“You have HIV,” the attending doctor at Manhattanville Renaissance Health Center told me after asking whether or not I intended to hurt myself if the results were unfavorable. I told her, “Shut up. No, I’m not.”
It was July 16—the day before my birthday—and I was accompanying my buddy to his HIV test. Though this friend described himself as “sluttier than Mae West on poppers in a gay bathhouse,” he refused to get tested unless someone accompanied him. So, every year, we had a test date.
If the results came back positive for him, I would take him out for pancakes and let him cry on my shoulder. Because I was a monogamy whore, we both knew that seroconversion was impossible for me, so there was no contingency plan in place for me testing positive.
“Show me what your little machine is showing you, and then I’ll decide,” I snottily told the doctor, certain that she’d made a mistake. She hadn’t—and all I could say was, “Well. Fuck a duck.”
After she asked if I wanted to talk, I told her, “Why the fuck would I want to talk to you?” Trying on cynicism and finding that it fit my mood, I declared, “I’m not in South Africa or Brazil, and this isn’t the ’80s, so I’ll be fine.” It was a soap opera–scale monologue—and proof that I was a mess.
What happened next was like something out of a business meeting. I asked about next steps, received a letter that certified my HIV-positive results along with a referral to see a specialist, and walked out of the office. I sat in the waiting room until my buddy returned with his news, celebrated his negative status, lied to him about my own, and walked home.
I continued to tell everyone I was fine, even as I bared my status openly, unnecessarily, and often. Because I talked about having HIV without remorse, I convinced myself that I did not need to process my feelings about it any further. It has taken me over five years, but I have finally realized that I have been living with compounded trauma related to my diagnosis.
I need therapy. Whether a person is living their best life and thriving or on the verge of homelessness, anyone who receives an HIV diagnosis deserves and needs immediate therapy.
I believe that same-day mental health care should also be an offering for people who test HIV positive, just as same-day treatment options are now available on the day of diagnosis. I’m not alone in feeling that way. Nathaniel Currie, D.S.W., LCSW, a clinical social worker and therapist who specializes in treating trauma, also believes that therapy is essential for people who have been newly diagnosed with HIV.
Having worked with many people living with HIV in his own practice, Currie has found, “Even though it’s no longer a terminal illness, there are parts of you that die after finding out that you’re HIV positive.” He says that the prospect of dealing with a lifelong dependency on medication, fear of rejection, or feelings of personal failure can be emotionally debilitating, especially because there is so much stigma related to the virus.
“You’re a different person after you’re diagnosed,” he says. “On some level, it doesn’t become 100% real until someone shows you that piece of paper.” Currie reports that many of his patients descend into denial after learning about their diagnosis. “The grief cycle is the best way to describe an initial diagnosis. And if you're grieving, you need a therapeutic intervention.”
In my case, after performing her due diligence, my doctor was eager to kick me out of her office. Maybe it is because I was being rude, but in retrospect I find it preposterous that she did not push back against my stoicism. I wish that she’d said, “Wow, you’re being extraordinarily dismissive of your condition and toward me. I think that you might need help.” Or, “You should talk to someone about these intense feelings you’re having.”
Obviously, therapy or mental health care can’t be forced onto people, but I think it should be encouraged and emphatically suggested to individuals who experience life-changing circumstances. Receiving an HIV-positive diagnosis may not be the worst thing that can happen in a person’s life, but it is life-changing and should be treated as such in terms of its impact on one’s mental health.
I am adamant about this because I know that grief counseling is offered to people who have lost relatives. No one kicks a family member out of a hospital room after they have been informed that someone dear to them has passed. But Currie says that this is precisely what happened to a patient of his after receiving a positive HIV diagnosis.
This patient shared that his doctor was “kind of cold and didn’t seem to really engage besides telling him some stupid facts and wanting him to leave the room.” The patient did not want to leave the room. I can imagine why. Though I walked out of my diagnosis room ready to move on, I can see that this guy might have needed more time to process his shock.
Instead, he was told that he needed to leave because the clinic was closing. Currie says that this patient reported that he was given no alternatives for engaging his mental state or discussing his well-being. I was not there, but this is in line with stories I have heard from many people who are living with HIV about what happened to them after they received their diagnosis.
This strikes me as particularly egregious, because I know that compassionate care services are offered to people who have been diagnosed with cancer. I know that because I received it after finding out that I had a tumor in my colon. The difference between how I was treated after my cancer and HIV diagnoses are worlds apart.
Asked about what changes he’d like to see in care offered to people who have been newly diagnosed with HIV, Currie says, “Whether you test negative or positive, my wish is that there be an opportunity to speak to a counselor.” He believes that testing offers a great chance to check in on a patient’s well-being and safety.
“There are many times that I’ve gone into rooms to talk to people who are there for HIV tests,” he says, “and found out that there’s domestic violence or poverty at home. An HIV test can bring up a lot of stuff, and sometimes it is one of the only times that a person can escape their environment to talk to someone confidentially.”
Looking at the best ways to treat people who have tested positive, Currie says, “There should be a licensed clinician on hand, wherever there is HIV testing. And those licensed clinicians have to be culturally competent. They have to understand LGBTQ identity, trans experience, and Black and Brown experience.”
This reflects an important point that was shared during SYNChronicity 2020’s Black Women’s Health Institute: When one does not feel represented or comfortable with their care provider, discussions around personal needs fall to the wayside.
What stands out to Currie from his own experiences with advocating for and treating HIV-positive clients is “understanding that dealing with a positive result mirrors the five stages of grief: denial, anger, bargaining, depression, and acceptance.” He says that successfully navigating these stages throughout one’s HIV diagnosis requires “information, communication, emotional support, guidance, and direction.”
Of course, all of this requires a care provider to take the time to sit with and address the shock of a patient. Because for many people, after finding out that they are HIV positive, the world comes to a standstill.
Thinking back on my HIV diagnosis, I wish that my doctor had looked to the part of the Hippocratic Oath that says, “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm,” and considered that part of my world had just ended—and that more than medication, I needed mental health care.
I am starting therapy for my HIV diagnosis next week. If you’ve never engaged with your trauma over your diagnosis, I suggest that you do so now. We all deserve to live a stigma- and trauma-free life. And that starts by acknowledging that you might need help.
If you are living with HIV and think that you might need mental health care services, try speaking to your primary care provider. If you do not have insurance or want to work with a different care provider, try calling the toll-free HIV/AIDS hotline for your state. There are representatives on hand to assist you with navigating your needs or point you toward agencies that can advocate for you.