Charlie Sheen had become better known for $50,000 prostitution tabs, public debauchery and wild-eyed rants about “tigers blood” than for his once-prominent film and television career.
But on Tuesday, the actor took on an entirely different role.
In a frank and awkward interview with NBC’s Matt Lauer, the 50-year-old actor confessed that he had become infected with HIV four years ago and had paid “millions” in blackmail to keep it a secret.
Immediately, Sheen became an altogether unlikely face of the disease at a time when the medical world is struggling to maintain HIV and AIDS awareness among an increasingly uninterested public.
His admission comes as the stigma of being HIV-positive has declined somewhat and the chances of surviving the disease have risen dramatically.
It’s been almost 25 years since basketball legend Earvin “Magic” Johnson stunned the world when he admitted to having HIV, the virus that causes AIDS.
That was during an era when contracting HIV was often a death sentence. But now, powerful antiviral drugs have vastly increased the life expectancy of patients.
“We’ve gotten to a point of complacency when we think about HIV and AIDS,” said Dr. Bertram Jacobs, director of the School of Life Sciences at Arizona State University and a professor of virology. “We don’t think about it because we don’t have people dying all the time like we did in the 1980s and early ‘90s.”
Treatment with a cocktail of antiviral drugs can quickly reduce a patient’s viral load to undetectable levels. As long as patients take the drugs every day, for the rest of their lives, they can stave off AIDS, and also greatly reduce the risk of transmission to others.
“There’s a pretty low chance of sexual transmission,” Jacobs said of patients who take the drugs as prescribed. “It’s at least a 95% or 98% reduction in transmission rates. It’s dramatic.”
Given all these advances, few believe Sheen’s announcement will be a Magic Johnson moment.
Still, advocates for people with HIV say they hope Sheen’s case will bring more understanding, particularly outside of the gay community.
“The fact that he is a heterosexual male playboy, maybe that will speak to certain people that wouldn’t consider this their issue,” said AIDS Healthcare Foundation President Michael Weinstein.
Sheen’s wild ways are already coming under scrutiny in the wake of his announcement.
In California, it is against the law for a person to willfully expose others to the human immunodeficiency virus. The crime is punishable by up to eight years in prison.
In May, an HIV-positive man in San Diego was convicted of having sex with a partner without revealing his illness. He was sentenced to six months in jail.
Lauer asked Sheen on Tuesday if he had knowingly or unknowingly transmitted the virus to someone else. “Impossible,” Sheen responded. “Impossible.”
The actor said that he had unprotected sex, but with partners who were “under the care of my doctor and completely warned ahead of time.”
However, at least one of Sheen’s partners said Tuesday that the former “Two and a Half Men” star did not tell her about his HIV status before they had sex in 2011. In fact, she said Sheen told her that he was clean. (It was unclear Tuesday exactly when Sheen had been diagnosed with HIV.)
“There were times we didn’t use condoms,” the woman, Bree Olson, told radio host Howard Stern.
In an open letter, Sheen wrote that he felt shame and anger about his diagnosis, which led him to an “abysmal descent into profound substance abuse and fathomless drinking.”
He told Lauer, however, that he no longer felt that stigma.
Healthcare experts say that shame often prevents people from getting diagnosed and treated, and that this only contributes to the spread of the disease.
“Thirty-four years into the epidemic, treatments for HIV have advanced considerably, but perceptions regarding people who are positive haven’t,” said Christopher Brown, director of health and mental health services for the Los Angeles LGBT Center.
In the U.S., an estimated 1.2 million people over age 12 have HIV, and almost 13% of them have not been diagnosed, according to the Centers for Disease Control.
On Tuesday, Sheen suggested his actions might help others.
“I have a responsibility now to better myself and to help a lot of other people, and hopefully with what we’re doing today, others may come forward and say, ‘Thanks, Charlie, thanks for kicking the door open.’”
West Hollywood City Councilman John Duran, who is also HIV-positive, called Sheen’s announcement a “great first step.”
But, he added: “Now what? What can you do, Charlie, to help?”
Duran said that while Sheen has access to some of the best healthcare in the world, there are many people who don’t. Many of those living in poverty or with mental health issues aren’t getting treatment, and they could be endangering others by having unprotected sex, he said.
Antiretroviral therapy, or ART, is expensive, and costs $12,000 to $13,000 a year. It can also cause side effects, such as tingling hands and feet, and intestinal problems. These factors sometimes cause patients to stop treatment.
“The big issue is compliance,” Jacobs said. “People have to take the drugs every day. It’s really critical that people take the drugs when they’re supposed to.”
Duran said he hopes that Sheen will get behind large-scale public health efforts to reduce the spread of HIV. In January, West Hollywood pledged to become a “zero-transmission” city by 2017, joining San Francisco and New York in a promise to completely eliminate transmission of the virus.
That has required a multi-pronged approach, Duran said, including educating people about Truvada — a daily pill that can prevent HIV infections — and advertising the medicine on online hookup sites such as Grindr. Working with physicians and reaching out to the homeless population is also important.
“Charlie can be a big part of that if he decides to get into the fray,” he said. “I hope that he takes the next steps.”
Weinstein said he hopes that Sheen’s announcement inspires more men to use condoms. He said he thinks people are engaging in more risky sexual behaviors now that fear about the AIDS epidemic has died down.
“To the degree that it’s disappeared from the front pages of newspapers and people think that it’s handled, I think the news could have some benefit, even though it’s a personal crisis for him,” said Weinstein.