World Aids Day: We all need to be more honest about getting tested and living with HIV

Posted on November 30, 2018

This year’s World AIDS Day theme is “Know Your Status” – and the fact that so many people living with HIV do not know their status is a sign that this focus is urgently needed.

Are people who don’t know their status lying to themselves? Or have we lied to them by promoting the idea that an HIV test is emotionally simple and stigma-insignificant, and that a life of antiretroviral treatment is unproblematic?

Against this backdrop it is worth asking what HIV reveals about how society views truth, and who should be truthful. Most of us would argue that honesty is a socially desirable trait, and that liars are anti-social. Perhaps the truth of this is more complex.

I recently attended an ethics workshop for psychologists on lying. The aim was not to show psychologists how to pull the wool over their clients’ eyes – though some cynics do see psychologists as manipulative! Rather, it set out to explore whether truth-telling is wired into the human condition.

What I learned there seemed paradoxical: When young children learn to lie, this is not a sign of moral decline, but a developmental advance. Lying in children shows they have a “theory of mind”, that is, they can imagine self and other, and know that what is in their mind can be hidden from the mind of the other. This is a significant level of self-awareness that shows intelligence and sophistication. In addition, children who lie can mask their expressions and “manage” the signs they give off, keeping their stories consistent. Again, this is a significant developmental advance for a young mind – being able to manipulate and organise social cues shows self-control and growing self-awareness.

I also learned that lying is probably wired into us: we lie to protect others from painful truths, we lie to ourselves when we don’t want to accept something, we lie if we feel the greater outcome is morally better (for example, people lied to the police in apartheid South Africa to protect someone on the run). And, if we are being honest, we must accept that we lie to our children when we wish to avoid a complex conversation they may not yet be emotionally or developmentally ready for.

In sum, truths and falsehoods go hand-in-hand. And when it comes to HIV, perhaps we need to be more honest about the lies we tell.

Does encouraging people to test signify social hypocrisy? Are we lying when we minimise the fears and stigmas surrounding the test and living with HIV? Are we lying to ourselves when we deny our HIV risks, or turn away from the signs that our partner is not sexually exclusive, or is clearly unwell, knowing the truth is overwhelming? Is lying to someone who asks us directly if we are HIV-positive – a colleague for example – an act of duplicity or necessary self-protection against an intrusive enquiry?

Are we being untruthful when an HIV counsellor asks us about how many sexual partners we have had, and we halve the number, not because we want to misinform, but because we worry about being judged?

Do we lie when we say “I’m sticking to my meds” to our HIV practitioner, knowing that we have missed doses because we were depressed, anxious that the truth will disappoint or distance the person we rely on for our health?

Of course, “Know Your Status” is an important message – as is making HIV testing more widely available – normalised, but not trivialised. Today there is self-testing, routine testing, “testing and treating” as soon as a diagnosis has been made.

All of this is good, and we need to do more to promote and encourage ethical testing. At the University of Pretoria, HIV testing for students is free and accessible at Student Health centres, and the Centre for Sexualities, AIDS and Gender (the latter also offers this to staff). This is a well-run and well-used service of a high standard, run by caring staff and volunteers.

But, in promoting “Know Your Status”, it is crucial to acknowledge that there is work to be done to understand and address the personal and social barriers to testing and, if the result is positive, what it takes to commit to a life of treatment. We need to be more honest about human frailty, more truthful about social hypocrisy, clearer about the demands of chronicity, and more realistic about our expectations of truthfulness.

It is said that honesty is the best policy, but perhaps not at the expense of personal or social integrity.

Pierre Brouard has worked in HIV for more than thirty years and is the Deputy Director of the University of Pretoria’s Centre for Sexualities, AIDS and Gender and a registered clinical psychologist. His interests include sexualities, gender, diversity, transformation and human rights.

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