Ambiguity and the Need to Set it Free
Thank you for your contribution to disclosure of HIV to sex partners.
“But if our work is merely descriptive and not aimed at revealing how such events have come to be in the first place, at what point does such straightforward documentation become gratuitous? Since the beginnings of the epidemic, people living with HIV have been framed as social outcasts, deviants and criminals. What new contributions can we make to the body of social research in this area to advance understandings of how and why regimes of medical and legal governance are historically, socially, culturally and economically constituted?” (McClelland, A. October 14, 2013. Research at the medico-legal borderland: perspectives on HIV and criminal law. Transcription Series, HIV, Science and Social)
Institutional framing of people living with HIV as outcasts, deviants and criminals manifests itself on interpersonal levels, causing much ambiguity and fear At an institutional level there is usually no personal stake, no personal risk and no personal loss, therefore no personal stress related to ambiguity. On the grassroots level where people living with HIV are making decisions about sexual partners the anxiety related to ambiguity manifests itself in many ways.
Let us examine on the interpersonal level how ambiguity manifests itself as we promote decision making about sex which allows for diversity, as a means of addressing alleviating fear of people living with HIV as potential sex partners. Let us focus on fear and ambiguity on an interpersonal level as described in case examples, stories and testimonials which present the reality of living with HIV, while we acknowledge how fear and ambiguity is embedded and perpetuated at a larger institutional level. Let us focus on people living with HIV who are sexually active.
There is often so much fear and discomfort in having sex or a relationship with a person who is living with HIV, most of it unfounded. How can we address the fear? Open dialogue about the comfort zones of couples in discordant relationships and fears in general of dating people who are living with HIV, having direct communication, while leaving out mixed, ambivalent messages which simply cause more fear and stigma is a good place to begin. Delving into the discomfort to make it more comfortable, digging deep, as one goes to an uncomfortable place to openly discuss fears is encouraged. Discomfort in discussing the perceived difficulties of dating a person with HIV as described in a case example titled “I’m HIV positive and my boyfriend is negative”, dated September 30, 2013, in The Body.com where the question is asked “what should I do”, which Sharon R, Southall responded to, are encouraged. A comfortable space to openly express without judgement, fear of having sex, condom fatigue, fear of transmitting and contracting HIV, fears around having children and fear of losing a partner in a relationship due to HIV, as mentioned in this case example, are needed.
The overall general ambiguity surrounding HIV, is an all consuming force. One has to wonder if ambiguity will or does become a self fulfilling prophecy whereby a person living with HIV ensures the partner leaves, partly as a way of alleviating the chronic stress related to living with ambiguity. This, of course, leaves the fear unaddressed. The question “what should I do” which carries so much weight on ones’ shoulders should be shared with everyone. In taking an approach which examines and breaks down fear and discomfort into manageable components, challenging whether the fear is real or perceived, is a starting point for managing HIV with sex partners or in a relationship whereby HIV will become a background component and not an insurmountable obstacle. Ongoing work through education, learning, teaching, collaborating, professional intervention, open dialogue with our communities, peers, and sex partners about fear and having outlets to openly discuss the stress, discomfort and accompanying resistance to change concerning reactions to disclosure are essential. Rather than reporting how people should ideally behave with sex partners, we could approach fear of HIV closely by asking men who have sex with other men, including those who are HIV positive, to share how, in reality, they negotiate sex.
In the SPOT study of men who have sex with men in Montréal, Amélie McFadyen commented how “her teams’ results showed that while gay men make strategic use of condoms, their risk-reduction strategies are diversified and complex and go beyond condom use. The groups showed evidence of various combinations of serosorting, viral sorting, negotiated safety, viral load, HIV testing and PEP”. “Public health messages, prevention programs, and counseling must be adjusted to account for this diversity,” she added. (October 7, 2013, in Gus Cairns, Revisiting the safety spectrum: how gay men fall into different ‘risk classes’ for HIV, aidsmap )
There are rich experiences to be explored and examined here as we ask men who have sex with men who are HIV positive, how they negotiate sex and what the key elements are which reduce their fear of HIV. This is a point of reference to address public fear and in turn deliver messages to the public about sex which are more diverse and practical. In providing more choices and diversity, rather than a set of do’s and don’t’s or desired behaviours, and using diverse approaches we can continue to address and change the way people living with HIV “have been framed as social outcasts, deviants and criminals.” Speaking and listening to those who are directly involved in negotiating sex at the grassroots level, keeping our ears close to the ground,keeping it real and acknowledging our own fear and resistance to change and diversity will set ambiguity free.