Fear of HIV: Counselling for Gay Men

sign to confession and counsellingI’m so worried about HIV I can’t enjoy sex…
… every time I say ‘that’s the last time I bareback’, but then I do it again…
…I’m thinking about going on PrEP.

Fear of becoming HIV positive remains a significant source of anxiety for many gay men. If you are worried during or after gay sex, talking it over could help.

It’s just over 2 years since I started this blog and today I realized I hadn’t posted anything about a topic that comes up quite often in both my online therapy and Sydney clinic practice: Anxiety around HIV.

I started my professional career talking about sexual health and HIV with gay and bi guys. Over the last 25 years, scientific knowledge about HIV has grown steadily. Accessibility of treatments mean that many gay men now describe their HIV status as ‘undetectable’. Others are using medication like Truvada as PrEP (Pre-exposure prophelaxis) to protect themselves from HIV.

Yet fear of contracting HIV through gay sex continues for successive generations of men. The anxiety experienced by some guys after sex can be debilitating and disruptive to the functioning of their lives. And whether the sex itself is low risk or not, anxiety can still be present.

So why, when there is so much information around about how to have safer sex, do some men experience such anxiety?

Gay Shame and Risk-Taking

In my experience, it’s not only risk-taking that can lead to fears about contracting HIV, shame plays a huge role as well. This is particularly the case with penetrative sex between men. Feelings of shame get in the way of negotiating sex but also in seeking help or support when something risky has happened.

When people feel bad about what they have done, they are more likely to imagine others judging them and less likely to seek out help.

When gay and bisexual men do seek help they might encounter prejudice (yes! Even in Sydney!). Some medical practitioners, and – it seems terrible to write this – some psychologists and counsellors, respond to anecdotes of risk by treating the person as a pathology. Many of my clients have told me they were diagnosed with a sex addiction when their sexual lives did not match up to a professional’s ideas of what was ‘normal’.

Obviously this feeds shame as well.

We make sense of our lives through telling stories to ourselves and others about something that has happened. It helps us to decide what to do next. So when a man cannot talk about the sex he is having, or what he would prefer to be happening, it makes it much harder to make changes. When professionals are judgemental or show a lack of acceptance about gay sex, or barebacking, gay and bisexual men become reluctant to talk.

The Cycle of Worry about Sex

I’ve found this with men of all ages including young guys in their twenties who are starting to have sex and men in their forties and fifties who are coming out of straight marriages. A lot of men try to sort out their anxiety on their own. And it is not uncommon for gay men to cycle through phases: An occasion of sex leads them to worry (a bareback experience, for example), so they decide to be celibate, only to suddenly abandon that when it becomes unsustainable.

While it might seem embarrassing to begin with, talking over your choices with a non-judgemental professional can lead to more sustainable ways of managing your sexual desires. Taking extreme measures might seem the only option but is usually unrealistic. And deciding how to handle different scenarios in advance can leave you free to be in the pleasure of the moment while avoiding the worry that comes with regret.

Advances in HIV prevention mean that there are now more choices available to men who have sex. PrEP, a medication that has been shown to be effective against HIV transmission when taken as instructed, is one way some guys are choosing to protect themselves. But to work out what is right for you, it can be worth having a chat to a sympathetic GP or counsellor.

For more information about my services, or to make an appointment to see me in Sydney or online, contact me.