HIV/AIDS: Self-Disclosure Shouldn’t Replace ‘Condom Code’

      Writing in Friday's San Francisco Chronicle, medical anthropologist Tim Vollmer argues that the promotion or legislation of self-disclosure by HIV-positive individuals "may actually undo the remarkable progress of the last two decades and repeat in HIV prevention the same mistakes that have been made in the efforts to control drug use." He notes that the national debate has now come to the Bay Area, as San Francisco AIDS Foundation Executive Director Pat Christen has exhorted gay men to be "brave enough to hold themselves accountable" to prevent more people from "becom[ing] needlessly infected." But Vollmer argues that public health efforts should stick with the "condom code" -- the strategy that all sexually active individuals should assume their partner is HIV-positive and use protection. Not only does it cover "those situations in which someone might lie about his or her status," he says, but it deals with those who may be unaware of their status. Disclosure policies, on the other hand, create the "dangerous illusion that sex between 'negatives' is safe without condom use" and may create a "viral apartheid" in which people are tempted to lie so as not to become ostracized. Vollmer concludes: "Dealing with HIV transmission through the criminal and legal system rather than through community, medical and public health spheres (a transfer of responsibility that has occurred in the effort to curb drug use), may have disastrous results, turning what so far has been a war on HIV into a war on people with HIV" (7/9).

War Not Over
      In a San Francisco Chronicle op-ed, San Francisco Public Health Director Dr. Mitchell Katz and special policy adviser Dr. Herminia Palacio write that the city's "breathtaking drops" in HIV infections and deaths are due to the city's "successful HIV prevention model" and the power of antiretroviral drug cocktails. They argue, however, that in the face of declining charitable donations and amidst the clamor by some for reduced federal funding, the war is not won. Unsafe sex among gay men is on the rise. Moreover, the drug regimens "are complicated, have numerous side effects and are expensive. And the track record of the new drug cocktails, while impressive, is only three years long." They conclude: "Some may argue that our success should lead us to move on to other battles, but history has shown what happens when support is withdrawn prior to developing a cure or vaccine. The withdrawal of funds to combat tuberculosis was one of the factors leading to the re-emergence of a deadly drug-resistant strain of the disease in many of our urban areas. Instead, let us use our success in this battle as a motivation for winning the war on HIV once and for all" (7/9).