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Mortal Secrets

Truth and Lies in the Age of AIDS

Robert Klitzman, M.D., and Ronald Bayer, Ph.D.

Publication Year: 2003

In the era of the Internet and Oprah, in which formerly taboo information is readily available or freely confided, secrecy and privacy have in many ways given way to an onslaught of confession. Yet for those who are HIV positive, decisions about disclosure of their diagnosis force them to confront intimate, fundamental, and rarely discussed questions about truth, lies, sex, and trust. Drawing from interviews with over seventy gay men and women, intravenous drug users, sex workers, bisexual men, and heterosexual men and women, the authors provide a detailed portrait of moral, social, and psychological decision making. The interviews convey the complex emotions of love, lust, longing, hope, despair, and fear that shape individual dilemmas about whether to disclose to, deceive, or trust others concerning this disease. Some of those interviewed revealed their diagnosis widely; others told no one. Some struggled and ultimately told their partners; others spoke in codes or half-truths. One woman discovered her husband's diagnosis in a diary; when confronted, he denied it. Each year in the United States, 40,000 new cases of HIV arise, yet approximately one-third of the 900,000 Americans who are infected do not know it. As treatments have improved, unsafe sexual behavior has increased and efforts at prevention have stalled. Many of those infected continue to fear and experience rejection and discrimination. Addressing broad debates about the nature of secrecy, morality, and silence, this book explores public policy questions in the light of the nuanced, private decisions that are shaping the course of an epidemic and have broader indications for all.

Published by: The Johns Hopkins University Press

Contents

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pp. ix-

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Acknowledgments

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pp. xi-

This book could not have been written without the gracious assistance of many individuals. First and foremost, we wish to thank the men and women whom we interviewed—who shared with us their deepest secrets, pain, shame, and hopes. Without their candor and trust, this project would not have been possible...

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Introduction: Secrets, Lies, and Private Life

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pp. 1-16

“I tell the truth about half the time,” he said. Tall, handsome, and intelligent, he worked in an AIDS service agency in New York. His candid acknowledgment about how he spoke to sexual partners was striking and surprising. He spoke as part of a study exploring how people adapt to the...

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1 Getting Tested: Uncovering the Truth

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pp. 17-29

Deciding to get tested for HIV can profoundly change one’s life.The decision may involve a protracted process of weighing the risks and benefits of learning the truth in the light of possible discrimination, and the burdens of being diagnosed with a fatal disease. For the individuals in our study, how they decided whether to be tested and how they reacted to their...

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2 Sexual Partners: Sex, Love, and Disclosure

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pp. 30-72

To be infected with HIV is to face a moral and psychological challenge: how honest to be with sexual partners. The infected men and womenwith whom we spoke had to decide whether and whom to inform—only current partners or those from the past as well? Some felt morally obligatedto tell the truth all the time. Others felt no obligation to tell anyone and...

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3 Secrets and “Secret Secrets”: Disclosure in Families

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pp. 73-96

With parents, children, sisters, and brothers—relationships inwhich transmission of HIV is not a risk—disclosure poses very different challenges than with sexual partners. How did infected men and women feel about revealing their diagnosis to family members other than their spouses? What did it mean to do so? After disclosure, what did infected individuals...

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4 Disclosure in Other Worlds: Friends, Co-workers, and Going Public

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pp. 97-121

Infected individuals must make decisions about disclosure not only in family circles but in the broader social worlds we all inhabit. These individuals must determine which friends, acquaintances, neighbors, coworkers, and employers, if any, to tell. Such choices, like decisions about telling family, must be made within a social climate that many see as hostile...

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5 Dangerous Acts

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pp. 122-157

Infected men and women must make difficult decisions, not only about disclosure but about how to act with sexual partners. For many, the AIDS epidemic has transformed the world of sexual intimacy from a haven into an uncertain and dangerous quagmire. Men and women must weigh...

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6 Making Moral Judgments

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pp. 158-184

In communities where HIV-related suffering, disease, and death were widespread, men and women—both infected and uninfected—inevitably had to confront questions of whether and how to judge those who placed others at risk. Many of the individuals we interviewed saw no...

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Conclusion: Secrets in Public Life

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pp. 185-201

The men and women in our study typically learned they were infected with HIV in settings where confidentiality, and sometimes anonymity, were promised. Nonetheless, from that moment on, they were forced to struggle with questions of how and with whom they should share their...

Appendix: Interview Guide

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pp. 203-205

Notes

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pp. 207-212

Index/About the Authors

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pp. 213-218


E-ISBN-13: 9780801881473
E-ISBN-10: 0801881471
Print-ISBN-13: 9780801881916
Print-ISBN-10: 0801881919

Page Count: 232
Publication Year: 2003