HIV/AIDS and Mental Health
The summer of 1981 marked the start of the now four-decade-long HIV/AIDS Epidemic.
Acquired Immunodeficiency Syndrome has claimed the lives of over 700,000 people in the United States alone.
Recently, the infection rate has been stable, and mortality rates are declining. Despite promising strides in the prevention and treatment of HIV and AIDS (which are separate illnesses), stigma and misinformation about its relation to the gay and bisexual community remain.
This stigma causes adverse mental health effects for gay and bisexual men across the country and overseas. It also furthers homophobia and general healthcare inequality for LGBTQIA+ people. Overall, we are looking at two epidemics standing side-by-side, feeding into each other. One is the continuing HIV and AIDS epidemic. The other is the mental health crisis plaguing the gay/bisexual community.
Today, we will discuss a classic case of the chicken or the egg, why stigma persists, and how it affects our mental well-being.
Chicken or Egg?
If you are lost, the question I am referring to is: Which came first? The chicken or the egg? This is meant to be a metaphor for what may be a cause and what may be an effect. Side note: according to evolutionary biologists, the answer is the egg.
Obviously, mental illnesses have been around longer than the AIDS epidemic. The metaphor is being used here to ask a different question. We all know that mental illness did not cause the HIV or AIDS crisis. However, it is fair to say that once it dug its teeth in, the relationship between poor mental health and illness became intertwined.
In 2022, researchers have shown that HIV-positive gay and bisexual men experience poor mental health because of the diagnosis. Interestingly, there is also evidence that mental illness can increase one’s risk of becoming HIV-positive. Therefore, while we know mental illness did not cause the epidemic, it could be giving HIV/AIDS staying power. Or HIV/AIDS, and the discrimination that comes with it, could be what is causing the gay/bisexual mental health crisis?
Evolutionary biologists might have a harder time on that one...
Thankfully, that is what we have researchers and mental health professionals for! In 2004, an observational study was conducted where intake information was collected from HIV-positive gay and bisexual men who sought clinical care.
The study, which was recorded in the Journal of AIDS Patient Care and STDs, found that “depression (96.3%) and low energy (78.2%) were the most frequently endorsed symptoms” by observed patients. These mental health issues are present in many more gay and bisexual men than straight men, regardless of HIV status.
So, who is to say the reason these disorders are present is due to the diagnosis and not because the gay/bisexual male population already has high rates of depression?
In favor of the latter answer, an article in the Journal of Acquired Immunodeficiency Syndrome states, “the more psychosocial health problems...the greater...risk for both participation in sexual risk behaviors and HIV infection.”
As we know, the LGBTQIA+ population all-around is at a greater risk than the non-LGBTQIA+ population for mental illness. If poor mental health increases one’s risk of HIV infection, then it would make sense that the egg (mental illness) came before the chicken (HIV/AIDS).
Nevertheless, it still is hard to say one way or the other. Reasonable arguments could be made for either side. I like to stay in the middle, sticking to the idea that it depends on the case. What are your thoughts? Leave a comment!
The Role of Stigma
Whichever theory you subscribe to, everyone can agree that stigma plays a role in HIV and AIDS-related mental health problems.
Let’s look at the types of stigma that are relevant here:
Social rejection.
Sexual rejection.
Abuse (verbal, emotional, physical).
Internal/Self-rejection.
Social rejection is the most visible form of stigmatization in our society. When the AIDS epidemic became public knowledge, phrases such as “gay cancer,” “the homosexual flu,” and other derogatory utterances that are not worth the effort to type entered the public’s vocabulary.
From the start, HIV and AIDS have been weaponized by bigots to scorn the LGBTQIA+ community. Although gay and bisexual men do make up many cases of HIV, they are not the only ones who live with and die from the illness. In fact, in 2020, women and girls made up 50% of all new cases of HIV globally. Currently, 52% of all people living with HIV are women and girls. That is the majority.
Only by 2%, sure, but the majority, nonetheless. Clearly, the idea that only gay and bisexual men get infected is a wild misconception.
Widespread and dangerous misconceptions can cause the community to be stigmatized, open the door for bullying, and provide unfounded “evidence” of the “wrongness” of gayness. All that unjustifiable hatred pours into the LGBTQIA+ community. Even those who are HIV-negative suffer the consequences by association.
Public fear and hate are only two factors in AIDS-related mental health problems. Internal rejection, or internalized homophobia, can also bring down one’s mental well-being. The messages we receive from the media, unaccepting associates, leaders, and our own government engrains self-hatred or disgust among many gay and bisexual men.
They may feel pressure to hide their sexual orientation or sexual activities to avoid stigmatization. Hiding can cause severe stress, anxiety, depression, and other mental issues. You can learn more about internalized homophobia here.
Discrimination also discourages some gay and bisexual men from getting tested or seeking treatment for HIV. I do not think I need to explain why refusing HIV treatment is a disastrous choice.
You would never, not in a million years, tell someone not to treat their Tuberculosis (TB) or COPD. Why? Because refusing treatment increases the risk of complications, spreading the infection, and death. But since the stigma is so horrid, some individuals prefer to take their chances than face the illness.
Those who refuse treatment are more likely to be depressed, lack social support, and have anxiety. People who refrain from testing possibly suffer from the same mental health and social issues. Mental health challenges and healthcare refusal likely stem from fear of further stigmatization, as gay and bisexual men, already face some level of it.
Their fear is reasonable. Besides the physical risks, studies have shown that “HIV positive GBM experience significant levels of stigma that are associated with heightened risk for suicide.”
But here is the thing…
Just because your fear makes sense does not mean it can have power over you.
Yes, it is scary. Yes, you may face more discrimination from other people. But do you know what else is true? You will be okay even if it is hard. Our community has beat criminalization, fought for our right to marry, and overcome the police brutality of the 70s and 80s.
The gay and bisexual men of our community have been resilient for centuries. We need to make sure we are following them and beat down discrimination. You do not have to go in alone, either. There are resources for HIV-positive LGBTQIA+ people struggling with their mental health. Take advantage of those systems, our history, and even this blog.
Whether it be HIV, AIDS, depression, anxiety, BPD, eating disorders, PTSD, or any other health challenge, you can win. All you need to do is keep moving forward.
Sources:
https://pubmed.ncbi.nlm.nih.gov/15633261/
https://pubmed.ncbi.nlm.nih.gov/28278571/
