Freedom from Being Toxic – HIV Status Disclosure

By Rick Coons, Psy.D.

Freedom from Being Toxic – HIV Status Disclosure

The moments right before a person living with HIV discloses their status to a potential sex partner, they are thinking….Will they still want me? Will they be afraid of me now? Afraid to touch me? Will I ruin a chance for potential love? Will I be rejected? Will they see me as infectious and toxic? Will they be upset that I didn’t tell them earlier? Will they become hostile or violent? Can I escape if they do? Will they throw me out or will they run screaming? Am I truly unlovable? Am I really too damaged to be any good? Since I am “damaged goods”……no harm in another load…right? Will I allow that to happen just so I can be touched? They could actually be turned on by the “danger” of it all. Just this once…but knowing they won’t get that close to danger a second time. Maybe they will pity me. Get aroused at the idea of care-taking the infected. Maybe they will be one of those truly fucked up ones that see me with a “gift”. Someone who wants to be infected to become part of this exclusive club. What if I just fail to mention it all together? Avoid the whole topic. Not disclosing means avoiding the rejection. For a brief while I can pretend that I am negative once again. See myself through the eyes of someone who assumes I am since I didn’t say anything. But, even if protection is used, guilt and shame will follow this encounter. What if they eventually find out? I can never see them again even if I like them….especially if I like them. Disclosing after the fact is much more volatile then disclosing before. When they do find out, and sometimes they do…they may blame me for not being responsible for their health. I should have answered the question they failed to ask because they shouldn’t have to. The expectation is that if I am positive it is up to me to protect the world from myself. Why should negative people have to disclose their status….right? Could I be “lucky” and they are positive as well and all this becomes a whole hell of a lot easier? Then we are at least the same kind of toxic. Maybe even no condoms since there is no fear of getting anything worse than what we already have…or so we convince ourselves. But there is at least a freedom from the fear of infecting someone else. A freedom from being toxic.

To be sexual and HIV positive brings with it complications for creating and maintaining a healthy sexual identity. HIV related stigma makes disclosing problematic and also impacts sexual risk taking. HIV positive gay men are among the most marginalized groups within our society and may experience multiple layers of stigma due to sexual orientation in addition to their HIV status (Dowshen, 2009). Misinformation and fear often contribute to the stigma, and it also perpetuates the hostility directed at those living with the disease (Vanable, Carey, Blair, & Littlewood, 2006). “The more we deny or avoid dealing with HIV-related fear and shame, the more difficult it becomes for all of us to be honest with ourselves and with others in our sexual negotiations” (Minwalla, 2011, p. 13).

Because HIV positive individuals continue to face psychosocial stressors, which include stigma, medical costs, and impact on physical well being, adequate coping strategies are essential. Inadequate coping can lead to depression, increased psychological distress, social isolation, high-risk sexual behavior, substance abuse, impaired immune functioning, and possibly accelerated disease progression. Conversely, positive coping skills along with good psychological adjustment have all been associated with reduced disease progression and better overall physical and mental health (Schneiderman, Antoni, & Ironson, 2011). Cognitive behavioral stress management (CBSM) is a short-term therapeutic approach that has been shown in studies to improve the effectiveness of coping with HIV. During CBSM therapy, patients living with HIV/AIDS learn recovery skills that are useful throughout their lifetime. These techniques and skills can help with medication adherence and have also shown a decrease in isolation and depressive symptoms while improving immune functioning (2011). The Poz + Sexual Program provides psychological health services based in the CBSM model combined with The Institute for Sexual Health’s values of promoting integrity, intimacy and integration. Workshops, support groups, individual & couple’s therapy help to promote healthy and satisfying sexual relationships, disclosure skills free of shame while managing both physical and mental health concerns and HIV-related stigma.

For more information, please contact The Institute for Sexual Health at 310-286-1300.

References:

Dowshen, N., Binns, H.J., Garofalo, R.G. (2009). Experiences of HIV-related stigma among             men who have sex with men. AIDS Patient Care and STDs, 23(5), 371-376.

Minwalla, O. (2011).The truth about HIV. The Fight, 3, 12-13.

Schneiderman, N., Antoni, M., Ironson, G. (2011). Cognitive behavioral stress management             and secondary prevention in HIV/AIDS. American Psychological Association,                         http://www.apa.org/pi/aids/resources/research/schneiderman.aspx.

Vanable, P.A., Carey, M.P., Blair, D.C., Littlewood, R.A. (2006). Impact of HIV-related                     stigma on health behaviors and psychological adjustment among HIV-positive men               and women. AIDS Behav., 10(5), 473-482.