HIV Secrecy Is Proving Deadly
New York Times—Tuesday, November 25, 2003
Howard Markel
The failure to disclose HIV infection to partners, whether intentionally or unintentionally, is a significant but underreported factor many health experts say contributes to the continued spread of HIV in the United States. CDC estimates that as many as 33 percent of the 900,000 Americans infected with HIV may not know it.
Two Columbia University professors, Dr. Robert Klitzman, a psychiatrist, and Dr. Ronald Bayer, an ethicist, have explored the range of views and practices concerning HIV disclosure in a newly published book, "Mortal Secrets: Truth and Lies in the Age of AIDS."
The authors used oral history interviews of the sexual practices of 49 men and 28 women in New York City. Sixty of those interviewed are HIV-positive, and there is diverse representation in ethnic background and sexual orientation.
Klitzman said one of the most disturbing findings was that about a third of the gay men interviewed "admitted that, at some point, they lied about their status, but it is probably a higher number." "I was horrified by some of the things people told me," said Klitzman, "and at the end of each interview we spoke to the subjects about safer sex and the importance of disclosure. But it led us to think about the importance of a code of sexual ethics."
Although the interviews occurred from 1993 to 1996—before the advent of highly active antiretroviral therapy (HAART), experts believe little has changed. Sharon Boyd of the Michigan Department of Community Health said her current research suggested that as few as 20 percent of HIV-infected people in Detroit had told their partner of their status.
According to Bayer, practicing sexual ethics in real life is complicated by many factors, including social stigma or acceptance of people with HIV. "Fear and terror often shaped their decisions," Bayer said of his study's participants.
Mark Barnes, a lawyer and former New York City health department official in the early 1990s, recalled being shouted down in meetings when he urged those with HIV to disclose their status. "It's been woefully lacking in our prevention efforts, although there has been a new push by the CDC and local health departments to encourage people to disclose," he said.
Reprinted from the CDC HIV/STD/TB Prevention News Update. You can view the entire Prevention News Update, search the archives, and sign up for E-mail delivery at http://www.cdcnpin.org/.
 Send this page to a friend >>
|
