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, , , , , , , , , , , , , , , , , , , , , ,

Nobody left behind..

The Melbourne Declaration is the final document of the World AIDS Conference 2014 in Melbourne / Australia. In the times of discrimination and stigmatization but also criminalization especially in African countries it is important to reflect on the aspects being able to give birth to a HIV free generation. A declaration is only as potent as the implementation after the event:

AIDS 2014 Melbourne Declaration
We gather in Melbourne, the traditional meeting place of the Wurundjeri, Boonerwrung, Taungurong, Djajawurrung and the Wathaurung people, the original and enduring custodians of the lands that make up the Kulin Nation, to assess progress on the global HIV response and its future direction, at the 20th International AIDS Conference, AIDS 2014. We, the signatories and endorsers of this Declaration, affirm that non-discrimination is fundamental to an evidence-based, rights-based and gender transformative response to HIV and effective public health programmes.
To defeat HIV and achieve universal access to HIV prevention, treatment, care and support – nobody should be criminalized or discriminated against because of their gender, age, race, ethnicity, disability, religious or spiritual beliefs, country of origin, national status, sexual orientation, gender identity, status as a sex worker, prisoner or detainee, because they use or have used illicit drugs or because they are living with HIV.
We affirm that all women, men, transgender and intersex adults and children are entitled to equal rights and to equal access to HIV prevention, care and treatment information and services. The promotion of gender equity is essential to HIV responses that truly meet the needs of those most affected. Additionally, people who sell or who have sold sex, and people who use, or who have used illicit drugs are entitled to the same rights as everyone else, including non-discrimination and confidentiality in access to HIV care and treatment services.
We express our shared and profound concern at the continued enforcement of discriminatory, stigmatizing, criminalizing and harmful laws which lead to policies and practices that increase vulnerability to HIV. These laws, policies, and practices incite extreme violence towards marginalized populations, reinforce stigma and undermine HIV programmes, and as such are significant steps backward for social justice, equality, human rights and access to health care for both people living with HIV and those people most at risk of acquiring the virus.
In over 80 countries, there are unacceptable laws that criminalize people on the basis of sexual orientation. All people, including lesbian, gay, bisexual, transgender and intersex people are entitled to the same rights as everyone else. All people are born free and equal and are equal members of the human family.
Health providers who discriminate against people living with HIV or groups at risk of HIV infection or other health threats, violate their ethical obligations to care for and treat people impartially. We therefore call for the immediate and unified opposition to these discriminatory and stigmatizing practices and urge all parties to take a more equitable and effective approach through the following actions:
• Governments must repeal repressive laws and end policies that reinforce discriminatory and stigmatizing practices that increase the vulnerability to HIV, while also passing laws that actively promote
equality.

• Decision makers must not use international health meetings or conferences as a platform to promote discriminatory laws and policies that undermine health and wellbeing.
• The exclusion of organisations that promote intolerance and discrimination including sexism, homophobia, and transphobia against individuals or groups, from donor funding for HIV programmes.
• All healthcare providers must demonstrate the implementation of non-discriminatory policies as a prerequisite for future HIV programme funding.
• Restrictions on funding, such as the anti-prostitution pledge and the ban on purchasing needles and syringes, must be removed as they actively impede the struggle to combat HIV, sexually transmitted
infections, and hepatitis C among sex workers and people who inject drugs.

• Advocacy by all signatories to this Declaration for the principles of inclusion, non-criminalization, non-discrimination, and tolerance.
In conclusion we reaffirm our unwavering commitment to fairness, to universal access to health care and treatment services, and to support the inherent dignity and rights of all human beings. All people are entitled to the rights and protections afforded by international human rights frameworks.
An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the epidemic.

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

Infected!? – an interesting approach…

Reading through several blogs I came across the following lines:

Infected! Oh, My!
April 5, 2014
From TheBody.com

I'm not 'infected' with HIV ... I'm 'living' with HIV!

How many of you remember being told that you had tested positive for the antibodies which cause HIV? I remember it like it was yesterday! The results were shocking, nothing would EVER be the same! I was filled with dread, I was filled with shame, and I was filled with fear. Took me a few years to get comfortable in my skin. And so, as most of us activists/advocates take deeper looks at words, I found a word which is offensive to me, particularly in the HIV platform — but could very well fit any situation. The word “infected” bothers me. Dictionary.com gives these few definitions of the verb ‘infected’:

  • contaminated
  • tainted
  • corrupted

These are not words most of us would like to be associated with, whatever our medical condition. I believe that one of the first steps to living a more positive life, begins in how we think about ourselves. We cannot be healthy or begin on a holistic journey, if we think of ourselves as contaminated or tainted or corrupted.  By the same token, if society puts that label on us, it is no wonder they would feel they need to distance themselves from us or place us in boxes which stigmatize us.
The truth of the matter is: I am not tainted. I am not corrupted. Nor am I contaminated.
That being said: neither are you.
“As you think, so shall you become” — Bruce Lee
(copyright TheBody.com )

I never thought about it that way, but while reading I sense it has its merit to have such a point of view.  Stigmatization has many levels – it started on the caring level in Primary Health Care Facilities in the beginning of the pandemic, when there was the certain bench people had to wait, the special door to receive counseling and advice, the milk products handed out in full view of other patients, which clearly identified mothers being HIV positive.  And it continues in our days still when HIV positive people want to travel or they are looking for employment . It even continues in our churches when we priests or communities fail to appreciate the blessings of somebody going through the life changing experience of discovering to be positive.

I personally like the word “positive” – it opens up the horizon of  hope and light and a chance to change life to the better.

Filed under: General, HIV and AIDS, HIV Treatment, Religion and Ethics, Society and living environment, Uncategorized, , , , , , , , , , ,

AIDS as disturbance of creation?

English: Freddie Mercury in New Haven, CT at a...

 Mercury in New Haven, CT at a WPLR Show. (Photo credit: Wikipedia)

Relaxing a bit after the Berlin Gala, I watch with interest a TV production about 40 years of the rock band “Queen”. Central to the story is obviously the life and death of Freddie Mercury – singer and song writer of the band.  The life of a genius musician cut short through the HI virus. And there is the sudden realization, how much HIV and AIDS has robbed human mankind of the development of art and culture. As St. Paul writes about creation still ongoing, there is surely to consider that HIV might have disturbed creation in cutting down the potential in human beings to become in a lifetime what they were supposed to be. Or is the HIV pandemic part of creation, part of it laying still in labor?
As God and creation are connected, it makes more sense to talk about the body of Christ having AIDS, being in pain and suffering. And even if in Europe HIV is not that much connected to suffering, death and dying any more – worldwide millions of lives are cut short by this virus. The suffering, the stigma, the discrimination continues despite all successes in treatment. And theological, there is still so much more to learn and develop and put into our teaching than we have done before. The climate within my church has changed – at least it is allowed again to think without fear – it would be great to use this time of spring to see, what else HIV and AIDS can tell our theology.

 

 

Filed under: Catholic Church, General, HIV and AIDS, Reflection, Religion and Ethics, , , , , , , , , , , , , ,

Using the term “HIV negative” as a substitution for “not being tested”

An attempt at a discrimination graphic.

An attempt at a discrimination graphic. (Photo credit: Wikipedia)

I recently came across an opinion piece from Preston Mitchum, a policy analyst for LGBT issues. He reflects on the question how people use the wording” HIV negative” almost as a hideout for not getting tested. But telling his own story about dating a person being HIV positive and rejecting him, he touches on the whole question of maturity and discrimination. We as church always emphasis not being judgmental and not discriminating against somebody being positive. I remember a talk in a Secondary School for girls here in Cape Town where I discussed with the students the question of stigma and discrimination in the context of HIV and AIDS. And being assured from all present that discrimination would never be an option for themselves, especially being students in a Catholic school,  I dared to ask who of them would have the courage to take a boyfriend who is HIV positive. There was silence and from more than 200 girls only one hand was raised.

I am convinced that we start tackling stigma and discrimination when starting to deal with our own fears, when we confront ourselves with all our hidden anxieties and when we are able to be honest about it looking into a mirror. The honest testimony of Preston might be helpful to reflect on our own standing when it comes to stigma and discrimination in our own midst.

Using ‘HIV-Negative’ as a Substitution for ‘Haven’t Been Tested’

by Preston Mitchum

A policy analyst for LGBT issues confronts his fears about HIV testing.

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

13th HOPE Gala Dresden

HOPE Gala Dresden - the event to be in DresdenOctober 27th, 2018
10 months to go.

Ball of HOPE 2018

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

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© Rev Fr Stefan Hippler and HIV, AIDS and HOPE.
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