17 August 2010

HIV: should you out him?

If you're HIV-positive, or think you might be, of course you tell a new partner. But is he telling you?

“I'm the 26-year-old mother of a 6-year old girl. I am attractive, full of life and have a great career. “ writes a Health24 reader, whose nick is "Concerned", on the HIV Peer Support Forum.

“In March 2007 I met, let’s call him K, at a friend's birthday party – 42, charming (the type to cook and serve you dinner), funny, loving - he came across as respectful and non-judgemental. He was just right - or so I thought.”

“In June 2007 I was admitted to hospital with acute diarrhoea, headaches, and severe cramps. I had tests, including an HIV test - the next day I received my results and it felt as if a brick wall was caving in on me. I called my mother, my granny and my best friend, and the father of my baby, being the last person I had slept with before I met K. Being uneducated about HIV/Aids, I immediately thought it must be from my baby’s dad. I thought that it could not have come from K, because I had just met K, but when he tested, my baby’s dad tested negative.”

I was afraid that I had infected him.
“K came to see me that evening. I was terrified, but I had to tell him the truth, and I suggested that he get tested as well, because I would feel so bad if I had infected him. He said that he would be fine, that it’s like any other illness, and that I shouldn’t worry as he was not going anywhere.

After a week I was discharged, and life carried on as normal. During intimacy I suggested we use a condom, but K said that we need not worry. Still in a state of shock and confusion I let it be, but I had a lot of questions - why would he put himself at risk, could this have come from him? We carried on without using condoms for two weeks, but I felt terrible about it. I could go on forever about my experience with K, but the bottom line is that he failed to tell or protect me - it turns out that he has known about his positive status for a long time.

”I pressured K for answers. He began to distance himself, and I started snooping around on his phone. When I realise, from his text messages that he was very promiscuous, it was the final straw, and I left him for good.”

Only one of many.
”I have learnt, upon further investigation, that K has been positive for over 15 years and has apparently infected countless women and girls deliberately. Some have passed away, some are ill, some have only recently found out, and others don’t even know yet. He has never apologised, explained himself or admitted that he is positive to any of these women or myself. People know, but no-one seems to want to deal with him. I recently found out that his latest conquest - a university student - is ill, and can’t attend her lectures.

“Do I expose him because he is putting innocent lives at stake? Or just let him infect many young women and girls, and just worry about my own well-being? You never know, maybe someone on this forum was infected by him because K has been around.” Read the full story here.

No straightforward legal recourse
In a flurry of heartfelt responses, other Health24 readers suggested "Concerned" take legal steps – in part to punish K, and in part to stop him moving on to other women, and infecting them too. There were also some queries – does he live here? Does he drive this car? – from readers who thought they, too, might be victims of K.

There is some legal precedent for suing. In June last year The Mercury newspaper reported that a Pretoria switchboard operator had been awarded nearly R840 000 by the Pretoria High Court in damages from her former lover who had knowingly infected her with HIV.

In a case in Britain in 2006, a hair salon receptionist was sentenced to 32 months in prison after she admitted to knowingly infecting her then boyfriend with HIV. The Inner London Crown court heard that the receptionist had been found by a psychologist to be in denial about her illness, and that she was fearful of the social stigma attached to it.

But these cases are few and far between. In South Africa, according to the Aids Legal Network, there is no law dealing with infection due to non-disclosure – and, although individuals have fought court battles in this regard, it is not easy to prove legally that one was negative to begin with. Even armed with positive test results, it still comes down to one person’s word against another as to whether either, or both, parties were faithful or celibate after the last negative test, and prior to involvement with the infected individual.

The notifiable disease debate
A notifiable disease is any disease that is required by law to be reported to government authorities. This collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks. Many governments have enacted regulations for reporting of both human and animal (generally livestock) diseases.

The controversial debate on whether to make HIV/Aids a notifiable disease, continues – it was originally raised in the late 1990s during foreign minister Nkosazana Dlamini-Zuma’s tenure as health minister, when it was proposed that HIV/Aids be made a notifiable disease in order for the government to monitor the epidemic and plan interventions accordingly.

Resistance to this proposal centred on the human rights of the HIV-infected, and the proposal was rejected. Because Aids is not a notifiable disease, when a person is diagnosed with HIV/Aids, or when a patient dies of Aids, health care workers do not have to report it to the health authorities. The Department of Health sent out draft regulations in April 1999 to make Aids a notifiable disease, but these have not been passed as law.

Positive or negative - how do you know?
All the more reason, according to Glenn de Swardt, Health24’s Gay and Lesbian Expert, why each of us should practice safe sex, no matter what:

“The big issue is that when someone says that they are negative, we don't ask how they know that! The average person is not sure of their status, and all they're actually saying is that 'I have not tested positive'. And perhaps their last test was a year ago, or they’ve never tested at all,” says De Swardt.

”My advice is to treat everyone you meet as if they are positive, until they can prove to you (with a written, recent test result) that they are negative. For couples, especially where there is an open relationship, or it is likely that one partner may engage sexually with someone else (and yes, it does happen), there needs to be very candid discussion with no secrets. The communication within the relationship should be so functional and open that partners should be able to discuss safer sex (HIV and other STIs) very openly.”

This leaves us with the question: Do you think HIV/Aids should be a notifiable disease, as TB is?

(Joanne Hart, Health24, updated August 2010)

Read more:
HIV pop star in court for infection claims


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