HIV/AIDS: The Good, the Bad, and the Ugly

Recently, I had the privilege of being able to walk in the 2nd Annual Fresno AIDS Walk.  Having known people who have died from AIDS related complications, events like this one always hit close to home.  As a gay man, HIV/AIDS has always been “something to think about.”  I guess though that I take it for granted that I’ve educated myself on the dangers of unprotected sex, the reality of HIV, and how it can affect my life and the lives of others.  It never ceases to amaze me that there are still people with some terribly inaccurate views of HIV/AIDS.  Even more amazing is the number of people with hostility toward those individuals living positive and all the misconceptions and misinformation that is propagated through nothing more than fear.  Even some of my own family members and friends expressed concern for me when they found out I was walking.  Some people thought I was positive.  Some people were worried that I would contract it from walking with people who are positive.  Some were upset that I was “exposing my son” to HIV by allowing him to walk in the event.  I had close to 20 emails from different folks, all with different ideas and comments.  So, I decided that I would take those comments and thoughts, break them down, and use them as an opportunity to educate a few people.

Before we get into the good, the bad, and the ugly, I’d like to take a moment to present some history on HIV/AIDS and dispel a few common misunderstandings.  The first thing I want to address is: There is a difference between being HIV+ and having AIDS.  Being HIV+ (positive) very simply means that a person has tested positive for the Human-immunodeficiency virus.  Having AIDS (Acquired Immune Deficiency Syndrome)  means that a person is HIV+ and that the progressive damage done to the immune system over time (in most cases, many years) has weakened it to the point that it can no longer fight off a defined range of opportunistic infections or the number of specific types of cells drop below a certain level.  AIDS is the inevitable consequence to having untreated HIV, but in this day and age, with timely and appropriate treatment, HIV almost never develops into AIDS.   The next thing I’d like to address is the origin of AIDS.  I have heard so many stories and “facts” about it, that I’ve lost tract.  I’d like to share a few of the more laughable lines I’ve been fed.

Myth:  AIDS was created by god to punish gays (gay men).
Fact:  Straight men having sex with female prostitutes actually carries the highest exchange rate among those infected at a whopping 43% likelihood of infection.  Of those affected, the demographic with the highest number of infections is: African-American females.  My point- HIV doesn’t care if you are gay, straight, black, white, male or female.

Myth:  AIDS was a government experiment by the (CIA,NSA, Air Force, etc.) as a biological weapon.
Fact:  If you actually believe this conspiracy theory, nothing I say will change your mind.  However, I will say…we know where it comes from, and it wasn’t the United States Government.

Myth:  We cured smallpox and that let AIDS thrive.
Fact: No, no, no, no.  Again, conspiracy nuts go crazy, but the government didn’t spike your smallpox vaccine with HIV.  In fact, the smallpox vaccine is contraindicated to HIV patients, their partners, and immediate household members.  Furthermore, the only link between smallpox vaccines and HIV came from the reuse of unsterilized needles during mass vaccinations in African countries.

Myth:  AIDS is a “gay cancer.”
Fact:  AIDS is not cancer.  Cancer is neither homosexual nor happy, and therefore not gay.  This myth came about in the early 80s, when even the CDC referred to HIV/AIDS as “gay cancer.”   This misconception was perpetrated by the presence of Kaposi’s  Sarcoma in AIDS patients, which is actually caused by human herpes virus 8.   While it is more commonly found in people with compromised immune systems (and 300 times more common in AIDS patients), it is not exclusively AIDS-related.

Now that we have those pesky myths out of the way, let’s move on to the rest of the story.  The best and most probable theory on HIV infections in humans is a cross-over infection from the simian immunodeficiency virus.  There is some discrepancy on how this happened, but in general it is believed that a mutation occurred to allow the virus to infect non-human primates.  Exposure to body fluids from primates allowed the virus to transfer to humans after the mutation, most likely during the hunting or butchering of an infected animal.  There have been all kinds of speculation about how it made its way to the United States, but the truth is, no one can say for sure.  While many of the first patients in the U.S. were gay men, they only made up about half of those infected in this country.  World-wide, gay men didn’t even make up 50%.  Regardless of how it came to the U.S., Robert Rayford, a 16 year old African American male, was the first person to die from the AIDS-related complication – Kaposi’s Sarcoma.  Since then, the CDC and Dr. William Darrow have made multiple attempts to identify “Patient Zero,” but no such patient has ever been “officially” named. Several books and a movie insinuated that a Canadian-born flight attendant, Gaetan Dugas, was patient zero due to the number of infected individuals connected to him sexually, but that theory has since been dismissed.  The only thing that the average person needs to know about the origins of HIV/AIDS is this: It’s out there, and no one is immune to it.

On to the part we’ve all been waiting for…the Good, the Bad, and the Ugly.  This is the part where I take all those questions I get asked and try to sum them up for people.  We’ll call this HIV Education 101.

$1.        Can I get HIV/AIDS from casual contact (kissing, handshakes, food sharing, etc.)?

The Good:  NO!

The Bad:  It would be easier to catch a cold or the flu from casual contact than to contract HIV from casual contact…period.

The Ugly:  There are worse things you can get from casual contact like MRSA and necrotizing fasciitis that are still more likely than contracting HIV from casual contact.

$2.       Can I get HIV from insect bites (mosquitos, fleas, ticks, etc.)?

The Good:  NO! Not at all!!!!

The Bad:  You can get lyme disease, malaria, typhus, or rocky mountain spotted fever from those.

The Ugly:  Ticks are not insects.  They are Arachnids.  Your question is invalid.

$3.       Can I still have sex if I am HIV positive?

The Good:  With the right precautions (condoms, taking meds properly, etc.)  you can still have a relatively normal sex life.

The Bad:  Having unprotected sex is irresponsible, even if you are with someone else who is also HIV positive.

The Ugly:  Having unprotected sex with someone else who is HIV positive is not OK.  You can contract different strains of the same condition, which can cause issues with medications and other forms of treatment.

$4.       Will I die from HIV/AIDS?

The Good:  It’s less likely now than it was 20 years ago.  Many HIV+ people are living longer, productive lives than ever before thanks to advancements in treatment.             

The Bad:  With any chronic illness, there are always risks.  If you don’t take care of yourself and follow a treatment plan, you will reduce your life expectancy.

The Ugly: You’ll probably live to be 120 if you handle your business and get fat, old, and ugly just like the rest of us.

$5.       Do I have to tell everyone I am HIV+?

The Good:  Well, the good news on this one is…it’s a free country.   You don’t have to tell anyone.  You should tell anyone that you intend on having a sexual relationship with, and it might be a good idea to tell someone close to you for medical purposes.  Again…you don’t HAVE to tell, but…

The Bad:  If you don’t tell someone you are HIV+ and you knowingly have unprotected sex with that person, you can be criminally charged in some states.  You have a responsibility to others by not putting them in harm’s way AND allowing them to make choices about their bodies.

The Ugly:  Be prepared to run into jerks.  Some people can’t handle it and they will treat you unfairly.  Also be prepared to run into “Bug Chasers.”  These are people who want to be infected with HIV.  Don’t ask me why.

$6.       Don’t HIV medications make you sick?

The Good:  We’ve come a long way in HIV treatment, and the newer medications have fewer side effects that some of the older medications.

                   The Bad:  Some side effects are common to most all HIV meds, most notably nausea and over time, these side effects typically lessen.  If they don’t, your doctor can suggest alternatives.

The Ugly:  All medications can have side effects, some more than others.  Some can be very serious.  If you experience side effects from your meds, you should consult your doctor immediately.

$7.        What about the flu shot – isn’t it bad for me?

The Good:  NOOOOOO!!!!  Get the damn shot!  It is safe and will be beneficial to you.

The Bad:  Flu shots typically hurt like a bitch, but being HIV+ is not a good excuse for avoiding the pain.

The Ugly:  Fear of needles is also a lame excuse.  Get the damn shot.

$8.       Can I be  fired from my job for being HIV+?

The Good:  Not on a whim, but…

The Bad:  Yes, under certain limits and restrictions. The ADA permits employers to exclude individuals who pose a direct threat to the health or safety of themselves or of others, if that risk cannot be eliminated or reduced by reasonable accommodation. But employers can’t simply assume that a threat exists-they must establish it through objective, medically supportable methods.

The Ugly (For the employer) Transmission of HIV is very rarely a legitimate “direct threat” issue.  There is little possibility that HIV could ever be transmitted in the workplace. The fact that your employer may be ignorant of these facts is no excuse for them to discriminate against you.

$9.       If I have HIV, am I covered by the American’s with Disabilities Act?

The Good: Yes, absolutely. You may not feel that you are “disabled” by HIV in any way. However, you are considered to have a “disability” if you have a physical or mental impairment that substantially limits one or more major life activities. People with HIV, both symptomatic and asymptomatic, are protected by the law. You are also protected by the law if you are regarded as being HIV-positive. For example, a person fired on the basis of a rumor that he has AIDS-even if he does not-is protected by the law.

Moreover, the ADA protects people who are discriminated against because they associate with someone who is HIV-positive. For example, the ADA protects an HIV-negative woman who is denied a job because her boyfriend is HIV-positive.

The Bad: Not all businesses are covered under ADA.  Small business with less than 15 employees are exempt.

The Ugly:  The reasonable accommodations clause is tricky.  An employer is not required to make an accommodation if it would impose an undue hardship on the operation of the business. Determination as to whether a particular accommodation poses an undue hardship is made on a case-by-case basis.  However, Customer or co-worker attitudes don’t matter. The potential loss of customers or co-workers because an employee has HIV does not constitute an undue hardship.

$10.   Will you still think I’m sexy if I have HIV, Jase?

The Good:  Someone’s “positive status” is not a factor in what I consider sexy.  So maybe…

The Bad:  I’m very picky…

The Ugly:  I’m married, so it doesn’t really matter. J

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