Leitmotif

Reason as the Leading Motive

HIV and AIDS

Posted by Jerry on November 12, 2007

The other day, I happened to catch a Hindi movie on television halfway through. The movie was one of the few recent attempts by the Hindi film industry to discuss the issues of HIV and AIDS. The two lead characters–played by prominent Indian actors Shilpa Shetty and Salman Khan–were HIV positive; notably, they were also a heterosexual couple, which was the context in which this disease and its issues were discussed.

In India, HIV is not known to be a gay disease; this is because most HIV+ individuals here are married men and women. However, given the social stigma of homosexuality, it’s quite likely that there are many married men and women in India who are in fact gay. In any case, regardless of sexual orientation, a disease simply cannot have a selective sexual preference for its host: this is a natural fact and cannot be refuted unless one makes some appeal to supernaturalism of some sort, in which case the argument is not a refutation anyway. Nevertheless, I would agree that HIV is a prevalent problem among same-sex partners.

Of interest to me is the several complex moral issues that HIV/AIDS poses. AIDS is a truly dreadful disease, utterly dreadful. I don’t think most people–particularly, the young and sexually active–appreciate the dreadful magnitude of this disease. In a very real sense, having AIDS is literally having your very DNA breached by the parasitic virus, such that every cell in your body becomes a carrier of the virus. As your immune system progressively loses the impossible battle, the virus gradually compromises your entire existence, making you susceptible and open to any other parasite seeking a host. 

When I was younger, I used to be a volunteer HIV/AIDS activist; I worked with the Indian National Service Association in promoting AIDS awareness among high-risk groups like sex-workers. I even gave a brief talk on HIV/AIDS to a group of young Indian college students. Ironically, however, reflecting in hindsight about my outreach efforts, I sense that the impact and magnitude of this deadly disease is dulled by the approach to AIDS awareness we adopt. I realize that our efforts–the secular AIDS awareness advocacy–tries very hard to strip off all moral associations with the disease and with the individuals afflicted by it. Realize that AIDS is more than just a physical illness; in most cases, it is a consequence and realization of unfortunate mental, philosophical, and spiritual ailments.

There is a fine balance to be maintained between retaining an objective moral perspective on the matter on the one hand and eradicating the stigma from the disease in order to protect psychological health, legal rights, open debate, access to medication, and early treatment, on the other hand.

Nonetheless, in an effort to raise awareness and promote open discussion, we have deliberately tried to ignore and shroud the moral and philosophical issues inextricably linked to HIV/AIDS. There is a deeper issue here than just not using condoms or sterile syringes: there is the issue of values, rationality, moral accountability, self-esteem, dignity, self-identity, and more.

The efforts to promote safe-sex awareness adopt a concrete-bound approach to behavior: here’s the disease, here’s how you get it, here’s how you can avoid it. While this may work for some people over the short-term and is effective in mass communications, a permanent and psychologically rooted transformation in the behavior of a culture does not come about from this behavioral emphasis. This pragmatic approach does not even address the causes of high-risk behavior, which are more philosophical and psychological than behavioral.

If one agrees that man’s behavior is motivated by ideas–implicitly or explicitly held ideas–then it should be easy to see that the way to change behavior–any behavior–is to identify the bad ideas at the base and uproot them. In other words, one has to explicitly draw a connection between a behavior and the motivational premises in order to be able to change both–fundamentally and for a lasting effect.

The secular AIDS awareness and safe-sex efforts almost never discuss the moral and psychological contexts that in fact promote and make high-risk behaviors possible. Beyond merely stressing the importance of having safe-sex with single partners and using sterile needles to do drugs, there must be a simultaneous effort in sex education and rehabilitation to explicitly tackle the moral (i.e., philosophical) and psychological premises that permit a man to be reckless with his own life and that of his loved ones.

Observe, in contrast, that faith-based rehabilitation programs–whether they are for alcohol addiction, sex addition, drug abuse, or any other self-destructive behavior–focus on a wholistic transformation of the individual–a physical transformation that proceed from and follow the mental and spiritual transformation. Faith-based rehab programs either explicitly or implicitly push the individual to subscribe to a specific metaphysical worldview and to its corresponding ethical principles. They either explicitly make you adopt a Christian deity or some unnamed spiritual super consciousness to whom you become morally accountable. (For example, a man in Alcoholics Anonymous attributes his ability to stop drinking to a Higher Power.)

An example comes to mind of an HIV+ gay man who appeared on the Oprah show. He admitted to being reckless with his life, being a chronic drug abuser, and a mindless hedonist. The man claims that he has now found Jesus, after undergoing some faith-based detox and rehab program. He claims to have reformed and now considers it his mission to spread awareness about the disease and lead gay men toward a spiritually enlightened lifestyle.

The point is, morality, values, spirituality, and ethics have traditionally been in the religious domain and are the tools of religious rehabilitation programs by which they achieve their transformative goals. Those who know better know that you don’t need Jesus; you know that these tools are even more effective when used with a consistent body of philosophical principles that require no appeal to supernaturalism to address the spiritual in man. Religion–as a primitive form of philosophy–can safely be replaced with a rational philosophy that identifies man as a unified whole: both spiritual and physical–and grounds the union on a natural, realist metaphysics.

Secular outreach efforts–particularly in sex education in schools–lack this most crucial and life-saving methodology. And this is a symptom of the culture’s view that spiritual and mental values have no place in a scientific approach to a problem. The secular approach is to inundate and saturate a culture with concrete facts and exhortations to use contraceptives and sterile needles. Sex education in schools discuss sexually transmitted diseases outside the context of moral and spiritual values proper to a sexually healthy human being: they merely point out the disease, the ways of contracting them, and how to behaviorally avoid the disease. They have conceded the moral and spiritual ground entirely to religion, and even deride religious methods as psuedo-scientific, unempirical, and therefore, mystical. Quite logically then, those who seek a wholistic rehabilitation of their mental, philosophical, and psychological premises have no rational and secular institution to turn to or a rational method to adopt; hence, they turn to new-age mystical meditative and/or ascetic techniques in search of spiritual upheaval.

The secular outreach must come to recognize this glaring and life-threatening gap in their efforts: if HIV/AIDS–and any other self-destructive behavior–needs to be curbed, an education about the rational and moral nature of man–which guides man’s actions as his tool of survival–is imperative as early as possible in a sexually active person’s life. One should not shirk the responsibility of drawing moral evaluations of volitional actions (with the requisite sensitivity) in order to plant a truly rooted transformation of behavior that is motivated by newer, better, and rational premises.

In sum, it is as important and life-saving–if not more–to spread and promote a rational approach to life as distributing free condoms.

===================

The complex moral issues about AIDS that I have not yet fully developed my thoughts on include moral culpability; perhaps, at some point I might raise the issue in a separate post. Specifically, should it be a crime for an HIV+ individual to have unprotected sex with an HIV negative partner? Depends on informed consent. If both partners are aware of the entire situation and still engage in this highly risky behavior, then it should not be illegal, although I regard it as immoral.

Is it a person’s responsibility to ascertain the HIV status of his sexual partner before having unprotected sex, or does the responsibility of disclosure lie with the HIV+ person? Perhaps, since it is difficult (impossible?) for a person to ascertain the HIV status of his partner by just asking or looking at him, the moral responsibility of disclosure should fall upon the HIV+ individual. To hide this life-threatening possibility from one’s sexual partner such that the partner is unable to make a fully informed decision about whether or not to enter into a sexual tryst is deceitful. Although, I would also state that to agree to have unprotected sex with someone whose HIV status you are unsure about or cannot verify is reckless (and immoral??) on your part.

Does non-disclosure amount to criminality? I don’t know yet. I’m open to being rationally persuaded either way.

Should disclosure of HIV status be mandatory before marriage or civil unions? No, not by the government. This can be handled privately by the concerned individuals. 

Should disclosure be mandatory for immigration–if yes, would the same principle apply to all other diseases, or only HIV/AIDS? Why? I’m uncertain on this issue as well. Reader comments are welcome.

[Edited to reflect the balanced approach of advocating concrete behavioral changes along with rational philosophical premises.]

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13 Responses to “HIV and AIDS”

  1. rambodoc said

    Another angle: should an HIV positive doctor (or dentist) risk his or her own survival by disclosing his HIV status to his patients, knowing that there is a miniscule chance of transmitting the virus to them?

    As far as sex is concerned, I am clear in my mind about this being a criminal act, provided the affected person knew about his positive status. Disclosure should be mandatory between consenting parties in a marriage (and of course without Government intervention).

  2. Ergo said

    Hmmm… interesting. Should a doctor be required by law to disclose his HIV status before operating on a patient? Well, are HIV+ doctors even allowed to perform surgeries? I guess they do; and many are private practitioners, like dentists. I don’t know.

    A related question, does HIV create unusual moral complications only because it is an uncurable disease that certainly leads to death or we are imputing moral character to a disease because of how it is contracted and spread? Are we even making such a distinction? Do we need to?

    Many worthy questions.

  3. rambodoc said

    Ergo,
    At present, this has not been known to be a problem, and so there are no editorials or debates on the issue. However, this brings to focus a glaring conflict of interest, where being honest and transparent would inevitably lead to the doctor’s ruin. Not telling his patients would likely be rationalised or equivocated by even a morally conscious doctor as ‘it’s not proven that my being HIV positive is harmful to my patients. Why then should I disclose what is my personal information to the public?”
    On the other hand, none of us would like to risk the possibility of getting AIDS because the doctor was positive, and would likely consider it an infringement of rights.
    There is no moral option but disclosure, but this would be virtually self incriminatory, isn’t it?
    As far as the moral aspect of AIDS is concerned, this is a significant reason why many people don’t wish to live by acknowledging the disease to their near and dear. The shame gets too much.
    I, for one, do not think any disease like this should be subjected to examination under a moral microscope. Sexual indiscretion is one of the ways of acquiring it, but then it is only one of the ways. Furthermore, I don’t ascribe morality to one’s sexual actions. I know I am possibly going against Objectivist ideas on this, but I look at sexuality more in biological terms than moral ones.
    By implication, a mind-body dichotomy? Maybe, but maybe not. I am willing to learn, as always.

  4. rambodoc said

    I found some official guidelines for infected health care workers and informing patients:
    “They advise that it is no longer necessary to notify every patient who has undergone an exposure prone procedure by an infected HCW because of the low risk of transmission and the anxiety caused to patients and the wider public.”
    Sounds very practical, but self-serving as well, isn’t it?
    🙂

  5. Ergo said

    Rambo, thanks for looking up the official guidelines. I suspected that the possibility of HIV transmission through most medical procedures is minimal. In my early activist days, I was told that the virus cannot exist outside a hosting body for more than a few minutes, and need a specific kind of environment. It wouldn’t even survive in a mosquito.

    Nonetheless, I do believe that for some highly invasive/risky surgical procedures, an infected HCW choose to refrain from being directly involved in the procedure if he or she is unwilling to disclose. To not do so would require deliberately evading–faking–the possible risks of transmission, and evasion of any kind is immoral.

    Finally, I respect your moral views on sex so long as they are the best conclusion you can reach given your committment to thought. I do not agree with your views, as you probably suspect; but I would hate for you to hold a moral position only because it happens to be the “Objectivist” position. Every rational principle has to be cogent and convincing. You shouldn’t hold a moral or philosophical view unless you are rationally convinced of its veracity to the best of your intellectual ability.

    With regard to HIV, I am not just referring to sexual indiscretion but also to drug abuse and other self-destructive, psychopathological behaviors. For example, I’m also including the issue of post-infection behavior and responsibilities.

  6. […] he asked. That resident was me. Those questions were unanswered then. Today, prompted by Ergo’s post, I will try to answer […]

  7. It's a Lie said

    “…the moral (i.e., philosophical) and psychological premises that permit a man to be reckless with his own life and that of his loved ones..”

    pray elucidate, what are these?

  8. Ergo said

    “…the moral (i.e., philosophical) and psychological premises that permit a man to be reckless with his own life and that of his loved ones..”

    To elaborate, volitional irrationalism, lack of self-esteem, and a purposeless, aimless approach to life.

  9. It's a Lie said

    Dear Ergo,

    I guess these missed your attention.

    A few facts on Aids/HIV status in India,

    http://www.avert.org/aidsindia.htm
    http://www.avert.org/indiaaids.htm

    Given the situation, while your intentions are noble, the psyco therapy propogated by you seems highly irrelevant.

  10. thetbones said

    Have you heard about this? http://www.reuters.com/article/middleeastCrisis/idUSN13630047

  11. Ergo said

    Yes, I read about this earlier, on someone’s blog I think. I realize that the available tests for the retrovirus often have false positives; but in this Chicago case, it repeatedly came off with false negative results. Years ago, I had read an article that argued that the testing methods–PCR and Elisa–are so highly unreliable that a statistically significant number of HIV negative people were tested positive and started upon antiretroviral treatment, and that most of these people fatally succumbed to the harsh and numerous side-effects of these medicines than dying from a disease they didn’t have.

    Also, regarding the organ donation issue mentioned in the news report, this high-risk organ donation could have been highly avoided–and the infection averted–had the government not decided to interfere in a free market of organ donors and recipients trading with each other as they would any other commodity. I’ll try to find the blog where I read this perspective nicely elucidated. [Here, this is the well-written post.]

  12. Stephanie said

    Stephanie

    \”…For others, it is better to find a rehab center that is further away from home because the memories and the people there make it too difficult to refrain from abusing drugs or alcohol…\”

  13. POZ Guy said

    Great that movies make us think about the risks of HIV/AIDS, especially for the hetero community who thinks it’s only a gay disease 🙂

    If you’re HIV+ like me, visit http://www.AIDSchat.org for a chat.

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