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Mortal Secrets: Truth and Lies in the Age of AIDS
 
 
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Mortal Secrets: Truth and Lies in the Age of AIDS [Paperback]

Robert Klitzman (Author), Ronald Bayer (Author)
4.2 out of 5 stars  See all reviews (4 customer reviews)

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Book Description

March 9, 2005 0801881919 978-0801881916 1

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.


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Editorial Reviews

Review

An engaging consideration of the competing and sometime contradictory values that influence disclosure decisions in the lives of HIV-positive adults... [and] a stimulating and deeply satisfying discussion of the tensions inherent in disclosure stories.

(Robert Kertzner, M.D. American Journal of Psychiatry 2004)

An in-depth look at the motivations, beliefs, and practices of those who must decide to get tested and if positive, whether or not to disclose, and when... Mortal Secrets delivers a powerful message using the voices of those most affected.

(Lisa K. Waldner, Ph.D. Journal of the American Medical Association 2004)

Nonjudgmental... Readers may find themselves with newly gained compassion and understanding for the dilemma of when and how to disclose HIV status.

(Marla J.Gold, MD Annals of Internal Medicine 2004)

This is an interesting book that social workers need to read so as to understand their clients concerns. A recommended book for all academic libraries.

(AIDS Book Review Journal 2005)

Klitzman and Bayer provide an engaging consideration of the competing and sometimes contradictory values that influence disclosure decisions in the lives of HIV-positive adults.

(Focus: A Guide to AIDS Research and Counseling 2008)

It is an aim that succeeds to an extraordinary degree... So well thought-out is this study, and so well presented are the accounts of the participants, that I put the book down with a real—and rare—sense that my understanding had grown and my thinking about the ethics of HIV—in particular the responsibilities of those infected—had shifted... The examples given here put such bald statements into a new context, and make the social and cultural factors that shape the pandemic seem vivid and emotionally real. Such vividness serves powerfully to enhance understanding.

(Tamsin Wilton Journal of Neurology, Neurosurgery and Psychiatry )

This is a very interesting and thought-provoking book, which utilizes, but also moves beyond, the interview data in order to address broader debates around complex issues of sexuality and morality.

(Elaine Denny New Genetics and Society )

A useful resource for both clinicians and laypersons, and I recommend it as a highly accessible and expertly written book.

(International Review of Psychiatry )

Mortal Secrets is a book for anyone desiring to move forward in the fight against the illness, not the people.

(Erica Prigg Health Communication )

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.

(Renée C. Fox, University of Pennsylvania )

From the Inside Flap

"An in-depth look at the motivations, beliefs, and practices of those who must decide to get tested and, if positive, whether or not to disclose, and when . . . Mortal Secrets delivers a powerful message using the voices of those most affected."—JAMA

"Readers may find themselves with newly gained compassion and understanding for the dilemma of when and how to disclose HIV status."—Annals of Internal Medicine

"An engaging consideration of the competing and sometimes contradictory values that influence disclosure decisions in the lives of HIV-positive adults."—American Journal of Psychiatry --This text refers to the Hardcover edition.


Product Details

  • Reading level: Ages 18 and up
  • Paperback: 232 pages
  • Publisher: The Johns Hopkins University Press; 1 edition (March 9, 2005)
  • Language: English
  • ISBN-10: 0801881919
  • ISBN-13: 978-0801881916
  • Product Dimensions: 8.9 x 5.9 x 0.6 inches
  • Shipping Weight: 12 ounces (View shipping rates and policies)
  • Average Customer Review: 4.2 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Best Sellers Rank: #1,830,545 in Books (See Top 100 in Books)

More About the Author

I am a Professor of Clinical Psychiatry at Columbia University, where I direct the Masters of Bioethics Program.

 

Customer Reviews

4 Reviews
5 star:
 (2)
4 star:
 (1)
3 star:
 (1)
2 star:    (0)
1 star:    (0)
 
 
 
 
 
Average Customer Review
4.2 out of 5 stars (4 customer reviews)
 
 
 
 
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4 of 4 people found the following review helpful:
4.0 out of 5 stars A worthwhile project, but less a Book than a Dissertation, December 18, 2003
By 
MORTAL SECRETS: Truth and Lies in the Age of AIDS is a book that is much needed as we read about the disheartening upswing of the AIDS pandemic. Now that so many new drugs are available and now that living with AIDS is a reality instead of an unachievable goal (as we all wait for a vaccine and a cure), this is an opportune moment for addressing the psychological and ethical issues faced by both HIV positive and HIV negative persons. What Drs. Klitzman and Bayer (a Psychiatrist/Bioethicist and a professor of sociomedical sciences) set out to do is make observations based on interviews with gays, bisexuals, straight people with histories involving drug use and prostitution (or partnered with one from these groups) on several topics: transmission of the disease, attitudes about getting tested, about being positive, about disclosure to partners, parents, extended family, co-workers, and the public at large, and the painful struggle about making moral judgments as to when to disclose positivity to sexual partners, etc.

The introduction is levelheaded, the interviews are isolated paragraphs instead of two-way conversations, and the presentation of the data and the opinions of the writers is fairly dry and flat. Knowing this is an investigatory, extended paper makes the reader finally absorb the material as though for a class in college. Not that this is at all bad: I think this book will provide a good reference for future works whether they be fact based or novel enhanced. One wishes for more writing like the following sentence in the closing paragraph: "Shame, desire, passion, fear of abandonment, lures of secrecy, vicissitudes of moral character, and qualities of relationships all mold private life and individuals' willingness to talk about HIV. Policy Makers can shape the context of private choice, but the exercise of such choice remains beyond their control."

In writing about this most devastating of diseases one hopes for more passion on the part of the writers. How do these men really feel about the pandemic? There really are no "Conclusions" here. But then, again, this is more a dissertation than a support session.

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3 of 4 people found the following review helpful:
5.0 out of 5 stars Useful insights, not righteous prescriptions, December 19, 2003
By A Customer
This book is a welcome respite from the "damn or defend" approach usually taken to hot-button issues like HIV disclosure. Rather than inserting themselves as authorities who tell people with HIV what to do, the authors let people who are wrestling with all the complexities of HIV disclosure--with casual partners, with long-term partners, even with parents and friends--speak for themselves . The result is a portrait that won't satisfy those who want to mandate how it is people with HIV who live their lives, but also doesn't pander to people who want to whitewash away the uncomfortable truths about how people infect one other. Many of the voices here capture the complexity that gets lost in sound bites about HIV. This is just how it should be with a book about an issue that is simultaneously so everyday and so freighted with consequence for many of us. Get it. Read it. It will make you feel human, and appreciate the humanity of others.
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3 of 4 people found the following review helpful:
3.0 out of 5 stars Disclosure and its meanings, December 15, 2003
By A Customer
This book is a disppointing read. The data are old: the epidemic has moved on from pre-HAART days so that the narratives about disclosure are distorted by the time warp. The material isn't organized well either, so that the social patterning of disclosure (e.g. by gender, social class, race etc.) is never revealed. The book needed a better and deeper theoretical analysis to elucidate the connections between social patterning, HIV transmission and disclosure. Further, the material presented here is a little too rosy. Many people do not disclose their HIV-positive status in the short term and often not in the long term either. It was difficult to get a sense of the meaning behind the material in a way that would be useful for dealing with issues of disclosure in the field.
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Inside This Book (learn more)
Browse and search another edition of this book.
First Sentence:
"I tell the truth about half the time," he said. Read the first page
Key Phrases - Statistically Improbable Phrases (SIPs): (learn more)
uninfected gay man, former male prostitute, former drug user, white gay man, partner notification, unprotected anal sex, gay actor, anonymous partners, uninfected individuals, unsafe sex
Key Phrases - Capitalized Phrases (CAPs): (learn more)
New York, African American, United States, David Nyberg, Sissela Bok, Department of Health, San Francisco, Body Positive, New Zealander, Green Beret, Pacific Islander
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