My name is Josh Kruger and I’m HIV-positive. The details of my seroconversion are irrelevant. Whether I was a needle drug user, the son of an HIV-positive mother, less than consistent with my condom use, or a medical professional exposed inadvertently to the virus, at the end of the day, I’m HIV-positive. Regardless of the reason or the background, I am living daily with the same virus other HIV-positive individuals do for many of these same reasons. 

That is perhaps the most interesting part about HIV. There is a culpability and a responsibility involved with it that does not exist with other chronic medical conditions. Have you ever asked a diabetic how he got it? Or, perhaps, asked someone with hypertension how long he had it and if he knew who gave it to him? Of course not, and it’s wrong to equate HIV with these conditions just as it’s wrong of me to act as though men should ignore my status and feel absolutely comfortable dating or having sex with me.

From a practical and medical standpoint, HIV is comparable to diabetes, and many would argue it is easier to live with HIV than diabetes – medically. Psychologically and socially, however, HIV is not on par with these and for us to lie to ourselves and our community and ignore the overarching moral and philosophical question surrounding HIV does a great disservice and impedes honest discussion.

This is most apparent in online profiles, the easiest and most accessible way to peer into the id of the modern homosexual. “Clean and want to stay that way.” This is a common and rather boringly typical statement in a profile you’d find on any app or website, one I myself thoughtlessly uttered once or twice in the past. But consider for a moment the logical implication of saying this. If being HIV-negative is clean, then conversely, as an HIV-positive man, I am dirty. And, I obviously deserve what I have because had I not acted recklessly or stupidly or taken unnecessary risk, I’d not be saddled with this tarnish and grime flowing through my bloodstream.

Obviously, I did not “want to stay that way” enough, you might think. But regardless of how fastidious about hygiene I may be, regardless of the fact that I volunteer or that I am a good man and a good neighbor or that I vote in every election or that I pay my taxes or that I’m an uncle to a lovely five-year-old boy, I am inherently unclean and therefore untouchable.

With the smug self-satisfaction of, so far, having avoided the virus, one can summarily dismiss and marginalize an entire population of human beings. And it’s happening. Yet, sometimes the negative reaction about being positive comes from the same individual barebacking “other neg guys” and who loves Gay Bingo, but he’ll delete my email without having read it because I’m one of “those.” The other. The unclean, irresponsible black sheep, the drunk uncle at Thanksgiving who has the inconvenient ability to remind people of failure.

I’m entirely too realistic and the issue too profound to think about during the search for sex or dates these days. And, what’s most intriguing is that some men will have sex with me so long as the topic isn’t even broached. Act like HIV does not exist, and the pool of sexual partners – including HIV-negative men – increases ten times over. But mention HIV the least bit in conversation or online, and you’ve become the asexual advocate.

And, no matter how physically strong or robust I am, no matter how healthy or professionally ambitious, once HIV is brought up, I’ll always be a cliché, a sick AIDS case, the walking embodiment of God’s divine judgment (I rather like that one, actually.)

But what’s perhaps most surprising about becoming HIV-positive is the amount of men who suddenly become HIV-positive the minute you are. That is, men in person and online – who for years insisted they were HIV-negative – are now quietly reaching out or implying that, perhaps, they were not as honest as they could be.

Why would they lie or conceal their status? Perhaps it’s the same reason I paused when I was asked to write this. Even now, I’m afraid. What exactly am I afraid of?

Well, I don’t date or have sex with anyone who isn’t aware of my status. Those I truly love in this world were all made aware of it the minute it happened. Legal protections are in place to ensure that I am not hurt financially or professionally because of my status. So, what is the reason I and these other men have such trepidation surrounding public affirmation, this second coming out, so to speak?

Your online profile – the one where you talk about being “clean” – might have something to do with it.

Publication of this piece earlier appeared in Josh’s own blog here and   in Philadelphia Magazine’s G Philly Blog on April 25, 2012 found here. 

The CBC this week reported Health Canada will allow men to donate blood if they haven't had sex with a man in the last five years, a change in policy that will go into effect in the coming weeks. Here is a statement from the Canadian AIDS Society received May 22. 

Ottawa, ON – The Canadian AIDS Society (CAS) acknowledges that Health Canada today approved a change to the blood donor deferral period currently imposed on men who have sex with men (MSM) from indefinite to five years from last MSM activity.

The Canadian AIDS Society has, along with other LGBT groups and patient groups, worked to support a proposal from Canadian Blood Services to Health Canada in December 2012 to change the MSM policy on blood donation. The proposal also calls for regular reviews based on scientific data to be collected.

CAS has been an active partner with Canadian Blood Services and others, working for many years to support the five-year time-based deferral as an incremental step towards a behaviour-based screening model for blood donation. Monique Doolittle-Romas, Chief Executive Officer of CAS said, “While a five-year deferral is still too long, we see it as an important step in the right direction. Ultimately, though, we’d like to see a model based on a donor’s behaviour rather than one based on sexual orientation and gender.”

With this important shift in the blood donation policy, CAS believes that there will be an opportunity to gather further evidence to create an even shorter time frame for the deferral in the future. However, Health Canada must continue their support through an increased commitment to research in this area.

“Protecting the safety of the blood supply in Canada has always been and will always be an important issue for the Canadian AIDS Society,” Doolittle-Romas reiterated

The title quote was written by George Bernard Shaw in ‘Saint Joan’ in 1923 but if ever a saying is timeless it’s this one.

The reason I’m dragging it out of the cliché locker is because I feel I have to take issue with a couple of articles that have appeared on PositiveLite.com recently.  

They are IS HIV TRANSMISSION POSSIBLE WHEN VIRAL LOAD IN THE BLOOD IS UNDETECTABLE? from CATIE and INFECTIOUSNESS coming from Aidsmap.com

I respect the work that people in HIV organisations put in to the struggle to control the virus and I appreciate the time and effort put in by writers who do their best to provide us with information – we’d be in a sorry state without them. I also know the perils of one article writer criticising another but I genuinely mean no disrespect. These two articles are pretty representative of what you will find all over the net and therefore my problem is more with the genre than the individual articles themselves.

The CATIE article addresses a question which is in the back of everybody’s mind. It’s crucial, both for positive and negative sex partners. The title suggests that the question will be answered but unfortunately that’s anything but the case. The first paragraph sums up what viral load actually is but hardly gives hard and fast rules which we can hang our hats on. It talks about the viral load being measured in the bodily fluids of a positive person. Surely it’s not. It’s measured in the blood and only very rarely in semen, saliva etc.

“Research shows that successful HIV treatment can reduce the viral load to “undetectable” levels and this can reduce the risk of HIV transmission. However, HIV transmission may be possible when the viral load is undetectable…The risk of HIV transmission when taking antiretroviral treatment may increase if sexually transmitted infections (STIs) are present…This risk may also be higher for anal sex than for vaginal sex.”

What do they mean, ‘can’ and ‘may’? We’re thirty years into the history of the virus. We should be hearing ‘does’ and ‘will’, not bet-hedging to cover all possibilities!

The following is something we’re all very aware of but what does a statement like this actually tell us?

“Viral load tests used in Canada cannot detect HIV in the blood if there are less than 40–50 copies/ml. Therefore, an undetectable viral load means the amount of virus in the blood is too low to detect, it does not mean that there is no virus present.”

First of all, we know the testing procedures are still limited but surely we’re entitled to ask why? Secondly, what the hell are we supposed to take from such a statement? Getting everybody to undetectable status is the universal aim but is pretty pointless if we don’t know how much of the virus has escaped detection because the procedures are lacking. Of course ‘undetectable’ suggests ‘less infectious’ but thirty years into the disease and its treatment and we still don’t know whether that’s entirely true. Until other bodily fluids are routinely tested we’re no closer to an answer and even then, the virus may be hiding in bone marrow, organs and brain tissue. Testing every susceptible piece of the body may never be possible but telling us we’re undetectable but maybe still dangerous, tells us almost nothing; we deserve better.

Another pretty meaningless statement is:

“Research shows that a lower amount of virus in the blood is usually associated with a lower risk of transmitting HIV to others, and a higher viral load is associated with a higher risk.”

Duh! And by the way, what research? We probably all accept the truth of this statement but what research proves that? Far too often the words ‘Research shows…’ are thrown at us in the expectation that we’ll accept that as gospel. Very often research is so small-scale and out of date that it is barely relevant. It is wrong to assume that the reader can’t cope with references to the exact piece of research and it should be expected that research is looked at with a critical eye but very often, ‘research shows…’ will back up a multitude of assumptions.

CATIE quotes HPTN 052 research to back up theories that a lower viral load reduces risk but that research was conducted amongst tiny groups of sero-discordant heterosexual partners in Africa and Thailand. The research is ongoing but trials to measure the same risk reduction when it comes to homosexual, anal sex…well you can whistle for that one! A lot of people hang a lot of credence on HPTN 052 but for HIV+ gay people, it suggests absolutely nothing and proves even less. To be fair, the CATIE article does point this out and even questions the relevance of the research but still draws conclusions that say we can reasonably assume that the same applies to anal sex. Uhm sorry, no it doesn’t!

When a paragraph begins with:

“Successful antiretroviral treatment can lower the viral load in the blood and other bodily fluids to undetectable levels and this can reduce the risk of sexual HIV transmission...Antiretroviral treatment may be much less effective than 96% when these conditions are not met.”

You know that it means very little. We want to know that in the majority of cases, ‘it will’!

More woolly information follows:

“A higher level of HIV in the semen, vaginal fluid, and rectal fluid may increase the risk of transmission when the blood viral load is undetectable. However, it is unclear how often this happens and how significant it is in terms of HIV transmission. Research shows it may be more common if a person has an STI, but can also happen in the absence of STIs.”

There they are again: ‘may’ and ‘can’, plus a ‘research shows’ and an ‘unclear’. How exactly is this useful information? The fact is that the research in all areas of HIV is still shockingly lacking and in the meantime we have to put up with guesswork. That's not good enough in 2013. If there’s no more money for  extensive and indisputable research; or no plans are on the table; or government and scientific bodies are standing in the way; or moral objections are blocking funds it’s the responsibility of HIV sites and organisations to say so and tell their readers the truth. “We just don’t know and this is why we don’t know,” is far more acceptable than ‘cans and maybes’. At least then we know where we stand.

Doesn’t this next sentence just sum it up?

“Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.”

Pitiful, really! Are we going to have to take to the streets again to demand efficient and relevant research which will end up saving the state millions in health care and why aren’t our large HIV organisations leading the charge?

The second article comes from aidsmap.com, which is generally regarded (just like CATIE) as a reliable and up-to-date source of information. The introduction is as follows:

“Aidsmap.com reports about 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. Whether or not this level of HIV in semen is associated with transmission is unknown.”

Now I thought this was interesting and went in search of this new research. It stemmed from a University of California study into the effect of the herpes virus on HIV transmission (read more here.) It involved 46 people, split between so-called HIV transmitters and non-transmitters and could hardly be called ‘large scale’. The Aidsmap article refers to 114 men in the study but even that’s hardly a significant research group. The point is that Aidsmap presents this as fact, based on ‘a US study’ when in fact it’s a little more complex than that and to state that 10% of men on HART have low levels of HIV in their semen seems pretty conclusive, yet it is based on a small study concentrating on the Herpes virus. Again, the statement may be true; it may be relevant and important but we need more evidence to back up global statements like that. (Editorial comment. PositiveLite.com says: even more important is whether such low levels of virus have any significance, i.e the ability to result in transmission. Is in fact the semen issue a complete red herring? We suspect yes, given the transmission history -  or lack of it -  in people with undetectable viral load in their blood.)

PositiveLite.com has quite rightly questioned the accuracy of aidsmap's references to the HPTN052 research, which is trundled out yet again yet proves practically nothing for gay men.  (Editorial comment; PositiveLite.com has since received acknowledgement from aidsmap that the aidsmap information was incorrect and that a retraction (apology?)  will be issued shortly. The moral is, as Dave says, question EVERYTHING you read.)

The article then goes on to say:

“But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load”.

What rare case reports? How many? Why isn’t this being investigated right now, on a large scale, to actually establish some facts? It’s almost as if HIV organisations and sites have become so accustomed to writing generalised pieces that repeat the same old suspicions and assumptions, that it has become a new truth of its own. Why aren’t they screaming out for new research and not settling for worn out cliché responses?

It goes on:

“Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.”

‘May’! Why don’t we know for sure?

Finally, statistics are rolled out:

“They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load…A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.”

Okay, let’s assume that the study involved 114 men and not 46. 36% of 114 is 41. Is it really valid to come to wide-reaching conclusions based on the results of 41 people? The urethral bacteria numbers are even less relevant: 5 people out of 114!

The point is that readers take headlines and believe them to be true, when in fact they’re often based on such small-scale studies that they barely merit a mention. Of course, all these studies may be revealing vital information and should be reported but if one (small) study suggests a trend then it should be replicated on a wide scale across the HIV community in order to establish whether it is more than just a medical soundbite. It’s the responsibility of authors and their organisations to look at these things more critically and if necessary make readers aware of the scale and validity of studies, statistics and suppositions.

The reader also needs to question anything that’s not clear, or seems to be stated as fact when it’s not proven. The problem is that life’s just too short to take the time to do that. So the promulgation of half-truths and loaded headlines becomes the easy way out, eventually leading to mistrust and suspicion.

This article of mine may seem like an attack on two highly regarded HIV information sources; it’s not meant to be. I have used them as examples of what we see every day in articles and discussions throughout the HIV community. We really do deserve better than to be fed meaningless conclusions based on ‘maybes’ and ‘possibilities’ but it’s not the fault of the authors. News has to be reported, no matter how tenuous the facts.

Unfortunately, it looks like the HIV community has to start demanding again. Demanding proper, well, funded and large scale research at home and abroad. The World Health Organisation has a responsibility (and the finances), as does the pharmaceutical industry and every other research or research-funding facility across the globe, including the major philanthropists like Bill Gates etc.

I’m fed up with endless arguments as to whether an undetectable status is safe or not, or whether TASP, PrEP, PEP and various other acronyms are the way forward, or whether the viral load in your blood reflects the true levels in your body. Just how safe is condomless sex between sero-positive people on HART? The questions are endless but I would like answers and soon. Some people and organisations are dragging their feet in providing them. It’s a question of having the political will to do the necessary research and damn well prove things once and for all and if the ‘climate’ makes it difficult to instigate the discussion and find the evidence, then we’ll just have to scream and shout until that changes. If it doesn’t happen then confusion drives apathy and stigma grows.

When you next read an article about the latest theory concerning HIV treatment and transmission; count up the number of ‘statistics, if’s, may’s, possibly’s and researches show’ and ask yourself if you are being presented with new facts and are you learning anything new. If the answer is negative then you may well be being short-changed!

I’m fully aware that some people will be irritated by this article but then I hope they’ll respond and widen the discussion. If I’m talking out of my backside, I hope you will say so  - but you’re going to have to prove it! 

March 15, 2013 - 11:30 pm

Met a guy last night online who was visiting LA for the weekend. We meet up this evening and found we had more than just a simple mutual attraction. He's newly POZ (just six months) so when he got an eyefull of the tattoo he was a bit confused but being in the medical field he quickly connected the dots. His reaction, like many, was supportive yet I got the distinct feeling it wasn't for him. Coming from a more traditional background I think being openly gay and now POZ was more than enough for him to deal with though he did have a nice tribal tattoo.  I wonder if the tattoo would have been an issue for him if we wanted something more serious or maybe he would want one as well ... there's a thought.  

March 17, 2013 - 12:30 am 

We decided to meet up late this evening but because I presently have roommates and like my privacy we chose a more ‘interesting’ venue to hang out at, the local gay bathhouse.  To be honest I have avoided the bathhouses for many years as they no longer hold much appeal. But lacking a place, seeing how he had never been to one before and me desiring to gauge the reaction of people to the tattoo in a sexually charged environment, the bathhouse on a late Saturday evening was the perfect place. 

We did the grand tour of the smallest bathhouse in LA and while he was filling his eyes with the sights - bathhouses by nature defy description so I will not attempt - I was focused on the patrons and their reactions … which was nothing.  That said, we were never approached, nor did we approach anyone to get any sort of reaction.  After a thorough once over of the place we retired to our room and later headed out to West Hollywood. 

March 17, 2013, 2:30 am 

We arrived at one of my old haunts, the now remodelled Mickey’s bar for after hours but instead of dancing we found ourselves on the patio talking.  He attended small high school where he was openly gay, a handsome guy who was into weightlifting at the time and had the respect of his fellow classmates.  Now in his early 30’s he was having to quickly come to terms with being HIV+, something he was having issues accepting and this caused him difficulties disclosing.

Knowing he came from a small southern community I asked if he had told anyone of his family he was positive, something I have yet to do.  Upon his diagnose he called his siblings and told them, “I am HIV+, I need you to go on the web tonight and learn about it because when I call you tomorrow I am going to need your support!” and hung up.  He called back the next evening and when they answered the verdict was unanimous “you are not going to die!”  I have to be honest, this was one of the most simple yet powerful disclosure stories I have ever heard.  

March 17, 2013 - 4:30 am 

We spoke some more and being the night was still felt young to us we decided to retire to LA's largest bathhouse to round out the evening.  If I was going to get a reaction to the tattoo I imagined it would be at this location. Though it was late, there were still lots of people awake and looking to connect. We got a room on the ground floor and made a quick tour of this location; it had changed a bit since my last visit years earlier but the general layout remained the same, with a basement, ground floor and upstairs. 

My guest had a mind to get a third to join us, so we set out on a search. There was no shortage of guys and though we made several attempts, whether being a couple was too intimidating or the tattoo worried the players or the general luck of the evening, we were unsuccessful. Neither approached nor shunned, without actually interviewing someone I couldn't say for certain what was the root issue, if any. So much for testing the tattoo at the bathhouses. 

March 24, 2013 - 10:00 pm 

Yet another in my series of my trips to the Korean spa with the tattoo, one guy struck up a conversation about it saying it looked like the Olympic symbol (it does have three semi concentric rings), I corrected him saying it was actually a biohazard symbol and left it at that.  I was not particularly interested in informing him of my status as this was still the Korean spa and I didn't feel entirely comfortable just announcing my status randomly, sort of defeats the idea of limiting disclosure.  However if he pressed me I would have willingly explained why I was wearing the tattoo as it’s purpose is to promote discussion and it definitely empowers me to disclose. 

March 26, 11:45 pm 

Sitting in the spa at the gym before closing, just myself and another guy (seen him before never talked to him), when out of the blue he commented on the tattoo saying it looked like a gay symbol. (In fact the biohazard tatt is rainbow coloured so it serves to ID me as gay to the observant).  In context this was the day of the US Supreme Court hearing the arguments regarding the Defense Of Marriage Act (DOMA) and the following day they were scheduled to hear Proposition 8 arguments and he was curious how I felt about it as well as the possible outcome.  This was fascinating, as the tattoo appears to get people talking about things that are close to my heart other than just my status. This was a great and most unanticipated result. 

March 30, 2013 9:00 pm 

Arrived late to the Korean spa. I had problems applying the tattoo that evening; the skin seems oddly irritated but I ignored this and off to the spa I went. Only ten minutes into my visit I notice the tattoo, a thin sheet of acetate glued to my skin, was bubbling up. Argh! I pressed hard to get it to adhere and thought it would just stick ... it didn't.  The temporary tattoo that I usually wore for three to five days without any issues was coming unglued.  By the time I was done with my 70 minute session it had peeled up to the point that once I returned to my locker to change I needed to remove it.  It appears my skin has built up an allergic reaction causing the temporary tattoo to not only bubble up but actually cause physical pain to the application site.

So no more temporary tats, the universe has spoken! 

April 1, 2103 10:45 pm 

In the shower at the gym the following evening, a sexy young black guy is one shower over and is clearly looking for some action. Never been one for public play but without the tattoo I felt oddly more naked than I already was ... interesting that the tattoo appears to work for me both as a shield as well as a warning. 

April 6, 11:30 am 

Finally I made contact with Jill Jordan, a highly respected and innovative tattoo artist! Set an appointment with her for April 14th at 1:00 pm. My gym buddy Alonso is so excited he also wants to meet Jill (he has a tattoo of his own in mind). 

April 7, 2013 9:00 pm 

I meet up with my first former bf David while he was visiting LA and being that he was one of the inner circle of people who knew I was poz I wasted no time telling him about my desire to get the biohazard tattoo. Why open with the tattoo? David and I have also had a very deep connection on a spiritual level and I wanted to hear him ask "what is your intention?" 

I gave him my canned answer - it will make it easier to disclose, show solidarity to the HIV+ community, etc., yet I was merely buying time to really look deeper and see if I could find an even more tangible answer. This was always the way with us because of our connection and frankly it's quite refreshing to speak about life in terms of spirit and action.  Oddly I rarely avail myself of such opportunities anymore ... makes me wonder why. 

We had both been through some serious life events, broken relationships, health and financial issues, yet we seemed to be better off for it all.  By the end of the evening I was feeling very comfortable with David again and was ready to give him a better answer with regards to my intent of getting the tattoo. 

First, I wasn't branding my soul, only the body. It reminds me to be mindful of the infection but not overwhelmed by it. A few years ago I might have found such a reminder very disturbing, a constant reflection of a mistake I made and was unable to undo. But now much, like knowing I will die, I am coming to terms with it. The tattoo reminds me my life and time on this earth is precious as well as short and to embrace life at every opportunity. 

Second, the tattoo is a method of communication of not just my HIV status or that I am gay (the rainbow flag has many people identifying as a gay symbol) but purely as an art form with a language all its own.  I trust many will appreciate it on many levels but haters will hate and how I deal with such situations will be a measure of my own growth.  Most reactions have been good and I predict that though this seems like a bold act now it will be passé in 10 years but no less important to me! 

Lastly, it memorializes the freedom of my mind if not body from HIV (my spirit has always been free and I am beginning to appreciate that more and more). David applauded my intention and asked me to meditate further on this act. II told him I would and let him know what conclusions I reached. 

April 10, 10:00 pm 

Over the following days I considered what David and I talked about and we shared more messages over FaceBook when it dawned upon us - damn this tattoo really does get people talking. That’s when it hit me this was an immerging aspect, not just to communicate to other people but to get people talking - about HIV, about gay issues, breaking down the barriers we put up in our daily lives.  I am not so naïve to think this tattoo will change the world but getting people talking is a great start! 

I changed roles from Positive Prevention to Women’s Community Development about, oh, eight months ago or so, which means that I’ve gone from working with mostly gay men, to working mostly with women.

Like a lot of people in this role, I sit on quite a few committees. There are planning committees, steering committees, research committees, working groups, alliances, the list goes on. Naturally, committees involve a lot of group collaboration and negotiation.  From writing a scholarly article to putting on a health forum to getting a research project funded, a cohesive group necessitates the active participation and voices of all members.

All of the committees I sit on (and there are about 15 of them) are made up entirely, or almost entirely, of women. One of things I noticed right away when I changed positions was the difference in how women tend to communicate on committees. While this is certainly not the case in every situation, I have noticed a tendency for many women to be quite cautious when they share their opinions. In many causes, non-assertive language is used, voices are lowered, and opinions are hedged by phrases like, “this is just my idea,” “…or we can go with your original plan” and “but I’m fine with either way.” In one meeting, the chair encouraged the participants to share (and keep sharing) their emotions after she had recommended a change of plans. “Are you sure you’re all okay with this? I feel like some of you might be holding back…”

It’s interesting to observe. I think back to my participation in male-dominated committees during my Positive Prevention work and the difference is startling. When I showed up to the Positive Prevention Working Group (an all-male committee), to obtain feedback on ACG’s Train-the-Trainer manual in 2009, the feedback was delivered – how shall I say – very directly. Attend any Gay Men’s Sexual Health Summit and you will find an abundance of men who are not afraid to challenge one another or share their views. I believe that the capacity to debate and challenge one another is a strength; the diversity of opinions that are shared in these committees and summits helps to push us all towards a higher level of accountability and excellence in our work, from theory to practice.

Obviously, strong, confident women exist in this field too – indeed, there are many of them - but I can’t help but notice that many of the committees upon which I sit tend to operate in a reserved, restrained manner. In many of these committees, women use words like “maybe,” and phrases like, “as long as you’re on board,” or “I hope I’m not being difficult or demanding.” Opinions are rarely shared as confidently as they were at the Positive Prevention Working Group.

Am I being male-normative, to assume that women-operated meetings must be carried out with the same level of speed and self-assurance as those led by men? Perhaps we, as women, should feel justified in having our own method of building relationships, building trust, and gaining the confidence of the other members. Perhaps we lead more quietly, and with more empathy.

Or, perhaps we operate in a more cautious and restrained way because we are trained to be overly-concerned about other people’s feelings, because we are taught that our opinions are less important, and because we have learned – often through lived experience – that women who are bold and assertive get labeled as “bitches”.  Perhaps we have learned that women who display “too much” confidence and self-assurance often take a social penalty.

It’s something I wrestle with personally. I desire to be a good leader and cultivate my own leadership abilities.  When I chair a committee or contribute as a participant, I try to do what is right – I give myself permission to assert my own voice, my own thoughts and ideas. I aim to express myself with some tact and diplomacy, and make a genuine effort to listen openly to the ideas of others, validate their suggestions, and cultivate mutual discussion. But I also try not to limit my own self-expression, or downplay the credibility of my suggestions.

I do not want to contribute to a culture that reinforces social norms in which women should not speak confidently or assert their viewpoints. I do not want to contribute to gendered norms that hold women back from being successful. I do not want to let fear limit our ability to be efficient and create change.  Instead, I want to contribute to a culture that encourages women to speak with conviction. I want to contribute to a culture that says, ‘it is okay to disagree and to challenge one another.’ I want to contribute to a culture that allows women to profess their knowledge, assert their beliefs, and engage in healthy debate without having to worry about being labeled a bitch. 

This is my goal, but the truth is, chairing meetings brings anxiety. It usually happens after the meeting is over. I lead the meeting in a way I think is most appropriate, balancing the aforementioned goals. But after, I worry - was I too assertive? Do the other women think that I am over-bearing, or too controlling, or that I think too much of myself?