Actor Charlie Sheen revealed that he has been HIV-positive for the past four years in an appearance Tuesday on the “Today Show.” He told Matt Lauer that he had paid millions to sexual partners in order to keep his disease secret, and had been the target of “shakedowns” for more money.
Sheen said that he had unprotected sex with some sexual partners after his diagnosis, but had done so safely to ensure that none would contract HIV. He also told Lauer that he had informed his sexual partners of his diagnosis prior to engaging in sexual relations. That has raised questions among the public, and has been contested by at least one former sexual partner.
Heather Boerner, a writer who specializes in health care, is the author of “Positively Negative.” When news broke of Charlie Sheen’s diagnosis, she wrote a Facebook post addressing some of the stigma and confusion attached to the disease, which we’ve repurposed. She also answered additional questions via email about HIV treatment. Answers have been edited for length.
Based on what Sheen said, how is it possible for someone that’s HIV-positive to have unprotected sex without passing it on?
The answer is highly-active antiretroviral treatment (HAART). That is, HIV meds. Today’s HIV meds are better, have fewer side effects and are often available in a single combination pill. When taken consistently and when followed closely by their doctors, people with HIV can achieve an undetectable viral load and maintain it for years.
So when Sheen says that it’s virtually impossible for him to pass on the virus, he’s right.
Sheen said that his viral load is undetectable. What does that mean?
An undetectable viral load means that the copies of HIV in his blood are so few that current tests can’t even find them. In other words, if Sheen’s viral load is undetectable, you could draw Sheen’s blood and the blood of one of the HIV-negative women Sheen dated, and their blood would look the same. He’s not cured of HIV, but you can’t find it in his blood. And while HIV concentrates differently in the blood than in seminal fluid — and viral loads fluctuate — having an undetectable viral load also means that there’s no virus in his system to pass on to anyone he sleeps with.
A major study that came out in 2011, featured in “Positively Negative,” found that just having a suppressed viral load can reduce the risk of transmitting the virus by 96 percent. Final results of that study, released earlier this year, found that study found that not a single partner of an HIV-positive person who started treatment early and had a suppressed viral load acquired HIV from their loved one. So it may be more effective than 96 percent.
If someone’s viral load is not undetectable, can a partner protect him or herself from the virus?
There are two powerful ways HIV-negative partners of people with HIV can protect themselves, even if their partner isn’t on treatment: PrEP and PEP.
PrEP stands for pre-exposure prophylaxis, and it’s not a medicine so much as a treatment regimen. But here are the basics: You’re HIV-negative and you love someone with HIV. If you’re concerned or think it’s right for you, you can take a specific HIV drug called Truvada every day and your risk of acquiring HIV goes down tremendously — more than 90 percent if taken consistently. Studies have found this to be true in gay men, in transgender women, in non-trans straight women and in injection drug users. Some have called this a chemical condom. It works, and the FDA approved it.
PEP is post-exposure prophylaxis, and the idea is similar. If you’re a sex partner of Sheen’s and a condom breaks, or you find out your man has HIV the morning after you have sex, you can go to the ER or your doctor and ask for PEP. You’ll get a more powerful combination of HIV drugs that you’ll have to take for a few weeks. If you begin PEP within 72 hours of exposure, your chance of acquiring HIV drops precipitously.
Why would Sheen have needed to tell his partners he had HIV? What would be the consequences if he didn’t?
The law says that Sheen and all people with HIV must disclose their health status to partners or risk jail time — that’s regardless of viral load, treatment or even transmission of the virus. It’s a hold-over from the bad-old-days of HIV stigma, when doctors wouldn’t treat HIV-positive gay men.
So-called HIV criminalization laws vary state by state, but in general, they make it a crime to have sex with someone if you don’t disclose your HIV status ahead of time. According to a 2013 ProPublica investigation, at least 35 states have laws that criminalize HIV transmission or not disclosing your HIV status. In 29 states, that crime is a felony. While many might consider it common sense to share your diagnosis, there are lots of reasons one might not.
First of all, most laws don’t require that someone actually transmit HIV to be charged. Even if no HIV transmission occurs, people with HIV can still be prosecuted and convicted. The HIV-negative partner doesn’t even have to file a complaint. There have been cases of HIV-negative partners who go to the ER for PEP, don’t file charges, and their partner is still prosecuted under HIV criminalization laws.
Second, the law is applied unevenly. Just as Sheen described the “shakedown” from women he’d slept with to whom he disclosed his status, people with HIV often find that their status is used against them in abusive relationships. This is not rare. People with HIV, in general, and women with HIV in particular, have histories of violence before they are diagnosed. A 2012 AIDS and Behavior paper found that 55 percent of women with HIV had ever experienced violence from a partner. Violence has been found to predispose women to HIV, and then violence has been found to increase after HIV diagnosis.
The laws are also applied unevenly based on race. Earlier this year, a former college student in Missouri was sentenced to 30 years in prison for exposing others to HIV. The media latched on to his “hookup” app username, Tiger Mandingo. What some pointed out was that Missouri has failed to expand Medicaid, and that HIV is still and primarily a disease of poverty and a disease of disenfranchisement. A 2013 study of HIV criminalization convictions in Nashville from 2000 to 2010 found that those convicted under HIV criminalization laws were more likely to be black than white.
The fact is, for better or worse, when it comes to HIV disclosure and criminalization laws, it’s one person’s word against the other’s, and often the weight of HIV stigma predisposes people to distrust the person with HIV.
Read more from Boerner at www.hivlovewins.com.