When the Internet learned of Charlie Sheen's HIV status, the response was what you'd expect — in 1990, maybe. We saw a throwback to a time before we knew better, when such a diagnosis had fearful, ignorant bystanders desperate to prove to themselves that those suffering from the incurable, deadly Sexually Transmitted Infection (STI) had done something to deserve it.
For the most part, we pretend to have shed this stigma. We know that anyone can get HIV, and that it's not some failing of character or self care. There are risk factors that increase chances of transmission, yes, but we're supposed to realize that the 35 million men, women and children living with HIV are people.
But Charlie Sheen's "risk factors" — sex, drugs, abusive behaviors, wild sprees — were fodder for public entertainment. And with his diagnosis, we see the truth of the matter: We're not quite over the desire to prove that HIV is something dirty and dangerous that only dangerous, dirty people get.
This was made all too clear in Sheen's "Today Show" interview, where he revealed his status in response to repeated attempts at blackmail. In one particularly cringe-worthy moment, Sheen is asked — interrogated, really — about the partners he had after his diagnosis. He insists that he used protection and disclosure to keep his sexual partners from contracting HIV, but the implication is clear: He should feel guilty for wanting to keep having sex, and it would be his fault if anyone he slept with got HIV. Never mind any precautions he took, or whether they gave their consent.
"I think Matt Lauer's insistence on calling 'condomless' sex with an HIV+ individual who has an undetectable viral load as 'unsafe' was completely irresponsible," James Krellenstein, a member of ACT UP New York's Prevention Working Group and a consultant with Treatment Action Group (TAG), told The Post in an e-mail.
Sheen -- like many HIV+ individuals today -- responds so well to his daily medication that the virus barely shows up in his blood, making transmission a slim possibility. This brings his risk of transmitting the virus down to almost zero, according to the most recent research. In fact, the use of antiretrovirals can reduce transmission risk by up to 96 percent, while condoms alone only reduce risk by 80 percent. It's true that the best practice is to use both -- reducing risk by over 99 percent -- but that doesn't mean a 96 percent reduction in risk is something to sneeze at, should both parties consent. Without these precautions, it's estimated that 8 out of 10,000 incidences of intercourse between an positive man and negative woman would result in an infection. The risk for a man having penetrative sex with an HIV+ woman is half that.
"Condomless sex with an HIV+ individual who is undetectable and on treatment is safer sex. Treatment is prevention," Krellenstein explained. "We have solid evidence from both a large randomized control — HPTN 052 — and a large observational study — the PARTNER study — that the risk of HIV transmission from an undetectable individual is virtually zero. This is more robust than the evidence supporting the efficacy of condoms in preventing HIV transmission."
In spite of this evidence, several states still have laws designed to prosecute those with HIV who have sex with negative individuals, unless disclosure can be proven. In theory, these laws prevent reckless behavior, but even the Centers for Disease Control and Prevention has urged that the laws be reexamined. In this day and age, there really is such a thing as safe sex with someone who has HIV — and treating potential infection as a criminal act (especially when truly willful exposure can be prosecuted under any number of general laws) just doesn't make sense.
As someone who's not in Sheen's head or bed, I can't speak to the care he's taken for his partners.
But this line of questioning — not to mention the rumors that swirled on the topic before the interview, with many suggesting that Sheen had willfully exposed women to the virus without their knowledge — isn't just damaging to Sheen. It's damaging to everyone with HIV — or any stigmatized STI, for that matter.
I spoke to Ella Dawson, a member of TED's social media team who's made a name for herself fighting the stigma around herpes. While the viruses are different, she said, the shaming has a lot in common — and it all sucks.
"We feel comfortable shaming Charlie Sheen because that's what we've always done: He's been in and out of the tabloids for years now," Dawson wrote in an e-mail to The Post. "That little 'maybe I shouldn't make a joke about HIV' empathy response doesn't go off when it comes to someone we already have such a questionable opinion of. But people living with HIV need support, not judgment and rejection. If we shame Sheen for having HIV, if we 'make an example' of him, that shame will be felt by anyone who has been diagnosed, especially if they feel like they fit that negative stereotype. When I got diagnosed with herpes, I felt like I was being punished for having casual sex. In reality, a transmission of an STI takes just one moment. It's not karma. The best way to encourage safe sex is by offering real information about how to have safe sex, how to get tested and how to have a normal sex life if you receive a positive diagnosis."
And research shows that stigmatization makes it harder to stop the transmission of an STI. People are less likely to get tested and less likely to get treatment if they feel like their diagnosis is shameful. It's wrong to shame Sheen (or anyone with HIV) for wanting to have a normal sex life. That shame is exactly what makes them more likely to lie to partners and fail to take their medication — or worse.
"The shame that our society subjects people who become infected with HIV is deadly," Krellenstein said. "Just last month, I gave a talk at an Ivy League school, where the director of the testing program informed me that a student who just tested positive tried to kill himself. He did not do this because he was afraid of the health consequences of HIV — patients on treatment can live healthy, normal lives — but because of the stigma and discrimination that he expected to face once he disclosed his status."
So if your big takeaway is that we should all look to Charlie Sheen as an example of what not to do, you've missed the point — and you're doing more harm than you know.