God, AIDS, Africa & HOPE

pensées of a Catholic priest

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

From Internet worries to gay conversion – moments of a week’s work

Often when people make contact with me or it comes to a meeting they ask what a  typical week looks like for me as a priest and AIDS activist and the only thing I can say is: There is no typical week. A lot of time this week was spent on HOPE Cape Town affairs: we getting used to a new computer system which records every meeting, every result thereof and to do so, one needs some training and motivation to get used to it. How much bits and pieces of information gets lost when one not religiously records encounters, offers and follow-ups during the day? I can tell, it is amazing and the older one gets, the less one remembers with all the information streaming in every day. But HOPE Cape Town also changed this week service providers for the internet, email, web hosting etc. and as expected, there are some problems arising until everything is settled. Not being able to access email and information is very disruptive in our days and once again one is reminded how much we depend on it. Connected with this was a meeting with TBWA – a well-known marketing / advertising company in South Africa which does pro bono work for us. After re-designing our flyers it shifts now to our webpage which will be the next object of reflection and changes. All has to do with branding and getting the brand “HOPE Cape Town” known and identifiable in using all instruments available in this department. Doing good and getting the message across is so important , from an informational point of view as well as from the fundraising aspect. Another aspect of work this week was to go through the new employer handbook for HOPE Cape Town – we have to adhere to the South African labor law and this is indeed changing again and again. So the newest version was checked by labor lawyers and now we have to finalize it before it is handed out to the employees of HOPE Cape Town and forms then part of the work contract. On Wednesday I also met with all HOPE Community Health Workers on the issue of the “bonus” to be paid out at the end of the year. Obviously everybody likes a bonus to shop for all the Christmas presents, but a bonus is always at the discretion of the board. It also is a result of merit assessments – and once in a while one has to remind employees that a bonus is paid for exceeding expectations at work; not for doing what one is paid for anyhow. On the other hand it must be clear-cut how an assessment is done and what tick boxes are important to receive a bonus. Surely all important discussion points. HOPE Cape Town also secured it’s first official HOPE Cape Town Ambassador – watch the space, I will not tell here and now who was chosen and accepted gladly.
What else happened the last week?
The Southern African – German Chamber of Commerce and Industry hosted a luncheon with MEC Alan Winde. As a member of the Regional Council I attended this event and listened carefully what Alan had to say about the state of affair when it comes to business and investment in the Western Cape and in South Africa. As new legislation comes into effect regarding BB BEE coming year it is also important for HOPE Cape Town to know the next changes we are BB BEE approved and we would like to keep it that way.
Bavaria and the Western Cape celebrating 20 years of partnership next year, so a meeting to find out how HOPE Cape Town can participate in these events in Bavaria and showcase its contribution towards the partnership.
A meeting with Rev Ryan from the Philippines saw discussions about HIV / AIDS support groups in this part of the world.  I learned that the Catholic Church in the Philippines supports conversion programs trying to get gay people straight – quite shocking for me – as this runs counter all academic research and adds to the burden to people anyhow threatened by HIV and AIDS and the difficulties to come out in a very Catholic environment. It surely adds to the shame people feel as being HIV positive and gay at the same time as it implies that there is something wrong with them besides the punishment of HIV. Somehow the expression “dark middle ages” came to my mind. Conversion as a possibility to get rid of being who I am is on an ethical level as bad as criminalizing is on a legal level. I once again realized how much is still to do….
Exhalation of the Cross – the Catholic Feast celebrated with the Catholic Community in Belgravia ended a week – being reminded of all the crosses people carry and are burdened with and celebrating our believe that the good message of the kingdom of God is told to all and everybody – unconditional love, that’s what we are called for.  And that is a good starting point for the coming week which will bring me to Europe again for a couple of days.

Filed under: Catholic Church, General, HIV and AIDS, HOPE Cape Town Association, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Networking, Politics and Society, Reflection, Religion and Ethics, SA-German Chamber of Commerce & Industry, Society and living environment, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Good news: Ball of HOPE in Cape Town booked out

This is indeed great news for the organizers and who ever could get hands on a ticket for the annual Ball of HOPE will not be disappointed: A great entertainment program, the introduction of a MC leading though the procedure of the evening, great food and a fantastic live band will make this evening an unforgettable one.
But this is also good news for the people, HOPE Cape Town is so compassionate caring for; all proceeds will give them more hope, more life, more joy and for some even an entire future. We often forget how little it takes to change the fate of a person to the good and every cent donated on this eve will translate into practical assistance and help.
I remember the first time in 1998 when the Ball, at that time called “dinner-dance” at the Mount Nelson was launched. Desmond Tutu was the guest of honor and spoke to us till the food was cold, but it was all in all a marvelous evening for 80 mostly German-speaking people. How far have we come since then and how grateful should we be for the journey of 16 years of this annual event. With the opening of the office of the Southern African – German Chamber of Commerce and Industry at the beginning of the new millennium in Cape Town, the “dinner-dance” was transformed into a real black tie affair. Anja Tambusso Ferraz as my partner in crime put her special stamp on the event and together we developed it as we went along. But all was only possible through the great support of so many people along the way – no way two people can stem an event like this without so many never officially mentioned colleagues, friends, partners, associates and supporters. The opening of the Westin Hotel gave us the chance to add to the number of guests possible for the event and so when we will launch the Ball of HOPE 2014 in a couple of days, there is again excitement paired with gratefulness to all and everyone supporting this charity in lieu of HOPE Cape Town. It is also good to know that the German-speaking Catholic Community remained faithful to this event all the years. There is a lot of German and German rooted influence in Cape Town and surely on the society side, the Ball of HOPE was a welcome addition to the social calendar of the mother city.
So welcome to all our guests from Cape Town, but also flying in from Germany and Switzerland for this event and let’s celebrate life and doing good at the same time.
Picture: 1998 the author and Archbishop Desmond Tutu @ the first “dinner-dance”

1998

 

 

 

 

 

 

 

Filed under: Catholic Church, General, HOPE Cape Town Association, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Networking, Politics and Society, Reflection, SA-German Chamber of Commerce & Industry, , , , , , , , , , , , , , , , , ,

Mortality of people with HIV compared to non-infected peers

The eternal question of people being infected or just getting their positive test result is: How long do I have to live? Does it make sense to continue living as if there is a future ahead? HIV-positive people taking antiretroviral therapy who have an undetectable viral load and a CD4 cell count above 500 cells/mm3 have a mortality risk comparable to that seen in the general population, investigators report in the online edition of AIDS. Researchers looked at mortality rates among participants enrolled in two large, randomized controlled trials – the SMART and ESPRIT studies. “We identified no evidence for a raised risk of death compared with the general population in HIV-infected people on ART with an undetectable viral load, who maintained or had recovery of CD+ T-counts to at least 500 cells/mm3,” write the authors. There have been significant improvements in HIV treatment and care in recent years. Anti-retroviral therapy has become more powerful, less toxic and easier to take. Data from cohort studies suggests that people doing well on treatment – often defined as the maintenance of an undetectable viral load and a CD4 cell count above 500 cells/mm3 – have a life expectancy similar to that of age- and sex-matched HIV-negative individuals.
The whole article which was published via NAM’s aidsmap you can read here.

Filed under: HIV and AIDS, HIV Treatment, Medical and Research, , , , , , , , , , , , , , , , ,

HIV transmission and questions around it…

HIV Particle

HIV Particle (Photo credit: AJC1)

Even in a world where all information about HIV is out in the public there are still questions around transmission and viral load of people living with HIV. Especially when it comes to couples with one being positive and the other negative  these questions arise. In our South African context where there is a whole generation with many people being born and living with the virus, those questions are essential to be asked and answered properly.
Questions like:

* What is exactly viral load and how is it affected by HIV Treatment?
* What is a normal “viral load”?
* What does it mean to have an “undetectable” blood viral load?
* Is the viral load in the blood associated with a person’s risk of transmitting HIV?
* Does HIV treatment reduce the risk of sexual transmission of HIV?
* Is HIV transmission possible when the viral load in the blood is undetectable?
* What is the risk of HIV transmission when the blood viral load is undetectable?
* What does this all mean for people who want to use HIV treatment to prevent HIV transmission

The Body published an article from the Canadian AIDS Treatment Information Exchange Project on all these questions and it is worth reading for those interested. Click here to read the article.

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

14th HOPE Gala Dresden

HOPE Gala Dresden - the event to be in DresdenNovember 16th, 2019
more info www.hopegala.de and admin@hopecapetown.com

Ball of HOPE 2020

Join us @ The Westin in Cape TownMay 23rd, 2020
6 months to go.
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© Rev Fr Stefan Hippler and HIV, AIDS and HOPE.
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