Trust, luck and the STD lottery

Less than a year ago, I wrote a post wondering aloud what people in South Africa's rural areas are thinking when they have unprotected sex. These days, I'm wondering what anyone's thinking when they do it.

First scenario this week: I'm at a clinic. A nurse is drawing blood from my arm for an HIV test. It's my fourth test in under 12 months. There were two during my pregnancy (first in SA and then again when I got registered on the NHS); then after my return home, I had another for my medical aid and yet another for my life insurance. None of these institutions - the private doctor, the NHS, the medical aid, the insurers - are prepared to trust the results of the other. Even though each one is wasting the extra R100 or so that the HIV test costs them, I can see why it's not in their interests to trust the results of the others. Why should they? Who's going to divulge honestly that they're HIV-positive when they're applying for medical or life insurance, if they think they're not going to get checked up on?

As it happens, I'm only too happy for them to run the extra tests, given my ex-partner's recent revelations about his behaviour during our relationship. Which would be beside the point, but inevitably this is part of what got me thinking about trust, luck and the ticking time bomb that is the spread of very serious sexually transmitted diseases.

Scenario two: I'm at a table with several women, some married, some not. One of the women is unhappily married, and her longstanding extramarital affair is common knowledge among those around the table. Let's call her Jane.
"How many sexual partners do you have?" I ask her.
Despite her usual bluntness about her affair, Jane seems nonplussed by the directness of the question.
"Two," she answers, and names the husband and the lover. She laughs somewhat harshly, and I can't place the laughter - whether it's self-consciousness or pride, or a mixture of both.
"And do you have safe sex?"
No, Jane tells us, because she's allergic to latex. "So until they produce non-latex condoms, I'm condom-free," she says, with a similarly difficult-to-read laugh.

So Jane is protecting herself against whatever allergic reaction she might get from latex. An excuse which is perhaps reasonable, perhaps convenient, perhaps true, perhaps not. But the excuse isn't protecting anyone in the dubious chain of trust in which she's entangled.
Jane's lover knows about her husband, obviously. The husband does not (as far as we know) know about the lover. And what does Jane know about her husband?
"Oh, he's not having sex with anyone else," she says. Confidently.

It's the confidence that fascinates me. My ex was confident that he wouldn't get caught. He was also confident that I wasn't cheating on him. Jane is confident that she's the only one in the scenario forming an open link of trust - and risk - with both her sexual partners. How well-founded is their confidence? What is it based on?

Well, Jane is confident for a number of reasons. She doesn't find her husband all that attractive any more, so she finds it hard to believe that anyone else does. She regards herself as the sexually adventurous, attractive one in the relationship. She knows she has needs, and she knows her husband is not meeting them. She is not interested in her husband's needs, so it's hard for her to think that anyone else is either. In addition, her lover makes her feel a bit more attractive. All of these conspire to give Jane an imagined edge of power over her husband.

In order to keep her affair from threatening her sense of herself as an okay, lovable person, it also suits Jane to ignore the needs or feelings or experience of her lover's wife. Or the fact that the invisible wife is now effectively one of Jane's own sexual partners (assuming that the lover occasionally services said wife.) Do we know whether the lover's wife is faithful? It suits Jane to imagine the wife as sexually nonexistent; in fact, it probably suits Jane not to imagine the wife at home. But let's imagine that she is, in fact, human. She is left at home quite often while the husband is out and about with Jane. Who knows what she's up to?

I know very few people that haven't, at some point, cheated or been cheated on. I know that in the cases it's happened to me, the culprits have always demonstrated complete confidence in my own fidelity. As though a lack of suspicion or jealousy is evidence of fidelity. Either they are correct, and they are the only ones capable of cheating and dissembling successfully. Or, perhaps, their trustworthy-seeming partners are simply even better at it than they are. How can they know which it is? And given that they know that they themselves are capable of cheating, how can they doubt that anyone else is?

Interestingly, those that cheat tend (in my experience) to have more concern about the perceived betrayal of romantic trust than about the far more pressing risk that they may well have exposed their partner to potentially life-threatening disease. In other words, they are more worried about being found out to appear untrustworthy or dishonest than about the possibility that they may have condemned another person's health irreparably. What other people think of us is, in this case, more threatening than serious, potentially chronic illness. It's a weird (but consistent) weighting of personal concern.

The nurse at the clinic asks:
"Has anyone discussed with you the implications if your test showed positive?" No, I say, but I have a fair idea of the implications.
"Do you get many people testing positive here?" I ask. After all, this is an office block in Sea Point, one of the most affluent areas in Cape Town. We're in the epicentre of the HIV pandemic by virtue of being in South Africa, but this is still a zone where most people will be wrapped in the idea that It Can't Happen To Me. She looks somber.
"It's a ticking bomb," she says. "Put it this way, there are a lot of people out there that just don't seem to keep to themselves."
Don't I know it, I think. And I can't help wondering whether Jane wouldn't better off with a bit of an allergic reaction to latex than something a whole lot worse.