So we’ve discussed what responsibility is.  But let’s look at the reality of the world of a person living with HIV.  We’ve mentioned a few responsibilities that may emerge as a way of ‘owning’ our own process of getting well.  But how does this contrast with the current reality of individual living with HIV?Some activists have suggested that current health-service paradigms pose challenges to taking responsibility for our own health.  In a health system that asks the sick to come for assessment, then dispenses medication as the ultimate answer to the illness, one can wonder where there is room for the individual with HIV to take any personal responsibility.  Maybe in adherence.  But are we just responsible for this? Surely there is more to this process! In any other situation we have to address all the dimensions— how do we contract the illness? How do we pass it on? How do we ensure that we get better? How do we stay better? And this may become more uncomfortable, because it says to the individual— Listen, yes you are ill, but there is still a lot that is in your own hands.  There’s a lot of power that you can exert to control and, perhaps, change your (or other’s) health.  Which means that responsibility assumes that the individual has a lot of stuff within them that they can use to stay strong and to develop strength in a situation that shifts like unsettled sand.

I think that empowerment— the positive kind that has the force to change circumstance from something within the individual— is central to responsibility.  If we take responsibility for our lives, then we must somehow be empowered to do so.  But if we assume that our responsibility for our health ends with stepping into the health provider’s office, are we actually empowered? Or are we actually abdicating responsibility through abdicating power to the provider? Yes, you know what is best for me.  But isn’t it more complex than this? Shouldn’t our response be deeper, more challenging?  These are, after all, my needs— my health— that is being addressed.  And so what does my health require? My physical health. Yes medication, but also a proper diet and exercise.  My mental health.  Perhaps counselling, relaxation.  My social health. Organisations and networks that come alongside and support the individual and their family, activism that pushes for a society free of stigma and wrong presuppositions, of unjust criminalisation. The list continues on.

This is obviously a hard topic, because there has to be a balance.  Yes, we are empowered and need to step into this empowerment through acting responsibly.  But we are also human beings that have fundamental rights, and we don’t want to set up an impossible scenario where the individual is constantly fighting.  The point is that we want people with HIV to get well.  And this requires a balance between rights and responsibility.  And this balance presupposes that responsibility must inherently come alongside rights.