Spoiled Identity: Gay Men, HIV and Stigma
ur community has never been without internal divisions and social hierarchies. Many gay men come out expecting to find, at last, acceptance among their peers. Instead, many find a divided subculture rife with cliques and judgments. Now, a more ominous trend is evolving within the gay community: overt stigmatizing of HIV-positive gay men by other gay men.
Over the duration of the epidemic, many services have evolved for people living with the virus. For several years, I have heard increasingly vocal complaints from negative men about the abundance of such resources available to HIV-positive men. Fueled by growing stigma, these have recently developed into divisive stereotypes which are reminiscent of the "welfare queen" dialog (in which people are believed to exploit programs and services). They include beliefs that men become HIV-positive simply to enjoy the benefits and spend the day at the beach, or that gay men on disability all drive expensive cars, or that being gay and positive means all the steroids you want and lots of free time for the gym.
The notion of someone on disability and medications living the carefree good life is, of course, ludicrous. There are a minority of people who exploit services, but the great majority display a remarkable resilience which is devalued by such comments. Such stereotypes only further stigmatize those living with the virus and divide the community.
Evidence of this division among gay men can be seen in the stigmatizing short-hand of profiles on sexual networking sites, and it's not just limited to positive or negative. "Drug and disease free -- UB 2." "Masc only." "No fats, no femmes." Some people attempt to temper this harshness by adding "just a preference." While it is true that everyone has their own sexual template and the right to express themselves sexually with whomever they want, very real harm results from such dismissive comments that reinforce both stigma and the gulf between gay men. I was pleased to see one man address these comments with his own, empowering declaration: "HIV-positive and intend to stay that way!"
There are few quantitative data documenting this rift within the gay community, but most people feel it. One organization, men2mencollective.com, is researching this in Europe and Canada. I recently asked the HIV-negative men in a group I lead if they had HIV-positive men within their close social circle. Few hands were raised. I have had the same response with groups of positive men. Very often the majority of their close acquaintances are also positive. It is natural for men to socialize based on affinity. Someone who has been diagnosed with HIV, has disclosed to family and friends with varying consequences, has been taking medication with all the side effects, and perhaps experienced an opportunistic infection, will have a natural alliance with others who share these experiences. They also share the bond of stigma, discrimination, and its consequences, resulting in the tendency to limit social interaction.
Many gay men living with HIV utilize substances or behaviors to numb painful feelings brought on by stigma, and they are at much higher risk for addictions, mental disorders, and even suicide. Drugs such as methamphetamine have a particularly dangerous appeal, despite devastating consequences, because they temporarily soothe the effects of stigma: low mood, lack of energy, feeling disconnected, isolated, and sexually unattractive. Stigma creates a perfect storm for those who feel like "damaged goods" to seek a way to numb these feelings. Chemicals are not the only negative coping mechanism. Behaviors such as sexual compulsivity also create a numbing effect while pushing the individual toward even greater isolation and despair. Some men attempt to reclaim their power by embracing the very taboo identities that are used to stigmatize them, such as "barebackers" or "slammers." While this creates a sense of belonging and identity, it also perpetuates higher risk behaviors and, ultimately, stigma itself.
Coping With Stigma
he effectiveness of programs or activities to combat HIV-related stigma is still largely unknown. Most involve change at a personal level, directed either at the person experiencing stigma or the individual perpetrating it. For those who experience stigma, interventions include modifying their critical, internal dialogue of self-doubt as well as their negative assumptions. Programs designed to increase awareness among those who stigmatize have had some benefit, the most powerful being combination approaches. For example, the impact of an HIV-positive speaker "humanizing" HIV is enhanced when followed by an educational component clarifying misconceptions about the virus. Unfortunately, few programs address the structural sources of stigma expressed in laws, policies, and institutional discrimination.
Positive coping strategies which move an individual toward healthy empowerment are the most effective tools to address stigma. These involve a variety of methods aimed at reclaiming a healthy sense of self, a feeling of personal power, a shared identity with others, and a solid sense of self-acceptance in the face of painful stigma and discrimination. These range from dealing with specific interpersonal situations to confronting institutional power that enacts, legislates, and perpetuates stigma. Here are a few:
Join a group: The act of uniting with others living with HIV is a powerful way to learn self-acceptance and trust. Drawing on their power provides a mirror for one's own struggles and creates a rich resource of wisdom and support that is invaluable when confronting stigma.
Commit to counseling: Every individual has great healing potential, but everyone, at times, needs guidance. Jung described the concept of shadows, those parts of ourselves which are too painful or too unpleasant to acknowledge. Sometimes we handle them by projecting them onto others, such as when someone who has made hateful, stigmatizing pronouncements about gay men is revealed to be struggling with his own gay identity. Each of us has shadows that make us vulnerable to stigma and fuel our potential to stigmatize others. Therapy greatly enhances the healing process, whether it be trauma, limited self-acceptance, or any situation or belief that is causing emotional distress.
Connect to others: HIV/AIDS frequently results in profound isolation. Whether related to shame, side effects of medication, energy level, or any number of other concerns, people living with HIV/AIDS can become disconnected from others, thus increasing their vulnerability to stigma as well as limiting their potential to help others. Sometimes these connections are structured (such as "joining a group" mentioned above), but those which are informal are equally valuable. Making a phone call, reaching out to someone in need, or simply having a casual conversation with a friend about nothing in particular can be profoundly healing and grounding.
Help others: Most of the services for people living with HIV/AIDS were initially created by individuals taking personal action, not by institutions. The ability to put compassion into action is the basis of countless lifesaving efforts. Personal emotional healing results from assisting someone else. It pulls you out of your own concerns and transforms your struggles and pain into a useful tool both for you and others.
Educate: Stigma about HIV, homosexuality, mental illness, or countless other attributes is fueled by ignorance. People fear what they do not understand and, despite 30 years of crisis, the level of ignorance about HIV is astounding. According to the Washington Post/Kaiser Family Foundation 2012 Survey of Americans on HIV/AIDS, people are somewhat more comfortable interacting with coworkers who have HIV/AIDS (up from 32% in 1997 to nearly 50%), yet 25% of Americans do not know HIV cannot be transmitted by sharing a drinking glass, almost the same as 1987.
Learn from others: Chances are high that someone else has already faced your challenges. There are many people who share your experience and who can serve as role models. When such people are not geographically close, the Internet can be an effective resource for communication. Connect with others living with the virus -- it will help you all heal.
Advocate: Finally, every person living with HIV/AIDS needs to challenge institutional structures that promulgate stigma. There are increasing and disturbing efforts to criminalize HIV, funding for essential services is in peril, and new waves of intolerance are rolling across the country. Stay informed, vote knowledgeably, and increase your advocacy.
Stigma is powerful, painful, and often confusing because it resonates with our own internal fears. Overcoming it takes persistence, courage, a strong sense of self, and a willingness to work with others. Don't succumb to the false belief that you are "damaged goods," but rather expose your shadows, reclaim your power, and reach out to others making this journey with you.
David Fawcett is a psychotherapist and clinical hypnotherapist in private practice in Fort Lauderdale, Florida. He is active in the gay men's health movement, writes regularly for TheBody.com, and is a national trainer for the National Association of Social Workers' "HIV Spectrum Project."
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