On Tuesday morning, Charlie Sheen officially announced that he was HIV positive, confirming a story that many of us had read about on news and gossip sites a full day prior. Sheen’s diagnosis was treated as a salacious story—the Hollywood bad boy gets his comeuppance for years of drug use and sex workers. It was a modern-day parable for clean living. It also made clear that many Americans are still mired in the ignorance, fear-mongering, and stigmatization that defined the HIV epidemic in the 1980s.
The media reaction to the announcement reinforced many of the reasons people living with HIV may choose to do so in silence. As is true for many STIs, HIV is still viewed as a scandalous infection of the unsavory, unfavorable members of our society. It affects a certain type of person. Risky people—you know the type.
Radar Online managed to fit some of the best, worst examples of this into one lede. “Sex maniac Charlie Sheen not only bedded porn stars, groupies, call girls and strippers — he also slept with transsexuals and men!” They describe him as a sex maniac, because normal run-of-the-mill sex-havers would not be infected with the virus. His female partners are referred to with loaded terms, implying that HIV only affects women who are promiscuous and indiscriminate in their choice of partners. They reveal that he may have had sex with men—a trifecta of homophobia, transphobia, and the throwback idea that men can only contract the disease through anal sex. Wrap it all up with an exclamation point at the end that lends an air of juicy gossip to a conversation about an infectious disease. I suppose they should be lauded for not going for the obvious tiger blood joke.
Sheen has reportedly paid millions of dollars to blackmailers who threatened to reveal his HIV status. After watching the response to his announcement, one can hardly blame him. Nearly every site that covered the news managed to work in some combination of blame and shame into their assumptions about his health, and their claims that he is being sued for transmitting the virus to past partners. Comedians on Twitter made him a punchline. Many others said he deserved it after years of domestic violence and drug use. Jenny McCarthy said, eloquently, “Ick!”
Just as HIV was once considered a punishment for the sin of homosexuality, now it’s a punishment for dangerous or violent behaviors. But the judgments levied at Sheen weren’t just at him. They were heard by the 1.2 million Americans currently living with HIV and the 50,000 people who are newly diagnosed each year. This was an opportunity to show we have moved past the social stigma of HIV, and it was a spectacular failure.
Charlie Sheen is arguably the most high-profile person to publicly identify as HIV-positive since Magic Johnson. When he spoke to Lauer about his experience, it was clear that this significance did not escape him. “I have a responsibility now to better myself and to help a lot of other people,” Sheen said. “And hopefully with what we’re doing today, others may come forward and say, ‘Thanks, Charlie, for kicking the door open.’”
He’s far from the first to kick the door open (that distinction belongs to Rock Hudson), but he is the first American celebrity to use their personal story to draw attention to HIV infection in the US for over two decades. In 1991, Magic Johnson held a press conference during which, without a trace of self pity or shame in his tone, he casually and optimistically announced that he was retiring from basketball because he had been diagnosed with HIV. He stood at the podium and announced to the world that he would become a spokesperson against HIV, promoting safe sex, and confidently telling reporters and fans that “it can happen to anybody, even me, Magic Johnson....It has happened, my life will go on. I’m going to be a happy man.”
The significance of his actions was monumental. HIV and AIDS still carried a heavy stigma, and public perception of the disease shifted with a vibrant, beloved, strong, black, heterosexual athlete announcing that he had been diagnosed with a disease thought largely to affect white, gay men. Advancements in prevention and treatment have significantly reduced the rates of HIV in the United States since then, but no other watershed moment presented itself in the public consciousness until Sheen.
He positioned himself to restart a dialogue in which there are so many things to be said. Testing is available for free at health departments nationwide, but only 54 percent of Americans age 18-64 report ever being tested for HIV; that number is as low as 29 percent in some states. This may be responsible for the fact that an estimated 12 percent of HIV positive Americans are unaware of their status and 32 percent are diagnosed late in their illness. 25 percent of newly diagnosed cases in the US are in youths age 13-24. HIV education is mandated in 33 states and DC—but in 27 of those states, the education mandate stresses abstinence over condom use. There are groups with an increased risk of contracting HIV, but anyone can contract the virus. And aside from the facts, something enormous could have been restated: that there is absolutely no shame in having HIV—that no diagnosis defines you.
Unfortunately, all of that was swallowed by a great deal of public curiosity around Sheen’s sex life. Matt Lauer didn’t dance around the issue on every good gossip monger’s mind: he wasted no time shifting blame to Sheen’s “unsavory and insipid” companions, casually blaming sex workers for his infection. People began speculating on the status of his partners, none of whom had come forward to discuss their health at the time. Sheen was adamant that he used condoms and disclosed his status with all sexual partners. The question then shifted to: Is that required?
The 2013 UNAIDS report stipulated that criminal laws on exposure should only be applied in cases where the is intent to harm, particularly when the risks of transmission are low. Despite this, many states in the US have STI and HIV disclosure laws that classify knowingly exposing sexual partners to a communicable disease as a misdemeanor or felony.
According to the CDC, there are 67 laws in 33 states specifically focused on persons living with HIV. 24 states require persons aware of their HIV status to disclose to sexual partners.
This past March, the Repeal HIV Discrimination Act of 2015 was introduced to the US Congress: among other things, the act aimed to ensure that punitive HIV-specific laws, policies, and regulations are informed by “public health-oriented, evidence-based, medically accurate, and contemporary understanding of HIV.” The disclosure laws have long been questioned by those in the HIV advocacy community who argue that the laws are based on outdated science, and have failed to evolve with our knowledge that risk of transmission exists on a spectrum.
So, the facts: People with HIV are typically most contagious after infection, but before they receive their diagnosis, when the level of virus in their blood is high. With antiretroviral therapy, some patients (like Sheen) are able to achieve an undetectable viral load. Essentially, their treatment is so effective that it decreases the amount of HIV in their blood below what is detected by standard tests. This drastically reduces the risk of virus transmission during sexual intercourse (in some studies, by as much as 96 percent). Condom use can further reduce this risk. Criminalizing sexual activity for individuals with HIV can make people less likely to be tested and continue to enforce the harmful stigma around the diagnosis. And, regardless of whether Sheen revealed his status, he is not subject to felony charges in California, where intent to infect is key.
There is still a global epidemic of HIV. Over one million people die each year from complications associated with the virus—many of them due to a lack of appropriate medical care. But for those with access to care and medication, HIV is largely a manageable, chronic disease. People with HIV can live long and healthy lives. They go to college, have careers, have kids. Their status should have little bearing on their everyday life—if the rest of us would accept it.
Get tested for HIV and other STIs. Talk to your partner about sexual health.
Caroline Weinberg has previously written about science and health at Eater, Vice Motherboard, Aeon, the Washington Post, and a few dry academic publications. You can find her on twitter @ckw583.
Images via National Enquirer, GIF by Bobby Finger.