Love in a Time of HIV

love-in-a-time-of-hiv

Love in a Time of HIV, clocking in at just under an hour, is a BBC documentary consisting of three separate segments about people living with HIV.

The first segment takes place in New York. Susan was infected with HIV by her husband, though she didn’t know it for several years, and had a daughter Christina who was infected from birth. A year after the two of them were diagnosed, the husband died of AIDS. Since then, Susan has become an AIDS activist and runs an HIV educational program in New York, while Christina has grown up with HIV and is now in high school.

The second segment takes place in Johannesburg, South Africa where HIV-positive South African Idol contestant Tender advances deep into the competition before being voted out as soon as she makes her positive status public.

The final segment takes place in London. HIV-positive Andrew and his wife Michelle are participating in an experimental program where Andrew’s sperm is cleansed of all traces of HIV before being used to artificially inseminate Michelle. Andrew is a hemophiliac who was infected with HIV as a young child.

All three are interesting stories, worth seeing. The film raised a number of topics and points in my mind:

Insofar as the film is an attempt to depict what it’s like to live with HIV, that’s awfully tough to do because every person and every situation is different. Certainly you can’t generalize from these three cases, or any three cases, and think you understand what people with HIV are like.

Especially since these are not representative cases (not that any really would be). One can infer that these folks were chosen to put a positive face on the HIV-positive population. They are appealing, articulate people for the most part making responsible choices, so they are easy to sympathize with. And they are people who didn’t get infected in ways that a general audience might be inclined to find blameworthy.

Susan was infected by her husband, so the husband is the bad guy, not her. Christina was born with HIV. Andrew was infected as a hemophiliac child. The only one who was infected through any kind of choice that she might be responsible for was Tender, who it is implied was infected through unsafe heterosexual sex. But the very fact that it’s implied rather than discussed indicates it’s being downplayed, plus she was probably a teen when it happened, and people are more forgiving of the poor choices of someone that young compared to an adult.

What you don’t have is party hardy gay guys making blatantly irresponsible choices, people shooting up drugs, poor people, homeless people, mentally ill people, people responding to being HIV-positive in some non-productive way like rage or excessive drinking, emaciated sick or otherwise non-photogenic people, etc. It’s all uplifting stuff about “regular,” sympathetic people dealing with HIV in positive ways, not letting it stop them from pursuing their dreams.

Moving on, the film functions as a reminder that HIV/AIDS stories nowadays are typically about people living with HIV/AIDS rather than dying of HIV/AIDS.

I had occasion to have a long talk not long ago with a physician who specializes in HIV and who has done a great deal of medical research in the field. One of the points he made is that HIV drugs have advanced to where—if you take them as you’re supposed to, which is a very big “if”—patients pretty much don’t get sick and die of AIDS anymore, as evidenced by the fact that life expectancy is virtually unchanged. (I believe he said the most recent study indicated that—keeping all other factors constant—someone infected in his 20s has a life expectancy only about six months shorter than an uninfected person, so 83 versus 82 and a half or whatever.) So an HIV-positive diagnosis is no longer a death sentence or anything close to it. Or, again, it doesn’t have to be if the patient does what they are supposed to do.

And sticking to the drug regimen can indeed be tough, though the only one in the film who admits to deviating from taking the drugs as she is supposed to take them is Christina, who says that she had periods of depression as an adolescent where at times she skipped a dose.

She evidently got through that OK, but it’s risky because, as the doctor I spoke with explained to me, the effectiveness of the drugs is dependent on their being taken as directed. The more often you skip a dose—which is tempting, especially for young people, since you’re not symptomatic and missing a dose has no immediate detrimental effect on how you feel—the HIV virus can develop an immunity to those drugs. That doesn’t necessarily mean you’re screwed, but it can mean you have to switch to less desirable drugs. So—and don’t take these specifics literally because I don’t remember all he said; this is just an illustration—the original drug regimen might have been to take six pills three times a week, have little or no side effects, and have a 99% chance of preventing you from getting AIDS, whereas once you burn through that and have to go to the next best drug regimen it might be ten pills twice a day, a few slightly more significant side effects, and a 97% chance of preventing you from getting AIDS.

It’s good that people know that HIV can now be controlled to the extent it can, but on the other hand that knowledge can also lead to an unjustified complacency and a resumption of risky behavior, as if the threat has passed.

The only segment where that really comes up in Love in a Time of HIV—since it’s focused much more on positives—is the South Africa one. Tender comments with helpless disappointment that her younger sister is already following in her footsteps in terms of dating young, and wanting to live a kind of glamorous, party lifestyle (she’s also an aspiring singer), including sex that is not always condom-sex. More generally, she notes that she sees such risky behavior routinely in South Africa, with males especially valuing promiscuity, and the entertainment industry still having a lot of “casting couch” situations where young and ambitious women and girls wanting to get ahead know that putting out is helpful if not mandatory.

One of the main issues the film brought to mind for me is HIV-positive people having children.

Leave aside Susan and Christina, since Susan’s pregnancy occurred before she ever knew she’d been infected with HIV. But Tender got pregnant and had a baby knowing she’s HIV-positive (the baby was premature and died within a few days of being born), and now is looking into adopting, and of course the whole segment on Andrew and Michelle is about their trying to get pregnant.

There are multiple moral angles to this. One is whether people with an incurable disease should commit to child raising at all. I think almost everyone would say—and I’m inclined to agree, though I’ll admit to at least slight remaining misgivings—that given my earlier point that life expectancy is now very close for HIV-positive people and HIV-negative people, and given that being HIV-positive should have little or no effects that would adversely affect the ability to parent (it’s not like you’re going to be in and out of the hospital the rest of your life, or that you’ll be horribly fatigued all the time or anything), there is no longer a problem with HIV-positive people being parents. (Let’s note, though, that life expectancy being almost the same, and capacity to parent being unaffected are both conditional on the HIV-positive person sticking strictly to their drug regimen, a condition that is far from universally met.)

That would cover adoption, or the kind of special procedure Andrew and Michelle are using to get pregnant with sperm “cleansed” of the HIV virus, but what about specifically a case of a “normal” pregnancy where the baby will be HIV-positive from birth, such as Tender’s pregnancy?

That still makes me uncomfortable. I’m torn, though, because I certainly don’t want to go down a slippery slope where it’s morally wrong to have any imperfect baby. Are you morally obligated to abort if you find out your baby will be born blind? Deaf? With Down Syndrome? A dwarf? What if there’s a significant risk of a significant disability? Are you morally obligated to not get pregnant? How large does the risk have to be? What if it’s not a physical thing; what if you’re poor in a society with crappy social programs, so your child will grow up with various poverty-related disadvantages?

But I still have trouble countenancing creating a baby that you know will have HIV. I think Love in a Time of HIV would be OK with it, in the sense that one of the messages of the film is that HIV-positive people have the same right to experience everything in life that anyone else does, with parenthood being one of the ones the film most emphasizes. Tender, for instance, speaks of her doomed baby not with regret but with affirmation of how important it was to her to have a baby.

I’d say, though, that her subsequent decision to look into adoption is the far more responsible one. Of course the twist there—as she finds out—is that a large number of the babies in South Africa available for adoption are themselves HIV-positive. Obviously, though, adopting an already existing HIV-positive baby is not morally equivalent to the decision to bring into existence an HIV-positive baby.

Love in a Time of HIV is a decent documentary, a collection of human interest stories that gives you some understanding about how a few people live with HIV. As such it’s reasonably well done, in a straightforward, competent way.

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