A Note from the Ethicist
Not long ago, I replied to a question from a young gay man who was H.I.V.-positive but whose virus levels, monitored over the course of more than a year, were consistently undetectable. He wanted to know whether he had a duty to inform casual hookups about his status, if he wasn’t asked. A few relevant facts: There’s now a vast amount of empirical evidence in support of the U = U (undetectable = untransmittable) slogan. The virus can be spread by people who wrongly think they’re negative, or who simply don’t know what their status is, and so don’t think they have anything to disclose. If you have a sexual encounter with a stranger, one thing you know about your partner is that this is someone who has sexual encounters with strangers. My judgment was that, because the man was incapable of transmitting the virus, it was on the stranger to ask. (My judgment was also that you had to be honest if you were asked, and transparent with someone with whom you’re entering into a relationship.)
Since I shared these thoughts, people have pointed out that certain jurisdictions have laws that criminalize the failure to disclose — even when there’s no risk of transmission — and that there’s a movement to revise or repeal such laws. Studies indicate these statutes have not reduced H.I.V. transmission; instead, historically, they’ve lent themselves to misuse and abuse, unjustly targeting people living with the virus.
H.I.V. is now far from a death sentence, but the risk of contracting it has to be taken with utmost seriousness; like hepatitis B infection, it remains irreversible. For good reason, PrEP, a “pre-exposure prophylaxis” regimen, is now widely used by gay men who have multiple sex partners. Just around the bend: A twice yearly shot of lenacapavir, a new class of antiretroviral, has proven astonishingly effective at protecting people from H.I.V. transmission in large-scale trials in Africa, and promises to transform the epidemiological landscape around the world. Unfortunately, too many state legislators, very notably those in Ohio and Arkansas, evidently haven’t kept up with the scientific consensus and haven’t grasped that a person can have tested positive for H.I.V. without being capable of transmitting it. I don’t know specifically whether people who have achieved full viral suppression have been charged with violating partner-notification laws since the C.D.C. endorsed U = U in 2019; I do know that what’s on the books in some places hasn’t yet caught up with good sense. And so a statutory fact remains: you may pose no risk of viral exposure, but if you live in the wrong place, you may wish to consider your legal exposure.
Readers Respond
Last week’s question was from a concerned ex-spouse. He wrote: “My former husband is a brilliant and accomplished man who developed a crystal-meth addiction that recently led to the end of our 30-year marriage. Not long ago, he was arrested on drug-possession charges. … I wrote to the judge directly requesting leniency and treatment rather than prison time, highlighting his positive qualities and potential for recovery. When the case was reassigned to a new judge and my ex discovered my letter, he was furious, feeling betrayed. He insists his lawyers’ sole purpose is to clear his name and prevent punishment. I’m now questioning both the ethical duties of his legal team and my own role. I struggle between wanting to help my former husband and respecting his wishes. … How can I help him get rehabilitation without overstepping boundaries? I’m desperate to find a path that leads to his healing, not just his freedom.”