5 thoughts on “The Confessional

  1. I remember an essential part of the ritual at my first HIV test years ago, taken a few months after an “indiscretion,” at a time when I didn’t know anything about the pseudo-science surrounding testing. The nurse wanted me to bring a friend with me to get the results in case I tested positive, and she told me that I could not find out about negative results over the phone since that would undermine the process. That is, if they revealed negative results over the phone, and positive results only in person, that would make it clear that you were positive if were asked to come in person. On reflection, that part of the ritual felt very much like Dante’s entrances to either Hell (HIV+) or Purgatory (HIV-).

    Thereafter I tested once more before entering a serious long-term relationship and eventually marriage. At the time (late nineties) a negative test was a sort of societal passport, with the implication that a positive test placed you squarely outside of the society, an outcast, from which you could only relate significantly to others who were HIV+.

    What a grotesque perversion of normal relations. To think that one man (Gallo) could create a disease, an entire industry surrounding it, a huge private income for himself (the test patent), and a way for him to remain powerful in the US medical industry. It was brilliant and enormously evil. By using immune marker patterns from blood samples of men with “AIDS” he defined a “disease catchment” (the medical equivalent of an environmental catchment) who were “infected” by a new, elusive, ephemeral virus.

  2. Catholics have always excelled at formalizing their rituals, and confession is no exception. When it comes to guilt tripping though, few religions can hold a candle to the Baptists, imo.

    Of course you’re right to point out that the Church of HIV/AIDS has raised the bar for all of them.

    Great to see you doing the ‘toons, Liam.

  3. Perfect. Awesome. I love the ‘toon format here. I hope it becomes a comic book. I’m quoting this one — with attribution to Liam — in my own book. I wonder how this Ph.D. passes muster at the biggest nest of AIDS-mongers west of Harvard: UCSF.

    A lot of people get tested to get that “absolution,” for sure. They pretty much say so.

    And I ask sometimes why someone didn’t ask me to take the test, and they say, because I’m white and middle-class and a nice girl.

    Let’s not kid ourselves. It means white, which means clean, which means uncontaminated, which means safe. Congratulations! You test white! And heterosexual! So what’s the big deal? I can go get tested, come out clean, and enjoy the company of nice, respectable (white) men. Just a formality. A ritual, if you will.

    If one claims a privilege reserved only for white people, doesn’t that make them a racist? And if one does it as a religious ritual of absolution, isn’t that even more scary? Some kind of hypnotic, sacrificial, Hitler- or Stalin-like act that can’t be stopped once it starts? Next, you can prove your purity or loyalty to the regime by turning in the not-so-pure-or-loyal — or anyone you know who said they would never take the test. Can we trace your sexual partners? Why not? What are you hiding? Hm? Confess and be saved.

  4. A lesbian at very low risk for HIV infection insists on getting tested twice a year. Should she get tested so often?


    Answered by Nicolas Sheon, HIV InSite Prevention Editor


    I am an HIV test counselor. Every so often, I see clients who are very low risk that want to get tested every few months.

    For example, I saw a woman recently who reported that 5 or 6 years ago she performed oral sex on an HIV+ woman without a latex barrier. She has been tested twice a year since then, except for the past three years – she has been tested 8 times since 1996: all negative. Her only other partner since this encounter has been an uninfected female she has been mutually monogamous with for three years. In my experience I find many people confuse the HIV antibody test window period with progression to an AIDS diagnosis in an HIV+ person; so I made sure that this client understood this – that she did not have to wait years and years to find out whether or not she was infected.

    This was her ninth test in three years and it seemed to me she was very low risk: she had been monogamous with someone for 3 years and reported using latex barriers all of the time. There was nothing I could say or do to let her know coming in for all these tests was not necessary, from a clinical standpoint – once a year would be fine if she and her partner maintained monogamy.

    At the same time, I did not want to deny her a test, and she was so emphatic about having a risk I wasn’t sure of an appropriate way to address this. There is, of course, the possibility that this patient had some kind of risk activity that she did not report to me, although my “gut feeling” tells me she was being honest.

    Any advice for test counselors on how to handle low risk patients who seem too paranoid or obsessive compulsive?

    This is an intriguing question that I asked myself when I first started counseling. Soon after the HIV test was licensed in 1985, certain patterns emerged in the way people used the test. First of all, counselors told clients to get tested every six months, ostensibly because of the uncertainties around the window period. For a number of reasons, clients heard this as an injunction to test every six months. Magic Johnson’s announcement that he was HIV positive late in 1991 initiated an enormous increase in testing volume among low-risk people. That increase in testing volume has largely remained steady over the years, clearly suggesting that HIV testing for low risk people has become routinized. After Magic, it was no longer possible to claim “innocent victim” status because it was your responsibility to know your status and test regularly.

    Another perspective on this comes from my research on confession rituals. I find that testing begets more testing because people find it convenient to get a “clean slate” every six or twelve months. Testing has become a routine part of dating and courtship rituals as well as a way for individuals to cope with the growing anxieties around sex and intimacy during the conservative period that followed the sexual revolution. The test and the intense scrutiny imposed by the test counselor’s risk assessment represents a modern version of the ancient rite of confession. A negative test is therefore sought, not so much in response to a particular risk incident, so much as in response to a sense of moral or sexual pollution that is often expressed as a nagging doubt about one’s HIV status. In this way, a negative test result represents a kind of absolution. However, because the epidemiological (and ethical or even theological) significance of HIV risk behaviors remain shrouded in uncertainty, a negative test result offers only a fleeting sense of reassurance and absolution must be sought again and again. Note that this parallels Western discourses on sin and confession. For centuries, priests and theologians debated the issue of scrupulocity and recidivism, or how to deal with the spiritually worried well and those recalcitrant sinners who regularly confessed but refused to change their ways. I think HIV counselors can learn a lot from the history of confession rituals, something I explored in my dissertation.

    The problem with assessing Obsessive Compulsive Disorder (OCD) is that I believe AIDS really challenges traditional criteria for diagnosing and treating this disorder. While you can incorporate behavioral therapy into a treatment for a fear of heights or agoraphobia, it’s difficult to imagine behavioral therapy for someone obsessed with the idea that they were infected with HIV from a blow job or lap dance they received from a sex worker three years ago. Is repeat testing a ritual response to an obsession (akin to washing one’s hands or checking the stove) or is this person merely being “responsible?” There are screening tools for OCD, but it’s really difficult to draw the line between paranoia and prudence when talking about safer sex.

    I think there are particular contradictions that lesbians face around safer sex. The dominant society associates lesbians with exclusively same sex behavior which is, in turn, associated with AIDS. However, the actual risk of transmission between women is unknown, largely due to the fact that lesbians have been excluded from epidemiological risk groups. At the same time, many lesbians — up to 70%, according to one study — have had sex with men, a fact which challenges many of the assumptions made by and about lesbians with regard to HIV risk.

    There is also the possibility that this woman’s need to test regularly is related to power issues in the relationship. Maybe she is worried about her partner’s fidelity or the other way around. Rather than discuss this issue with her partner, she may be using the test to avoid the issue. In this case I would try to discuss with her how she talks with her partner about testing, and whether her partner gets tested as well.

    Hope this helps.

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