HIV Non-Disclosure

If the title was not trigger warning enough, be aware that this is one of those “alienate the rest of my readers” posts.

Recently, I listened to Episode 643 of the Savage Lovecast, Dan Savage’s situational ethics podcast. One call in particular made me more furious than usual, and I am still trying to understand why. In the spirit of free association I am going to type things out and see whether I can find any clarity.

The call in question was from a transwoman sex worker. She had a sugar daddy who was offering to take her on a trip (a boat cruise?). She had not told the sugar daddy (or presumably her other clients) about her HIV+ status, and wanted Dan’s blessing for this. She claimed to have an undetectable viral load, and since undetectable equals untransmissable, she reasoned (or “reasoned”) that this was none of her sugar daddy’s business, and besides if he knew maybe he would not be her sugar daddy any more. Dan gave the sex worker his blessing on ethical grounds, but cautioned that legally there might be laws (oh so regressive laws!) that mandated disclosure from HIV-positive people to their sex partners. Dan said that if the caller did not want her sugar daddy seeing her pills, she should not go on the trip.

The caller was pretty flippant. She rhetorically asked whether she was the future for not disclosing. She was pretty clear that she was happy not to disclose to her partners, and she was pretty clear that she did not want to lose business on account of her status. Hearing that made me very, very angry. To be fair, I was already angry, but this call made me angrier in ways that other calls (including the previous call, which was also about HIV disclosure) did not. Let’s explore why, starting with the most phobic reasons.

Am I just being HIV-phobic? Sure. There is an element of that at play. Intellectually I know that undetectable is untransmissible. I also know that it is safer for somebody to be on HIV meds than sleeping with somebody whose status is unknown and who is not on PrEP (aka HIV meds). But even though my intellectual comfort with HIV has improved over the years (particularly since 1996), I don’t think that emotional gutpunch will ever go away. Maybe it would if I was in an intimate relationship with somebody who was poz. Maybe not. I have a lot of debilitating and sometimes irrational phobias, and HIV is one of them.

If some hypothetical universe where somebody was willing to sleep with me, I would be pretty ticked off being in that sugar daddy’s position. That is not limited to HIV. If somebody had syphilis or chlamydia or even herpes, I would want to know, so that I could be the one making the decision of sleeping with that person, as opposed to having that decision made for me. I feel very strongly about this, and it is probably a large source of my anger.

So there is an emotional gut-punch of HIV-phobia, but I do not think that explains everything. Let’s turn to the next accusation. Am I just being transphobic? Am I reacting so poorly to this call because the caller is a transwoman?

My answer to this is maybe. Certainly other people (in particular some trans activists) would label me as transphobic, because I do not adhere to every ideological stance taken by (some? most?) trans activists. I do not, however, think that I am more transphobic than the median LGBTQ+ person. I won’t pull the “some of my best friends are trans!” nonsense on you (it is not as if I have friends) but I do know and occasionally interact with at least a dozen trans people through my activities with local LGBTQ+ groups. I am not trans and do not claim to know what being trans is like, but I broadly support the rights of trans people to exist and live with safety. But I am sure it is possible that I reacted poorly because this caller was a transwoman as opposed to a gay man or cis woman sex worker.

Am I just being anti-sex-worker? Maybe. There is definitely an element of my reaction that is related to the caller being a sex worker, but that has more to do with trust and less to do with her profession. I believe that uncoerced prostitution should be legal, but that people should have good choices available to them so they do not have to become sex workers unless they really want to. But overall I do not see that much difference between being a sex worker and being a regular worker. They are both forms of prostitution, in my view.

I think there is more going on here, though. The first thing has to do with what being ethical means. My personal definition (which I am sure I have unconsciously stolen from some famous philosopher) is that ethics is the tension between individual and group benefit. When I do something for my own benefit at the expense of broader society, then I am (usually? always?) acting unethically. In that light, I see two ways in which this caller is clearly acting unethically, and neither has to do with HIV-transmission directly.

The first way in which this seems unethical is the same way in which staying in the closet is unethical. By being out of the closet straight people see us and become more used to having LGBTQ+ people around, and thus they are less likely to be phobic to us or about us. In some sense, we have gay marriage because Lynn Lynne Mary Cheney came out to her dad, and because George W Bush enjoyed watching Queer Eye for the Straight Guy. Having said that, although remaining closeted does some passive harm to our fellow LGBTQ+ people (by not paving the way) it is difficult for me to argue that it does active harm, provided that we are not acting in homophobic ways ourselves to fit in. I consider not coming out a venial sin, not a mortal one.

In the same way, this caller is missing an opportunity to reduce HIV stigma in the world by not coming out as HIV positive. That part is a venial sin. But there is something about her situation that feels more serious. The caller is staying in the HIV-positive closet not only to avoid stigma, but to financially benefit from this lack of disclosure. That seems more serious to me. The caller wants to have as much business as possible, and is unwilling to disclose any information that might reduce that business, regardless of whether those reasons are rational or not.

Say this sugar daddy (or the caller’s other clients) is comfortable with the idea of hiring an HIV-positive sex worker. Then there is no harm done if the caller comes out. Say the sugar daddy is not comfortable with this, and like me feels a gut emotional reaction to HIV. Then what? Then this caller is definitely doing harm to broader society, because when this guy finds out it will affect not only her business, but the business of other sex workers as well.

That brings up trust, which I think is the biggest ethics violation here. The caller is not disclosing her HIV status because she has a financial incentive to hide it. In doing so, she undermines trust in all sex workers. (To be fair, this is a problem with all of capitalism, which is why the smoothest transactions happen between partners that already know and trust each other, and the most frictionful ones happen between strangers.)

But she also undermines her own trust. She knows that her sugar daddy would prefer to be aware of his sugar baby’s HIV status, but she does not want to lose the business. Otherwise she would not have called at all. So she is deceitful for her own benefit. Why should we believe she is trustworthy in every other way? When she says that she is undetectable and therefore untransmissible, why should we believe that? What other things is this caller willing to lie about to secure her business? The flippant way in which she dismisses this deceit makes me want to not trust her at all.

The analogy that comes to mind is when people have affairs (another activity that Dan Savage almost always blesses, on the basis of increasingly flimsy “what-if” scenarios). The damage when someone has an affair is not usually the sex. Usually it is the loss of trust from that person’s spouse. How do you recalibrate to know the ways in which this person is or is not trustworthy?

Maybe I do not like this caller because she is HIV positive, or because she is trans, or because she is a sex-worker. I definitely do not like this caller because she has demonstrated herself to be untrustworthy, and I would feel very very betrayed if I was her client. Maybe that is just my internalized hatred speaking, and this really is about transness or HIV status or career choice. But based on how I have reacted when straight, non-sexworker men of unknown HIV status have ripped me off, I have my doubts.

Biokids

While we are on the topic of Labor Day, let’s talk about babies. In particular, let’s talk about fatherhood. Nobody wants to speak frankly about gay men and kids, and I think that is a problem.

Don’t get me wrong. I don’t want kids myself, and never have. I went so far as to get The Snip as added protection against accidents (as if I had to worry about accidents, or indeed anybody wanting to touch my penis ever). Admittedly, I am a freak, but there are also lots of successful, well-adjusted gays who don’t want kids: CB, Travel Penguin, Blobby, Sassybear, and probably many others.

Having said that, there are gay men who want children. Poor Steven has expressed regret at not having kids, and John Gray has (wistfully?) commented that he would make a good dad. The standard prescription for this is to make like Dan Savage or the couple from Jesus has Two Daddies and adopt. That is fine if it works for you, but there are men — even gay men! — who for whatever reason want their own biological children. This may be irrational but I think this urge lives underneath our rational thought. Our genes want to propagate themselves, and those whims are difficult to resist.

So if you are a gay man who wants to have biological children, what do you do? If you are rich, maybe you can pay to rent somebody’s womb, find an egg donor, and then have a baby carried to term for you. You can then rip the infant from its mother and raise it as your own, which raises no ethical concerns whatsoever.

What if you are not rich? Then life gets trickier… or does it? After all, many gay (and to be fair, bi) men in the blogosphere have fathered biological children: Two Lives from If I Do the Right Thing, BearToast Joe, Buddy Bear from One Step at a Time, and of course Michael54 from My Secret Journey. Although it seems Michael54 has a tough relationship with one of his kids, for the most part this group of bloggers has been grateful for their children. Of course, all of these bloggers have something else in common: they married women. Some of them married women accepting that they had homosexual attractions, and some of them married in the hopes that straight marriage would cure them.

I feel this is a problem. Is the best gays can do to marry women, have kids, and then lead lives as openly gay/bi men later on? Is it okay that gay men who hate themselves and desperately want to be straight get rewarded with biological children, and gays who come out early enough in life that they don’t get straight married have no options other than renting a womb?

The lesbians have figured this out, possibly because wombs tend to be more prevalent in the lesbian population. Lesbians watch some educational movie on the miracle of birth, decide that they want to be moms, and then hit the Internet or male-order catalogues for a vial of sperm and a turkey baster. Before you know it, Heather has two mommies. But it seems way more complicated for same-sex couples with no wombs between them.

Andrew Solomon, the aforementioned author of Far From the Tree, offers a glimmer of hope. He has a complicated, multiple-state web of biological children, where he and his partner had some lesbian friends carry their kids to term, and in return he and his partner provided sperm for those lesbians. Maybe this is not that different from renting a womb, but it feels more egalitarian somehow. To some extent it reinforces heteronormativity, though: it turns out the homophobes were right, and you really do need Tab A to fit into Slot B if you want babies.

I don’t have a clear answer for this. I do think it is a difficult truth that we should acknowledge, especially as kids come out of the closet earlier and earlier. Some of those queer kids are going to want kids of their own, and it is not clear to me what ethical ways there are to deal with that.

Mind! It is not as if the straights have everything figured out either. Nobody wants to acknowledge that women are more fertile (and maybe have healthier babies) when they are quite young, in their late teens or through their twenties. Biologically this makes sense, but socio-economically we have decided this is a bad idea, because (surprise!) straight couples want financial and life stability before having kids, and that often means that women get to have careers. Thus we end up with Facebook and Apple offering to freeze eggs for their female employees, so they can put in 80 hour weeks at their Silicon Valley jobs while worrying less about their biological clocks. Too bad freezing eggs is expensive. What do the rest of the straight people do, now that we expect kids to go to school until age 25-30 and then wait another 10 years to get out of precarious employment?

Also, can we please outlaw two parent households? I won’t go so far as to call two parent households child abuse outright, but I am tempted. Children need way more than two parents, as far as I can tell. In the Good Old Days there would be grandparents and spinster aunts and confirmed bachelor uncles to help take care of the kids. But now we obsess over the nuclear family as being the platonic ideal of a “correct” family, and I feel it is doing children a lot of harm. The nuclear family may be economically convenient for capitalism but it’s no way to raise a family.