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.

20 thoughts on “HIV Non-Disclosure

  1. Ohhh Lurkie!
    This is a very tricky one. First of all, I don’t think your beef is with the girl or with her job. It’s got more to do with the morality of the issue. Not disclosing one’s HIV status equals lying. Lying on moral grounds, including lying for profit violates moral and ethical standards, IMHO.
    I understand she does not want to lose an source of income, but I believe her moral duty is to always disclose her status or at least only have safer sex. And here is where it gets tricky: she may be able to either charge more or keep this specific sugar daddy cause she’s having unprotected sex.
    It may be true that undetectable means it’s untransmissable but that’s not an excuse for non-disclosure. I would need to know if the man who is fucking me is positive, for obvious reasons: like you, I’d make an informed decision. Not that I would refuse having sex with someone just because of his status, but it would be my decision to do it or not and take measures to ensure we are both safe.
    She is thinking from the point of view of normative ethics. You are seeing it from the point of view of moral ethics (and so am I). She’s being utilitarian, we are somehow signaling virtue.
    I agree with Dan, though, if she doesn’t want to disclose, she should not go on the trip.

    XoXo

    P.S. now you can comment on my blog. No more excuses, Lurkie!

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    1. Good point about the different kinds of ethics.

      Okay, no more excuses. I shall leave comments on your blog, but probably not on every post.

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        1. Unfortunately, I might have to continue responding via blog, because I still cannot comment! I saw that you do not require a Google account any more, but (as with J. Gray and Maddie) when I try to put a comment in then it just disappears.

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  2. I think the status should be shared and let the other person [in this case the sugar daddy] decide what should be done and how to proceed.
    I believe in full disclosure and full honesty whether it’s HIV or any kind of STD/STI.
    And, as Sixpence says,if she doesn’t want to disclose, don’t go on the trip.

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    1. It is easy for us to say that when our livelihoods do not depend upon our duplicity. The caller would probably argue that if she was transparent, she would not pay her rent.

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    2. What an irky scenario. I do not like deceiptful behaviour especially when their are negative consequences for another person. Assuming she, the sex worker, does continue taking her medication, and her viral load continues to be undetectable, and therefore untransmittable(??) there is still likely to be negative consequences. When the sugar daddy finds out, or any of her other clients for that matter, it is likely they will feel very betrayed and probably very scared. It is the sort of scenario which could change the way a person perceives humanity. I am very against that sort of behaviour.

      My little sister was a sex worker. She had a couple of sugar daddies who treated her well enough. Her life spiralled out of control when she became caught up in the drug scene and her habit could only be maintained through “unethical” means. Theft was a guaranteed path to gaol. After several chances the magistrate gave her a final ultimatum to choose between long term rehab, or gaol. Unsurprisingly she chose rehab. She lasted there for six months before bailing. Two weeks later she was dead. Aged 20.

      It was a horrible couple of years watching my little sister self-destruct and not being able to do much to help her. I paid for her legal costs and would search the streets before her court cases to make sure she would get there. One time she was gang-raped by friends of one of her dodgy friends. After she was released she was in a bad way and police picked her up. The cops bashed her. They didn’t care if she had been raped – because she was “low-life junky scum and got what she deserved” and anyway “prostitutes are use to sex”. My poor little sister. I was so out of my depth knowing how to help her. We were very close. I was 28 when she died and have now lived for more than two of her lifetimes.

      I have an issue with unfairness and power imbalances.

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      1. One time I was tidying up my sister’s room and Mum was helping. She had left a small pile of sharps in a corner and Mum got a needle stick injury. At the time I knew that my sister’s HIV status was negative. But I also knew that she had had some friends over. I wanted Mum to tell her GP about it. She wouldn’t. It made me feel very uncomfortable for some time about Mum’s health. And to a lesser extent about Dad’s health. I justified to myself that it was up to Mum to tell Dad – and that it probably wouldn’t make much difference because I doubted they still had a sex life. I was pretty clueless back then. My response now would be different.

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      2. Holy cow. You have really lived a life. Your poor little sister, indeed.

        Ugh. Sex work is so complicated. It makes me upset how middle-class voluntary sex work advocates paper over the real problems in the profession. On the other hand I am glad they talk about police indifference towards sex workers.

        In addition to being frightened I worry that the sugar daddy in question could become violent.

        Have I ever recommended Gabor Mate’s books to you? His book In the Realm of Hungry Ghosts has been influential about how I think about poverty and trauma. (I guess some of these ideas have been popularized as ACE — adverse childhood experiences.)

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    1. The caller’s claim is that non-disclosure will not affect the health of her clients, because undetectable == untransmissable.

      I am sure there are instances in your life where you keep secrets. For example, maybe one day you go to a bistro and eat delicious waffles that are superior to Guido’s. Do you keep that to yourself?

      I am so glad you are back in the blogosphere for a while. Have you been okay?

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  3. I found it really hard to follow you on this post Lurker. I will say that it’s not unreasonable to expect honesty from the person you are having an intimate relationship with. Even worse here in Ottawa it looks like a man already in jail, is going to get off for secretly stealthing or pozing up a bunch of men, including a young mentally challenged boy on purpose. It was his kink to infect people and he bragged about it online. He is probably going to get off now because it’s no longer considered a death sentence. The thing that makes me livid is the gay groups supporting him. What he did is sexual assault that is now a lifetime for those men. Some how we are the bad ones for not feeling empathetic towards him.

    I find it hilarious that sixpence is trying to get you to comment on his blog… be careful for what you wish for.. right Lurky ; )

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    1. I’m sorry you found it difficult to follow. I agree that it was not particularly well-written. (I wish I could blame free association for this.)

      I do think there is a significant difference between not disclosing because you have undetectable viral loads and thus have confidence you will not infect others, and not disclosing because you are actively trying to spread a disease. I do not think there is much gray area in the latter.

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  4. If you read my blog, I state my status.

    Here in the Lil Banana Republic State … Not informing a potential sex partner of your status is a Felony, and the list for not telling is a long list that can place you behind the steel bars.

    Presently, I am U=U, but your viral load flucatuates from time to time, Its better to just put it out there, of your status.

    I have found that if you do that, as a gay man, the person you have in your bed, will say lets go or he will head out the door…..

    Just be upfront and honest …….

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    1. Tommy! It is nice to see you. I do read your blog, but not as regularly as I should.

      That is a good point about viral load fluctuating. The U=U advocates do not mention that part, though.

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