Studies from around the world, with both men and women, have found that sexual abuse leads to a greater risk of getting HIV.
Researchers and therapists say this happens for a number of reasons. For example, survivors of any kind of abuse -- emotional, verbal, physical or sexual -- tend to have a greater risk of depression. This can paralyze them from taking care of themselves, such as having protected sex. They also have a greater risk of alcohol or drug abuse, which in turn has been shown to increase the risk of having unprotected sex.
Social worker and therapist Jeff Levy, co-director of the Live Oak counseling group in Chicago, has been working with gay male survivors of the most heartbreaking kind -- survivors of childhood incest and sexual abuse -- for more than 15 years, both one-on-one and in group sessions his practice calls "Healing Circles." The issues and strategies for healing he works with apply to women and straight men as well.
Survivors can do a number of things to aid their healing process. Perhaps these healing strategies will help those who are also positive take better care of themselves in the face of living with HIV, whether it's taking charge of their health or taking medication correctly, or anything else.
Levy quipped that this can be a very short article: "Seek professional help." There are many ways that abuse can affect individuals, and it would be best for survivors to get help in looking at how abuse affected them specifically, especially when their behavior troubles them, but they don't know how to stop it. Still, Levy gives 10 good strategies for healing, so read on. (Remember, free or affordable professional help is available -- see the list.)
"Many survivors have learned strategies to manage the pain and vulnerability of their abuse that were adaptive and served a purpose during childhood," says Levy. Survivor strategies include "numbing out," especially with the use of drugs or alcohol, and by withholding painful feelings.
On the flip side, they may become aggressive. "It's important to understand that this comes from vulnerability. It does not remove your accountability for the pain you may cause others, but it may help you understand that you are responding in the only ways you know to gain some sense of protection, control, and power in circumstances that feel overwhelming."
Other strategies are more counterintuitive. For example, victimized children might initiate further abuse. In a strange way, this helps them to feel in control of the abuse, or to be better able to predict it (as in "getting it over with"). As they mature, they may have multiple sex partners. In this way, they avoid emotional intimacy, such as the time it takes to get to know someone well.
Levy says that, "These strategies are all attempts to manage pain, provide predictability, and to somehow master experiences that were overwhelming and/or unmanageable.
"But part of the problem is that these strategies, which may have served a purpose at some point, create additional vulnerability as they are maintained longer and into adulthood. Some survivors engage in sexual behavior that somehow re-enacts the abuse -- usually unconsciously -- in an effort to gain control or power over it. Other survivors disengage from sex entirely, or have exclusively anonymous sex -- they disconnect sex from love. They might medicate painful feelings and sexuality with alcohol, drugs, food, work, or other process addictions."
"There is no simple 'one-size-fits-all' or 'cookie-cutter' answer to taking control of your life and finding happiness," Levy says. "The first step is typically a recognition or awareness that these old and familiar strategies are not currently working. People begin to realize that they are experiencing more negative consequences as a result of the abuse and subsequent behaviors than they are positive consequences. Here are some strategies that I think are probably applicable to most survivors."
1. Get Support
The first step in making changes is to stop keeping secrets. There is power in secrets and once secrets begin to be opened, changes can occur. Tell a trusted friend, a trusted family member, or a counselor/therapist.
2. Identify Others Who Can Empathize With Your Experience
There is comfort in sharing your experience and feelings with others who "know." There are incest survivor groups all over the country and many, run like 12-step recovery programs, are free of charge. There are also programs offered through YWCAs, community mental health agencies, and some LGBT [lesbian, gay, bisexual and transgender] social service agencies that have reduced fees or operate on sliding scales.
3. Take Care of Your Body
For most people, sexual abuse involved some loss of control over their bodies, so many survivors disconnect from their bodies or do not take good care of their bodies. Eating well, getting exercise, and getting enough sleep may sound overly simple, but these are three strategies that help create balance and a sense of grounding. Feeling better about one's body can also lead to better self-care in other areas.
4. Create Something Every Day
Many of the residual effects of abuse are stored in parts of the brain that cannot be accessed through "talk." By engaging in creative and/or expressive activities, it is possible to process (or metabolize) parts of the trauma without having to speak about it. Drawing, painting, photography, playing an instrument, and dance are just some examples of creative/expressive activities that help process trauma and also help get back in touch with the body.
5. Connect With Nature
One of the effects of trauma can be a disconnection with the larger world and the larger community of living things. By getting back in touch with life's cycles, it's possible to feel a greater connection to other people and the world at large. Place plants in places where they can be seen regularly. Take walks by lakes, oceans, mountains, valleys -- anything that allows reconnection with the larger world. If possible, have an animal or pet as part of daily life. Caring for and receiving unconditional love from an animal can be a powerfully healing experience, and can be a precursor to more rewarding relationships with other people.
6. Connect With Some Power Greater Than the Self
Abuse leaves people questioning the existence of God ("if there was a God, how could s/he let this happen to me?"), so it is often helpful to include some type of spiritual practice into daily life. This does not need to be organized religion. It may be lighting a candle each day, reciting a homemade prayer, creating daily rituals, or connecting with a more organized religious community that provides support and healing.
7. Do Soothing Things
Because abuse often causes people to be in a constant state of alert and/or perceived threat, engaging in activities that reduce this higher level of arousal can be immensely helpful. Meditation, yoga, Tai Chi, breathwork, massage or other activities that lower levels of arousal can help in feeling more grounded, more connected to the body, and more connected to feelings in a manageable way.
The act of helping others and feeling worthwhile is a significant antidote to self-loathing, low self-esteem and feelings of inferiority that frequently are the result of abuse. Finding ways to find purpose once again and to feel valued by others in some way helps to create structure in one's life and provides a foundation from which to re-build self-esteem.
9. Allow Feelings to Be Felt as They Arise
Many survivors have learned that emotion is scary and when feelings come up, they are to be pushed back down. By "feeling" the feelings as they come up, people are less likely to engage in acting out or destructive behaviors to mask them. It is often helpful to engage in creative/expressive activities when feelings arise, so that they can be processed and released. Sometimes keeping a journal is also helpful as it allows feelings and thoughts to be recorded on paper and not stored in the head or body of the survivor.
10. If Possible, Access a Therapist or Counselor Who Is Trained in Working With Survivors of Abuse
There are unique issues that arise for survivors and it's important that if therapy is an option or choice, that the therapist chosen has special expertise and sensitivity to these issues.
Many community mental health agencies have free, low-cost, or sliding-scale programs to meet the needs of a variety of individuals. YWCAs frequently have programs addressing sexual abuse/assault at lower cost, and many LGBT social service agencies also have free or low cost programs.
There are also therapists in private practice who have reduced-fee or sliding-scale programs set up specifically for persons who do not have the financial resources or insurance to pay full fee. It's important to ask, if an expert in this area is identified, if s/he has reduced rates or negotiable fees. (As an aside, I always reserve several spots in my groups for survivors for folks who cannot afford full fee).
Editor's note: Jeff Levy, L.C.S.W., C.T.R.S., is co-director of Live Oak. Levy is also an adjunct/part-time instructor at the University of Chicago School of Social Service Administration and the University of Illinois-Chicago Jane Addams College of Social Work. Live Oak is "a group of psychotherapists and consultants who provide counseling and educational services that enhance the emotional and psychological well being of individuals, families and communities." Located in Chicago's Boystown neighborhood, the group specializes in services to lesbians, gay men, families, and youth-at-risk. Call 1-773-880-1310, ext. 82. E-mail firstname.lastname@example.org. Visit www.liveoakchicago.com.