This installment of the Grandma's Home in Taichung lecture series featured moderator Ch'en Yen-han, Director of the Taiwan Gdi Association, in a dialogue with panelists Goddess Afternoon Tea, an out living-with-HIV activist, and human rights attorney Chou Yu-hsiu, addressing various questions about people living with HIV collected prior to the event.

The moderator opened by inviting the panelists to share their personal connections to the issue of HIV.

Attorney Chou Yu-hsiu, who has handled several cases concerning people living with HIV during his legal career, shared that many people's impressions of people living with HIV are deeply influenced by early Stephen Chow films. 1990s cinema loved making jokes at the expense of people living with HIV; viewed from today's perspective, those scenes are actually extremely awkward.

Goddess Afternoon Tea is a drag queen and YouTuber who has been living with HIV for about five years. After a breakup, they publicly came out as an HIV-positive person, subsequently beginning to share their life story, life changes after infection, and engaging in HIV advocacy.

Next, the moderator posed questions to the audience: "Do you have any friends who are living with HIV?" and "Do you know how many people living with HIV there currently are in Taiwan?" Audience members guessed numbers ranging from 300,000 to 100,000. The moderator then revealed the answer: there are approximately 40,000-plus people living with HIV in Taiwan.

The moderator pointed out that, calculated against Taiwan's population of 23 million, this figure means roughly one in every 500 to 600 people is living with HIV. Everyone has likely interacted with far more than this number of people throughout their lives. Yet why is it so difficult for our friends to disclose their infection status to the outside world? Through the panelists' sharing of their responses to these questions today, we can perhaps better understand why people living with HIV find it so hard to make their status public, as well as the societal oppression or discrimination they may face after doing so.

Goddess Afternoon Tea stated that most of these associations are myths and the source of stigmatization. It is difficult for ordinary people to judge whether information is correct on the spot. For instance, blood donation still requires professional screening; it is not simply a matter of a person living with HIV wanting to donate blood and the aforementioned scenario happening.

To help the audience delve deeper into this topic and subsequent discussions, the moderator explained that HIV transmission routes are roughly divided into three categories: sexual transmission, blood transmission, and mother-to-child vertical transmission, with the first two being the most frequently discussed.

The moderator added that regarding the aforementioned 40,000-plus people living with HIV in Taiwan, data from the Centers for Disease Control shows that about 80% were infected through male-to-male sexual contact. Seeing this data, people instinctively assume HIV is linked to male-to-male sex, without exploring the actual cause of HIV transmission, which is actually related to the form of sexual practice. Male-to-male sex commonly involves the anus. The anus is not originally intended for sexual intercourse like the vagina; therefore, engaging in sexual intercourse via the anus is relatively more prone to causing micro-tears. Tears and blood are key factors in HIV transmission pathways, which is why anal sex carries a higher risk of contracting HIV. However, if heterosexual partners engage in sexual intercourse via anal sex, their infection risk is the same as that of same-sex couples. Contracting HIV is actually related to the method of sexual practice, not the person.

Regarding whether kissing transmits HIV, Goddess Afternoon Tea responded, "No! That is a severe accusation." The moderator further asked Goddess Afternoon Tea whether any past partners had minded kissing due to HIV. Goddess Afternoon Tea shared that one ex-boyfriend had a extreme fear of HIV; after being informed of the HIV-positive status, that ex-boyfriend indeed refused to kiss them. Having experienced this firsthand, they believe instances of refusing to kiss are likely quite common.

Attorney Chou Yu-hsiu approached this issue from another dimension. He pointed out that discussing HIV prevention and control requires discussing sex education. However, in early Taiwan, even sex education was difficult to discuss and was regarded as a taboo topic. Schools even skipped teaching it, making it harder to expect deeper discussions on more advanced topics later on. Questions like "Can you get pregnant from kissing?" were still being asked 20 years ago. When trying to discuss deeper issues like "Can kissing transmit HIV?," ordinary people cannot readily jump into that analytical framework, which allows online rumors to be blown out of proportion.

Attorney Chou Yu-hsiu: "An online claim I used to see was that someone puts a needle inside a vending machine drink dispenser, and getting pricked gives you HIV. When I was in junior high school, I found this terrifying and avoided buying things from vending machines.
Later, when I was cooperating with epidemic prevention doctors from the CDC, I asked him about this. He said, 'How long has that blood been dried out?! What are you thinking?!' HIV only survives within blood; once it leaves the blood, it loses its vitality. So if a needle is sitting there, we don't even know if it pierced blood. Even if it did and drew a bunch of blood, the blood would coagulate or dry up under the sun, losing its infectivity to some extent. From a medical logic standpoint, this simply cannot happen. If these issues are not properly thought through, people's reactions remain overblown—just like in Stephen Chow's movies, which look not at all funny today."

Goddess Afternoon Tea stated that they have never been refused treatment by a dentist, likely because predecessors had already faced refusal, meaning there is now a system listing HIV-friendly dentists. This makes it easier for people living with HIV to know where dentists are friendly, reducing problems with refusal of care during medical visits. However, they had also heard of other friends who underwent surgery and, due to their HIV status, were required to place their worn surgical gowns into specially marked hazardous waste boxes, encountering discriminatory treatment.

Attorney Chou Yu-hsiu shared that the refusal of medical care to people living with HIV still exists today. Medical issues frequently bring up dentists for two reasons: first, the frequency of visiting a dentist is higher than undergoing surgery; second, visiting a dentist involves a higher likelihood of contact with blood. People might assume doctors must fully understand these concepts, but not every dentist deeply understands HIV. After all, medicine is a highly developed profession with very fine sub-specialties, and we can hardly expect every doctor to be well-versed in HIV.

Attorney Chou Yu-hsiu further prompted everyone to consider why hospitals know who is living with HIV and subsequently refuse them treatment—it is because of the National Health Insurance card. He believes striking a balance between the right to privacy and public interest is very difficult in discussions. From the perspective of a person living with HIV, naturally, they do not want others to know; moreover, medical records constitute sensitive personal data under Article 6 of the Personal Data Protection Act and should not be casually disclosed. From the perspective of the healer, however, healers need to understand the patient's condition to provide comprehensive treatment.

Attorney Chou Yu-hsiu: "A situation previously occurred where an injured person was bleeding from a car accident, and the fire department went to rescue them. Only after the rescue did they realize the injured person lying on the ground was living with HIV. Let's consider this: does the injured person lying on the ground have an obligation to inform the firefighters of their HIV-positive status?"

Both Goddess Afternoon Tea and the moderator agreed that the injured person has no obligation to disclose their HIV status. The moderator noted that, as Attorney Chou mentioned earlier, HIV loses activity rapidly after leaving the human body and cannot be transmitted to others, making transmission to rescuers extremely unlikely. Furthermore, rescue equipment should be disinfected whenever it comes into contact with blood, without needing to specifically distinguish whether it was used by a person living with HIV or not. Attorney Chou Yu-hsiu argued that establishing a comprehensive SOP is a much more relevant approach.

The moderator added that forms of rights violations through refusal of care sometimes manifest not as turning away people living with HIV, but as cold remarks or discriminatory language during the consultation process. Such remarks mostly stem from a lack of understanding about HIV among the general public, including doctors themselves, indirectly causing people living with HIV to resist using medical services—such as choosing not to seek medical attention or take medication out of fear of cold treatment by doctors.

Attorney Chou Yu-hsiu pointed out that pursuant to Article 4 of the HIV Infection Control and Patient Rights Protection Act (hereinafter the HIV Act), the right of people living with HIV to medical care shall not be discriminated against or given differential treatment. Therefore, to a certain extent, complaints can be filed with local health competent authorities based on the provisions of the HIV Act. Upon filing, the competent authority will initiate an investigation process. If discrimination is established, the relevant medical institution may be subject to a fine. If the competent authority deems discrimination not established, an appeal can still be filed with the Ministry of Health and Welfare's (MOHW) HIV Rights Protection Committee, which will conduct a secondary review of the complaint content.

Attorney Chou Yu-hsiu further supplemented that the scope of protection under the anti-discrimination provisions of Article 4 of the HIV Act is broad, covering not only medical care but also employment, education, and various other forms of discrimination, all of which can invoke this provision to seek remedies.

Attorney Chou Yu-hsiu stated that when studying a law, beyond the statutory text itself, one also needs to longitudinally understand the amendment process of that law.

The HIV Act is divided into two parts: the first part is disease prevention and control, and the second part is rights protection. Initially, only the first part was enacted. However, successive individual cases that arose later—such as the aforementioned Article 4 rights protection provisions—stemmed from the Penghu blood transfusion case.

The background of the incident was that a child contracted HIV through a blood transfusion following a car accident. The competent authority at the time reported HIV as a communicable disease, but information was leaked during the reporting process, causing teachers and students throughout the school to find out that the child had contracted HIV. Classmates consequently transferred schools one after another, forcing the child to change their name and move from Penghu to the main island to slowly escape this nightmare. Therefore, subsequent legal amendments realized that disease prevention cannot focus solely on control; societal unfriendliness causes people living with HIV to be unwilling to acknowledge their condition or pretend they are not infected. If such individuals then engage in further interactions with others, it ultimately hinders disease prevention.

However, during the amendment process of the HIV Act, not every provision was revised. For example, Article 21, which has garnered heavy discussion in recent years regarding criminal liability, carries penalties equivalent to the crime of serious physical injury under the Criminal Code, and Paragraph 3 even penalizes attempted offenses, sparking considerable debate.

Article 21 of the HIV Act has three elements: first, knowing one's HIV-positive diagnosis; second, engaging in sexual behavior with others while concealing the fact of diagnosis; and third, subsequently engaging in sexual activity with the intent to transmit it to others. Based on these elements, an ostrich effect is triggered: for instance, people living with HIV might simply choose not to get screened so they do not meet the element of diagnosis. Furthermore, unlike the rule where medical visits do not require actively disclosing one's disease history, Article 21 of the HIV Act requires people living with HIV to proactively disclose their disease history during sexual acts, raising questions about privacy protection.

Attorney Chou Yu-hsiu concluded that while some provisions in the HIV Act are progressive, others indeed require amendment. However, legal amendments are not easy. Therefore, continuously communicating to the outside world the necessity of adjusting the HIV Act is essential to gain support from all sectors and help the public better understand the real-world context behind pushing for legal reform.

Goddess Afternoon Tea stated that disclosing an HIV-positive status to a dating partner is in reality extremely difficult, as people living with HIV do not know what kind of situation they will face afterward. If the dating partner has adequate knowledge of HIV, the outcome of disclosure might be positive, allowing the two to successfully engage in intimacy; a bad outcome might be that the date falls through and they stop contacting each other, but the worst-case scenario is facing malicious attacks. The existence of Article 21 of the HIV Act makes dating extremely difficult for same-sex couples. After entering a partnership, people living with HIV struggle even more with how to bring it up. Not disclosing traps the individual in the psychological pressure of being insufficiently honest with their partner, while disclosing risks ending a relationship and forcing them to start all over again.

The moderator shared that in practical casework, when serving people living with HIV facing the dilemma of whether to disclose to a dating partner or partner, caseworkers do not directly tell them what to do, but rather respect their choice.

Attorney Chou Yu-hsiu further pointed out that Article 21 of the HIV Act has in fact been abused. After all, couples do not document in writing at the exact moment of sexual intercourse their full acknowledgment that the other party is living with HIV, turning the provision into a tool for threats or leverage when relations sour later on.

The moderator first explained that U=U refers to people living with HIV who have steadily received treatment for three to six months and whose viral load reaches an undetectable level, meaning they cannot transmit the virus to others and pose no transmission risk.

Attorney Chou Yu-hsiu stated that early judicial views were skeptical about the existence of the U=U state; thus, practical cases certainly included instances where people living with HIV were sentenced to four or five years in prison. He believes that since science has proven such individuals are non-infectious, treating them this way in legal terms is problematic. He observed that in recent years, prosecutors' offices have instead bravely granted non-prosecution dispositions, reasoning roughly that under a U=U state there is no infectivity and thus no dangerous sexual behavior to speak of. However, if a case proceeds to court, he believes it may still take time to persuade judges, as not everyone can let go of stereotypes regarding HIV.

The moderator added that the World Health Organization's "90-90-90" target—meaning 90% of people living with HIV know their status, 90% of diagnosed individuals receive treatment, and 90% of those treated have their viral load effectively suppressed to undetectable levels—was already achieved by Taiwan in 2020. As seen from the "90-90-90" targets, these goals focus entirely on disease control. In reality, however, the quality of life for people living with HIV has gradually declined in recent years, leading to discussions about pursuing a fourth "90" target: reaching a quality of life score of 90.

Goddess Afternoon Tea expressed surprise, noting that 68 points was better than expected. However, having lived with HIV for nearly five years, they noted that quality of life fluctuates with the duration of living with the condition. They shared that when first diagnosed, because their knowledge of HIV was already quite sophisticated, they did not experience excessive worry. As distressing incidents occurred or social discourse shifted, even with early self-acceptance of their HIV-positive status, feelings of astonishment and emotional impact were inevitable, all of which affect the evaluation items in quality-of-life surveys.

Goddess Afternoon Tea shared that apart from the aforementioned dilemma of whether to disclose one's HIV status to others, people living with HIV frequently ask questions related to romance, or whether they can engage in sexual activity with others after infection.

The moderator expressed that upon first seeing this question, the part they most wanted to share was relational dilemmas. They believe intimate relationships or romance are vital to life. While older service users tend to hold almost no expectations for romance, newly infected individuals in recent years hold vastly higher expectations for it.

Attorney Chou Yu-hsiu stated that he has handled numerous anti-discrimination cases throughout his legal career, and different issues actually share similar discussions—for instance, whether individuals with depression must disclose their medical history or medication use to employers when job hunting. He believes parties in anti-discrimination cases simply want the right to live ordinary lives just like anyone else.

Attorney Chou Yu-hsiu further explained that through handling anti-discrimination cases, he discovered the biggest problem in establishing Taiwan's anti-discrimination system is the lack of a systematic approach, relying instead on anti-discrimination norms stipulated in individual laws. The most troublesome aspect of an anti-discrimination system, he argues, is that without uniform standards, various competent authorities operate independently. For example, a student living with HIV was once expelled from school and filed a complaint with the MOHW; the MOHW could only handle matters concerning health and welfare, such as issuing a fine, while the student's expulsion fell under educational rights and should have been handled by the Ministry of Education. Precisely for this reason, Attorney Chou emphasized his focus on addressing holistic horizontal connections in anti-discrimination issues.

Attorney Chou Yu-hsiu explained that regarding claim rejections by insurance companies, within a certain insured amount, remedies can be sought from the Financial Ombudsman Institution (hereinafter the FOI) pursuant to the Financial Consumer Protection Act (hereinafter the FCPA). The relief process is as follows: first, a complaint should be filed with the trading counterpart, namely the insurance company. The insurance company usually dispatches a specialist to negotiate whether the complaint content is acceptable. If an agreement cannot be reached, an application for financial ombudsman evaluation can be filed with the FOI for a decision to be made.

Attorney Chou Yu-hsiu believes this method is more effective than filing a lawsuit in court. Similar to the Consumer Protection Act, it tends to stand on the consumer's side to a certain degree and adopts a more flexible approach in recognizing and applying the law. Moreover, if the FOI's decision favors the consumer, it carries executive force akin to a final judgment.

The moderator explained that this question was raised by the public during frontline casework. Theoretically, it is possible, but people living with HIV must bear many risks, including physical conditions where they remain undiagnosed and unmedicated after infection, or situations where they are diagnosed shortly after purchasing insurance and the insurance company refuses to honor the policy. Therefore, some groups have already begun promoting insurance policies specifically tailored for people living with HIV.

Goddess Afternoon Tea also added that people living with HIV currently cannot purchase medical insurance, but can settle for accident insurance as an alternative, expressing hope that dedicated insurance for people living with HIV will be available in the future.

Following up on the previous issue of insurance rejections, Attorney Chou Yu-hsiu pointed out that the most common practice in current reality is insurance companies barring people living with HIV from purchasing insurance altogether. He believes this practice is problematic when individuals living with HIV have undetectable viral loads and live lives identical to everyone else. Regarding insurance dedicated to people living with HIV, he believes that for insurance companies, Taiwan's population of people living with HIV falls within a certain small pool, meaning the coverage may not necessarily be favorable, and policy terms could even be harsher. Therefore, the issue should return to competent authorities supervising insurance companies' rejections to genuinely solve insurance problems.

Conclusion

The moderator concluded by noting that with the average quality-of-life survey score for people living with HIV standing at only 68 points, various aspects of their quality of life remain deficient with plenty of room for improvement. He shared: "Making society friendly is something everyone can achieve. As long as everyone puts in a little effort and pays a bit more attention to HIV issues, we can achieve the effect of improving the quality of life for people living with HIV."