When talking about HIV disclosure, it might benefit everyone to zoom out and think outside of the "HIV paradigm" for a change and focus instead on overall wellness. A bit of wordsmithing might help, too, if we swap out "HIV disclosure" for "STI info exchange". All this talk of HIV disclosure often leads to folks not discussing anything else besides HIV and that fails to address the big picture of both public and individual health. There is a middle ground here.
We all know the danger of stigmatization. We all know the desire to reduce new infections (hopefully, of any kind). If we bear this in mind at all times, all parties will be focused on their own personal health promotion. There is no reason that folks who believe they don't have HIV shouldn't be considering the broader concept of wellness and protection. Ditto for folks who know they have HIV.
Condoms help prevent HIV, but focusing on condoms as the sole source of our safety and protection fails to address the fundamental processes of how we make our choices and what motivates our decisions. The overwhelming majority of my clients have used a condom in the last 12 months. These are the same folks that have also decided in the same period of time to have anal sex sans condom. Asking someone the last time they had sex without a condom, and asking someone the last time they felt they likely put themselves at risk during sex, will often yield two distinctly different responses.
Condoms are not protection incarnate. Condoms are a form of protection. The sooner we (publicly) acknowledge that reality, the sooner folks can focus on making sure they are always using some form of protection, regardless of condom use. Condoms are effective at preventing many STIs; however, they don't provide 100% protection against herpes and syphilis. Furthermore, if we allow people to go on having oral sex without condoms with the mindset that they're having "unprotected sex" because they're not using condoms, we also enable them to stop thinking about protection outside the "condom box", such as a broader conversation about STIs in general and a discussion with partners on their personal sexual health promotion plans.
This is dangerous.
Equally dangerous is the mindset that HIV-positive folks have no other sexual health concerns now that they're positive. This is probably why we're seeing such large numbers of poz gay men with gonorrhea. They're not using condoms because they've had it drilled into them that condoms are (primarily) for preventing HIV, and if they're serosorting and only sleeping with other poz guys, they no longer have to concern themselves with "safe sex".
Safe sex is informed sex. We all make different choices when we have different information. We must encourage folks to figure out what information matters to them. I hope we rise above the ethical quicksand of "HIV disclosure" and embrace an idealistic reality that folks make good choices when they have good information. Folks need to be more conscious of decisions regarding their sexual health and have a set of criteria for what informs those decisions. These criteria should be developed by the individual, acknowledging their agency and ability to navigate their desires rationally, on their terms.
Get tested (for everything) and get talking.
