The Problem With Calling HIV-Negative People ‘Clean’

How a metaphor for living without HIV/AIDS hurts the poz community

In a 1990 episode of The Golden Girls, Rose (Betty White) is advised to get tested for HIV because her doctor believes she might have contracted it from a blood transfusion years earlier. In a state of panic, she confides in Blanche (Rue McClanahan), “Why is this happening to me? This isn’t supposed to happen to people like me.” Blanche, ever the judicious woman, replies, “AIDS isn’t a bad person’s disease. It isn’t God punishing people for their sins.”

The episode, titled “72 Hours,” aired when HIV/AIDS was still widely seen as a death sentence (two years later, it would become the leading cause of death for American men between the ages of 25 and 44). As such, Rose exemplified a common belief among Americans at the time that HIV was shameful. 

The thing is, even three decades later, HIV is still stigmatized, perhaps most intensely within the queer community itself, where the phrase “clean” is very commonplace.

“Clean” is used predominantly by gay men on queer dating apps to mean that someone is HIV/STD negative. David Malebranche, a physician specializing in HIV/AIDS treatment and a professor at Morehouse School of Medicine, tells me that this language makes people living with HIV/AIDS “feel like shit, feel less than and feel undesirable to others.” 

The term’s negative connotation, of course, derives from the idea that disease is dirty. “The sort of intimate human experience that [we] have with disease and how diseases are transmitted reinforces the idea that you’re either clean or dirty,” Tyler Kibbey, chair of the Linguistic Society of America’s committee on LGBTQ+ issues, tells me. “There’s this idea that you can take certain steps to prevent [getting a disease]. So if you haven’t prevented it, it’s somehow a shortcoming on your own part.” 

Queer language is often synonymous with metaphor. Because so much of it in the last century has been hidden behind innuendos and euphemisms, Kibbey says it’s commonplace to “soften” language when asking a personal question. He explains that open discussions about HIV/AIDS in particular “require layered, nuanced and metaphorical senses of language.” (Even though organizations like the CDC and the World Health Organization support the idea that HIV no longer implies a death sentence.)

AIDS activists like porn star Kayden Gray, who is living with HIV, are working to change that. Gray was diagnosed in 2013, which he later shared with the world in May 2017. In 2016, he began to work for Impulse, an organization that advocates for sexual health education and dismantling the stigma of HIV (though he recently stepped down from his role). Gray says there are three reasons we’re afraid of HIV. “The first is because it’s killed so many people,” he tells me. According to the WHO, 770,000 people died from HIV-related causes in 2018; that number, however, is significantly less than 2000, which the WHO reported to be 1.4 million. 

“The second reason is, there is no cure,” Gray continues. Still, PrEP has become an effective means of prevention, reducing the risk of getting HIV from sex by about 99 percent if taken daily. People living with HIV may also take Antiretroviral treatment, which suppresses their viral load to an undetectable level and means there is no risk in transmitting the disease during sex.

“Third,” Gray argues, “it’s connected to sex, which is our ultimate taboo. I think this is the reason why people vilify those living with HIV. They have a preconceived notion of what it means.” 

All of which is to say that terminology like “clean,” as Malebranche points out, makes it hard for people living with HIV to feel safe messaging that fact to other queer folk. “It makes me feel shitty,” says Jacob, a 26-year-old in Brooklyn who lives with HIV (though he’s undetectable) and spends a fair amount of time on Grindr. “I hate [those phrases], and I hate when people ask if I’m DDF.”

DDF translates to “disease and drug free,” which Jacob explains feels even more dismissive to him. “It’s usually used in profiles as ‘must be DDF.’ I just don’t like being referred to as diseased or lumped in with drug use,” he says.

On the flip side, Jed, a 25-year-old clinical laboratory scientist living with HIV, argues, “I think the term is harmful, but personally, I’ve come to terms with my status and health. I’m not any different from someone who is negative. Some people even thank me for being honest about it and go on to ask me more about my story and how I got it. Not that I owe anyone that.”

Getting rid of “clean” and “DDF” obviously won’t be an easy task. As Don Kulick, a linguistic anthropology professor at Uppsala University in Sweden, points out, “To expect or hope that language on a dating app (or in pornography) might not be offensive is to misapprehend the nature of the beast.”

The question then becomes: Should the LGBTQ+ community take more action to educate people about the harmfulness of these terms, or should apps like Grindr ban them?

“I think the responsibility lies in the government because we’re in the 21st century,” Gray says. “Especially in developed countries, we have a very good idea of the damage that lack of awareness causes. Lack of awareness perpetuates a lie.”

In the meantime, though, us queer people would do well to be nicer to each other. “People living with HIV are worthy and deserving of love,” says Wade Schaerer, a South African-based HIV activist. “We deserve nothing less than for people to love us proudly, loudly and without shame.”