Click here

Statistics about condom distribution, vaccinations and TB in South Africa are found here

Read about the reduction of bacterial vaginosis and other vaginal threats here

LGBT to be killed like mosquitoes – so the Gambian President Yahya Jammeh in an televised address. More here

Outrage about the imminent enactment of the Anti-Homosexuality Bill in Uganda which will also undermine HIV prevention. Read more here

Motsoaledi announces free new contraception in South Africa – more info here

The Roman Catholic Church is starting to reflect on families – read here what blunt assessment the Japanese bishops have on this topic

Enjoy the read.

Filed under: Catholic Church, General, HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Networking, Politics and Society, Reflection, Religion and Ethics, Society and living environment, Uncategorized, , , , , , , , , , , , , , , , , , , , , , , ,

PreP – one does not hear a lot about it…

“We don’t know the side effects of this drug. It’s too expensive. Insurance won’t cover it. It hasn’t been studied enough. It will encourage slutty behavior. And why the hell don’t people just use condoms?”
Sounds familiar? That has been the objections raised to the oral contraceptive progesterone (“The Pill”), approved by the FDA 54 years ago. And it seems that with Truvada as an alternative method to prevent a HIV infection it started similar. Pre-exposure prophylaxis would add to more sexual contacts, critics claimed and they painted the picture of orgies and inhibited sex lives. In an article at TheBody.com Mark S King tries to tackle all those concerns and to come up with a new assessment about the drug and its benefits and disadvantages as a prophylaxis.
To read more go to TheBody.com.

Damon L Jacobs from New York tackles this topic from a more practical side. He decided to take Truvada as PrEP since 2011 and reports on his findings in an article on this blog. As he is also a psychotherapist and safe sex educator in NY and SF it is indeed an interesting read. For more go to the blog.

The question is obviously whether PrEp would also function in South Africa and what the financial implications would be, if insurance companies and even government would consider this to be offered on a wider scale. This is certainly up to a debate which we have to start sooner than later.

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Reflection, , , , , , , , , , , , , ,

12th HOPE Gala Dresden

HOPE Gala Dresden - the event to be in DresdenOctober 28th, 2017
more info www.hopegala.de and admin@hopecapetown.com

Ball of HOPE 2018

Join us @ The Westin in Cape TownMay 12th, 2018
5 months to go.

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