Mortal Secrets

Mortal Secrets takes up the question of truthtelling, but not from the philosopher's armchair. Klitzman and Bayer have confronted truth and lying face to face with sufferers from, and in some cases, unfortunately, vectors for the great scourge of advanced countries in our age. What they discovered in these encounters will help us to survive it, but its implications for how we can and should reveal the truth reach far beyond AIDS. -- Melvin Konner, M.D., Ph.D., author of The Tangled Wing: Biological Constraints on the Human Spirit (revised edition) and Unsettled: An Anthropology of the Jews In Mortal Secrets, Klitzman and Bayer explore how we weigh the benefits of secrecy against the hazards of truth telling. This is a timeless question that is destined to become more and more important as the incidence of HIV rises. I was moved by the wonderful voices captured in this book, the voices of people wrestling with issues that are at the core of relationships; Mortal Secrets is illuminating and groundbreaking. -- Abraham Verghese, author of My Own Country: A Doctor's Story In this pioneering work, Bayer and Klitzman shed light not only on the complex and poorly understood world of communicating about HIV but also on the realities of morality as it is lived in the real world of frail and fallible human beings trying to talk about the most intimate matters imaginable. It is easy to advise our children and one another to always tell the truth. As Mortal Secrets reveals, that injunction can be and is applied in a variety of ways and with great nuance when the subjects at hand are sex, infection, and the transmission of disease. This study shows in ways poignant and telling that being ethical, while desirable, is neither simple nor easy. -- Arthur L. Caplan, University of Pennsylvania The ethical dilemmas of modern life are all too often discussed in general terms via presumptive rules and imagined examples. In Mortal Secrets, Klitzman and Bayer describe HIV-positive individuals struggling to decide when and when not to inform lovers, relatives, or friends of their condition through the troubled, eloquent, and above all concrete testimonies of those individuals themselves. The result is a powerful and moving portrait of moral deciding as it actually happens-practically, specifically, in the midst of fear, suffering, and the incertitudes of love. -- Clifford Geertz The women and men who people the pages of this book are not philosophers or humanistic scholars. But out of their lived experiences as individuals infected by HIV, or as partners of those who are, they speak with wrenched insight and authority about the deep and complex moral issues with which their situations have confronted them. Through the medium of their startlingly frank interview-testimonies, we hear them grapple with questions about truth and lies, candor and deception, secrecy and disclosure, silence and communication, physical and psychic intimacy, risk and safety, the reciprocity of trust, and responsibility for the protection of self and of known and unknown others. These questions are not confined to the realm of HIV/AIDS. They are fundamental to the viability and meaning of human relationships, and to life in society. -- Renee C. Fox, University of Pennsylvania

Addressing broad debates about the nature of secrecy, morality, and silence, this book explores public policy questions in the light of the nuanced, private decisions that are shaping the course of an epidemic and have broader indications for all.In the era of the Internet and Oprah, in which formerly taboo information is readily available or freely confided, secrecy and privacy have in many ways given way to an onslaught of confession. Yet for those who are HIV positive, decisions about disclosure of their diagnosis force them to confront intimate, fundamental, and rarely discussed questions about truth, lies, sex, and trust. Drawing from interviews with over seventy gay men and women, intravenous drug users, sex workers, bisexual men, and heterosexual men and women, the authors provide a detailed portrait of moral, social, and psychological decision making. The interviews convey the complex emotions of love, lust, longing, hope, despair, and fear that shape individual dilemmas about whether to disclose to, deceive, or trust others concerning this disease. Some of those interviewed revealed their diagnosis widely; others told no one. Some struggled and ultimately told their partners; others spoke in codes or half-truths. One woman discovered her husband's diagnosis in a diary; when confronted, he denied it. Each year in the United States, 40,000 new cases of HIV arise, yet approximately one-third of the 900,000 Americans who are infected do not know it. As treatments have improved, unsafe sexual behavior has increased and efforts at prevention have stalled. Many of those infected continue to fear and experience rejection and discrimination. Addressing broad debates about the nature of secrecy, morality, and silence, this book explores public policy questions in the light of the nuanced, private decisions that are shaping the course of an epidemic and have broader indications for all.