Shout Out Health

ASK THE THERAPIST: Shaking the stigma of HIV

 Q: I"m a fairly young, attractive enough, great guy who happens to be HIV positive, but I am having a hard time shaking the 'stigma' I feel about HIV. I'm basically living a totally 'normal' life, doing well, feeling well, but part of me is terribly judgmental and unforgiving towards myself. I don't want HIV to define me, but it is. I want to change, what can I do?

A: What is the change that you want?  Do you want to be the person you were before you acquired HIV or do you want to accept yourself as the person you are now that you have HIV?  Only one is possible... and it's the healthiest thing you can do.
 
After over 25 years in our consciousness, HIV no longer requires explanation.  We know what it is, how one gets it, what to do medically, and how to prevent others from getting it.  Though we have not conquered the spread of HIV, we have at least tamed it.  And yet, the negative attitudes that took hold when we first called the manifestations of HIV "Gay-Related Immune Disorder" persist.  American culture linked it to the already maligned gay community and the stigma took hold.  The disease became more than bad, it became "God's wrath" and those who contracted it were seen as "deserving" for having done such deplorable things such as having sex with someone of their same gender.  Even many in the gay community took to judging those with HIV and the judgment came hardest from the those who sanctimoniously believed that they themselves would never do something that might put them at risk.
 
It seems that some of the harsh judgments and negative opinions of society and our community have taken hold in you, and, most likely, were present in you before you tested positive.  And, how could it not?  We are constantly told that it is good to do things to prevent HIV and irresponsible to do things that put us in danger.  And, possibly it is.  But most people do not set out to get HIV and most go through a serious adjustment to their lives when they test positive.
 

ASK THE THERAPIST: "The idea of sex ... disgusts me."

 Q: I've been celibate for over a year now, and at first I thought it was because I was just tired of playing the dating game. But a friend told me the other day he thinks I'm just terrified of STDs and HIV in particular. I think he might be right. The idea of getting anything has pushed me into a shell and I don't trust anybody. Of course, I'm horny all the time but the idea of sex kind of disgusts me. Any suggestions?

A: I don't know about you, but I generally avoid something that disgusts me.  Corn dogs have that effect on me (no giggles).  Seriously, I loved corn dogs but one I day ate one that made me very ill.  After that point, I never wanted to have another one again.  They disgusted me.  I had paired corn dogs with illness.  And so now I avoid them.

Generally, we are biologically programed to both desire some things, like sex and the sensation of sexual contact.  And, programmed to be disgusted by and avoid other things, like illness and disease.  Luckily, most of us are able to put aside our thoughts about disease while engaging in sex, even though our mothers and health teachers would have it otherwise.  But if the two are paired together, it can really be a doggy downer (if you know what I mean). 

If you are like most with this issue, there was a time when sex was more attractive to you, but then something happened and you started associating sex with HIV and other sexually transmitted infections.  The thought of sex brought up anxiety, so you started avoiding sex and sexual thoughts to keep away the anxiety.  But if you are "horny," your body is telling you to have sex, but your mind is telling you it will lead to disease, then you end up with a bad combination of tension and anxiety.

I could prescribe a series of graduated exposure exercises where you gradually increase sexual activity with a patient and caring partner.  But, I would only do so after I looked at your overall tendency to be anxious about things like disease (as this may point to a general problem that is just rearing its ugly head in the sexual arena).  

After I have gotten to the bottom of what caused your disgust, I would look at your distrust of others.  Your distrust tells me that in addition to a fear of sexual contact, that someone has wronged you in either the sexual or relationship arena.  This could be very early on as a child or later in life.  Either way, I am more concerned about that than your sexual aversion.  You can get along fine (but frustrated) without sexual contact, but you are going to have far more problems if you deny yourself human contact.

I can guess what your friends suggest -- "find the right lover... hire an escort... join a nunnery" -- but you are probably not going to do any of those.  Even solo sexual gratification  (what the rest of us call masturbation) is only a partial solution.  So this is one for an expert.  I suggest a therapist (as religious professionals and parents tend to be squeamish around these topics).  Just walking into a therapist's office and sharing this problem will be a huge step toward fixing it (as avoidance and distrust of others are core parts of the problem). 

But choose a therapist wisely.  Pick someone who is familiar with and affirming of the kind of sex and relationships you wish to have.  Otherwise, you will find yourself avoiding therapist offices the way I steer clear of county fairs. -- Greg Cason, PhD

ASK THE THERAPIST: A Sexy Online Stranger ... Is He Mr. Right?

I recently met a guy online who seems sexy and nice, but he lives in another city. He wants to come visit and stay with me for a weekend. I'd love to meet Mr. Right, but he could be crazy, right? 

Well, right he could be totally crazy. But he could be totally sane, too. The fact is you don't really know anything about this guy. Nothing really tells us about a person like meeting face to face. I suggest you invite him to visit, but ask him to stay in a hotel, rent a car and meet in a public place. You'll find out soon enough whether you want to go on a second or third date. If it doesn't work out, you should offer to pay for half of his expenses for the trouble be took coming out to see you.

So may of us want to meet Mr. Right, but you have to be a little careful inviting strangers into your home. So go on dating online, and I have friends who have met their long-term partners online, but too often people spend too much time online and not enough out in the world. So join a hiking club, go to a coffee shop and see what's out there. He could be right around the corner.

-- Dr. Greg Cason, PhD