The 21st century challenge of HIV disclosure amongst gay men
HIV was the centre of gay men’s lives. It was the 1980s. And the stated rule in relation to HIV-disclosure was:

"Assume everyone is HIV-positive. Don’t ask, don’t tell. Practice safe sex always".

If everyone practised safe sex HIV-antibody status didn’t matter. At the time there were no treatments for HIV so no compelling reason to get HIV-tested. And documented levels of discrimination against people with HIV were horrific. Under this rule HIV is a shared experience amongst gay men – "we’re all positive". But gay men had by and large got HIV-tested and both positive and negative gay men were disclosing their HIV-status to each other. And the experience of actually being HIV-positive was fundamentally different to just pretending everyone was – and it was something you might actually need or want to "tell’ someone about.

Fast forward to now, in a decade close by. It is the 21st century. The old disclosure rules are so "last century". Now there is no stated rule or ethic. But the one most commonly said to operate is:

"If he is positive he should tell –
otherwise assume he is HIV-negative."

Now the default assumption is HIV-negative. And the unwritten rule is perhaps ‘practise safe sex most of the time’. Now HIV is decentred from gay men’s lives – and the experience of it is located out of the room, bar, bedroom, cubicle. Just like the 1980s rule was problematic so is this one. Because if he is positive chances are he won’t tell. The person most likely to transmit HIV is someone who themselves was recently infected and won’t know they are HIV-positive. So a non-disclosure of HIV-positive status offers only a false sense of safety.

The difficult place we have arrived at in relation to HIV disclosure is highlighted by the responses to two questions in the Project Maleout survey conducted in 2000. Survey participants were asked to rate the following statement - "Expect HIV-positive men to reveal his HIV-status before having sex with you?" 79.3% of HIV-negative participants agreed or strongly agreed with this statement, whereas 40% of HIV-positive participants agreed or strongly agreed. When asked if they "avoid having sex with people you think have HIV?" 61.7% of HIV-negative men said "Yes, always" (as did 7.5% of HIV-positive men). The researchers commented "On the one hand, most of the participants expected HIV positive men to disclose their status before sex. Yet, on the other hand, large numbers of the men stated unequivocally that they avoided having sex with HIV positive men. In such a climate there is little incentive for HIV positive men to disclose at all."

Positive men will often not disclose their status – so you cannot assume that non-disclosure means HIV-negative. And if you have been recently infected with HIV you may not know you are (or about to become) HIV-positive so you might say you are "HIV-negative" at the very time you are most likely to transmit HIV. So as a central prevention strategy HIV disclosure is seriously flawed.

However, we continue to live in sexual cultures where, in some contexts, gay men are choosing to have unprotected sex with each other. Such contexts include men in relationships with a partner of the same HIV-status or two HIV-positive men.

Disclosure is loaded with more meaning than just a piece of data that indicates whether a pair of casual partners can have unprotected sex. For gay men getting to know someone new, attitudes to HIV and HIV-status are part of the ‘getting to know’ process. For a positive man disclosing may have much more meaning than just sexual practice. Often HIV-positive men are disclosing in order to find other positive men and may be just as likely to reject HIV-negative men as vice versa.

No one wants more HIV transmissions. HIV-negative men usually feel strongly that disclosure should occur before unsafe sex, while positive men feel that negative men have an equal and shared responsibility to protect themselves. Many positive gay men can tell a story of an over the top response to the disclosure of their HIV-status.

If this all sounds too hard it’s worth remembering that it’s still the case in 2005 that most sex between gay men is still safe – and that responses to HIV disclosure are often sensitive and supportive. But we can do better – because at the moment, misunderstandings and mistaken assumptions happen too often.