Back in April I was delighted to head for a fancy pedicure at Cowshed, an east London spa, as a gift from some buds. Less delighting was the pre-treatment health questionnaire that asked if I had HIV.
“Why do you ask this?” I asked the receptionist.
“Well, if someone has HIV we take extra precautions, especially if they have cuts or broken skin.” I was speechless; the staff, sensing my discomfort, shuffled uncomfortably behind the counter.
Despite many salons routinely asking people’s HIV status, this question is totally unjustified in accordance with the 2018 Data Protection Act. Under the Equality Act, it is in fact illegal to refuse to tattoo or provide a beauty treatment to someone if they are HIV positive. But that isn’t stopping tattoo parlours or beauty salons like the one I visited from asking people to disclose their status – and there are many who say they have been refused tattoos and cosmetic treatments after doing so.
To provide much needed clarity, a national statement has been released today containing guidance for tattoo and beauty studios, written by the UK’s leading advisors for HIV care including the British HIV Association and the Terrence Higgins Trust. It confirms that “collecting information about HIV status is unnecessary in the context of tattooing, piercing and routine beauty treatments” and “to refuse to tattoo or provide a cosmetic treatment to a person on the basis of their HIV status is illegal under the Equality Act 2010.”
“There is absolutely no reason to treat someone with HIV differently to any other client,” says Professor Chloe Orkin, Chair of the British HIV Association (BHIVA). “Standard hygiene precautions like new, sterilised equipment should be used for each and every person having a tattoo, piercing or routine beauty treatment and there’s therefore no need to question a client about their HIV status.”
But what if someone knows they have HIV? What are the risks then? Over 100,000 people are living with HIV in the UK today and over 90 percent of them are on effective treatment. This means the level of virus in their blood is so low – known as ‘undetectable’ – that they can’t pass HIV on to others through sex.
The risk of someone undetectable passing on HIV through needles used in tattooing and treatments like Botox is also recognised to be incredibly low. An analysis of ‘sharps’ injuries (when one person is pricked by a sharp instrument already used on another) in the NHS between 2004 and 2013 showed that there wasn’t a single episode of HIV transmission recorded.
“People who don’t know that they are HIV positive, and so aren’t taking medication, could in fact present the greatest transmission risk,” says Orkin. “If a sharps injury happens involving a person who doesn’t know their status, the injured person should seek medical advice immediately.”
But facts don’t always fly and one person who has experienced this sort of discrimination first hand is Nathan*. “I wanted to get a tattoo done for years but put it off partly due to the shame I carry around HIV,” he says. “The prospect of rejection created a lot of anxiety in me. But as I'd worked hard to overcome my shame, I decided to get it done.”
Nathan’s viral load was undetectable, meaning that he couldn’t pass HIV on – but he still disclosed his status to his tattoo artist. “He cancelled the appointment saying he didn’t feel comfortable doing the work. He said ‘it only takes one needle prick’ and talked about ‘having a family and needing to think of them.’” Nathan asked if another artist at the parlour could do it, but says he was “ghosted” by the studio until he made an official complaint.
Nathan’s story isn’t unusual. Damaging myths about HIV transmission persist in our society, allowing HIV stigma to prevail. HIV stigma – the prejudice, negative attitudes and abuse directed at people living with HIV – is a serious issue, often perpetuated unknowingly and in subtle ways. The 2015 UK Stigma Index – a survey of 1,500 people living with HIV – showed that over half of the respondents reported feeling shame and guilt around their condition and a third had avoided sex due to fears of rejection.
“The experience brought back traumatic memories of other forms of rejection I've experienced, reinforcing the self-stigma I’d been battling,” says Nathan. “Fortunately I was accessing counselling at the time which helped to process the feelings it caused. I was very angry that a professional didn’t have the level of knowledge necessary to treat me with dignity and respect.”
Twenty-year-old activist George from Manchester was twice refused a tattoo after disclosing his HIV positive status. “Initially the situation made me feel helpless and solidified this idea that I was ‘dirty’,” he says. “But then it gave me a reason to fight for justice. I don’t want other people to experience the refusal of a tattoo based on the grounds of having HIV.”
Both Nathan and George are trying to channel their negative experiences into something positive. On the advice of National AIDS Trust (NAT) and the Equality Advisory and Support Service (EASS), Nathan made a formal complaint to the tattoo studio. He found its initial response unsatisfactory: “They insisted the tattooist had the right to decline work and even compared the situation to declining someone under the influence of drugs or alcohol, which caused me further offence.”
NAT wrote to Nathan’s local council in support of his complaint. The council then agreed to write to all local tattooists to remind them of their duties under the Equality Act. The EASS also wrote a letter to the studio in question outlining that their treatment of Nathan was discriminatory. “It was only then that their attitude changed – maybe because they feared I was getting legal advice.”
George turned to social media. “My initial response was to vent on Twitter. My tweets gained a lot of positive feedback which led to me appearing on BBC2 with the owner of one of the tattoo studios that had refused me. It was an interesting debate, but the owner didn’t change his views, despite being given the facts. I was then approached by George House Trust who got letters sent out to all tattoo artists in Greater Manchester explaining the laws around HIV and tattooing.”
It’s hoped the release of today’s statement will also provide education for tattoo and beauty treatment providers. Cowshed told VICE that they have rolled out new questionnaires that do not mention HIV status and are now retraining staff.
"We have never denied treatment to someone based on their HIV or hepatitis status," a spokesperson said. "We have changed our health questionnaires globally, and will be working with BHIVA to raise awareness across the industry."
According to people like George and Nathan, we have a long way to go. “The general public’s attitudes to HIV are very behind due to the mainstream media never catching on to progressions [sic] within the HIV world,” says George. “As humans we have a tendency to ignore what doesn’t affect us, meaning those who aren’t affected by HIV have no thirst to learn. We’re then left with people having only knowledge from the 1980s, ignoring more than 30 years of advancements in HIV care.”
Nathan feels the same. “It’s hit and miss and you don't ever know what you’re walking into. I think this statement will help in providing clarification for studios and reassurance to people in my position. This cannot remain the responsibility of individuals. This is a law, and it should be enforced.”
* Name has been changed