Sunday, February 1, 2015

RE: Privilege and Post-HIV Activism

Today's blog post is a response to a recent Queerty article titled "5 Reasons His HIV Status Doesn't Matter Anymore". The 5 reasons (in a nutshell) were, 1) You can choose low risk activities, 2) You might be on PrEP, 3) Viral load may be undetectable, 4) You should be worried about STIs in addition to HIV, so you might as well use condoms, and 5) HIV is practically only a problem when it isn't managed properly.

I agree with a lot of what the author was trying to get across, but there are a few missteps in their approach. A more accurate title read might be something like: "5 Reasons His HIV Status Doesn't Matter Anymore if You're Wealthy, Educated, and North American", but that's not so catchy. I use this blog post to illustrate 4 problematic elements post-HIV activism: the presumption of scientific literacy and access to medications, geographic bias, and insufficient differentiation for what HIV means for dating vs hooking up.

**Language note: I use 'HIV patients' to describe people with 'positive', 'undetectable', and 'detectable' HIV statuses because each term represents a medically created subjectivity indicating the necessity of ongoing medical care for the successful management of HIV.**

Post-HIV activism is a problematic practice because it relies on assumptions, foremost scientific literacy. I got an A- in a second year microbiology class and went on to do an Master's degree in gender studies; of course I know what undetectable viral loadPrEP, and PEP mean for risk mitigation, but I'm not the baseline in this analysis (Pre and Post Exposure Prophylaxis are medications taken prior to and following exposure to HIV respectively in effort to reduce the possibility transmission). When HIV patients present themselves as undetectable rather than HIV positive, they speak medicalized language that excludes people based on access to education, cognitive (dis)ability, mother tongue, and place of origin. I don't attempt to assign moral judgement to how HIV status is communicated, but I do think it's important to recognize that when creating the separate identity category of undetectable, it must be accepted that this subjectivity will not be universally intelligible across social and cultural difference. If millions of people don't understand the much simpler science justifying climate change, then assuming basic HIV virology is common knowledge is a very privileged perspective.

The second problematic element of post-HIV activism is the financial barriers people face acquiring the drugs that minimize risk, none of which, in any combination, can eliminate the risk of HIV transmission. Regardless of HIV status, there is no such thing as a zero risk sexual encounter (or zero risk in general). ART (anti-retroviral therapies), PrEP, and PEP are not free of charge (though programs administering PEP free of charge are available in some locations). Unless these drugs were universally available (read: free), their existence does not justify the rhetorical birth of a post-HIV era.

The case of PrEP drugs, currently only available as brand name Truvada, is particularly problematic because it's an extraneous and unnecessary prescription for those practicing safer sex. Truvada bears significant potential side effects, notably for the kidneys. It's particularly inappropriate to use PrEP drugs as a justification for post-HIV activism because not everyone can or should take these prescriptions. By contrast, PEP and ART are prescribed only under circumstances of medical necessity, after contact with and diagnosis of HIV respectively.

Truvada itself has a geographic bias designed into its chemical structure. Truvada was only designed to stave off one of two known strains of HIV, HIV-1. Truvada was not designed to help the body resist HIV-2 infections, which are only common in Western Africa.

Returning to a social focus, I ardently assert my belief that sero-discordance shouldn't be a barrier in the formation of social and romantic relationships (sexually active or not). There is, however, inherent transience and risk embedded in hookup culture that complicates sero-discordance.

Partner selection is by definition a discriminatory process, with everyone being discriminated against based on a litany of arbitrary preferences. The complication of sero-discordance within hookup culture is that the arbitrarity of HIV status depends on how the virus is managed (or not) in individual bodies.

People have every right to discriminate against a sexual partner for their HIV status, or any other arbitrary factor that negates their consent. Common examples of arbitrary sexual discrimination include body hair, marital or parental status, religion, and political orientation. Only consent is consent, and for a myriad of reasons, consent is withheld millions of times per day. (I don't sleep with conservatives...)

By law, people in Canada (not just Canadians) have a positive duty to disclose HIV infection ...ish. Supreme court rulings have enacted a practice wherein undetectable HIV patients who use condoms won't be held criminally responsible for HIV non-disclosure because of negligible risk (based on heterosexual vaginal sex, but that's a rant for another day). If an HIV patient transmits the infection after a non-disclosure event, they may be imprisoned for a minimum of 5 years. Disclosure of HIV status is the best way for HIV patients to legally protect themselves should the odds fleet their favour during an otherwise consensual fluid exchange.

Back to hooking up. Let's imagine an HIV- person has a casual sex prospect who discloses their HIV infection. Are they effectively managing their infection? How do you know? And what is your threshold of proof? It's not like they'd call the HIV patient's doctor and obliterate medical privacy, so hookup culture is left with two options: trust or discrimination. Both of these options are equally (un)acceptable ways to approach hooking up with HIV patients. The moral quandary of discriminating and the risk of trusting complete strangers in sexual situations can only be balanced by personal perspective on a case-by-case basis.

So after this lengthy blog post, I have two take away points:

1)There is no shame in establishing your own conditions for consent, and anyone who tells you differently is spewing rape culture.                          

2) If you think projects of health and equality rights have entered a post-HIV era, check your privilege.

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