Thomas Lister thought he knew everything he needed to know about his boyfriend, Ronald Gene Hill. But while the couple vacationed on a cruise ship bound for Alaska in July 2000, Lister made a startling discovery about Hill that would drastically change his life.

While his lover was getting a massage, Lister opened Hill's briefcase and found, among his papers, a doctor's note revealing that he was being treated for AIDS--something Lister says Hill flatly denied at the start of their five-month relationship. "I went into shock," Lister said. "I couldn't even pick myself [up] off the floor."

For Lister, the discovery was even more stunning because of his partner's occupation. Not only was Hill the former health commissioner of San Francisco, he was also an AIDS activist. But the news went from bad to worse. After learning of Hill's condition, Lister, now 38, found out that he, too, was HIV-positive.

Lister subsequently filed a police report and Hill was charged with a felony in September for violating California's law against intentionally exposing another person to HIV through unprotected sex; it was one of the first cases in the state's history.

But a Superior Court Judge in San Francisco dismissed charges against Hill on Dec. 11, citing insufficient evidence to support the charges, despite a grand jury finding that Hill engaged in a pattern of soliciting sex--with Lister and another man whom he met on the Internet--while falsely claiming that he was HIV-negative.

Police initially were reluctant to charge Hill until Lister won a $5 million civil suit against him in March 2002; at that point police began to take the case seriously, according to Lister's attorney.

Hill's attorney, Peter Fitzpatrick, argued before Judge Kay Tsenin that there was not enough evidence to show that his client had intended to infect anyone. The lawyer added that even if Hill had lied about his HIV status, the deception would not meet the standard of illegal acts under the law, which requires specific intent to infect someone. Hill could not be reached for comment at press time.

"My client is dying of AIDS," said Fitzpatrick, who was satisfied with the judge's ruling. "He is very happy not to be a criminal defendant at this stage in his life."

Prosecutor Greg Barge said he did not know whether the case would be refiled or whether Tsenin's ruling would be appealed. "I believe that when you have two separate victims, with identical Internet solicitation and identical conduct, I do believe he intended to infect," he said.

Under California law, a person who "willfully exposes" another person to HIV through unprotected sex has committed a felony, punishable by up to eight years of imprisonment. Calif-ornia's Section 120291 only applies to individuals who intend to infect others with HIV through sex as opposed to infecting them with a needle, according to AIDS Project Los Angeles.

It is designed to prosecute cases like the one in New York, in which a man infected more than a dozen young women, as opposed to policing every sexual encounter by HIV-infected people. The law applies equally to men and women, tops and bottoms.

The AIDS Policy Center in Washington, D.C., reports that 27 other states have established criminal penalties for knowingly exposing another person to HIV. No one in California, however, has been found guilty in a criminal case of intentionally exposing another person to HIV since the law was created in 1996.

Aside from criminal charges, a number of civil cases have been brought to court in which individuals have sued sexual partners who infected them with HIV for monetary damages.

The most famous of these cases occurred in California--Mark Christian, the sexual partner of Rock Hudson, sued the actor's estate and received $5.5 million. He claimed that Hudson denied he had HIV, despite Christian's repeated inquires. Even though Christian was not infected, he claimed damages due to emotional stress.

Many criminal-law experts doubted from the beginning that the California law would be effective in prosecuting such crimes. Before charges were even brought against Hill, Lister said he understood the case could be difficult to prove, but he argued that the time was right for the district attorney's office to test the new law on a jury.

Mark MacNamara, spokesperson for the San Francisco district attorney's office, said, "Because this is the first case to be tried of its kind, it presents many difficulties, but the evidence to the grand jury was compelling enough to indict him."

Prosecutors took more than a year to bring charges against Hill. Baron Drexel, the lawyer who represented Lister in his civil suit, said that prosecutors originally were unwilling to bring criminal charges against him. "People lie to each other," Drexel said, "but when it comes to an issue like this, it's not justifiable at any level."

According to the San Francisco Chronicle, another man who had sex with Hill testified to a grand jury that he lied to him too. Prosecutors alleged that Hill had a pattern of risky sexual behavior that involved deceiving his partners about his HIV status.

Hill, who served on the health commission from 1997 to 2000 after Mayor Willie Brown appointed him, disappeared during the civil trial and Lister has never received any money, Drexel said.

As new HIV infections continue to climb at an alarming rate in the United States, Hill's alleged concealment of the truth brings attention to the growing concern of millions of Americans that HIV-positive persons should openly disclose their status to their sexual partners.

Recent studies suggest that many gay and bisexual men engage in unprotected sex without telling or asking their partners about their status. One of the most obvious signs that disclosure of HIV is on the decline was revealed in a new study by the American Journal of Public Health. Thirteen percent of HIV-positive men or women are having unprotected sex with partners who are HIV-negative or uncertain of their serostatus, without disclosing their status to these partners, according to the study.

"The results of this study indicate that sex without disclosure of HIV status is relatively common among persons living with HIV," said Dr. Daniel H. Ciccarone of the University of California in San Francisco. "The numbers are large enough to suggest that substantial numbers of new HIV infections could occur among partners of HIV-positive persons who do not disclose their status."

The study surveyed 1,421 adults, age 18 and older, receiving medical treatment for HIV infection. Participants were asked about their partner's HIV status; whether they were in exclusive relationships with those partners; how often they engaged in oral, anal, and vaginal sex; and whether they disclosed their HIV status to their partners.

Overall, 42% of gay or bisexual men, 19% of heterosexual men, and 17% of women said that they had sex without disclosing their HIV status to a partner during the six months prior to the study. Gay and bisexual men were more likely to have instances of unprotected sex regardless of knowing their partner's HIV status.

Ciccarone suggests that gay and bisexual men with HIV may be less likely to tell their partners about their status because prevalence and awareness of HIV are higher in the gay community, leading to a situation in which HIV-positive men assume their partners are already aware of the risks.

The researchers also suggest that the stigma of being HIV-positive has not decreased in the 20 years since the HIV/AIDS epidemic began, which may help explain why so many people do not tell their partners about their HIV status. "Disclosure is undoubtedly complicated by perceived fears of rejection, discrimination, and violence from partners and others," Ciccarone said.

The primary motivation behind someone not revealing their HIV status to a significant other is usually based on fear of rejection, says Tom Moon, a psychotherapist based in San Francisco who works with gay and bisexual men and regularly contributes to Frontiers. "One of the biggest fears of HIV-positive men is that no one will have sex with them and they will be lonely," he said.

In most cases, HIV-positive men looking for anonymous sex with other men will not disclose their status because "they don't think of them as people, just as one-dimensional objects," Moon said. "And if you tell people your status, they may get mad. They don't want to know your status. They just want to have pleasure."

In instances in which drugs are taken before a sexual encounter, most men aren't interested in their partner's status because they are in an altered state of consciousness that clouds their better judgment. "This is a big reason why the epidemic is rising," Moon added.

In their book, "Mortal Secrets: Truth and Lies in the Age of AIDS," Robert Klitzman, M.D., and Ronald Bayer, Ph.D., reveal how ordinary people struggle with these issues. For those who are HIV-positive, decisions about disclosure of their diagnosis have forced them to confront intimate and rarely discussed questions about truth, lies, sex, and trust.

According to Klitzman and Bayer, telling the truth is commonly subjective because people find ways to justify lying, whether it is to protect themselves from unwarranted and unwanted intrusions on their privacy, and negative judgments, or to avoid hurting loved ones.

The researchers interviewed 70 gay and lesbian participants, intravenous drug users, sex workers, bisexual men, and heterosexual men and women. Some of those interviewed revealed their diagnosis widely; others told no one. Some struggled and eventually told their partners, while others spoke in half-truths.

Bayer told Frontiers that all of them had difficulties disclosing their HIV status on a psychological and emotional level. Some people described disclosing their status to a loved one as similar to the process of coming out of the closet, which occurred in various steps. The biggest surprise in their findings was that people had the most difficulty telling their family members for fear of "not wanting to burden the people you love," he said.

Most of the gay and bisexual interviewees indicated that they were less inclined to reveal their status to someone they had just started dating, as opposed to someone with whom they had been developing a long-term relationship. Some claimed it was an invasion of privacy to ask someone before getting to know that person.

For those who contracted HIV from someone who did not reveal their status to them, a common reason why their partner did not disclose was because they were not asked. "'It takes two to tango' or 'If he asked, I would have told,' was a common response," Bayer said in regards to participants' responses. "But people saw their silence as a lie."

Bayer suggests that people should always practice safer sex at the beginning of any relationship. But as it develops into a monogamous relationship and both individuals decide that they do not want to use condoms, "they have a moral obligation" to tell their partner about their status to prevent putting them at risk.

Another possibility for HIV-positive people to feel more comfortable about revealing their status is through peer-to-peer support, which in Los Angeles is offered at HIV-prevention programs like Positive Images.

Understanding how HIV-positive people can identify and solve issues of disclosure is based on different dynamics, said Scott Roland, program director of Positive Images. Many of those dynamics revolve around one's identification with their gender, religion, ethnicity, or sexual orientation--all of which play a significant role in HIV disclosure.

Not only is fear of rejection a barrier to disclosure, but so is discomfort with talking about sex in general, which makes it more difficult to discuss HIV, according to Roland.

Emotional issues and self-esteem also impact discussion of a person's serostatus. "It's more than just being HIV-positive," Roland said. "Most statistics show if [people] feel better about themselves, they will change their behaviors for the better."

Since discovering his own illness, Lister has made it a crusade to encourage frank discussion about the disease, sharing his story at various AIDS events. "You can't get rid of HIV," said his mother, Dena Smith, 73, "but he's trying to do something good so other people will be aware."

People close to Lister said his condition worsened in September, when he started taking several medications daily. "For the first time he broke down and cried to me, because he's afraid," said his friend Christina Burg, 32. "It makes the death sentence so much more real."

Lister, who could not be reached by Frontiers, said earlier that therapy helped him get over his anger at Hill; still, he has no regrets about pushing hard for Hill's arrest. "This is a matter of accountability," he told the Associated Press. "What he did to me was wrong,"

After Hill was charged in September, Lister told the AP: "For me, the civil case was never about a monetary reward, but rather as a matter of principle due to the fact that Ron lied to me about his HIV status and continued to deny it to me when I confronted him with the medical records I found.

"The $5 million civil judgment helped to increase awareness around the pending criminal case, as well as the overall importance of disclosure and taking personal responsibility for one's actions when it involves sexual relations with another person."

© 2004 Frontiers Newsmagazine; All Rights Reserved.