Vital Signs

Why we need to rethink HIV attitudes

Editor’s Note: Robert Klitzman is a professor of psychiatry and director of the Masters of Bioethics Program at Columbia University. He is author of “The Ethics Police?: The Struggle to Make Human Research Safe.” The opinions expressed in this commentary are solely those of the author.

Story highlights

Robert Klitzman: Many U.S. states still have laws criminalizing potential HIV exposure

Time has therefore come to re-examine these laws and our attitudes, he says

CNN  — 

“I’ve told my wife about my HIV infection,” a young man once told me in my office, as part of a research study I was conducting. “But I haven’t told the other chicks I sleep with.” He wore a condom with them only if they asked him to do so, he told me.

I was aghast and wondered whether to stop the interview and tell him he was wrong to do this. Some might argue that I should in fact have called the police and had him arrested.

I tried to keep my cool and instead asked him why he didn’t tell them. “I figure they’re out there sleeping with other guys, just like me,” he replied very matter-of-factly. “HIV is out there. I assume they know all about it.”

Robert Klitzman

His comments, and his justification for his behavior, have haunted me ever since.

This conversation occurred several years ago, before HIV medications were more widely available. But I have thought back to this conversation when I read about Charlie Sheen’s announcement in November that he is HIV-infected and has paid millions of dollars to keep his diagnosis secret.

Sheen’s infection is unfortunate, but his public announcement and subsequent revelations that at least one former girlfriend is suing him for allegedly not disclosing his HIV-status have important broader implications that have not received attention but should. I hope that when he appears on “The Dr. Oz Show” this week, that maybe they will.

Most importantly, Sheen’s case should remind us of the similar plights that millions of other people in the United States and abroad face daily. Despite enormous advances in treatment and prevention, secrecy, lies, stigma, shame and misunderstandings about HIV and AIDS continue.

The truth is that in the early 1980s until the mid- to late 1990s, HIV/AIDS was essentially a death sentence. But thanks to progress in medications and research, that is no longer the case. Unfortunately, laws and public attitudes have failed to keep up. That needs to change.

In the United States, 33 states still have laws criminalizing potential HIV exposure, with most of these laws outdated and punishing behaviors that have no or only negligible risk of causing infection.

Two-thirds of these laws were enacted before effective HIV medications (the so-called “cocktail”) were found to work. And most laws do not account for prevention measures, such as using condoms or taking drugs that eliminate the virus from the bloodstream, essentially making the individual noninfectious.

Certainly, individuals may deserve punishment if they fail to disclose their HIV infection to partners, fail to take HIV medications properly (and hence have detectable virus in their blood), don’t use condoms and in fact infect their partner. But other individuals take these medications appropriately, have no virus in their blood and use condoms and their partners take HIV medications as a preventive measure (so-called Pre-Exposure Prophylaxis, or “PreP”). Such behavior should not be criminalized. But in many states, it still is.

The time has therefore come to re-examine these laws and our attitudes.

Advances in treatment and prevention have made AIDS a chronic disease, with which patients live full and productive lives, as if they did not have the virus.

So the notion perpetuated by some celebrities and media outlets and websites that HIV is a dangerous secret fosters shame, discrimination, stigma and unnecessary fears. These attitudes impede people from talking about HIV, from preventing it or getting treatment – ensuring the virus spreads further.

When the man in my office told me that he failed to disclose HIV to his partners or protect them, we had only limited prevention tools – simply relatively thin rubber condoms. Before he left my office, I talked with him at length about the need to protect his partners. He nodded and said he agreed with me. I wasn’t convinced he would follow my advice.

Fortunately, the world has changed since then.

Every week, I get unsolicited email ads from airlines, Nigerian widows – and now biotech companies selling gene editing services. I usually just reflexively delete the biotech emails along with most of the others, giving them little thought. That was until last week, when British researchers made a momentous announcement: A British regulatory agency has given them permission to begin altering genes in human embryos.

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