the failed ones, the grave disappointments, the apathetic, the careless

May 14, 2013 9:50 AM

"The Sound of Stigma: An essay by Mark S. King—an AIDS advocate, an author and a blogger living with HIV since 1985—on why HIV stigma among gay men persists."
posted by andoatnp (148 comments total)

also linked to the same page, a NYT article on a political candidate who has recently come out as HIV positive, and the continued stigma.
posted by jb at 10:02 AM on May 14, 2013 [3 favorites]

"Gay men who get infected today are out of their minds. They are the failed ones, the grave disappointments, the apathetic, the careless, the irresponsible. They spit upon the memories of our courageous dead. They have no respect for our history, for our monumental tragedy. "

It's amazing how a community that grew together during a time when this disease was wiping us out turned against our own when the death sentence became a chronic health condition. It's horrible, the attitudes of those who think they're "better" and think that they somehow couldn't possibly find themselves infected.
posted by xingcat at 10:03 AM on May 14, 2013

Thank you for posting this. I’m not 100% sure that I agree with the conclusions here, but it’s a great article, nonetheless. For example, a great many of my friends who are HIV-negative gay men don’t consider themselves superior in any way, they consider themselves survivors of a roulette game that could have gotten them the same way that AIDS claimed the lives of their friends. If anything, I think there’s a perception now that HIV is not a big deal, that’ it’s manageable.

One important issue is that HIV transmission is still criminalized in many states, or even the perception that you, has an HIV positive person, had sex with someone with or without a condom who didn’t know your status. You can go to jail for that. For a long time.
posted by roomthreeseventeen at 10:07 AM on May 14, 2013 [2 favorites]

I think it's really frustrating that there can never be a middle ground on this stuff. You don't just see this with AIDS, but other STDs as well. It can't just be, "Hey, please don't treat us badly because we have a disease," it has to be "If you don't want to have sex with someone who has STD, you are a BAD PERSON who STIGMATIZES and is a BIGOT." The fact that the article casually dismisses the idea that HIV positive people who conceal that fact in order to have sex with people are rapists is really telling of where they're coming from, and it's not an awesome place.
posted by corb at 10:07 AM on May 14, 2013 [9 favorites]

The fact that the article casually dismisses the idea that HIV positive people who conceal that fact in order to have sex with people are rapists is really telling of where they're coming from, and it's not an awesome place.

On the contrary - I think the idea itself that HIV positive people who conceal that fact to have sex can be categorized as rapists is really telling of the people who thought that up.

Deceptive? Yes. Inethical? Absolutely. Worthy of scorn? Yeah. But rape? That's a huge reach, one which would make me wonder just what the originator of such an idea was trying to do.
posted by EmpressCallipygos at 10:12 AM on May 14, 2013 [3 favorites]

They were probably going for "intentionally exposing someone without their consent to a disease in order to attain sex." Rape may not be the perfect term but "worthy of scorn" and "deceptive" are a bit lacking IMO.
posted by leopard at 10:17 AM on May 14, 2013 [9 favorites]

On the contrary - I think the idea itself that HIV positive people who conceal that fact to have sex can be categorized as rapists is really telling of the people who thought that up.

The terms you can use to google about this is "sex by deception" or "rape by deception".

If someone believes that he is consenting to sex with someone that is HIV negative, and that he would not have consented to sex with someone who is HIV positive, then I understand why people might use the framework we have developed for rape to talk about that. I'm not saying I agree, but I understand how that can look like sex without consent considering what the person was willing to consent to and what actually happened.
posted by andoatnp at 10:20 AM on May 14, 2013 [3 favorites]

They were probably going for "intentionally exposing someone without their consent to a disease in order to attain sex."

Yeah, the problem with this is that people are accused of doing this when they were having protected sex, biting someone, spitting on someone, having oral sex with someone, having unprotected sex with the knowledge of their partner, etc. No other currently comparable STD is treated like HIV.
posted by roomthreeseventeen at 10:22 AM on May 14, 2013 [1 favorite]

Rape may not be the perfect term but "worthy of scorn" and "deceptive" are a bit lacking IMO.

They weren't meant to render that kind of deception dismissive, and I apologize if it came off that way.

I just question whether "rape by deception" is actually a thing, legally, as opposed to being "something Stabler grumbled about on Law and Order SVU."
posted by EmpressCallipygos at 10:24 AM on May 14, 2013

No other currently comparable STD
What STD is comparable to HIV? Most STDs can be cleared up with antibiotics, and herpes is not life threatening.


I just question whether "rape by deception" is actually a thing, legally

Depends on where you live.
posted by dragoon at 10:29 AM on May 14, 2013

I just question whether "rape by deception" is actually a thing, legally, as opposed to being "something Stabler grumbled about on Law and Order SVU."

Kind of.
posted by nooneyouknow at 10:29 AM on May 14, 2013

What STD is comparable to HIV? Most STDs can be cleared up with antibiotics, and herpes is not life threatening.

At least 20% of adult Americans, and perhaps twice that many, have a viral STD for which there is no cure. These lifelong STDs are genital herpes, human papillomavirus (HPV, or genital warts), hepatitis B, and human immunodeficiency virus (HIV), the cause of AIDS.
Bacterial STDs - including chlamydia, gonorrhea, and syphilis - usually can be cured by antibiotics but continue to spread at epidemic rates. Because chlamydia and gonorrhea often have no symptoms, many cases are undetected and untreated.
posted by roomthreeseventeen at 10:31 AM on May 14, 2013 [1 favorite]

This post has some information on the state statutes that seem to cover this, and information on a couple of prosecutions from Tennessee. Both of the cases involved someone pretending to be an entirely different person, which is probably a different kind of fraud than lying about HIV status (although I'm not a lawyer).
posted by andoatnp at 10:33 AM on May 14, 2013

> The fact that the article casually dismisses the idea that HIV positive people who conceal that fact in order to have sex with people are rapists is really telling of where they're coming from, and it's not an awesome place.

I'm honestly not following what you're saying here or what you're disagreeing with, can you clarify? At first I thought you were criticizing the writer for referring to people with undisclosed HIV as rapists? But this isn't what the article says, he's saying that these people are lumped in wholesale with rapists and any other type of sex offenders in order to shun them collectively.

The writer's point isn't to castigate those who don't want to have sex with HIV-positive people. He's criticizing the use of broad-based generalities and assumptions to sort people with HIV into a caste system for ease of blanket judgement, rather than regarding them as individual human beings.
posted by desuetude at 10:48 AM on May 14, 2013 [2 favorites]

But this isn't what the article says, he's saying that these people are lumped in wholesale with rapists and any other type of sex offenders in order to shun them collectively.

Yeah, sorry for any confusion. I was saying that I think anyone who engages in sex by deception /is/ a rapist - rape by deception - and it really bothers me that the author seems dismissive of that. It makes it hard for me to read the rest of his article without already being upset.

I just question whether "rape by deception" is actually a thing, legally

I don't know whether it is in all places or to what extent it is. I'm admittedly a bit of a hardliner on this - I don't think of this just about AIDS. To me, Barney Stinson is a serial rapist. Anyone who lies or withholds information in order to get someone to consent to sex they would not otherwise have agreed with is, in my eyes, a rapist. I'm really big on informed consent.
posted by corb at 10:56 AM on May 14, 2013 [3 favorites]

First, I didn't even know that there were places that considered "rape by deception" a thing. So I stand corrected on that score.

And yet, even so -

I was saying that I think anyone who engages in sex by deception /is/ a rapist - rape by deception - and it really bothers me that the author seems dismissive of that.

From reading the article, I don't recall the issue actually having been addressed in the first place, so now I'm confused about your accusations of "dismissiveness". Are you certain that it's was "dismissiveness" as opposed to just something that didn't come up?

Again, this is not to make light of the fact that there are indeed people who do conceal their health stats to persuade others into sex. I just question whether it's something endemic to HIV alone, which was the topic of the article.
posted by EmpressCallipygos at 11:02 AM on May 14, 2013

One in five people living with HIV in the U.S. don't know it.

Only 50% of people with HIV in the U.S. get regular care.

As TV friendly as the idea of 'rape by deception' or people deliberately lying about their status is, the majority of new infections probably come from people who don't know it or who would not pass it to another if they got regular care.

This is why the stigma matters.
posted by MCMikeNamara at 11:03 AM on May 14, 2013 [15 favorites]

This essay is great, and I hope more people read it than get derailed in some discussion on the fine definitions of words we use to describe deplorable behavior.

I don't know that I agree with everything the author says, but I love how well he communicates the raw emotion and pain that HIV has wrought in the gay community. Now, still, absolutely awful emotions and behaviors and treatment of each other. AIDS is an alien that invaded our culture.
posted by Nelson at 11:03 AM on May 14, 2013 [2 favorites]

I appreciate the writer's righteous anger, but I don't think it's absurd to have a jail sentence on the books for those who expose others to an incurable, life-threatening illness without giving them the chance to consent or not.

If you can't "bring yourself to disclose," you shouldn't bring yourself to have sex.
posted by lewedswiver at 11:09 AM on May 14, 2013 [10 favorites]

From reading the article, I don't recall the issue actually having been addressed in the first place, so now I'm confused about your accusations of "dismissiveness". Are you certain that it's was "dismissiveness" as opposed to just something that didn't come up?

Yeah, the part that really upset me was the negative tone in:

And God help those who don’t admit they are infected and have sex with a negative person, because they are the criminal ones, the terrorists, the dangerous liars who must pay dearly for what they’ve done. They belong in jail and off the streets, like drug dealers and rapists.

It seemed to be implying that the act of having sex while deliberately withholding knowledge of HIV positive status shouldn't be viewed as negatively as it currently is, that the offense was not as serious as actual rape. That could be my misreading of the sarcasm, but that's how I read that piece.
posted by corb at 11:13 AM on May 14, 2013 [3 favorites]

MCMikeNamara: "As TV friendly as the idea of 'rape by deception' or people deliberately lying about their status is, the majority of new infections probably come from people who don't know it or who would not pass it to another if they got regular care. "

This is a bad excuse.

Getting tested is stupidly easy, and free in most cities if you can't afford it.

On one hand, this stigma really sucks. On the other, we've gathered a lot of statistics that show that new generations coming of age do not take HIV seriously at all.

I think that there's plenty of room to start screaming about the completely preventable uptick in new HIV infections without resorting to victim-blaming.
posted by schmod at 11:37 AM on May 14, 2013 [1 favorite]

but I don't think it's absurd to have a jail sentence on the books for those who expose others to an incurable, life-threatening illness without giving them the chance to consent or not.

The problem, as noted in this thread several times, is that other STDs aren't treated like this in the law, and the law itself isn't even applied as written.
posted by roomthreeseventeen at 12:02 PM on May 14, 2013 [1 favorite]

Getting tested is stupidly easy, and free in most cities if you can't afford it.

Stigma helps people think they don't need testing, because they don't have sex with "bad" people.

One of the program areas at my job does a ton of partnered PSA work and education around HIV testing, and the folks who work in that program area talk a lot about how compiling a list of free or cheap testing sites in any given area is really easy; getting people to the point where they acknowledge they might benefit from testing is really, really hard.
posted by rtha at 12:15 PM on May 14, 2013 [10 favorites]

Here's a real thing that happened to me, last summer. I started dating a nice conservative guy who happens to be HIV+. Had a conversation with a smart, worldly friend that went like this:

me: "I'm a little worried about his HIV status..."
friend: "No big deal, just use condoms."
me: "And this morning, he posted a Glenn Beck quote on his Facebook wall."
friend: "Dump him immediately."

Liking Glenn Beck may be unfortunate, but it doesn't pose a health risk. And saying that HIV is no big deal is wishful thinking.

Sometimes it seems like we – and I'm talking specifically about the gay community – don't even know how to talk about the issue anymore.
posted by roger ackroyd at 12:31 PM on May 14, 2013 [5 favorites]

"Gay men who get infected today are out of their minds. They are the failed ones, the grave disappointments, the apathetic, the careless, the irresponsible. They spit upon the memories of our courageous dead. They have no respect for our history, for our monumental tragedy. "

It's amazing how a community that grew together during a time when this disease was wiping us out turned against our own when the death sentence became a chronic health condition. It's horrible, the attitudes of those who think they're "better" and think that they somehow couldn't possibly find themselves infected.

Three winters ago, in Helsinki, I was "roomies" with an HIV positive gay friend and got to know a lot about contemporary thinking in everyday life in Europe at least. Its a condition that's best kept as a secret in terms of general public. But requires the person to be highly disciplined in their hygiene and scrupulous with their coworkers, co-residents and loved ones. That's why the news that a friend, J was tested positive brought about grinding of teeth at his foolish idiocy and youth when some preventive good habits such as condoms and gloves might have made the difference.

Yes its a game of roulette but you can influence your own odds you know. The ratios are different for different demographics, I heard recently in Kenya that the fastest growing band of infectees are middle class women, so its not a matter of stereotyping but knowing one's social cultural mores may be riskier.
posted by infini at 12:45 PM on May 14, 2013

At least 20% of adult Americans, and perhaps twice that many, have a viral STD for which there is no cure. These lifelong STDs are genital herpes, human papillomavirus (HPV, or genital warts), hepatitis B, and human immunodeficiency virus (HIV), the cause of AIDS.
Bacterial STDs - including chlamydia, gonorrhea, and syphilis - usually can be cured by antibiotics but continue to spread at epidemic rates. Because chlamydia and gonorrhea often have no symptoms, many cases are undetected and untreated.

Just a note:
1) Genital herpes is not fatal, or life-threatening (except in the 0.1% chance of herpetic encephalitis), and for the most part is easily controlled with Acyclovir or other antiviral.
2) HPV is quite common in the USian population, but the serious complication of HPV is Cervical Cancer, which manifests usually in 10-20 years. There is a common vaccine, Gardasil, which protects against high-risk HPV strains 6, 11, 16 and 18 which may cause cervical cancer. The other consequence of HPV is genital warts and infertility, which while terrible, are not life-threatening.
3) HepB is commonly protected against via vaccination, and on that note Hep C can also be transmitted by sexual contact, and there is no vaccine for it.

Though antibiotic resistance fo gonorrhea is increasing (cephalosporin-resistant), chlamydia, gonorrhea and syphilis are generally cured using single-dose antiobitic regimens. (Not to say that getting them is all fun, heavy vaginal bleeding, cramping and other complications are common), but these things tend to resolve acutely.

I guess my point is that HIV is a life-long, chronic and debilitating disease. The only thing I can think of with the same horribly end-stage complications is tertiary syphilis, but no other STD comes close to the same overall level of virulence in my (admittedly layperson) eyes.
posted by kurosawa's pal at 12:58 PM on May 14, 2013

> It seemed to be implying that the act of having sex while deliberately withholding knowledge of HIV positive status shouldn't be viewed as negatively as it currently is, that the offense was not as serious as actual rape. That could be my misreading of the sarcasm, but that's how I read that piece.

The sarcasm is for lumping people who do not disclose HIV into a big generic box of "sex criminals just like the worst of 'em." The sarcasm is for the denial. It's driven by the fear of being the victim or perpetrator of unfortunate judgment calls.

He's not saying that undisclosed HIV is fine and dandy. It's that the comparison to rape is disingenuous measurement of seriousness. Rape is forcing someone to have sex against their will. Endangering someone's health via consensual sex is not rape. It's just not.
posted by desuetude at 1:20 PM on May 14, 2013

It's that the comparison to rape is disingenuous measurement of seriousness. Rape is forcing someone to have sex against their will. Endangering someone's health via consensual sex is not rape.

For me, it is actually less a matter of endangering someone's health, and more a matter of consent. And I don't think that consent can be given without it being fully informed. For an example:

* At the heart of consent is the idea that every person, woman or man, has a right to personal sovereignty – not to be acted upon by someone else (especially in a sexual manner) unless given clear permission to do so.

* Consent may be given verbally or non-verbally, based on an active, informed, mindful, freely decided choice. Intoxication (drug or alcohol) makes this (legally) impossible.

Just as date rape can occur when one person is too intoxicated to consent, so can rape by deception occur when one person is not fully aware of what they are consenting to. They may have even said yes, or seemed really enthusiastic - but they were not fully capable of consenting because they were not in possession of their reasoning faculties to weigh all of the factors and choose consent.

The idea that one type of rape is worse than another is a thing that I think is actively harmful to victims - it's the sort of idea that lets people prosecute date rape less seriously than stranger rape, and as noted, take rape by deception less seriously yet - laws are only on the books in some countries. (Sweden I think is one of them)

But rape is rape.
posted by corb at 1:38 PM on May 14, 2013

And saying that HIV is no big deal is wishful thinking.

I think I understand your view. But a negative person could very reasonably believe that the positive status of a relationship partner is no big deal where viral load is low due to medications and condoms are used. (Whereas there is no medication for liking Glenn Beck, rimshot.)
posted by ClaudiaCenter at 1:45 PM on May 14, 2013

Following on that last comment: Your (i.e., roger ackroyd's) friend may have been too blase, but you seem to imply that having sex with HIV+ people is a health risk even if you know your partner's status and you use a condom (or other appropriate protection). That's not supported by any medical evidence that I know of.
posted by blucevalo at 1:56 PM on May 14, 2013 [1 favorite]

blucevalo, there's still risk.

and honestly, I don't want to be using condoms for the rest of my life.
posted by roger ackroyd at 2:12 PM on May 14, 2013

What STD is comparable to HIV? Most STDs can be cleared up with antibiotics, and herpes is not life threatening.

Yeah, I can't figure out why Hep C doesn't figure a little more prominently in these discussions. I'm very glad HIV got people's awareness of STDs up, but Hep C is a debilitating, usually lifelong disease.
posted by small_ruminant at 2:26 PM on May 14, 2013

I'd suggest that is grounds for treating people who have other sexually transmitted, lethal and incurable diseases the same, not letting off people who don't disclose their infected with AIDS status to people they are having sex with. It absolutely is sexual assault and criminal behavior.
posted by tavella at 2:30 PM on May 14, 2013 [1 favorite]

Getting tested is stupidly easy, and free in most cities if you can't afford it.

A large proportion of HIV infections happen during the window period (i.e. between contracting the virus and seroconverting). Newer tests can reduce this window to around a month, I think, but 3 months is still standard. A lot of people do not wait three months between sexual partners. So yes, increased testing will help, and I think there's a strong argument to be made that reducing the stigma will lead more people to get tested. But it is not the whole story.
posted by en forme de poire at 2:43 PM on May 14, 2013

Just as date rape can occur when one person is too intoxicated to consent, so can rape by deception occur when one person is not fully aware of what they are consenting to. They may have even said yes, or seemed really enthusiastic - but they were not fully capable of consenting because they were not in possession of their reasoning faculties to weigh all of the factors and choose consent.

Okay. But I have absolutely no idea what this has to do with the article.
posted by desuetude at 2:50 PM on May 14, 2013

The problem, as noted in this thread several times, is that other STDs aren't treated like this in the law, and the law itself isn't even applied as written.

Well, What is the consensus here then? what do people expect? are they saying that law shouldn't exist? are they saying it should be uniformly applied to most/all STDs. I could get behind the latter, since there are definitely lots of scumbags of all genders/orientations who lie about STDs, but the former?

I always get pretty confused when i'm watching these discussions. I see lots of "things need to change, there's an unfair stigma and it's handled poorly!" without offering lots of real solutions that make sense.

Also, i generally get pretty damn uncomfortable around the "rape by deception shouldn't be a thing" people.
posted by emptythought at 2:54 PM on May 14, 2013 [2 favorites]

Also, i generally get pretty damn uncomfortable around the "rape by deception shouldn't be a thing" people.

Whoa, I think what I meant got really warped here - personally, for the record, I think it's evil as all hell to deceive someone as to one's sexual health status, marital status, or anything else in an attempt to persuade them into sex. Deception of any kind is bad juju.

The only thing that took me aback is to whether that kind of deception was legally classified as a form of rape, and it sounds like it's a big gray area. If the law of the land does at some point classify it as rape, fair enough - as to whether I think it should be, well, I'm not sure. I can definitely be down with it being criminalized, but whether it is a form of rape? It just...semantically sounds like a weird categorization, is all. I mean, you wouldn't say that someone who lied about their marital status to sleep with someone was guilty of rape, would you?

I do indeed grant that putting someone at risk to their health by lying about your own sexual health to sleep with them is a more grievous offense than putting someone at risk by lying about your own marital status (if someone sleeps with a married man/woman, they don't risk disease, after all). I acknowledge that. It just still feels like this kind of deception is a closer fit with criminal endangerment or felony-level fraud than with rape is all.

But the question of what you call it is a different kettle of fish than whether or not it's evil as shit, and I definitely think it is.
posted by EmpressCallipygos at 3:11 PM on May 14, 2013

Never mind that these men struggle to disclose their status, that they are routinely rejected socially and sexually, that their waning self-esteem is being strangled by our judgment

Dude, you do not have a god-given right to have sex with anyone you want to have sex with. People not wanting to have sex with you, whether it's because of your HIV status, your looks, or your behavior, are not "stigmatizing" you, they're making a decision. And if you struggle with disclosing and don't disclose, you are *lying*, you are lying to someone in order to fuck them, and all the "struggle" in the world won't absolve you of that.
posted by ThatFuzzyBastard at 3:19 PM on May 14, 2013 [11 favorites]

Rape is sex without consent. I'm with corb; it's all much the same to me if the impaired consent is because the victim is a child, if the victim is drugged or drunk, if you sabotaged the condom in an attempt to get your victim pregnant, or because you failed to disclose that you might infect them with a lethal and incurable disease. You can argue for what the level of punishments should be for each, but me they are all sexual assault and justly punished with criminal penalties.

Though I did have to consider if you lie about using birth control in an attempt to get pregnant, is that sexual assault? And while I don't think it's exactly the same as the reverse in the sense that it is not the risk of direct bodily harm or invasion attaching, it does seem the logical conclusion.
posted by tavella at 3:31 PM on May 14, 2013 [1 favorite]

People not wanting to have sex with you, whether it's because of your HIV status,

Given the history of the AIDS epidemic in particular and the gay rights movement in general, yes, people not wanting to have sex with you *just* because of your HIV status is actually stigma at work. Individual Person A is totally allowed to have or not have sex with anyone they want for any reason, but to divorce that personal decision from the larger context in which it functions is bad public health practice. Which, I realize, if you are not a person who works in public health in any way, then you're going to go "eh", but we have decades and decades of data about how stigmatizing a disease creates poor public health outcomes. The cure for stigma is not "Whatever, people can do what they want for whatever reason." It is relentless and exhausting public education.

There are still - still! - people in this country - this wealthy, well-educated country - who make their HIV positive relatives eat off of paper plates and drink out of paper cups. We seem to have stopped burning families with HIV positive children out of their homes (go, us!), but yes there is still enormous stigma, and yes it keeps people from getting tested and getting treated.
posted by rtha at 3:40 PM on May 14, 2013 [6 favorites]

So my decision to not expose myself to a STD by having sex with people with STDs is now destroying poor, poor men of their rightful share of sex? It's stigmatizing just because I don't care to run the risk of spending the rest of my life taking meds? FUCK THAT.
posted by tavella at 4:01 PM on May 14, 2013 [5 favorites]

There was an era in which an attitude of "non-judgmentalism" was necessary to deal with the AIDS crisis simply because the toll of the disease was much greater a priority to deal with than how one got infected with the disease in the first place. When the ship is sinking, don't argue over why someone chose one route over another-- the important thing is to save the passengers.

Well now we're dealing less with an AIDS crisis as much as people trying to figure out how to avoid getting HIV. And while making decisions to minimize the odds of infection is not a 100% guarantee that you will be uninfected, it is normal for people to prioritize risk-minimization and stigmatize those who don't (or are perceived to have not). If you want to avoid contracting a deadly, debilitating sexually transmitted disease, you may well develop an entire sexual culture that revolves around not having sex with people who have that disease.

It was once speculated that syphilis caused Puritanism. A deadly disease that could spread through entire communities and was transmitted by sex may well have caused entire cultures to suddenly make very swift, severe decisions about sexual mores in an effort to protect themselves: anyone having illicit sex was in fact endangering the entire community by exposing them to a deadly disease. And this is not exactly an irrational reaction, particularly given the state of medicine at the time.

Is this a gay version of Geek Social Fallacies? A marginalized, alienated group is unable to make judgments about their own because that would be too much like what they themselves were subjected to their entire lives?
posted by deanc at 4:04 PM on May 14, 2013 [3 favorites]

It's pretty darn telling that an post about stigma surrounding HIV/AIDS entitled "the failed ones, the grave disappointments, the apathetic, the careless" (which is from the article, if you didn't bother to read it) has turned into a derail about how non-disclosure of HIV status is rape, as if that's the only way you, a good, decent, noble, responsible person, could acquire HIV.

So, you're negative. Great. How about you chip away at that stigma by telling your next sexual partner your status up front and asking theirs? Or would talking about your risk, because it is non-zero, dirty you?
posted by hoyland at 4:16 PM on May 14, 2013 [2 favorites]

How about you chip away at that stigma by telling your next sexual partner your status up front and asking theirs?

I'm not sure who you're directing your ire towards, but that's pretty much standard operating procedure in my social circle.
posted by roger ackroyd at 4:23 PM on May 14, 2013 [1 favorite]

So my decision to not expose myself to a STD by having sex with people with STDs is now destroying poor, poor men of their rightful share of sex? It's stigmatizing just because I don't care to run the risk of spending the rest of my life taking meds? FUCK THAT.

Yeah, that's exactly what I said. Exactly.
posted by rtha at 4:24 PM on May 14, 2013

but no other STD comes close to the same overall level of virulence in my (admittedly layperson) eyes.
- kurosawa's pal

For women, chlamydia and gardnerella can have lifelong debilitating and/or fertility-affecting complications. Pelvic Inflammatory Disease happened to me after a single woman-to-woman chlamydia exposure; 30 years later, I will need my 5th round of abdominal surgery (having all ready lost a fallopian tube and ovary) and a hysterectomy to (hopefully) take care of the scarring and adhesions.

I am very, very careful about my safer sex practices, which lesbians as a subculture deny they need, even today. There is the mistaken impression that safer sex is only for HIV, which is difficult for women to pass to each other short of blood-to-blood contact (yes, what you are imagining). I have lost partners and been subjected to excruciationg public gossip within even large urban communities (making it difficult to find new partners) because of my insistence on safer sex, even within committed relationships.

The answer to stopping new infections is insistence on safer sex, no matter how hot you think the new one is, or how much you love an existing partner. I am a loving person, so my infection stops with me.
posted by Dreidl at 4:25 PM on May 14, 2013 [2 favorites]

I'm not sure who you're directing your ire towards, but that's pretty much standard operating procedure in my social circle.

Then maybe it wasn't you.
posted by hoyland at 4:26 PM on May 14, 2013

If you want to avoid contracting a deadly, debilitating sexually transmitted disease, you may well develop an entire sexual culture that revolves around not having sex with people who have that disease.

Except that serosorting is apparently less effective than always wearing condoms and/or seropositioning and may actually increase HIV transmission rates in some groups.
posted by en forme de poire at 4:27 PM on May 14, 2013

en forme de poire: "A large proportion of HIV infections happen during the window period (i.e. between contracting the virus and seroconverting). Newer tests can reduce this window to around a month, I think, but 3 months is still standard. A lot of people do not wait three months between sexual partners. So yes, increased testing will help, and I think there's a strong argument to be made that reducing the stigma will lead more people to get tested. But it is not the whole story."

3 months between unprotected sexual activity is the kicker.

Again, I really don't want to cross into the territory of victim-blaming, but this like driving above the speed limit without a seatbelt.
posted by schmod at 4:29 PM on May 14, 2013 [1 favorite]

So my decision to not expose myself to a STD by having sex with people with STDs is now destroying poor, poor men of their rightful share of sex? It's stigmatizing just because I don't care to run the risk of spending the rest of my life taking meds? FUCK THAT.

But I think this sentiment itself IS caused by stigmatization of HIV. If you think you can drop your risk of contracting HIV to zero but still remaining sexually active, you're not setting very realistic goals, because there IS no way but abstinence to 100% guarantee that you're at no risk - the only thing you can do is minimize your risk of contracting HIV. And in the long run, you're much less likely to get HIV from someone who actively discloses his status so you can both take precautions and has a low viral load versus someone who's in the process of seroconverting and whose last test was negative.

The issue here is that when we hear "HIV", we strip a person down to solely his HIV positivity while ignoring all other traits that may render that person desirable. Realistically given the evidence and the abundance of ways to manage HIV, it shouldn't be that way - HIV shouldn't be the switch that flips someone who is otherwise completely fine to you into an unwanted desirable. But because it's not that way, we discourage disclosure and testing - and ironically, that increases the risk for all of us because now we're focusing on taking shots in the dark rather than sitting down and having healthy conversations on how we can minimize risk in spite of a positive status.
posted by Conspire at 4:54 PM on May 14, 2013 [7 favorites]

So my decision to not expose myself to a STD by having sex with people with STDs is now destroying poor, poor men of their rightful share of sex? It's stigmatizing just because I don't care to run the risk of spending the rest of my life taking meds? FUCK THAT.

This is, err, actually fairly close to the problem i have with a lot of peoples arguments against the law.

I can't escape the feeling not as much through assumptions made, but in the tone and presentation of a lot of what people say about this that a big elephant in the room is that there's some kind of fair share to, or other entitlement to at least sexual opportunity being denied here.

And the entire concept of "everyone is entitled to their fair share of sex" is pretty fucked up, but simultaneously something that people will throw chairs across the room over.

And yea, a lot of people come off as saying essentially "the stigma against HIV is so great that i would have a vastly and unfairly limited my chances at sex by discussing it"

I also think the similar argument that "well your deluding yourself if you think your chance is zero with a random vs someone you know has it", that strikes me as incredibly fallacious along the lines of the tiger repelling rock kind of arguments. EVERYONE involved in these discussions knows the chances aren't zero. But it's up to the potential partners of someone who has tested positive to know that. whether or not they're less likely to get it from someone who is properly managing it who discloses doesn't mean that they're somehow fucked up or a bigot for still saying no.(Ok, i'll concede, this is debatable. but it's still their personal choice)

The entire crux of my argument is that the people who don't disclose have selfish reasons for not doing so despite the stigma that's floating around. The fact that some people may treat you unfairly isn't a free pass to avoid disclosure.

I'm still very, very confused as to what alternate solution the people who support that are looking for here.

I just think that a lot of these arguments come dangerously close to saying sex is something that people are entitled to, when in reality sex is like riding a motorcycle. No one needs to do it. It's fun, it can be dangerous. If someone looks at the risks and goes "eh, that's not for me" no one should be beating them over the head going "But your a moron, doing it this way may be less risky!".

This may be a shitty analogy, but i think there's some aspects here that are being taken in a way that makes me really uncomfortable, is my point. And i've seen a lot of these same attitudes before anywhere this comes up.
posted by emptythought at 5:08 PM on May 14, 2013 [5 favorites]

I agree with Conspire. I also think there's something telling about the fact that while this article is really wide-ranging and touches on a lot of facets of HIV+ stigma, the only thing we're talking about here is the part where we feel we can moralize the most confidently. Reminds me of that classic Brass Eye sketch.
posted by en forme de poire at 5:14 PM on May 14, 2013

And in the long run, you're much less likely to get HIV from someone who actively discloses his status so you can both take precautions and has a low viral load versus someone who's in the process of seroconverting and whose last test was negative.

The idea of being protected by a "low viral load" is part of the problem these days, for multiple reasons. Viral load doesn't stay constant, so just because your blood work may say your viral load is undetectable one day doesn't mean it will remain that way.

Also, from what I understand, HIV may not show in a blood sample, but may still be transmissible in semen. (Someone please correct me if I'm wrong.)
posted by roger ackroyd at 5:17 PM on May 14, 2013

At the heart of consent is the idea that every person, woman or man, has a right to personal sovereignty – not to be acted upon by someone else (especially in a sexual manner) unless given clear permission to do so.

be careful, people might get the idea that you are a Libertarian

A marginalized, alienated group is unable to make judgments about their own because that would be too much like what they themselves were subjected to their entire lives?

and then when they internalize the "Geek Social" meme, they will marginalize and alienate a portion of themselves and generate new "geeks" while becoming other than "geeks" themselves

denying poor, poor men of their rightful share of sex?

there's something kind of funny about how this is being said in relation to a gay rights thing
posted by This, of course, alludes to you at 5:19 PM on May 14, 2013 [1 favorite]

While we believe that it's just not realistic to expect people to follow abstinence outside of a monogamous relationship, in the same way it is just not realistic to expect people not to stigmatize infection with HIV when making decisions about sex partners. It wasn't that long ago that a death sentence could be the result of sex. Trying to go from that reality to "it's like diabetes. Don't hold it against someone or let it interfere with your choice of sex partners," is just never going to be convincing to a significant number of people. It might help to figure out how to work within those parameters rather than spit against the wind.
posted by deanc at 5:19 PM on May 14, 2013

> Rape is sex without consent. I'm with corb; it's all much the same to me if the impaired consent is because the victim is a child, if the victim is drugged or drunk, if you sabotaged the condom in an attempt to get your victim pregnant, or because you failed to disclose that you might infect them with a lethal and incurable disease. You can argue for what the level of punishments should be for each, but me they are all sexual assault and justly punished with criminal penalties.

Consenting to sex comes with risks. Consenting to unprotected sex requires trust. If I'm lied to by a sex partner, it doesn't retroactively invalidate my own agency in making that decision to trust them. It doesn't overrule my ability to consent to sex. It's unethical and in some cases illegal, but as a type of reckless endangerment, not a fucking time machine.

> So my decision to not expose myself to a STD by having sex with people with STDs is now destroying poor, poor men of their rightful share of sex? It's stigmatizing just because I don't care to run the risk of spending the rest of my life taking meds? FUCK THAT.

No. The point is that it is perfectly fine to not want to expose yourself to HIV without going out of your way to be a holier-than-thou jerk to everyone who has HIV.
posted by desuetude at 5:27 PM on May 14, 2013

Except the definition of "holier-than-thou jerk" here appears to be "decides not have sex with me."
posted by tavella at 5:34 PM on May 14, 2013 [4 favorites]

roger ackroyd, you're probably right, but I feel like sometimes we grasp at every straw of evidence we can to uphold the idea that serosorting is the only way - again, I see this as an issue of stigma. The problem is that we try to find evidence to justify our negative reactions against HIV-positive men rather than using the evidence to objectively assess risks and then come to conclusions. For instance, in the article that you linked above on the effectiveness of serosorting (linked again here), yes, serosorting was found to have an effect - but only in comparison to no strategy at all. Every other strategy - seropositioning, top-only, 100% condom, etc, all had a greater impact on risk of HIV infection than serosorting. So why doesn't seropositioning, with a risk reduction of 74%, get as much talk as serosorting, which only has a risk reduction of 51%, according to the article?

So it's not that serosorting is an invalid strategy and "bad", but we have to evaluate why one chooses to serosort. We're not always making rational decisions here, and I think it's important to recognize that stigma has a lot to do with why the coin always lands on serosorting whenever these conversations happen.
posted by Conspire at 5:52 PM on May 14, 2013 [5 favorites]

The problem is that we try to find evidence to justify our negative reactions against HIV-positive men rather than using the evidence to objectively assess risks and then come to conclusions.

Again, this elegantly states something I was trying and failing to articulate for the last 10 minutes - thanks.
posted by en forme de poire at 5:54 PM on May 14, 2013

Or you can use condoms *and* also eliminate having sex with known STD carriers. Shocking thought, I know.
posted by tavella at 5:55 PM on May 14, 2013 [2 favorites]

But tavella, again by the statistics in this paper, seropositioning has a higher rate of risk protection than serosorting, and both strategies can also likely benefit from the use of a condom. While the figures strike me as odd, my inference is that men intending to seroposition are on average better educated on HIV transmission and have a more relaxed attitude on HIV encouraging disclosure. To me, this suggests that education and developing a culture of acceptance around HIV results in lower transmission rates than attempting to segment a community through serosorting based on fear-mongering.
posted by Conspire at 6:10 PM on May 14, 2013 [1 favorite]

How about you chip away at that stigma by telling your next sexual partner your status up front and asking theirs? Or would talking about your risk, because it is non-zero, dirty you?

Who are you talking to? I mean, literally, who? Because no one in this conversation has even suggested that they would not tell their partner they were HIV-negative. I'm not even sure why someone would want to conceal that fact.

When I'm about to have sexytimes with someone (or was, pre-partnering), I go and get a test, and make them get a test. If they don't show me, they don't sleep with me. I show them and they get to decide whether or not to sleep with me. I was negative for everything and wanted to stay that way. They test for everything and I mean everything, and I get to decide on my own. This is...not really that uncommon behavior, I think.
posted by corb at 6:17 PM on May 14, 2013 [3 favorites]

Conspire, your odds are *always* going to be improved, no matter what other methods you use, by eliminated the known infected partners from your pool. The idea that I should avoid doing that and increase my risk so that I don't damage someone else's esteem... yeah, no. They don't owe me sex; I don't owe them sex.
posted by tavella at 7:02 PM on May 14, 2013 [3 favorites]

> Except the definition of "holier-than-thou jerk" here appears to be "decides not have sex with me."

No, it's really not. Did you even read the rest of my sentence?
posted by desuetude at 7:13 PM on May 14, 2013

Yeah, I'm confused. Conspire, are you saying that your risks actually increase by eliminating known infected partners?
posted by corb at 7:13 PM on May 14, 2013

HIV is one of those topics that metafilter doesn't do well.
posted by sevenyearlurk at 7:15 PM on May 14, 2013

Corb, I think Conspire is saying that having sex with a known HIV+ person who is taking medications to suppress his viral load is safer than having sex with someone who (falsely) believes himself to be HIV-, especially given that the virus is believed to be more readily transmittable by the recently seroconverted.
posted by roger ackroyd at 7:16 PM on May 14, 2013 [3 favorites]

No, honestly sevenyearlurk, that's not true. MeFi has talked about HIV in a number of contexts productively, calmly and without judgment. What MetaFilter doesn't do well is respond to hyperjudgy screeds on perceived animus. MeFi didn't start this conversation out poorly. The article writer started this out poorly by taking a big dump, passing out spoons and saying, "Dig in, assholes."

I can't even begin to understand his experiences. I was born the year GRID showed up. I didn't lose friends or partners or family members, though some family friends died of AIDS in the early 90s. Still, I can't imagine. The best I can do is imagine *the worst thing ever* and then try to multiply it by a hundred. And even that is fuzzy and unhelpful.

But even though I wasn't there, and even though I can't know what his experience has been like, I do know that we're all survivors. And there isn't a right or a wrong way to survive. You just do it, and you just do it the best you can. Culturally, we've turned "survival" into a fairy tale happy ending, but it isn't. Survival is ugly and hard and unpleasant and sometimes even morally sketchy. This writer is of the opinion that I'm Doing It Wrong. Sorry, bub. That's not how it works.

The thing MeFi doesn't do well is when people assume a lot about other people and then get all stroppy at them based on their own projected assumptions. This writer assumes a hell of a lot about what I think and feel about people with HIV. And he needs to slow his roll.
posted by jph at 8:24 PM on May 14, 2013 [3 favorites]

Also, from what I understand, HIV may not show in a blood sample, but may still be transmissible in semen. (Someone please correct me if I'm wrong.)

Viral load is generally higher in semen than in blood. However, viral load in blood is a very strong indicator of the likelihood of transmission. (And when people talk about someone having an 'undetectable viral load', I believe they mean in blood and semen or vaginal fluid.)

There is a school of thought that says HIV isn't sexually transmittable by people on antiretrovirals who've had an undetectable viral load for at least six months. Which seems like a pretty darn bold public health move if you're not sure you're right. Germany wasn't quite so bold and says transmission in such a circumstance is 'improbable'. Everyone else is sticking to 'use a condom'.
posted by hoyland at 8:30 PM on May 14, 2013 [1 favorite]

other STDs aren't treated like [HIV] in the law, and the law itself isn't even applied as written.

Syphilis used to be, before the advent of antibiotics.

If syphilis were to become antibiotic resistant and suddenly not have a treatment anymore, you would see the same attitudes return.

Actually, it would probably make attitudes towards HIV look pretty tolerant, because syphilis is pretty goddamn horrifying by comparison, and is much more infectious (chances of infecting from a single exposure).
posted by Kadin2048 at 8:30 PM on May 14, 2013

To clarify a little, I am talking about rate of HIV transmission in drawing my evidence from the papers linked, not individual risk of infection. While the two are certainly related, rate of HIV transmission for a population or sub-population says nothing about an individual person's risk within that (sub-)population. While we cannot say anything about an individual person's behavior or attitudes in these papers, we can say how a population, on average, tends to behave relative to others.

Think of it in terms of game theory. When talking about HIV transmission, serosorting on an individual level may seem smart, but we need to consider what happens when all of these individual decisions interact on a community level.

First, the key assumption by those who chose to serosort make is that they can tell between someone who is HIV+ and someone who is HIV-. However, this is a flawed assumption for two reasons. First, it assumes that someone with HIV is actually willing to disclose their status. Second, it assumes that someone who has HIV is actually aware of the fact that he has HIV - citing the paper at the bottom of my post, "MacKellar et al. [3] found that among young men who have sex with men who had disclosed as 'HIV negative', 6% had unknowingly seroconverted in the previous 6 months" and "individuals may erroneously believe themselves to be uninfected after a negative antibody test result, and disclose themselves as 'HIV negative' to sexual partners when, in fact, they are highly contagious."

Second, we can make certain assumptions about the behaviors and attitudes in sub-populations (divided by seroadaptive strategy) on average. Note again that this says nothing about each individual within the sub-population, but is merely talking about how the sub-populations tend to skew when averaged.

So looking at the way these two points interact, I can make several arguments:

1) On average, the sub-population of those serosorting will be less educated on HIV transmission than those seropositioning - this argument is based on the observation that seropositioning implies that the user of the strategy has knowledge of the mode and mechanism of transmission of HIV and furthermore may be aware of the relative risk factors of each seroadaptive strategy.

1a) I argue that education reduces the extent of negative attitudes towards HIV; given that stigma is a large factor in whether someone discloses their HIV status or not (regardless of the ethics), a less negative attitude towards HIV on average may increase the rate of disclosure of positive statuses.

1b) Furthermore, education and knowledge of mode and transmission may lead to less risky behaviors, including the mistake of inflating the assumption that one can tell if a partner is HIV+ or not.

2) On average, HIV goes undiagnosed for longer in sub-populations practicing serosorting, allowing for a greater time period in which individuals are on average, more infectious.

2a) I argue that users of serosorting tend to on average overestimate the effectiveness of the strategy. Furthermore, there is a greater prevalence of stigma attached to HIV within these subpopulations, dissuading testing. Thus, users of serosorting have on average, a lower frequency of testing.

Thus, serosorting may result in a greater rate of flawed identification of HIV than other strategies, both in terms of rate of disclosure and rate of identification of new infection. Another thing to consider is that human relationships resemble networks with pockets of density, so an infection may spread rapidly within those networks. Given that false identification is almost a given, a group's overall seroadaptive strategy may have an impact on the extent of HIV spread from incidences of false identification - I argue that based upon the above points I've made, groups that adhere to serosorting are not particularly effective at halting spread of HIV when speaking in terms of local density.

I will admit that most of these points are my inferences, but either way, the evidence suggests that serosorting is not a strong strategy, as the paper linked by en forme de poire earlier suggests. The paper is paywalled, but I have access to the paper from my academic institution - in a nutshell, the paper generally supports the arguments I've made above, saying that serosorting does not account for "unrecognized infections, treatment status and differences in infectivity by stage of infection", and thus actually increases rates of infection for riskier communities.
posted by Conspire at 8:40 PM on May 14, 2013 [3 favorites]

Corb, I think Conspire is saying that having sex with a known HIV+ person who is taking medications to suppress his viral load is safer than having sex with someone who (falsely) believes himself to be HIV-, especially given that the virus is believed to be more readily transmittable by the recently seroconverted.

Take Conspire's point to its logical conclusion though, and it suddenly seems ridiculous again. Are you supposed to assume everyone who tests negative is potentially positive? which, in this context comes off as "more likely dangerous than positive"

There's a big assumption which must be made here, which is that the other partners who tested negative have had lots of unprotected sex with people who could potentially be positive and not know it.

There's so many "this would have to be like that, and this would have to be facing this way" type of exceptions to this belief that its almost a strawman. Conspire is saying that having unprotected sex with someone who tested negative, who is also promiscuous and has unprotected sex regularly is more dangerous than having sex with someone you know is in treatment and HIV+.

I can't even come up with a good analogy for that. It's basically saying "doing this one dangerous thing is more dangerous than this other thing that people generally regard as dangerous".

What about the plenty of people out there(once again, all genders and orientations) who both themselves, and their partners have only had protected sex with 1-2 people, or who haven't had unprotected sex with a new partner for six months before the beginning of the relationship, etc.

I mean yes what you say is true, but this is borderline "aha! There weren't gas chambers at auschwitz!" Level positioning and framing the debate here and it kinda upsets me.

It may be safer if the alternative is only having sex with that one category of partners in that one way, but that circle doesn't include a hell of a lot of people. "Wait 4 months after the beginning of a relationship and get tested again before you have unprotected sex" is just as good of advice.
posted by emptythought at 8:46 PM on May 14, 2013

I'm not having sex as a community; I'm having sex as myself. As such, I most certainly will have better odds of avoiding infection if I eliminate everyone who tests positive for STDs and *then* being aware that a reduced number of the remaining pool may have hidden infections and taking precautions accordingly.

I am utterly creeped out by the idea that I owe people blind sex because it's "better for the community" or because it might hurt someone's feelings if I say no. This isn't vaccinations. This isn't medical care. No one requires sex, and if you don't get as much as you would like because I choose to be careful -- that's your issue, not mine.
posted by tavella at 8:51 PM on May 14, 2013 [2 favorites]

Who are you talking to? I mean, literally, who? Because no one in this conversation has even suggested that they would not tell their partner they were HIV-negative. I'm not even sure why someone would want to conceal that fact.

You, as it happens. Read my comment again. Particularly the first paragraph.

I am utterly creeped out by the idea that I owe people blind sex because it's "better for the community" or because it might hurt someone's feelings if I say no.

Where on earth did you conclude that was what anyone was saying?
posted by hoyland at 8:53 PM on May 14, 2013

I'm didn't write my post in reference to you personally, tavella, and I sincerely do believe that you've done well enough to inform yourself on the issue that you can, as an individual, make decisions to minimize your risk of HIV within your own context. However, the data from the papers cited as of far do suggest that serosorting is an ineffective strategy relative to other strategies, and may in fact increase rates of HIV transmission, so I am offering my interpretation as to why. Given that the FFP is talking about stigma and how it effects transmission on a community basis, I find it more relevant to talk about HIV transmission from a community standpoint than arguing about the reasons behind each individual person's decisions.

And I would also like to point out that no one is saying that you "owe people blind sex." I would encourage you to read my post closer - in no incidence did I make any value judgments on what's "good for the community" or "hurting people's feelings". I hope you aren't offended by my interest in and attempts to analyze how individual decisions stack to form a cohesive landscape - which, like it or not, you, as an individual, conducting your individual actions, do contribute to.
posted by Conspire at 9:04 PM on May 14, 2013 [2 favorites]

hoyland, that would be the people who keep announcing that my extremely rational decision not to have sex with people who have STDs is because I am unfairly stigmatizing them. Or that having sex with people who have STDs will somehow reduce my odds of getting them, so it's clearly not a rational decision.
posted by tavella at 9:25 PM on May 14, 2013 [1 favorite]

But we're not talking about you?
posted by Conspire at 9:29 PM on May 14, 2013

When people talk about the class of people who include me, then people are talking about me. For example, "people not wanting to have sex with you *just* because of your HIV status is actually stigma at work" above. If you are HIV positive, I don't want to have sex with you, because it is not worth the increased risk to me. That's not me stigmatizing you, that's me assessing the risks. Your misfortune is not my moral obligation.
posted by tavella at 9:38 PM on May 14, 2013 [4 favorites]

> hoyland, that would be the people who keep announcing that my extremely rational decision not to have sex with people who have STDs is because I am unfairly stigmatizing them.

Could you show us where people keep announcing this?
posted by desuetude at 9:43 PM on May 14, 2013

I quote, again: "people not wanting to have sex with you *just* because of your HIV status is actually stigma at work"
posted by tavella at 9:47 PM on May 14, 2013

My interpretation of that quote (even taken out of context, as you have done) is that it's pointing out how stigma artificially conflates the perceived importance of HIV status for many people. Which is to say, if you had a partner who was perfect in every way except he was HIV+, but still willing to sit down with you, discuss risks and develop strategies with you, and your reaction was just to shut everything down, there's a pretty good chance that stigma has a role in it. Am I correct, rtha?

I'm sorry that you're interpreting everything we say as a personal attack. How do you suggest we censor ourselves when discussing this highly relevant and important issue in our community so we don't hurt your feelings?
posted by Conspire at 11:40 PM on May 14, 2013 [2 favorites]

Correct, Conspire. Thank you for your patience in this thread.
posted by rtha at 5:45 AM on May 15, 2013

Which is to say, if you had a partner who was perfect in every way except he was HIV+, but still willing to sit down with you, discuss risks and develop strategies with you, and your reaction was just to shut everything down, there's a pretty good chance that stigma has a role in it.

So there's this thing that I just cannot understand, and it's the level of defensiveness over STDs - the idea that STDs are the one thing that it is not morally just to sort for - even as people suggest that it's morally okay to, say, sort against Glenn Beck-quoters, or what have you.

Conspire, as I'm reading you (and I am having a weird time based on your use of the word 'serosorting'), you're saying that it is not useful to make your sex choices based around who is identified as HIV positive because it is possible for HIV to not show up in blood for up to three months after infection and transmissability? Is this accurate? And if so, wouldn't an effective strategy be education that people need to wait three months between partners to test and be sure, while still refusing to have sex with people identified with HIV?

Also, on a societal level, it is possible that refusing to have sex with people who are identified as HIV positive (by either blood test or self-admission) will lead to higher levels of social ostracism for those who are HIV positive. But isn't it also possible that refusing to have sex or other contact with individuals who are HIV positive will also have the effect of virtually eliminating the virus in time, by narrowing and eventually containing its transmission? Wouldn't that also be a societal good overall? It seems that you are wanting to trade one societal good for another one, and thinking yours is more morally right - but why?

On an individual level, which you did not answer, I think it's very clear that refusing to have sex with people identified as HIV positive is a good strategy - particularly when combined with other strategies. It's true that a lot of people think that they don't need to use other strategies as well, but that's an education issue - and possibly a finance issue. When we have a vaccine that lowers HIV risk and we still aren't using it, it's certainly hard for me to take HIV prevention efforts in this country seriously, and I can understand frustration. But I don't understand this anger at people who are only taking sensible measures to protect themselves.

A partner who is perfect in every way except he is HIV+ is like a partner who is perfect in every way except he is sterile, or perfect in every way except he is married, or perfect in every way except that he is unemployed, or perfect in every way except that he hates cats, or perfect in every way except that he has a history of alcoholism, or a host of other things that it is completely legitimate to make relationship decisions based on. I don't think anyone except extremists would say that you were engaging in anti-sterility bigotry, or anti-cat-hater bigotry, or anti-married-dude bigotry - they would just say that you have your preferences and choices and that is what they are.

These things do not necessarily take place because of "stigma", they often take place because everyone makes their own decisions about what will make them happy in life.
posted by corb at 6:06 AM on May 15, 2013 [6 favorites]

What corb said. It's just bizarre that some are trying to cast "Do I want to have sex with them? Hmm, has a lethal illness that I may acquire, yeah, no" as unjust and immoral discrimination.
posted by tavella at 6:19 AM on May 15, 2013

Not quite, corb. At least, at a societal level, what folks are saying is that known HIV status is a poor indicator of who is actually HIV+ - so that it's not likely to reduce or eliminate (will actually increase!) the transmission of the virus. And I would guess that is just because human behavior being what it is, there are too many variables involved to really have this be a good policy.

I think, basically, we have created an externality here in our sex economics. Because people have placed such a high emphasis on "status" they've created incentives for people (on both sides of that status, mind you) to engage in riskier behavior. That *is* stigma, and I don't disagree with that assessment. We took a big social highlighter and marked up a whole group of people and said "DO NOT TOUCH."

There is probably a really good analogy here with Abstinence Only Sex Education. AOSE is based on this theory that you cannot get pregnant or disease if you never have sex. Independent of how questionable that assumption is, we've identified a lot of ways that AOSE just absolutely fails to prepare people for the realities of life. That's where a combination approach comes in, where you teach about human reproduction, you teach about safer sex methods, and you include abstinence as one-method-which-oh-by-the-way-works-best-when-combined-with-other-methods-and-also-please-have-a-backup-plan-because-we-all-basically-know-about-the-best-laid-plans-of-mice-and-men-and-teenagers-fooling-around-on-spring-break-mmmkay.

Where I part ways with this whole discussion of stigma is where some kind of personal animus is ascribed to my decision not to have sex with people who are HIV+. Sorry. This isn't about YOU. This is about me. And this is one decision (of many!) that I have made about my health. And I'm allowed to make those choices.
posted by jph at 7:11 AM on May 15, 2013

I would love to live in a world where everyone has perfect knowledge, and perfect risk-assessment skills. I would love to live in a world where no one is in denial, or lies, or chooses out of fear to not know. I would love to live in a world where everyone has good communication skills. I would love to live in a world where people acknowledge that attitudes and actions they hold or take as individuals can and do have a wider affect on the community. If we lived in that world, this discussion would be impossible, because HIV would never have gotten enough of a foothold to become an epidemic.
posted by rtha at 7:17 AM on May 15, 2013 [1 favorite]

But isn't it also possible that refusing to have sex or other contact with individuals who are HIV positive will also have the effect of virtually eliminating the virus in time, by narrowing and eventually containing its transmission?

No, because some people will make a calculation that HIV exposure risk is a risk worth accepting because their personal circumstances don't offer any other options. From a public health perspective, there will always be people who are going to be exposed to HIV, whether through ignorance or simply the calculation that remaining in a relationship that exposes one to risks is preferable to homelessness, destitution, loneliness, etc.. That's going to be a reality.

What's also a reality is having HIV+ status mark you with a "don't go there" stigma for a lot of people. That's reality, and if it were possible to change public perceptions over to "no stigma", you could also convince people not to have sex before marriage (where available), making, once again, the stigma issue a moot one.
posted by deanc at 7:40 AM on May 15, 2013

> I quote, again: "people not wanting to have sex with you *just* because of your HIV status is actually stigma at work"

This is not an example of "people who keep announcing that my extremely rational decision not to have sex with people who have STDs is because I am unfairly stigmatizing them." This is an example of how we're discussing stigma as a concept because it's the subject of the article.

The article isn't just (or even primarily) about choosing sex partners, it's about how people are treating each other in their everyday social lives. Don't you have friends in your social circles who you've ruled out as sex partners for one reason or another?

A stigma is a sign, a mark. What the article is talking about is social behavior which says "I don't want to have to risk meeting someone in a social setting and then finding out that I would have to acknowledge HIV, so let's mark 'THEM' so that we know to just completely avoid getting to know any of 'those people' in any context."
posted by desuetude at 9:10 AM on May 15, 2013

A stigma is a sign, a mark. What the article is talking about is social behavior which says "I don't want to have to risk meeting someone in a social setting and then finding out that I would have to acknowledge HIV, so let's mark 'THEM' so that we know to just completely avoid getting to know any of 'those people' in any context."

That's legitimate - but then it does need to be separated from the concept of any decision not to have sex with an HIV infected individual being based on stigma. That is the thing that people are reacting to and being offended by - as well as the implied idea that since HIV infected individuals face such "stigma" upon disclosure, they are morally entitled not to be honest about their HIV status while attempting to obtain sex.

The fact that so many people seem to be twisting so hard to avoid saying, "Yes, you personally are probably safer from infection by refusing to sleep with HIV infected people, but I think promoting that as a policy has dangerous implications" just kind of throws gas on the fire.
posted by corb at 9:20 AM on May 15, 2013

The point is not that any individual doesn't have the right to say they don't want to have sex with an HIV+ partner - that would be crazy. The point is that many people who are HIV- could stand to educate themselves about what the actual risks are of being with an HIV+ partner, especially when using multiple levels of protection, like PrEP and condoms, and how large and serious these risks would be in relation to other risks they already take in their lives. Speaking as a gay dude (for whom one in five potential partners might be HIV+) it is really hard to disentangle rational from irrational fears about things like HIV, and to be honest I am definitely not there myself. But I do think it's worth encouraging people to make a fair attempt to think it through and to try to parse out for themselves how much of what they're responding to is fact and how much is panic.
posted by en forme de poire at 9:28 AM on May 15, 2013 [1 favorite]

That is the thing that people are reacting to and being offended by - as well as the implied idea that since HIV infected individuals face such "stigma" upon disclosure, they are morally entitled not to be honest about their HIV status while attempting to obtain sex.

No one's said that, though, including the original article. I'm not really sure why you've put stigma in quotation marks, though.
posted by hoyland at 9:45 AM on May 15, 2013 [1 favorite]

The original article is problematic, because it makes a lot of damning assertions without any actual data. Even personal anecdotes would be more compelling.
posted by roger ackroyd at 10:07 AM on May 15, 2013 [1 favorite]

I see that the decision not to have sex with HIV carriers is indeed valid, and I have no qualms against that - it's up to the person for sure. I also do believe that serosorting when it stands independently from its associated traits, does result in a lower rate of transmission. However, the thing is - things don't exist in a vacuum. The population of serosorters - as I've argued above, on average are less educated on HIV and are on average more negative towards HIV. And as the evidence proves, these two factors have a much greater impact on rate of transmission, effectively undoing any decrease in rate on a community level caused by serosorting. Thus, my gripe against serosorting on a community (again, not on an individual!) level is that it's a strategy that's informed by stigma, which negatively affects education and attitudes. Serosorting itself is fine, but we have to understand on a community level, it's a package deal.

Speaking personally, the thing that scares me most about HIV is not the prognosis these days given the toolset we have to manage progression of HIV, but social attitudes towards HIV. If I were to ever get it - a possibility given my high risk group - I would see a greater decrease in quality of life from the social otracization and stigma than I would from management of what is truthfully, a chronic disease these days. I think that's enough reason for me to try to follow the golden rule and do my part to reduce as much stigma in the community on a personal level as I can.
posted by Conspire at 10:15 AM on May 15, 2013 [1 favorite]

I quote, again: "people not wanting to have sex with you *just* because of your HIV status is actually stigma at work"

I'm no longer quite so pissed off, which is why I've come back to the thread. It occurred to me on my commute this morning that you seem to be understanding 'your attitude is a product of stigma surrounding HIV' as 'you are a bigot', much like people often understand being told their behaviour is racist as being told they're a bad person. As an example, I grew up in and around Chicago, which is incredibly segregated and with that segregation comes racism. You know when you're in the 'wrong' place because people will react to your presence, though their reaction varies with your race. I know I do this too, because I've caught myself doing it. Is it racist? Yes, of course. Does it make me a terrible person? Hopefully not. I want to recognise when I'm doing or thinking something because it's part of Chicago's racism and not because it's rational.

It's totally okay for you not to sleep with someone who's HIV+. However, it's really not totally rational. Yes, if you have sex with someone who's positive with appropriate precautions, there's some non-zero risk of transmission, basically by definition. Functionally, though, that risk is really low. It's stigma around HIV that's leading you to (seemingly anyway) perceive that risk as much greater than it is. Like en forme de poire, I'll totally own up to being able to write this comment saying "Look, the functional risk is pretty darn small" and not fully knowing how I feel assuming that risk. I also know that my feelings aren't rational. After all, when are feelings ever rational?
posted by hoyland at 10:31 AM on May 15, 2013 [1 favorite]

I think that's enough reason for me to try to follow the golden rule and do my part to reduce as much stigma in the community on a personal level as I can.

Which is great. I hope this comes off as helpful when I say that a lot of what you're saying here sounds like research for a Freakonomics article, and not particularly convincing on a personal level. If you want to change minds, talk about your experiences with serodiscordant sex, and how it wasn't a big deal.

(btw, my personal rule about sex is summarized here. I think sex is usually hotter AND safer when you take time to get to know someone before you sleep together. But I'm old fashioned that way.)
posted by roger ackroyd at 10:38 AM on May 15, 2013

It's totally okay for you not to sleep with someone who's HIV+. However, it's really not totally rational. Yes, if you have sex with someone who's positive with appropriate precautions, there's some non-zero risk of transmission, basically by definition. Functionally, though, that risk is really low. It's stigma around HIV that's leading you to (seemingly anyway) perceive that risk as much greater than it is.

I guess what I'm trying to say is two-part: first, sex doesn't have to be rational, and I think it's okay to examine someone's desire for sex outside of cultural contexts. Secondly, though, that it is okay for some people to assume that even that low risk is too much for them - that they would much rather limit their risk still further. I feel like a lot of people are saying "It's totally low risk, so what's your issue?" rather than saying, "It's totally low risk, but if you still want to wall off that risk, it's OK."

However, I think it's also okay to say that part of the risk you are assuming is, in fact, as noted above, your own treatment by other people. And that might be the part of the risk that people are unwilling to assume. Having to tell every sex partner that you have an STD. Being segregated in various areas. Having people freak out. And it is totally legitimate to say that some of those things suck and should be eliminated - but not at the expense of saying people /have/ to change their preferences.

Does that make sense? It's a little disjointed, I know.
posted by corb at 10:55 AM on May 15, 2013

If you want to change minds, talk about your experiences with serodiscordant sex, and how it wasn't a big deal.

I have had some serodiscordant sex, and while the rational part of my brain realized it wasn't a risky activity, it was still, in some ways, a big deal for me. That sex has been, for the most part, either me as the top (using a condom), or getting a blow job from someone with HIV. As far as I know, it's basically impossible for me to get HIV engaging in either of those activities.

Even though it's probably not totally rational, I still mostly avoid having sex with people who have HIV, even if I am engaging in those seemingly no risk or low-risk activities. I've been trying to make an effort lately not to use HIV status as an automatic dealbreaker with someone I might date or have sex with.

While I respect the right of all individuals to make their own decisions, I think the net effect of all of our choices has been this stigma around HIV (described in the article) that is making things worse (i.e. people not getting tested who should be getting tested, people who have HIV engaging in reckless behavior, and people not disclosing who should be disclosing).
posted by andoatnp at 11:04 AM on May 15, 2013 [1 favorite]

It's totally okay for you not to sleep with someone who's HIV+. However, it's really not totally rational.

It's completely irrational, provided that you're using protection.
posted by roomthreeseventeen at 12:19 PM on May 15, 2013

Its a risk that my friend accepted was part of the burden of being infected. I've seen him heart broken but there's nothing you can do. He's got a good boyfriend now.
posted by infini at 12:22 PM on May 15, 2013

> That's legitimate - but then it does need to be separated from the concept of any decision not to have sex with an HIV infected individual being based on stigma.

Yeah, I said that already a few times. Like here:

> The writer's point isn't to castigate those who don't want to have sex with HIV-positive people. He's criticizing the use of broad-based generalities and assumptions to sort people with HIV into a caste system for ease of blanket judgement, rather than regarding them as individual human beings.

And here:

> No. The point is that it is perfectly fine to not want to expose yourself to HIV without going out of your way to be a holier-than-thou jerk to everyone who has HIV.

posted by desuetude at 12:26 PM on May 15, 2013

roomthreeseventeen: Condoms reduce the risk of infection by 80-85 percent. They most certainly are not absolute protection. Again, calling the choice to not deliberately expose yourself to a lethal illness (or my case, any STD) "irrational" is exactly why this thread pisses me off so much.
posted by tavella at 1:11 PM on May 15, 2013 [4 favorites]

I must agree. It's not irrational to wish to avoid a lethal illness (even if for many people modern medications turn it into a chronic illness treatable with a cocktail of hardcore drugs with serious side effects) even if you can reduce the risk of transmission by 85%. Hell, people on AskMe are regularly told it's not irrational for them to wish to avoid intercourse with someone who has HPV. And that's a paper cut compared to HIV.
posted by Justinian at 1:39 PM on May 15, 2013 [4 favorites]

It's not irrational to wish to avoid a lethal illness (even if for many people modern medications turn it into a chronic illness treatable with a cocktail of hardcore drugs with serious side effects) even if you can reduce the risk of transmission by 85%.

It is also not a crazy, irresponsible risk to make the opposite decision. The risk of transmission has been estimated at between 0 and 1% per person per year, which is in the same general ballpark as unwanted pregnancy with condom use. This rate could get even lower as post- or pre-exposure prophylaxis get more common: PrEP in particular also drops the rate of seroconversion 90% even for people who aren't totally compliant (by a mechanism which is independent from condom use). Then there's also seropositioning, choosing safer sex acts more often, minimizing user-error in condom use, etc.
posted by en forme de poire at 2:06 PM on May 15, 2013

The most irrational thing I've seen expressed in this thread is the idea that [this set of personal decisions made by an individual] are purely personal and don't have any effects on the wider world, because reasons. But [this other set of personal decisions made by an individual] totally have effects, because reasons.

The decisions you make, and the reasons you make them the way you do, don't happen in a vacuum. It's completely possible to keep making your same decisions while acknowledging that yes, they do have a wider effect, and that effect may be at least in part, negative. And to be very, very clear, this doesn't make you worse than [the worst person ever]. It just makes you human.

But as we can see in many, many contexts, denial is an extremely powerful force. It can overwhelm even the impulse to do what one knows is the good thing to do.
posted by rtha at 2:14 PM on May 15, 2013 [4 favorites]

the thing that scares me most about HIV is not the prognosis these days given the toolset we have to manage progression of HIV, but social attitudes towards HIV.

It's nice to have money.
posted by ThatFuzzyBastard at 3:06 PM on May 15, 2013

It's nice of you to make assumptions about what country I live in.

Although that does bring up a valid point. I wonder if differences between healthcare/insurance systems between countries contribute to differences in attitudes towards HIV?
posted by Conspire at 3:28 PM on May 15, 2013 [1 favorite]

Patents on current HIV medications are also set to expire over the next five years. (In addition to making treatment a lot cheaper it will probably have a pretty dramatic effect on the prevalence of PEP/PrEP.)
posted by en forme de poire at 3:36 PM on May 15, 2013

It's nice to have money.

What are you trying to say here?
posted by rtha at 3:41 PM on May 15, 2013

It is also not a crazy, irresponsible risk to make the opposite decision.

I definitely agree.
posted by Justinian at 3:44 PM on May 15, 2013

What are you trying to say here?

That being able to regard HIV as a managable condition rather than an existential threat is very much an expression of wealth, privilege, or at the very least a fine insurance system that you're happy to pull from.
posted by ThatFuzzyBastard at 4:10 PM on May 15, 2013

Okay. How does saying something that reads to me as awfully sneering helpful in any way? It also reads to me as incredibly and unnecessarily dismissive of the kind of social stigma that the link argues there needs to be less of. The consequence of the fear of social stigma is not just fewer dates. It is fewer people getting tested, getting treated, and getting the skills and support needed to communicate about their status effectively.
posted by rtha at 4:22 PM on May 15, 2013

Even in the bootstrappy, insurance-impaired USA, HIV medication is covered by Medicaid. In fact, Medicaid covers HIV medication for around 50% of the HIV+ population of the USA. People on Medicaid are generally not considered particularly economically privileged by US standards.
posted by en forme de poire at 4:44 PM on May 15, 2013

I make literally 22k a year, so can we please hold off on accusing me of class-ism because I still am inclined to think that the social stigma of HIV outweighs the physical aspects of it? I mean, I understand that I am privileged to live in a country that, you know, actually respects basic medical care and preventative medicine as a human right, but can I just express the least bit of frustration at how US-centric Metafilter can be at times? As relevant as it may potentially be to discussing the issue of stigma, do we really need to make this into another debate on the American medical system? Or even worse, assume that to be an adequate baseline to start our discussions at?
posted by Conspire at 4:48 PM on May 15, 2013 [1 favorite]

Before you accuse people of bad, mean, naughty stigmatizing for wanting to reduce their HIV risk, you should perhaps consider what contracting HIV means for people who aren't you.
posted by ThatFuzzyBastard at 11:35 PM on May 15, 2013

Before you accuse people of bad, mean, naughty stigmatizing for wanting to reduce their HIV risk,

I may have missed it, so could you link to where Conspire accuses people of being bad, mean, and naughty? Or is it just impossible for you to discuss this subject without being hyberbolic and dismissive of other peoples' points?
posted by rtha at 5:44 AM on May 16, 2013 [1 favorite]

Re-read his post. Conspire wasn't trying to make a blanket statement, he was talking about how for him the social implications would be the hardest part of HIV infection to bear, and that this made him personally - again, not prescriptively - rethink some of his attitudes about serodiscordant sex. The fact that you couldn't even allow someone to say this without making sure they felt guilty about it is actually a pretty good illustration of what we're talking about here.
posted by en forme de poire at 8:37 AM on May 16, 2013

It is also not a crazy, irresponsible risk to make the opposite decision. The risk of transmission has been estimated at between 0 and 1% per person per year, which is in the same general ballpark as unwanted pregnancy with condom use.

Sure. And no one is saying that it is crazy and irresponsible to take that risk - it is a different choice for different people who are not me, and not tavella. But to be told it is "completely irrational" to refuse to sleep with people who have HIV is not okay, and that response is what is prompting a lot of the blowback.

It is okay if a risk that is less than 1% is still too much risk for someone, and it is not irrational to make that choice.
posted by corb at 8:43 AM on May 16, 2013 [2 favorites]

The most irrational thing I've seen expressed in this thread is the idea that [this set of personal decisions made by an individual] are purely personal and don't have any effects on the wider world, because reasons.

When we have spent a lot of time explaining that the most important ethical attitudes and concerns, particularly with regard to sex, are one's personal autonomy over one's body and the idea of informed, honest, personal consent then, yes, you're going to see people prioritize that over other concerns, such as whether that promotes a "culture" or "stigma."

Possibly being someone that many people don't want to have sex with puts you in a difficult social category, but, once again, if you think you can change people's attitudes so radically to believe that you can convince them to de-stigmatize, for sexual purposes, an incurable, potentially deadly infection, then you should also be open to the idea of changing attitudes about social ostracization or sexual ethics in general. Not being an option for sex shouldn't make you a social pariah-- people have all sorts of reasons not to have sex with someone. Maybe that's the underlying problem, here.
posted by deanc at 8:49 AM on May 16, 2013 [2 favorites]

if you think you can change people's attitudes so radically to believe that you can convince them to de-stigmatize, for sexual purposes, an incurable, potentially deadly infection,

But this attitude is possible! It has and is already happening! It's taken more than 30 years of research and education and improving treatment options, but it's happening. It's not a completed process and probably never can be, but the progress that has been made in many countries and cultures is undeniable.

then you should also be open to the idea of changing attitudes about social ostracization or sexual ethics in general.

Who says I'm not (or we're not, in case you're not addressing just me)? If I've indicated anywhere here that I am not open to this, I apologize for not being more clear. In my experience and from personal observation, stigma around STDs in general and HIV in particular is not some special, separate thing over there that is unconnected from many other forms of stigma (around actual or perceived class, race, drug user status, etc.).
posted by rtha at 8:56 AM on May 16, 2013 [3 favorites]

While I appreciate you trying to teach me a moral lesson, your actions are just baffling me. I was very careful to avoid value statements and judgments, because truthfully, the issue is a very complex one that operates at multiple levels with many individual stakeholders, none individually at fault or obligated to action.

If I were to say, "none of us are individually at fault for global warming, but we all contribute to the bucket. We can take steps forward by better education and encouraging more rational assessments of how much individual actions benefit, risk and harm," would your reaction be "poor people can't afford fancy lightbulbs! Therefore, you're being class-ist!"?

Really, drop the oppression olympics. There is always going to be someone more disproportionately affected by a circumstance, but it really isn't helpful to squelch conversation about issues at every twist and turn by screaming that we're not being all-encompassing - which we will never be unless we're talking about the vaguest of generalities. I admit that I have my blindspots - but so do you when you effectively erased my class and racial background to make a moral point. Moral masturbation by playing social justice warrior on the internet might feel really good, but are you actually doing anything to helpfully point out anyone's privilege, or are you just arrogantly ignoring your own?
posted by Conspire at 9:16 AM on May 16, 2013 [4 favorites]

If I were to say, "none of us are individually at fault for global warming, but we all contribute to the bucket. We can take steps forward by better education and encouraging more rational assessments of how much individual actions benefit, risk and harm," would your reaction be "poor people can't afford fancy lightbulbs! Therefore, you're being class-ist!"?

Conspire, I think everyone is talking past each other. What seems fundamentally rational and logical to some seems crazy to others.

Springing off the global warming analogy, when I listen to you, the logic of your argument seems to be, "buying CFLs creates a stigma against incandescents and ends up just promoting global warming!" Similarly, if you were to place the blame for global warming on, say, people who chose to buy Toyota Priuses for "stigmatizing" SUV drivers and people who relied on oil heat and thus, counterintuitively, hurting the cause of fighting climate change, I'd find your claims a bit difficult to deal with. There are drivers who consistently say that it is the bicyclists who, by "flaunting" their bicycling ways, are acting arrogantly towards drivers and thus hurting the cause of better bicycle infrastructure and safety. These arguments are rightfully regarded as ridiculous. And your claims for the "greater good" associated with not considered HIV+ status a "do not have sex with" red flag is scientifically dubious, anyway!

The problem seems to be that being considered a non-option sexually because of your HIV status would make you a social pariah. Why not consider that the fundamental issue? Instead of focusing on changing the culture to get them to embrace a belief that is fundamentally irrational (ie, that there should be no sexual "stigma" attached to someone with HIV. Of course there is, and that is a fundamental starting point towards protecting your sexual health), that is where you should devote your energy when it comes to cultural change.
posted by deanc at 11:31 AM on May 16, 2013 [2 favorites]

Because you are treating my choice not to have sex as something you get to cast moral aspersions on. And that is not the same as criticizing my choice in lightbulbs. My body is not a public resource.
posted by tavella at 11:32 AM on May 16, 2013 [2 favorites]

But in your analogy, you misinterpret my claims. Again, I'm not arguing that serosorting in isolation is a harmful strategy, I'm arguing that the attributes that tend to inform serosorting have deleterious effects that end up counteracting the positive benefits of serosorting - which again, the evidence and papers cited in this post DO suggest. A better analogy would be, what if there was a defect that affected 6% of Priuses causing them to emit more carbon dioxide than SUVs, but Prius owners were too secure in their ownership of the car to test their car for the defect? Or what if there was an even more efficient and cheaper model of car out there, but the social status of owning a Prius meant that said model was overlooked? Or what if ownership of Prius on a community level interacted in a way such that it put every Prius owner at greater risk of environmental damage? The last point is dubious, but that just shows how you can't really extend a global warming analogy to cover all aspects of a public health issue.

We're trying to operate in an ideal world where the decision to serosort operates independently of education and socially informed attitudes, but that doesn't happen. Serosorting itself is not an irrational strategy by any means, but we have to look at the methods individuals use to come to their decision to serosort; and a decision founded on lack of education and stigma IS irrational regardless of whether the decision ends up being correct or not.

So you seem to be assuming that my argument is "we should stop serosorting for the greater good!" No, what I'm saying is "serosorting based on stigma is what we have right now as a stop-gap strategy that isn't as effective in the long run because people are scared and misinformed and we need to work against the source of that." I say serosorting based on stigma, and that's very important because there's fundamentally a difference between that, and serosorting based on rational assessment of evidence. So I don't see a difference between your stated goal and mine's at all.
posted by Conspire at 12:03 PM on May 16, 2013

I say serosorting based on stigma, and that's very important because there's fundamentally a difference between that, and serosorting based on rational assessment of evidence.

See, this is the problem right there. You're assuming both that these two groups exist, and that you can tell the difference between them.

I get the feeling you're thinking people choose not to have sex with HIV positive individuals because "Ick, they're dirty and yucky and who would ever sleep with one of THEM" type behavior. But that might all be in your head - there's no outward difference between that and "Wish I could, but this is beyond my acceptable risk factors."

People who do the latter are getting outraged because you seem to be putting them in the former category when they are in the latter.
posted by corb at 12:12 PM on May 16, 2013 [2 favorites]

And yet it's quite disingenuous to claim that serosorting based on stigma doesn't exist and isn't quite widespread, based on both anecdotes and evidences. Even discounting the stories in the FPP, how else do you explain the papers cited in this thread that do show that serosorting is ineffective and in some cases, even harms communities by increasing rates of HIV transmission? If the strategy, as you claim, reduces rate of transmission - which, again, as a stand-alone force, I do not dispute - what is counteracting the effectiveness of serosorting?

I don't claim to be able to tell the reasons why people serosort on an individual basis, which again, I've repeatedly emphasized, so I'd like to respectfully suggest that anyone who interprets what I say as personally categorizing them is deciding that for themselves, and needs to determine why they're so inclined to view my comments as a personal treatise on them. Furthermore, I cannot understand this backlash against the suggestion that one's actions may be at least partially informed by stigma. Stigma is a cultural force, and it doesn't mean that one is "weak" or "stupid" for being subject to it. Nor can I understand the idea that it's binary - you're either informed by stigma or you're not - because it's always there in the background. I think it's a great idea to be aware of how social and cultural attitudes inform my biases so I can work to inform myself and fall back on more objective measures than just my intuition.
posted by Conspire at 12:34 PM on May 16, 2013

Because you are treating my choice not to have sex as something you get to cast moral aspersions on.

Can you show me where Conspire has cast moral aspersions on you, or on anyone in this thread who has said they would prefer to not have sex with someone who is known to have HIV?

Conspire, I think everyone is talking past each other.

I disagree. I think some people who are choosing to interpret a statement like "Serosorting is not necessarily the most effective way to prevent infection" as "Those of you who serosort are shitty people who discriminate for no good reason."

That's not "talking past" each other. That's a misreading of epic proportion, and I don't know if it comes from some kind of extreme defensiveness or what, and I don't really care. I care that people stop accusing people of saying things they haven't said.
posted by rtha at 12:52 PM on May 16, 2013 [4 favorites]

And yet it's quite disingenuous to claim that serosorting based on stigma doesn't exist and isn't quite widespread, based on both anecdotes and evidences. Even discounting the stories in the FPP, how else do you explain the papers cited in this thread that do show that serosorting is ineffective and in some cases, even harms communities by increasing rates of HIV transmission? If the strategy, as you claim, reduces rate of transmission - which, again, as a stand-alone force, I do not dispute - what is counteracting the effectiveness of serosorting?

Okay, first of all: When you use the phrase "serosorting" - a phrase that very few people use or understand, and that the people you are arguing with do not use at all and one person at least has asked you to use less - you appear to be not trying very hard to actually cross bridges. There's a phrase for it that I can't recall - using very specific technical in-group talk as way of excluding others from the discussion. I can't recall it at the time, but it is pretty irritating when it happens. Let's talk in the Queen's English that we commonly understand.

It is not obvious that people refusing to have sex with HIV positive people do so on a widespread basis because they think they're dirty, bad people. The author of the FPP may think so, but he doesn't cite sources. If you want to say a claim like that, you need to cite sources.

The same with the claim that "serosorting is ineffective"or "increases transmission"- you need to cite actual papers that say that, not the abstract of a paper that may say that.
posted by corb at 1:14 PM on May 16, 2013

I'm using the term serosorting because it's value-neutral, and like I said, I'm not trying to pass judgment on individuals. I could reduce it to a more clunkier phrase like "men who choose not to have sex with HIV+ men", or "men who don't have sex with HIV+ men", but as you can see, the two terms differ in their connotations and pass subtle judgment. Or would you prefer me to use a loaded phrase, so you can then attack me for being judgmental?

There have been at least three papers cited in this thread, only the one you mentioned paywalled - and the abstract still does clearly state the conclusion. Furthermore, the statistical evidence cited only serves to build upon and lend credence to personal anecdote, the FPP included. I believe the premises that I've used to build my argument to be valid, and I decline an argument over quantity of sources especially when you seem to be confronting me with an attack on my premises merely to rationalize your reflexive feelings against the argument I am posing.

Why are you so desperate to grasp at every perceived slight of mine's to prove that I'm a horrible person who's deliberately trying to manufacture arguments?
posted by Conspire at 1:55 PM on May 16, 2013 [1 favorite]

Okay, first of all: When you use the phrase "serosorting" - a phrase that very few people use or understand, and that the people you are arguing with do not use at all and one person at least has asked you to use less - you appear to be not trying very hard to actually cross bridges.

To be absolutely clear, that person is you. Nobody else has mentioned they have a problem with this word, at least not in this thread. But anyway, "serosorting" refers to choosing HIV- partners if you are HIV- and HIV+ partners if you are HIV+. Often this is for the purposes of having unprotected sex, but you can also serosort and use condoms. "Serodiscordant" refers to a couple where one member is HIV+ and HIV-. "Seroconverting" is the process of going from testing HIV- to testing HIV+ at some point after infection. These are pretty useful words in this particular conversation and I think will make having the conversation a lot easier all around.

It is not obvious that people refusing to have sex with HIV positive people do so on a widespread basis because they think they're dirty, bad people. The author of the FPP may think so, but he doesn't cite sources. If you want to say a claim like that, you need to cite sources.

I think what you and possibly others may be missing here is that the author thinks so because he has thought these things himself. The entire framing device is about internalized shame and stigma: "I can hear my own tones in it, like a voice in a chorus, when it says the words I would never admit to thinking. Do you hear your own?" And yes, I definitely recognized a lot of what he was saying both from other people's mouths (I've heard several people say, for example, "I have no sympathy for people who contract HIV today") and from my own thoughts. I think it would be hard to grow up gay in this time period and not end up internalizing a lot of fear and moral panic about HIV, some of which may not ultimately be protective, or useful, or accurate.

I know this is true about homophobia more generally: even as a gay dude who's been out for the last twelve years or so, I have certainly internalized a lot of ideas about gay people (and about gender) that were rooted in stereotypes that I now believe to be actively harmful, and I've had to admit to myself that these internalized ideas may still be influencing me in ways that I don't intellectually agree with. I think the author is encouraging the people reading this essay to do that the work of observing their own internal narratives about HIV and to ask where they're getting them from, and to be open to the idea that not all of it may be as rational as they thought.
posted by en forme de poire at 3:29 PM on May 16, 2013 [2 favorites]

I think what you and possibly others may be missing here is that the author thinks so because he has thought these things himself.

I am pretty sure people doing what they can do avoid HIV aren't thinking, "Gee, HIV wouldn't be that big of a deal were it not for the bad reputation I would get to the neighbors." The reason this discussion and the original essay itself is so contentious is because many of the statements made sound ridiculous to the average person.

Is this a generational thing? Now that HIV is no longer the guaranteed death sentence it used to be, it's considered uncouth to take as drastic measures to avoid infection as they used to? I think there's a huge cultural gulf here, where some people are saying stuff that they obviously think is the most reasonable, rational thing in the world, but everyone else is like, "no way, that attitude is nuts!"
posted by deanc at 6:25 PM on May 16, 2013 [3 favorites]

For the "average person" HIV is a fairy tale or a distant tragedy. For me, it is 20% of my potential partners and climbing.
posted by en forme de poire at 6:54 PM on May 16, 2013 [1 favorite]

> Okay, first of all: When you use the phrase "serosorting" - a phrase that very few people use or understand, and that the people you are arguing with do not use at all

Unfamiliar term that comes off as jargon, okay, that's a thing that gives a person pause. Then, you Google it. Oh, unfamiliar term is a term for a thing I did not realize had its own term! Okay, carrying on...
posted by desuetude at 10:16 PM on May 16, 2013

Here is a whole page from UNAIDS on HIV-related stigma. There are many links to many reports on it.

Here is an entire scientific paper (free! Not even a pdf!) about HIV-related stigma and its effects on medication adherence. I found it by googling "HIV stigma."

I would really like it if people stopped talking about HIV stigma as if its only consequences are that the neighbors look at you funny. That is wildly incorrect and offensive hyberbole. If that's truly something you believe to be true, you do not know what you're talking about, and please go do some reading. If you're just making a defensively snarky point, please stop, because a lot of us - and maybe you too - have lost many people we love over the years to HIV, and more than a few of them died in part because of what stigma contributes to how people are treated and how they treat themselves, medically and socially.
posted by rtha at 6:39 AM on May 17, 2013 [1 favorite]

I'm using the term serosorting because it's value-neutral, and like I said, I'm not trying to pass judgment on individuals. I could reduce it to a more clunkier phrase like "men who choose not to have sex with HIV+ men", or "men who don't have sex with HIV+ men", but as you can see, the two terms differ in their connotations and pass subtle judgment.

But anyway, "serosorting" refers to choosing HIV- partners if you are HIV- and HIV+ partners if you are HIV+. Often this is for the purposes of having unprotected sex, but you can also serosort and use condoms.

See, here's the thing. In this thread, two people who are both very in favor of using the word "Serosorting" are both using very different ideas of what "serosorting" is. Because it's a relatively new word and one that hasn't been fully fleshed out and/or used enough to have a really clear definition.

Here is a whole page from UNAIDS on HIV-related stigma.

UNAIDS is very firmly on the side of the HIV-positive individuals on this one - I'm looking on the area of criminal transmission of AIDS, and they seem to think that if someone did not disclose their status and had sex with someone, as long as they wore a condom and didn't intend to transmit the disease, it should be fine.

Now that HIV is no longer the guaranteed death sentence it used to be, it's considered uncouth to take as drastic measures to avoid infection as they used to?

That's a really good point about a generational gap. I grew up when people were dying and fast. I went away to a pretty much HIV-free environment (when I joined, iirc the military would not let you join if you were HIV+ and they regularly test, and if you came up positive there were wacky things that you did that sent you to units you were unlikely to bleed in. I think. My memory on this part may be imperfect) and came back to...there's no cure but there's medication and people are living quite some time? I make a friend who's HIV+ two years ago and that person is still alive and relatively healthy and rocking the world today? It is strange and new and does not make sense as I emotionally and mentally feel about AIDS as the killer.
posted by corb at 8:19 AM on May 17, 2013

Because it's a relatively new word and one that hasn't been fully fleshed out and/or used enough to have a really clear definition.

This is flatly untrue. It may feel true for you, but everyone who works in any kind of capacity in HIV/AIDS education, direct care, and public health policy knows what it means, and it has an agreed-on definition. See the CDC.

UNAIDS is very firmly on the side of the HIV-positive individuals on this one

Which is unsurprising, given decades and decades of research on epidemiology outcomes when there is stigma involved. I'm not just talking HIV, but all kinds of diseases. This really is a Public Health 101 thing. It's not an unusual or non-standard "belief."

I appreciate that sometimes people talk about things they don't know much about because they think they know more than they do. I've done it, and probably will again. And I'm sorry if anyone here feels as if other people are trying to shut them out of the discussion by using terms that are unfamiliar. I can promise that for myself, this is not a thing I have done in order to shut anyone out, and I will bet money that no one else using these terms here has done so either.

But these are in fact common terms with accepted definitions and contexts for use. While I am not a public health worker, I work in public health policy, am married to someone who has worked in HIV policy for more than 25 years, and am close friends with people who do both direct care and policy work. This is stuff I know something about, although I'm far from an expert. One thing I'm sure of is that policy is really fucking hard.

There is an unbelievable wealth of information on the internet about national and international HIV policy, history, terms, care protocols, you name it. There's everything from the most basic, non-technical stuff to papers that are paywalled and require advanced degrees in some life science to fully understand.
posted by rtha at 10:14 AM on May 17, 2013 [2 favorites]

I think I'm going to lay off this fruitless argument over vocabulary now and just continue to use the word serosorting. Even after the issue was brought to light, no one but the person who originally brought the issue up said they had a problem with it. The word has been formally defined, and its usage has been proven by the CDC. And even the person who brought up the issue responded directly to the word previously in the thread on multiple occasions in a way that suggested that they understood the term. I see no point in continuing to argue over this.

deanc, I agree that there might be a generational gulf here - as a younger gay person, I have no doubt that I can do very little to sympathize with and understand the tragedies of the older generation, merely since I wasn't there. But at the same time, I feel like it's erroneous to categorize the older/younger generation into a "more drastic" approach versus a "uncaring attitude" towards HIV. Rather, I feel that both sides of the generation gulf are doing their very hardest to avoid and minimize infection and the negative consequences of HIV.

That's the key. Even though I don't believe in serosorting informed through stigma because I understand objectively that it may not be the most effective way, I still want to try my damned hardest to avoid HIV. And it's really weird when you characterize that as the younger generation not caring about getting the disease, or prioritizing "social good" over individual health. Because what I'm still doing is trying to personally avoid the disease the best way I know how.

I see the papers saying that transmission rate for serosorting is the highest amongst all strategies, even those that involve informed serodiscordant sex.

Furthermore, I grew up in an educational background and healthcare culture that taught me that societal attitudes can have drastic real-world effects on transmission of disease, and needs to be considered in tandem with physical factors of transmission.

I am in an environment that considers mental health care to be just as important as physical health, and that emphasizes mental health partially as a controllable product of societal attitudes.

Finally, I grew up in an environment where physical symptoms of HIV were becoming increasingly manageable to the point that it was no longer a death sentence but a chronic disease, and where social symptoms were becoming more and more exacerbated creating a larger emphasis on mental health care. Which is to say that I have a lax attitude towards HIV - I still don't want a chronic disease, even if it's not as bad as a death sentence! - but I have more breathing room than the older generation to let myself consider the reality divorced from my emotions, and make more objective risk-benefit decisions that take both the physical and mental aspects of HIV into account.

So I'm doing my hardest to avoid the disease, and it's really weird that I keep getting accused of not caring about whether I get the disease or not because I refuse to subscribe to a model that looks to me as effective on paper, but not effective in the real world in more complex models of disease transmission when social factors are added to the mix.
posted by Conspire at 10:44 AM on May 17, 2013 [2 favorites]

There's no reason for me to continue this as a back-and-forth between a few remaining participants, but I will just say that your perspective has been interesting and informative though, as I said, almost totally alien.
posted by deanc at 11:51 AM on May 17, 2013

So I looked at the CDC definition, and it is different, again, from both of what you guys stated as definitions. The CDC lists:

Serosorting is a practice some gay, bisexual and other men who have sex with men (MSM) use in an effort to reduce their HIV risk. This means they try to limit unprotected anal sex to partners with the same HIV status as their own. However, MSM who practice serosorting are at greater risk for HIV and other sexually transmitted infections (STIs) compared to those who always use condoms.

So the CDC's definition is pretty different from what myself and tavella were talking about, which is entirely ruling out someone who is HIV+ as a sexual partner, before even getting to the safer sex procedures assumed with partners. The CDC lists it as a specific practice around unprotected anal sex by men/with men only, not around any other form of sex.

So thus, it is possible for serosorting to increase risk - which is what tavella and I were failing to understand - because the technical definition of serosorting is not "refusing to have sex with HIV+ individuals" but by definition unprotected sex with individuals you believe to be the same as you.

So we were responding to the word - or what we thought you meant by it - but it in fact is not clear what you meant by it. Which is again, why I think it's important to use plain language.

So: "serosorting" may in fact increase risk, while "not having sex with HIV+ individuals" may lower it.
posted by corb at 11:53 AM on May 17, 2013 [2 favorites]

I don't know that it is a fruitless argument over terminology. Sero-terminology (as well as other terminology, like MSM) has developed specifically in response to stigma associated with HIV. So I think it is pretty germane, and I also think it is helpful to make sure more people understand the terms and what they mean. I do see that some people have attempted to explain these terms, and that's great.

I suspect that the opposition to the sero-terminology is because this is a really scary subject to a lot of people, and adding jargon to the discussion only leaves people feeling like they're understanding less and less. And honestly, as someone who *does* understand most of these terms, the terms and how they're used are *not* as clear cut as you might like to think they are, and they're used even less clearly in this discussion. As corb has mentioned, it is really not clear whether we're talking about serosorting more generally or as a method of facilitating condom-free sex. Both are drastically different circumstances.

When someone starts to feel alienated from the discussion, that contributes to stigma rather than eradicating it. If the goal is to reduce stigma associated with HIV, we're going to have to get a lot better about meeting people where they are and talking them off the ledge with patience and compassion.

That's why I was so disappointed when I read the article. It just immediately pushed every button I have, made me hyper-defensive and caused me to shut down. I am pretty sure that is exactly the opposite of the article's goal. And that's a shame, because I actually *AGREE* with him about the negative consequences of stigma and the need to eradicate it. Now imagine the effects on a less-sensitive reader's already-firmly-entrenched beliefs...
posted by jph at 12:22 PM on May 17, 2013 [2 favorites]

When people are talking about serosorting in populations having unprotected sex either increasing risk or failing to decrease it very much, the control population is people who are also having unprotected sex and not serosorting. What is most interesting about those studies is that they provide evidence that seropositioning - i.e., avoiding receptive anal sex with a partner of unknown or positive status - is about as effective as always using condoms. That indicates, perhaps somewhat counterintuitively, that choosing only partners whose HIV status matches yours may not be as important as avoiding the specific sex acts that carry the highest risk (e.g. unprotected receptive anal sex), and suggests to me that people who are relying on serosorting may be acting out of fear or misinformation more than an accurate assessment of risk.

This isn't to say that using protection and being in a monogamous relationship aren't helpful - of course, they also diminish your risk! Indeed, you can decrease your risk even further by using multiple strategies. Some of these measures might include things like pre-exposure prophylaxis (around which the author notes that there is also a related social stigma, even though this is a positive step being taken to protect someone's sexual health). But in any case, taking multiple measures to protect yourself is a good idea and should also be encouraged. That's why I said above that you need to judge the riskiness of a particular sex act in the context of the risks that you are comfortable with and the risks that you already assume (which may or may not be larger than you think).
posted by en forme de poire at 12:51 PM on May 17, 2013

I suspect that the opposition to the sero-terminology is because this is a really scary subject to a lot of people, and adding jargon to the discussion only leaves people feeling like they're understanding less and less

No. It is not because they're scared. It's because, as anyone would have pointed out in an AskMe about social skills, being jargony makes you difficult and unpleasant to deal with.

Furthermore, the jargon was obfuscatory-- Conspire was either deliberately or carelessly playing fast-and-loose with terminology and was using it in a way that was totally at odds with what people like corb and tavella were talking about. They weren't irritated about the jargon because they were "afraid." It was because people were wielding jargon as a cudgel while ignoring their actual statements and willfully deciding to not address what they were talking about while hiding behind jargon. And then people went on claim that their thoughts on avoiding HIV were actually more risky, which is at odds with what the research actually said.

I said I was going to stop commenting on a days-old thread, and I went back on that. That's my failure. But there has been such a severe mis-meeting of minds that I couldn't stand it. I'm going to have to agree with what someone said 3 days ago that HIV falls into that "doesn't do well" category of MeFi topics.
posted by deanc at 2:47 PM on May 17, 2013

So the CDC's definition is pretty different from what myself and tavella were talking about, which is entirely ruling out someone who is HIV+ as a sexual partner, before even getting to the safer sex procedures assumed with partners. The CDC lists it as a specific practice around unprotected anal sex by men/with men only, not around any other form of sex.

From the link: This means they try to limit unprotected anal sex to partners with the same HIV status as their own.

Men who do not have HIV try to not have receptive penetrative sex with men who have HIV.

If you, corb, are HIV negative, and you try to limit your sexual contact to only other HIV negative people, that right there is serosorting. Gay men do it. Bisexual people do it. Heterosexual people do it. Lesbians do it (although the rate of HIV infection in non-injection drug users who are women who sleep exclusively with women is so low that I've never personally heard of serosorting being common in the lesbian community, but I imagine it exists).

because the technical definition of serosorting is not "refusing to have sex with HIV+ individuals" but by definition unprotected sex with individuals you believe to be the same as you

Unless you are seeing recent copies of negative results from your sexual partners, you, too are having sex (protected or un-) with people you "believe" to be HIV-. Up to 20% of people with HIV do not know their status. Many believe that they are not at risk.

It was because people were wielding jargon as a cudgel while ignoring their actual statements and willfully deciding to not address what they were talking about while hiding behind jargon.

Bullshit.

I used a term that is common in many discussion about HIV prevention. I talked about the effects stigma can have. I did not call anyone immoral or wrong or bad for saying that they did not want to sleep with someone they know to be HIV+. And for that, I and Conspire and others were accused of moralizing and shaming. No one here has said anything like "In order to to contribute to stigma, you must go out and sleep with someone who has HIV."

The grossest thing I've seen here has come from you, deanc, in your dismissive definition of stigma as just some social thing that will give you a bad reputation to the neighbors. Oh, stigma, it doesn't count as, like, a real problem. If you didn't mean that, then I don't understand what your point was.
posted by rtha at 2:59 PM on May 17, 2013 [3 favorites]

"In order to to contribute to stigma,

There should be a "not" in there. In order to NOT contribute to stigma. To be clear.
posted by rtha at 3:54 PM on May 17, 2013

I just want to say really quickly that in this thread Conspire has very patiently explained his own personal thoughts and risk calculus about HIV, as well as the research that influenced his thinking, in the face of people jumping on his every statement (often out of context) with what to me read as bizarrely defensive and/or condescending reactions. To accuse him of not participating in this conversation in good faith is just sheer WTF to me.
posted by en forme de poire at 4:05 PM on May 17, 2013 [2 favorites]

This is a discussion on HIV stigma in a community known for having educated discussions. The moment someone mentioned that they might not understand the term, the term was defined both in terms of common discourse and its more formal, wider-encompassing definitions, and then pointed to as an accepted term in HIV discussion in a professional healthcare resource.

I have seen similar attacks happen when MRAs barge in on feminist communities and accuse them of misandry for using words like "intersectionality" within conversations where the word is very much crux to the topic, even when the word has been patiently explained to them a number of times. And that's not even a good comparison because the concept of intersectionality is at least like, a hundred times more complex as than the concept of filtering out sex partners on basis of HIV status.

Can I be absolutely sure that I'm not being trolled here? Because I am just baffled.
posted by Conspire at 4:42 PM on May 17, 2013 [1 favorite]

Men who do not have HIV try to not have receptive penetrative sex with men who have HIV.

But that is absolutely not refusing to have sex with HIV+ partners, that is refusing to have receptive anal sex with men who have HIV+. There is a difference - if it helps, the former is a large set, whereas the latter is a subset of that set. I am not talking about the subset at all - I am talking about the broader set.

Unless you are seeing recent copies of negative results from your sexual partners, you, too are having sex (protected or un-) with people you "believe" to be HIV-. Up to 20% of people with HIV do not know their status. Many believe that they are not at risk.

Well, I am. Because that, for me, is the definition of not having sex with people who are HIV+ - demanding recent negative test results before you sleep with someone.

So, given that is what I am talking about, I would like someone to actually give me an answer: given sorting against HIV+ status by way of recent test results, is there any study on the planet that thinks more negative outcomes arise from people sorting out HIV+ people from their sexual options, and if so, can you please explain how this happens?

Because I'm seeing a lot of "It's more risky because false negatives from people who don't test", but that seems totally disingenuous given that I am specifically talking about testing. Because really, who would just believe someone about something like that?
posted by corb at 8:34 AM on May 20, 2013

corb, it's not just from people who don't test - people who are newly infected are the most infectious themselves, much more so than people who are HIV+ but undergoing treatment. Even if you procure a negative test result you still need to trust any potential partner that they didn't do anything risky (or get very unlucky) within the window period. Whether this is a significant risk for you depends on the rate of HIV infections in your particular community, what kind of sex you're having, your personal history with this partner, etc.
posted by en forme de poire at 10:10 AM on May 20, 2013 [1 favorite]

"Also, on a societal level, it is possible that refusing to have sex with people who are identified as HIV positive (by either blood test or self-admission) will lead to higher levels of social ostracism for those who are HIV positive."

I used to think things like this, since it's a pretty handy econometrics shortcut, but what we actually know from decades of public health evidence is that it's ineffective in decreasing transmission rates, broadly. (The comparison to abstinence-only education is germane.)

Social stigma works better on majority groups doing something with low personal benefit and high social cost, e.g. spouting off racism. But for things like public health concerns, the twin confounders of mendacity and ignorance render stigma less effective; people will either not know, not know on purpose (resist testing) or lie about their status, all to avoid the stigma.

It's just not an effective strategy if the goal is to decrease infection rates, rather than feel good about heaping moral opprobrium.
posted by klangklangston at 12:01 PM on May 31, 2013