All gay men are affected by HIV, whether it flows through their own veins or
lives in the bodies of those they love, live and work with, identify with, and
The introduction of terms such as “post-AIDS” and “chronic manageable
infection” into the HIV discourse ignores the complex medical, emotional,
social, and spiritual implications of having survived 25 years of the epidemic –
and currently living with HIV. The medical excitement around combination
treatments and the media images of HIV-positive men climbing mountains fail
to recognize the reality of some gay men for whom terms like “lipodystrophy,”
“salvage therapy,” and “HAART failure” are familiar. As such, some long-term
survivors remain somewhat in the shadows—and their needs and concerns
go relatively unnoticed by the mainstream gay community.
At the same time, there are some long-term survivors who remain relatively
symptom free and take little or no HIV-related medication. Though
concerned about their HIV, these gay men can come to feel marginalized and
“different” from their peers who have been living with HIV for over 20 years.
HIV- positive gay men can have a broad range of mental health concerns
related to HIV that might benefit from psychotherapy:
1.) Problems in living related to disclosure of HIV status, medication
adherence, dating, sex and intimacy, and work/disability;
2.) Distress related to HIV illness or disease progression such as problems
adjusting to changes in health status, depressed mood, worry and anxiety,
loneliness, and bereavement reactions;
3.) An exacerbation of chronic or recurrent psychological distress due to
stress of coping with being HIV- positive, such as substance abuse ;
4.) Psychosocial problems including adjustment associated with sexual
identity, homophobia, and AIDS-phobia.
Psychotherapy gives voice to long-term survivors’ experiences of living with
AIDS, relieves their isolation, and helps them consider opportunities for
healing, surviving, and thriving in a “post-AIDS” community.