It is important we don’t miss the forest for the trees. As the Michael Neal scandal rolls on, with the Health Minister Bronwyn Pike now admitting that the health department “bungled” the case, we need to consider whether the “better protocols” being mooted as the answer for protecting public health in the future are really the answer. Or does officialdom need to dig deeper to discover why transmission rates of HIV in Victoria are high and rising.
I think we need to dig deeper. Down, in fact, to the central moral claims of the safe sex message at the heart of public health campaigns to reduce transmission of HIV/AIDS.
Debates about the moral adequacy of the safe sex message have been going on in the HIV Positive community for years. On one side are those who support public health messages focused solely on the responsibility individuals have to protect themselves from infection. From campaigns that cajole men to not be a fool and “cover their tool”, to the “cover yourself against AIDS” and “love is not enough” messages, the existing educational focus emphasizes the need for people who wish to avoid infection to watch their own backs. Commented the CEO of the Victorian AIDS Council on the Neal case: “Without wishing to sound like the last of the rugged individualists, people do need to take the responsibility to protect themselves”.
Of course the flip side of the “it’s all down to you” approach is that when unsafe consensual sex does result in transmission, it is the newly infected partner who wears the blame. This is particularly the case. it appears, if the reason the HIV-negative person had unprotected sex because they trusted that a positive partner would either disclose his status or simply refuse to proceed without a condom. “We’re trying to work on educating people not to make those mistakes and assumptions that stuff up their lives”, the convener of the National Association of People Living with HIV/AIDS said recently.
On the other side of the debate are those like the former convener of Positive Women Philomena Horsley who reject the blame-the-victim feel of this hyper-individualist approach to public health. They contend that while there may be good reason to design public health messages to trigger the natural inclination of most to look out for number one, the moral inadequacy of this approach – and it’s lack of cohesion with the moral expectations of many – demands an urgent revamp. They note that not only do some gay men assume their sexual partner will do the right thing by them, this propensity to trust others not to do the dirty on them is not just a normal and good thing, it is largely justified. According to a recent report by the Australian Research Centre for Sex, Health and Society, the vast majority of HIV positive men in Australia do disclose their status to sexual partners at the beginning of a relationship or the moment they discover it themselves, while the majority wear condoms in casual encounters with partners whose HIV status they either do not know or know to be negative.
In other words, despite consistent communications to the sexually active of all varieties that the only obligations we have are to ourselves, those infected by the virus – and at risk of infection – expect more than this, both from ourselves and from others. We expect that as human beings we have obligations not to harm our fellows, and that having HIV or being at risk of it doesn’t ameliorate this responsibility one jot.
Nor should it. It is not “ruggedly individualistic” but rather morally offensive for public health messages to imply that we have no responsibilities to other human beings, and that we are chumps when we expect others to recognize and honor their obligations to us. Not just offensive, but out of touch with the everyday sexual morality practiced by many, and dismissive of the needs and circumstances of particular at-risk communities.
Most notable of these is the small but sadly growing community of positive women. Women commonly contract HIV from their spouses or steady boyfriends, men who these women trust are not just faithful but straight. Public health messages that imply that these women had no one to blame but themselves for infection because they didn’t insist that “if it wasn’t on, it wasn’t on” overlook the culpability these men bear for failing to disclose their risk factors or to insist that a condom be worn every time.
What is the answer? I’d like to see a “Safe Sex Plus” approach to reducing infection rates. Men and women should continue to be told that the best way of protecting themselves from infection is to ensure condoms are part of each sexual encounter, but they must also be reminded of their obligation to do the right thing by others.
If individuals know they are or might be positive, they have an obligation to protect their sexual partner by either disclosing what they know – or don’t know – about their HIV status, or simply insisting on a condom every time. And if infection does occur, it is not those who trusted in others not to harm them who deserve blame, but those who didn’t do all that they could to avoid doing the harming.
Safe Sex Means Just That The Age