DIFFICULT MORAL QUESTIONS

Question 56: May an HIV-positive student keep her infection secret?

I am a woman, twenty-one, beginning vacation after my third year of college. I have tested and retested positive for HIV. The fact that I’m perfectly healthy right now and the hope that better treatments will be found are some consolation. I’ve told my parents, and it already has been decided that I shall return to school in the fall. That leads to my question: May I keep my condition secret from the college’s administrators and my fellow students?

If I say nothing, I will live in a dormitory suite with three other women, all close friends, sharing a bath and kitchenette. Also, I will be playing basketball, since I have a full basketball scholarship. The doctors tell me that if I am careful, the living arrangement will involve virtually no risk for the others, but continuing to play will involve minimal risk, though a real one, since players occasionally do bleed and get blood on one another. If I tell the school, I’m not sure what they’ll do, but my guess is they will ask me to live in a one-person unit and not play basketball, while continuing my scholarship and keeping my condition confidential. If I don’t tell the school but tell all the other students with whom I’ll be in close contact, I don’t know how they’ll react, but probably someone will talk and soon everybody on campus will know.

I want to do the right thing. But many people react irrationally to anyone known to be HIV positive, and it’s not easy to see what is right.

Analysis:

The moral issue the questioner raises is: How much risk to others can she fairly accept so as to keep her secret and continue her usual, legitimate activities? The answer should be sought by considering all the relevant facts and applying the Golden Rule. Also, mercy calls a Christian to put others’ interests first unless some moral obligation forbids doing so. If the HIV infection resulted from drug abuse or illicit sexual activity, the questioner should repent and amend her life, if she has not already done so. If others were involved in such activity, she also should warn them and urge them to repent and to seek appropriate assistance.

The reply could be along the following lines:

While I shall do my best to answer your question, you surely will need far more moral guidance and spiritual help than I can give you. So, unless you already have a suitable person to talk with, I urge you to try to find someone who is faithful to the Church’s teaching and a good listener—probably a priest—to provide that guidance and help.

You do not say what caused you to become HIV positive. Perhaps there was no wrongdoing on your part. But if there was, you should consider sacrificing your privacy and publicly bearing witness to relevant moral truths. Mistakenly imagining themselves to be invulnerable, many young people recklessly engage in behavior that is both sinful and risky. Unless consideration for your family and friends requires you not to make your experience public, you might do great good by sharing it.

Then too, people in certain situations might have a right that the law would recognize to be told you have tested positive for HIV. I do not know whether that is so, but I suggest you look into the possibility. If the law very probably would recognize such a right, you should presume that you are morally obliged to respect it.

Perhaps neither of the preceding considerations provides a compelling reason for you to forgo secrecy about your condition—at least, not vis-à-vis the college administration and your fellow students. In that case, your question stands as you present it, and I respond as follows.

In principle, your problem is no different from that of many other people who cannot fulfill their responsibilities by engaging in activities good in themselves without accepting some risk of serious harm to others. The problem arises for anyone afflicted with a communicable or hereditary disease. In every such case, the moral question is whether it is fair to carry on one’s usual, legitimate activities or whether one is required to modify them so as not to expose others. That can be decided only by applying the Golden Rule.

In doing so, one must take into account the interests of everyone concerned and all the ways their various goods are at stake. Then one must try to put oneself in others’ places. When not prevented by some moral responsibility, a Christian also should be merciful, which means putting others before oneself.

Playing well in any sport is worthwhile in itself and so is personally fulfilling. Since you have a scholarship for basketball, you obviously play it well. So, to give up playing the game would be a sacrifice, even if it would not result in the loss of the scholarship. You say the doctors have told you that the risk for others involved in your continuing to play will be minimal but real. Its extent depends on many factors: how much hard contact is likely to occur in the games you would play, whether you play a position in which you are more or less likely to be involved in such contact, whether wounded players who might exchange blood are promptly taken out of the game and kept out, and so on. You must honestly consider all such factors and judge what is fair. No one else can do that for you.

It does seem to me, however, that, unless the risk of infecting others is almost nil or your responsibility to continue playing involves more than your personal commitment to the sport, you should stop playing basketball. On the assumption that, if you tell your college’s administrators, you will be asked not to play but will not lose your scholarship, continuing to play is not required by any duty to either the school or others, such as your parents, who presumably would have to pay your tuition if you lost your scholarship. I doubt that the risk is almost nil; the doctors acknowledged some risk and probably did not exaggerate it. Granted, some people react irrationally to those known to be HIV positive. But can you honestly say it would be unreasonable for other basketball players to prefer to avoid the risk your playing would impose on them? Furthermore, like all of us, you desire others’ compassion. Does not mercy, then, require you to give others’ welfare the benefit of any residual doubt, rather than exercise your own questionable right to continue to play?

Someone might suggest that you could go on playing, provided you told your teammates and the members of opposing teams about your condition. I do not think that would solve the problem. Plainly, if you shared the information with that many people, it would become common knowledge. Moreover, school administrators or league officials might intervene and stop you from playing. And even if you were able to continue, telling other players about your condition probably would mean that some would refuse to accept the risk of playing the game with you, while, for those who did play, it would reduce but not eliminate the risk to them. Then too, if your opponents knew you are HIV positive, they almost certainly would try to avoid contact with you, and that would give you an unfair advantage over them.

With respect to your living arrangements, you say the doctors tell you that, if you are careful, you will impose virtually no risk on your three friends by living with them in a dormitory suite, with a shared bath and kitchenette.²⁰³ If you do share in that way, it seems to me you should confide in your three friends about having tested HIV positive. Even if the risk of living with you is virtually nil, it hardly would be friendly to deny them the opportunity to decide for themselves whether they wish to take the risk. Then too, if they know, by taking precautions they can almost eliminate any residual risk to themselves—for instance, by being careful never to use anything that might have your blood on it, such as your toothbrush, nail clippers, or razor. Moreover, friendship calls for sharing one’s concerns, not hiding them. If you do not take your friends into your confidence, you not only will deprive yourself of their support but will deprive them of the opportunity to grow by being loyal to you in this difficult situation.

Therefore, though I do not wish to substitute my attempt to apply the Golden Rule for your own conscientious and merciful application of it, it seems to me you should share your secret both with your three friends and the college administration. If you reach the same conclusion, I suggest you first have confidential talks with your three friends, and try to secure their agreement to carry out your plan to live together. All may agree, and almost certainly at least one will. You then can approach an appropriate school official and, before divulging your secret, request that the conversation be kept in the strictest confidence. Having received that assurance and explained that you have tested HIV positive, you should share the advice your doctors gave you as well as your friends’ response to you. On that basis, you can try to work out an agreement to give up playing basketball, continue to receive your scholarship, and live with all or at least one of your friends.

Of course, if you accept this suggestion, carrying it out will involve some risk. One or more of your friends might violate your confidence and spread word about your condition. Also, contrary to your expectation, the college might not only ask you to stop playing basketball but take away your athletic scholarship. But do not overestimate the significance of these risks. That others know you are infected need not prevent you from living a good life in the time remaining to you, and, even if the college takes away your scholarship, both compassion for you and public relations considerations are likely to motivate it to find another way to help you complete your education. So, you can hope for the best in accepting the unavoidable risks in doing the right thing—which you commendably want to do.

If your infection with HIV resulted from drug abuse or nonmarital sexual intercourse, I hope you have repented that misbehavior as well as any other grave sins of which you were guilty and have firmly committed yourself to amending your life. Nothing is more important than that you live blamelessly before the Lord from now on so that you will die in his love. Moreover, if the infection resulted from wrongful activity with others whom you can identify, you ought to tell them you have tested positive, and urge them to repent, amend their lives, and obtain appropriate medical, psychological, and spiritual help. Finally, no matter how you became infected, you owe it to others to do what you reasonably can to minimize the risk of infecting them, especially to avoid all wrongdoing that might transmit the infection.

203. A summary of information about the epidemology of HIV: John G. Bartlett and Ann K. Finkbeiner, The Guide to Living with HIV Infection, developed at the Johns Hopkins AIDS clinic, 3rd ed. (Baltimore: Johns Hopkins University Press, 1996), 28–40; this volume summarizes a great deal of information that would be helpful to a person infected with HIV, but offers morally unsound recommendations on matters such as contraception and abortion.