The truth, half truths and knowing about our HIV status

This year’s World Aids Day theme was “Know Your Status” – and the fact that so many people 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 antisocial. Perhaps the truth is more complex. I recently attended an ethics workshop for psychologists on lying to explore whether truth-telling is wired into the human condition. What I learnt seemed paradoxical: when young children learn to lie, this is not a sign of moral decline, but a developmental advance. It shows they can imagine self and other, and know that what is in their mind can be hidden from the other.

This is a significant level of selfawareness that shows intelligence and sophistication. In addition, children who lie can mask their expressions and keep their stories consistent. Again, this is a significant developmental advance – being able to organise social cues shows selfcontrol and growing self-awareness. I also learnt 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 SA to protect someone on the run). And, if we are honest, we lie to our children to avoid a complex conversation they may not be 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 of HIV? Are we lying to ourselves when we deny our HIV risks, or turn away from signs our partner is not sexually exclusive, or is clearly unwell? Is lying to someone who asks us if we are HIVpositive – a colleague for example – an act of duplicity or self-protection against an intrusive enquiry? Are we being untruthful when an HIV counsellor asks us 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 the person? Of course, “Know Your Status” is an important message – as is making HIV testing more widely available. 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 encourage ethical testing. But, in promoting “Know Your Status”, it is crucial to acknowledge that there is work to be done on 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, and more truthful about social hypocrisy. It is said that honesty is the best policy, but perhaps not at the expense of personal or social integrity. Brouard has worked in HIV for more than 30 years and is the deputy director of the University of Pretoria’s Centre for Sexualities, Aids and Gender and a registered clinical psychologist.