The recent Hollingsworth case in Austin has brought to light one of the ugly aspects of the HIV epidemic: unsafe behavior by HIV-positive people who know they are infected. Exactly how much this happens is unknown, but certainly some number of infections occur this way. Why would an HIV-positive person do this?
(The Hollingsworth case didn’t establish any facts in a trial, so, as in the previous two columns, we will examine the question generically.)
On its face, the “knowing exposure” of another to HIV – and potential death – is a callous act, beyond the bounds of civilized behavior. However, the reality also is that such acts are seldom deliberate. Some combination of the following is usually operative:
• If they lack essential knowledge about how transmission occurs, HIV-postive persons might not understand the risk their behavior poses, even though they know they are infected.
• HIV-postive individuals may be in a form of denial about their infection. They have consciously put it out of mind; in its “nonexistent” state, it is “harmless” to themselves and to others.
• Most infections occur in the context of alcohol and/or drugs: judgement is clouded.
• Infections happen as a result of sex or drug use, both very powerful
drivers.
• Rejection upon acknowledging HIV-postive status is the norm, establishing a negative incentive for voluntary disclosure.
• Complacency results from the improved treatments available today. If an HIV-postive person’s viral load is low/nondetectable and he/she is feeling well, they may not see themselves as infectious or HIV as especially dangerous.
• Depression, whether short- or long-term, can lead one to a type of
emotional desperation.
• “He/she didn’t ask my HIV status or insist on condom use. He/she must be infected, too, so it doesn’t matter.” This is one of the most common rationales among gay men. In some ways, it sums up one of the root problems: the inability to communicate honestly about sexual intimacy.
As reprehensible as such behavior is, it usually isn’t because these
people are monsters; it happens because they are all too human. And because of such human frailty, it is essential that we each exercise responsibility for our own decision making, too.
This article appears in May 4 • 2001.