So, tell me about your HIV status…

It was a Saturday afternoon in 2006, and Florence and two girlfriends were planning to go to Kenyatta National Hospital to get their HIV results. The previous day, one of the girlfriends had called Florence in distress; she had found her boyfriend cheating with a girl who was rumoured to have been around the block quite a few times, and now she was worried that she had contracted HIV from him.

Florence and another girlfriend got together to accompany her to the hospital for her tests – and also took the test themselves in a show of moral support. Florence wasn’t really worried about her HIV status, though; she thought it would come out negative. Instead, she was focused on a party she was due to attend later that evening, thrown by an ex-boyfriend. They had dated in college, broken up and re-kindled their romance the previous weekend. 27 at the time and enjoying her first steady job since graduating with a degree in business administration, life was looking up for Florence.

Later that afternoon, a counsellor at the hospital pushed a box of tissues in her direction and gave her the hard news: she was HIV positive.

Eleven years later, Florence is now the communications manager for the International Community of Women Living with HIV (ICW). But back then, she didn’t tell her friends about her diagnosis. She pretended everything was okay and went for the party afterwards where she continued her denial. Then, that night, she walked into her ex’s bedroom and found him dabbing a bloody finger with cotton wool. He had accidentally sliced it with a kitchen knife. “The blood and the act of dabbing his finger made me a fall apart,” she says. It reminded her of the counsellor pricking her finger and dabbing it with a swab. “I screamed at him and blabbed incoherently for a few minutes, and ended by saying, ‘You know that’s what they did to me today and now I have Aids!’” 

The relationship was as good as dead after that. He accompanied her for one clinic visit, and that’s the last she saw of him in a long while. Thus began her journey of navigating the dating scene, and learning the whens and hows of disclosing her HIV status to potential partners.

THE ELEPHANT IN THE BEDROOM

Few people are socialised to have the HIV disclosure conversation despite the fact that it is a key part of intimate relationships. Patrick* and James* are both married and in their late 50s. I ask them, “Do married couples talk about HIV/Aids?” Patrick, the more talkative and animated of the two, quips, “Aiii bwana! If I bring this up my wife will wonder what I’m trying to say!” It is assumed that each one is okay since they are ‘with each other’, he adds. James nods. Patrick adds, “It is the young girls you meet who assume you are safe because you are married. But I would never not use protection with anyone else except my wife.” James nods his agreement again.

Thirty-year-old Mary and her previous boyfriend never had the HIV disclosure talk. They used condoms for the first two months of dating, “then one day we just did it without,” she says. “We talked about it after (sex). He asked whether I was ‘safe’. But he was asking about my chances of falling pregnant, not my HIV status. After that I had a pregnancy scare which turned into a HIV scare. We got tested and both the pregnancy and our HIV status turned out negative.” Mary hasn’t dated anyone else since, but she says that next time, she will find a way to bring up the HIV conversation before discarding the condom. “Hopefully it will not weird him out,” she says.

Knowing a partner’s HIV/Aids status is meant to be one of those early deal-breaker pieces of information, but people seem to be more concerned about not offending their potential partner with the conversation. “I told a date that I had just been tested. Her response? ‘Oh, okay!’” says Kennedy, a 33-year-old designer at an ad agency. “I asked her if she was curious about the results. She said, ‘I’m curious but it’s so impolite to come right out and ask.’ I mean, when you’ve gone out with me on several dates, I’m thinking that the prospect of being intimate is quite high, right? Don’t you want to know?!” he asks rhetorically.

THE DISCLOSURE PROCESS

Florence believes that we are still stuck in the past when it comes our attitudes towards HIV, no matter what medical advancements we make. In her case, disclosure became a minefield after she found out her status. “I’d go out with my friends, meet guys and engage in some harmless flirting. When I’d leave to go to the bathroom, one of my girlfriends would tell the guy, ‘Be careful with that girl, she has Aids,’ despite the fact that being HIV positive doesn’t mean you have Aids.”

She dated one man for four months during which she didn’t tell him her status because her girlfriends warned her that it would scare him away. But the same girlfriend from the nightclub got to him first. “He went silent,” she says. “I sent him a text asking him what was wrong. He suggested we meet for coffee. He asked me if there was something he needed to know, like my health status. And I knew that he knew.” That was the end of that.

Florence confirms that disclosing one’s status could be received either way. “I’ve had a man show up for our Valentine’s dinner after he found out. On the other hand, I’ve had one guy go cold after telling him.” The difference is that the first disclosure happened gradually; the second one was on the first date.

“Disclosure is a process,” Florence continues. “Give someone a chance to (get to know) you as a person before they know you have the virus. This is still the most stigmatised disease and I don’t want to come into a relationship from a point of shame. I want to be myself first. ‘HIV positive’ is not my identity.” Florence has been in her current relationship for three years.

WHO TO TELL AND WHY

When does Florence think is the best time to disclose one’s status while dating? That depends on why you are doing it, and also on the depth of the relationship. But she also insists that HIV positive people also have a responsibility to make their partners aware. “Remember, the Sexual Offences Act has criminalised deliberate exposure,” she says. At the end of the day, though, it is everyone’s responsibility to take care of their own health. “Whether HIV negative or positive, take responsibility for (your) sexual health and initiate the conversation,” she says.

***

When is the best time to talk about HIV?

Dr Chris hart is a relationship coach

 “When a couple first realise that they’re starting a relationship, they should also start to be 100 per cent honest with one another. Anything less than that and the relationship is going to flake at some point. You can’t disclose every tiny detail on the first date though; there’s a gradual process of mutual disclosure.

“People very often don’t do that in casual relationships, and this causes trouble when a fling gradually turns into something serious. Most importantly, many people do not know their HIV status. But those who realise that something serious is starting should always give each other a broad-brush description of their relationship history (no details, just the basics). As they approach the point of becoming intimate, they should discuss issues like monogamy, contraception, and HIV.

“Many don’t. The issues get ducked for a whole variety of reasons, the commonest being that they start being intimate using condoms, then one day ‘forget’ to use one, and then they can’t go back because that implies distrust. We’re all somehow hard-wired to take risks whenever sex is involved, which doesn’t help!”

***

Asunta Wagura is the executive director of the Kenya Network of Women With Aids.

She has lived with HIV for 26 years

 “The conversation around dating, marriage and HIV/Aids is still sensitive. I remember bringing it up in my relationship but my partner would brush it away.

“The other party has a right to know your status before committing themselves to a relationship, especially because non-disclosure could attract criminal charges. On the other hand, one needs to consider whether their confidentiality will be protected after disclosure. It is a tug of war.

“When one person is infected and has an undetectable viral load, there’s little risk of transmitting the virus to the other party and so some choose not to tell – especially if it’s casual sex. But in case of long-term relationships, the parties need to discuss this at length.

“HIV should be an everyday discussion among couples, just to ensure that they continue to safeguard their negative status, rather than continue in ‘good faith’ and end up being infected. I think we are far from discussing or just letting anyone know our status the way one would do with diabetes or cancer. When you let people know about your HIV status, the greatest fear is rejection – even from partners we thought had loved us all along.”