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30 Jan 2004

total hiv disclosure: why trust isn't enough

How and when - if ever - do you have the, "Have you been tested?" conversation? And if you do, would and should you trust someone with HIV/AIDS to tell the truth when there is little incentive for him to do so, knowing that his chances of bedding that someone would be significantly reduced?

It doesn't matter what kind of loving you're getting. You might be in a monogamous relationship, doing the dating or mating dance with one or several (or lots and lots) of partners, but the question is the same. How and when - if ever - do you have the, "Have you been tested?" conversation.

After all, knowledge about our partners' sexual history and status is one barometer of risk, regardless of our own HIV or STD status.

But the conversation is easier said than done.

"I just think it's something most people don't want to talk about. They would rather not deal with it than confront the awkwardness of asking," says Taylor*, a 39-year-old photographer who lives in New York City. "Asking someone in a bar would be horribly awkward," he adds.

The scary fact is a lot of men who have sex with men (MSM) trust sexual partners to disclose their HIV status - and make determinations about risk based on what partners say - according to findings in the report Vital Statistics 2002, the sixth annual Gay Men's Sex Survey.

Men were recruited for the survey, conducted by Sigma Research in partnership with 119 health promotion agencies across the United Kingdom, at Pride events, on the Internet, and using booklets that were distributed to HIV health promoters working with MSM.

"Although we have observed an overall decrease in recent years, expectations that men with HIV will tell a prospective sexual partner their HIV status are still very widespread," according to a report. "Over a third of all men not tested HIV positive both expected a positive partner to disclose their status prior to sex and would not want to then have sex if they did."

It's one thing to decide not to ask, but why trust people to tell you, especially when they know you may not have sex with them after they disclose their status?

Taylor says if you're having safer sex, you don't necessarily need to ask the question, but assuming your partner is HIV-negative may lead to risk taking that otherwise wouldn't occur.


"It's much easier to discuss HIV status online when you're meeting partners. That's easy, it's not as awkward to do," says Taylor. "It's pretty common in the online dialogue to ask about HIV status. In fact, profiles usually address it so you don't even have to ask," he says.

But as the study authors warn, "In this climate, it is difficult to see what incentive men with HIV have for disclosing their HIV status."

Not to mention the reality that some men may not be honest, or may not have been tested in a long time. The fact is Taylor hasn't been tested in a long time - he won't say just how long - and he considers himself negative, despite some concern.

That's why researchers say educating people about the reality that some men with HIV won't disclose - or don't know - their status is a huge and necessary part of future HIV prevention efforts.

"Disabusing negative and untested men of the notion that positive HIV disclosure will happen (and that their risk assessments can be based on such an assumption) remains a vital health promotion aim," the survey authors wrote.

It comes down to the message we've all heard a zillion times, I know. Use condoms.

The survey also found that discrimination, harassment and abuse remain a huge problem for MSM.

"Despite advances in social and political equality, everyday cruelty and harassment of gay and bisexual men continues. A third of all men had been verbally abused in the last year. One-in-four has experienced discrimination from strangers in public (verbal and physical abuse) with the workplace being the next most common site of abuse and discrimination."

While some people may make no connection between homophobia and risk taking, the synergy between the two seems evident. "You try being in the closet for much of your adult life," Taylor says. When you finally get to the point when you are out and having sex, after missing your adolescence, and a large part of adulthood, he explains, you don't want to deal with HIV and other downers when you have sex. But the cost of ignoring such issues might be your life.

POLL: Would you have sex with someone you'd just met if he tells you he's HIV+? Please click on the link below to post your answer/comments.

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