September 13, 2012
It began rather insignificantly but quickly escalated. The group which I had facilitated for several years consisted of ten to twelve gay men of all ages, most of whom were HIV negative. That night I mentioned a new service for people living with HIV and one man asked, "Why do the positive guys get everything? What about us negative guys?" Another group member spoke up about poz friends who were eligible for all kinds of support. He was indignant that he had been laid off, was struggling and, unlike "them," lacked access to community services such as food banks and housing assistance. Someone else expressed annoyance, and a fourth growled his protest. A strong and divisive vein of anger within the gay community had been exposed.
The men in this group are thoughtful and community-minded, yet nearly every one of them believed that the quantity of services for HIV-positive individuals was out of balance with the greater needs of the gay community. As in any discussion that combines social issues with strong emotion, there was a mixture of fact, speculation and outright distortion. It was reminiscent of the "welfare queen" concept that has once again emerged in the national dialogue, which asserts that many of those receiving government benefits do so excessively and opportunistically or worse, through fraud or deception.
"I hear that many guys become positive so they don't have to work and can just spend all day at the gym or the beach."
"I've seen the cars in the parking lot at the HIV food bank ... they're all Cadillacs and BMWs."
"Who wouldn't want to get all the steroids they want and get real ripped?"
I interrupted the complaints, had everyone breathe deeply and then asked them to do a reality check. I described clients of mine who struggle to survive on disability payments, forced to work under the table, dependent on a shrinking safety net and unable to afford a car to get them to their various medical and social service appointments. I clarified the reality, despite pharmaceutical propaganda, of the complications of living with HIV, including medication side effects and overt stigma. I reminded them that HIV/AIDS is characterized by isolation and that the people most often impacted are largely invisible, even in a small, close-knit community like our own.
Are there people taking advantage? Yes, of course. I shared my own indignant feelings when I saw a very muscular man I know to be HIV positive utilize his handicapped tag to park in a space for the disabled and stride into the gym for his workout. And I have had clients who willingly seek out, to their own long-term detriment, the few physicians in the area who are "generous" in overprescribing certain medications. However, I noted, those cases in no way represent the norm or even a significant percentage of persons living with HIV, and portraying them as such does great harm to the thousands with the virus who struggle daily simply to survive.
The anger in the room that night underscored a need for greater services for everyone regardless of HIV status. Many in the entire community -- including, of course, negative men and women -- are dealing with medical concerns, housing, employment, and are seeking opportunities for healthy social connection. For me, the solution lies not in resenting those that receive the services, but in advocating for increased opportunities for everyone. And as we have seen with the history of the AIDS epidemic, griping is not enough. Advocacy followed by action, including working together as a community to build these services, will be necessary.
Beyond this resentment, however, lies a deeper and more disconcerting trend in our community: the divide between positive and negative gay men. I asked the negative members of the group how many included someone living with HIV in their close social circle. Few hands were raised. I've posed the same question to groups of positive men and got the same response. Is a subtle form of social serosorting taking place?
Perhaps it is natural for people to choose to spend more time with those with whom they have an affinity. For positive men, there is the shared experience in living with HIV: constantly balancing various powerful emotions, handling stigma, the numbing routine of doctor visits and medications. For negative men as well, not sharing such life events can result in an entirely different life path, void of the momentous and ongoing impact of an HIV diagnosis. Generational factors are also significant in shaping social connections. For example, many younger men have not suffered the loss of the majority of their friends in the prime of their lives.
More practical elements also contribute to this gap between positive and negative. Something as simple as socializing together can be impacted. People living with HIV often don't have regular employment and may not have the money to go out to restaurants with their negative friends. Over time, such factors can lead to a widening gulf that becomes a fertile breeding ground for misunderstanding and stigma.
This "envy," then, is really anger and, consciously or not, results in gay-on-gay stigma against men living with HIV. While this tension is no newcomer to our communities, it has only recently begun to be quantified. An article called "HIV-related stigma within communities of gay men: a literature review" (in the journal AIDS Care in 2011), found "a growing division between HIV-positive and HIV-negative gay men, and a fragmentation of gay communities based along lines of perceived or actual HIV status." That study was sponsored by the Men2Men Collective, an organization working to reduce stigma against gay men living with HIV in Europe and Canada.
This same community-level tension can also get very personal, right into the bedroom. Serodiscordant couples, where one is HIV negative and one positive, have to consciously work at balancing their needs and can be hard-pressed to find much support. I am proud to be part of a clinical team at Fort Lauderdale's Pride Center which has just developed a program for such couples. The goal is to teach skills for increased communication and safer health practices. Sadly, there are few such services available anywhere in the nation.
We need to heal the fissures that are emerging in our gay communities. It can be tempting to succumb to the emotional rush of outrage, but to do so comes with a cost. Stereotypes and stigma develop; a passive, victim mindset evolves; and instead of finding common ground, we begin to only see how someone is "different" from us. Even worse, our divisions can be exploited by those who have no use for any of us.
There are legitimate needs among all members of our communities. Let's come together, advocate for what we believe, and follow through with creativity and action to get the results we all need.