When the Crisis Lasts a Lifetime: HIV, Burnout, and Emotional Survival

Living with HIV creates one stressful event after another: anxiety about getting tested, dealing with news that one is positive, when to start medications, dealing with anxiety, depression and stigma…The list is endless.  It is critical that we learn how to manage these feelings because the toll created by chronic stress is directly related to a drop in CD4 counts.

At the recent Positive Living 15 conference in Fort Walton Beach, I gave this presentation on some ways to cope.  Here is a pdf verson of my presentation:

Download Positive Living 2012

The slides explain how stress impacts the body, symptoms, and tools to address them, including gaining a sense of optimism, improving interpersonal skills, identifying and appropriately expressing feelings, and most important, getting connected to others with whom you can give and receive support.  

Emotional survival with HIV is certainly possible but doesn't come without work, commitment, and sharing the experience with others.

The Endangered Wonder of the Positive Living Conference, and Why It Matters for Our Patients

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Every spring, on the white, sandy beaches of the Florida Panhandle, an unlikely gathering takes place. On that narrow strip of land, between the Gulf of Mexico and Choctawhatchee Bay, 450 HIV-positive men and women from around the country, but mostly from the Southeast, come together amidst occasional spring breakers for a weekend of socializing, education, some silliness, a few tears, and just plain fun.

This year, the Positive Living conference turned 14, an extraordinary success by any measure, but even more poignant because it is the only remaining large-scale conference for persons living with HIV. It is a remarkable blend of individuals: Those who are well-known for their work in the field mix easily with positive men and women who may never have seen the ocean, or been able to spend a weekend by themselves at a hotel, or (most certainly) been around so many other positive individuals in one place.

I am always struck by the rich amount of valuable information available for both attendees and presenters. Tom Liberti, Florida's HIV/AIDS Bureau Chief, gives an annual review on the state of affairs, especially poignant this year because of the AIDS Drug Assistance Program crisis. There are medication updates and workshops on mental, physical and spiritual health. There is a daylong AdvocacyU workshop, where attendees learn how to use their voices to advocate on their own behalf.

And there is history. Until his death, Martin Delaney never missed Positive Living. And this year, as Martin Delaney did in years past, Paul Kawata, the executive director of National Minority AIDS Council, gave a keynote that captured a long-term view of HIV — where we have been, our successes, our setbacks, our power, and the many struggles to come.

 

The heart of the conference lies with the participants, and it is here that the immense benefit for one's clients living with HIV can be clearly seen. Most receive scholarships, which pay for the beachfront hotel rooms and meals. Many are from the rural South and simply don't have adequate access to medical resources — or, for that matter, each other. Positive Living fosters the formation of networks for both medical and social support; but mostly, at least for a few days, it normalizes the stigma of living with HIV. For one brief weekend, everyone is HIV positive (or a very close ally). One can feel a sense of joy and freedom in sharing this physical and emotional space.

The very existence of this conference is a tribute to the vision and hard work of Butch McKay, the executive director of a relatively tiny agency, Okaloosa AIDS Support and Informational Services, Inc. McKay and a handful of staff raise the necessary funds and organize this event with a mastery and focus that have a sense of life or death. And there is no doubt that Positive Living enhances, and even saves, the lives of persons living with HIV.

But the conference itself, like others before it, is at risk. Every year, fundraising is more difficult even as the need grows. Across many states vital programs are being cut, individuals are struggling with fewer resources, and bureaucratic shifts resulting from budget cuts make maneuvering the system, and surviving, that much harder. We witness our clients struggling with these issues every day.

It's easy to see why such events have disappeared. They require extraordinary determination to bring them to life, and the costs are daunting. But their demise represents one more great loss attributable to this virus. Without such gatherings, persons living with HIV have one less resource by which they can remain educated, connected, empowered and even sustained.

Too often we allow ourselves to focus on the objective data of HIV: CD4 counts, viral loads and years since diagnosis. Events such as Positive Living heal at a deeper, more subjective level: the spirit. They renew our determination as providers and they reenergize our clients' ability to integrate healing at multiple levels. For all this and more, they are well worth fighting for.

NATIONAL GAY MEN’S HEALTH SUMMIT TO BE HELD IN FORT LAUDERDALE AUGUST 25 – 29

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Hundreds of gay men and their allies from throughout the country and beyond will gather on August 25 – 29, 2010, at the Sheraton Fort Lauderdale Airport and Cruise Port Hotel to participate in the 2010 National Gay Men’s Health Summit. The theme of the event is  “Creating a Brighter Future: The Next Decade of Gay Men’s Health” and will be held jointly with the 9th annual Southeast Regional Gay Men’s Health Summit.   Over 250 gay men (as well as, bi, trans men, other men who have sex with men and their allies) will gather to reflect on and celebrate gay men’s lives while working on a brighter future for gay men’s health and wellness.

The summit is open to all and registration has been underwritten for residents of Dade, Broward, and Palm Beach Counties by the Broward County Health Department and the Florida Department of Health.   Pre-summit workshops begin on Wednesday, August 25, and include a panel featuring an intergenerational dialog around gay youth, adults, elders and ancestors; another focusing on body image and weight issues; and a gay men’s leadership institute.

The formal summit begins on Thursday, August 26, and concludes on Sunday, August 29, and features a number of plenary speakers and nearly 70 workshops on topics as diverse as addictions, mental health, HIV, wellness, dating and relationships, and spirituality.  Many of the workshops will address special topics and populations, such as HIV negative youth of color, building community among Hispanic gay men, return to work issues for those on disability, and addictions recovery.  The summit is designed to promote social interaction and fun.  A significant number of the workshops are experiential, such as laughter yoga or meditation, and are intended to be edgy, such as the impact of GRINDR on our community and the use of social media to improve gay health and wellness.  Besides casual interaction with gay men from around the country (and beyond), there will organized social events such as a show and a pool party.

The gay men’s health movement grew from an interest in expanding the scope of gay men’s health beyond (but certainly including) HIV to a full range of other issues that impact our health and wellness.  At the Summit, gay men and their allies will have frank and open dialogue about race, racism, identity and gender politics, aging and class. We will discuss these and other domains and paradigms for thinking about gay men’s health. Our conversations will cover the broad spectrum of interests for gay men with key focus on strengths-based organizing, emerging issues, and other hot topics.
One of the key challenges facing gay men is to ensure that we continue to be involved in the strategizing and implementation phases of Health Care Reform. Another key challenge is to develop creative funding strategies and work alongside key policy makers while we simultaneously work with fellow advocates to shape policy such as ADAP and the National HIV/AIDS Strategy.

Walk-up registration is available beginning at 10:00am on Wednesday, August 25.

A Different Longtime Companion: Reflections on World AIDS Day 2009

 David Fawcett, PhD, LCSWRed_ribbon


It was 1982 when my friend Andrew developed an odd pneumonia that put him in the hospital and ran through his body with such ferocity that he was dead in three days.  My friends and I were stunned, until it soon happened again – this time with another acquaintance who survived longer, but ultimately succumbed to an illness the New York Times called “GRID,” gay-related immune deficiency.  GRID soon became AIDS, and one by one almost all of my friends became sick.

Thus began a journey that continues to this day, first marked by terror, then sadness, then overwhelming grief, and then by sheer determination as we stepped up to care for each other.  My life as a thirty-something gay men in New York was quickly transformed from exuberance in the aftermath of Stonewall to determination marked by caretaking and political advocacy. 

The energy on streets in the Village and the Upper West Side, once both high-spirited and sexually charged, became heavy with sadness.   Many men simply disappeared as the disease confined them to their homes, or their friend’s homes, or hospital wards.  Many died.  Others were out using the patchwork of services that began to develop in response to the crisis.  The streets were filled with the odd sight of thin men with wide terrified eyes walking awkwardly with canes.   I vividly recall one very cold winter day when I helped one frail young man struggle across Seventh Avenue through slippery frozen slush on his way to St. Vincent’s.

Despite persistent optimism and a strong sense of spirituality, for me the eighties became a human tragedy.  My life was entwined with AIDS at every level: intimate, social, and community.  As we lost one friend after another there was nothing to do but go forward, caring for those who were dealing not only with physical illness but also struggling with the emotional pain of rejection and stigma.  And AIDS kept coming.

One price we paid, among many, was never really stopping to grieve because so much needed to be done.  We hardened our emotions and our resolve – there was simply too much to do.    Men of my generation live with a great wound that, for many, remains unacknowledged and unexpressed.  We need to heal, even in the face of the ongoing epidemic.

Now, nearly thirty years later, AIDS continues to create suffering.   For many, it has lost its urgency.  A new generation has grown up with the disease and new medications, and view it as a manageable illness, but it is relentless and continues to demolish lives.  Long term survivors have developed an acceptance of the unknown.  They have given their bodies to drug trials and dealt with multiple losses, either through the death of partners and friends, or alienation from family.  Ironically, they now face a new wave of heart, liver and kidney disease as a result of the medications that have kept them alive. 

We need to remain vigilant about AIDS.  We need to advocate for new treatment alternatives like rectal microbicides and redesigned prevention efforts.  We need to remain informed and fight complacency.  We need to end the stigma that surrounds AIDS to this day, undermining both prevention and treatment.  Mostly, on this World AIDS Day, we need to remember the pain, the lessons, the courage, and the successes of the past and use them to renew and reenergize our continued work to end AIDS once and for all.  

DON’T BE INVISIBLE – JOIN “THE COUNT”

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Did you ever wonder about the LGBTQ population where you live? How many of us are there? How old (or young) are we? What races and ethnicities do we represent? What is the status of our health, or our households, or our finances?

Today it is impossible to determine the answers to these questions, but if you live in Broward County that’s about to change. This summer you will be able to participate in an online census for the gay, lesbian, and transgender community called “The Count.” The collected data will finally give us a statistical presence that not only provides an awareness of our numbers but also assembles information that can be used for public policy and funding decisions. The census is a collaborative effort that includes the United Way, Sunserve, the GLCC, Broward House, and the Broward County Department of Health. This is the first effort to quantify and document information about our community.

Why is this important? One key reason is that it will enable better funding for health care, social services, and other vital resources. For example, as Chair of the South Florida Methamphetamine Task Force, I have been frustrated in applying for funds that could provide additional treatment services because there is no specific data on the pervasiveness of substance abuse among Broward’s LGBT population. In the case of meth, we know there is a serious problem but grant makers want specifics, and documenting how many people are affected, their other health concerns (like HIV or Hepatitis), or their treatment needs is impossible because there is no data. This seriously affects our ability to get funding to help the community. If we aren’t seen or heard, we will be overlooked.

Many of my psychotherapy clients express frustration about what they perceive to be a lack of community. This census is an important step in affirming that we are not only here, but that we will be seen, heard, and counted.

“The Count” will go live this summer, but you can register now on the site to be notified about updates.

The Gay Men’s Health Agenda 2009: Making our Voices Heard

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As the new administration in Washington massively shifts national priorities, an opportunity has presented itself for the LGBTQ community to speak up and to be certain that our long-neglected healthcare needs are both recognized and addressed.

The Gay Men’s Health Agenda   is a significant document which grew out of a grassroots effort within the gay men’s health movement. After soliciting comments from gay men around the country, a draft was presented for feedback at the Gay Men’s Health Summit in Seattle in October, 2008, and the final version has now been published.

The Agenda is significant because it urges policy makers to recognize that the health care needs of gay men extend far beyond HIV/AIDS, and include mental health, substance abuse, external and internalized homophobia, and a sometimes appalling lack of cultural competency of many health care providers in recognizing and appropriately treating the health of the gay, lesbian, and trans community. This is even more vital as the federal government is now drafting "Health People 2020," which will serve as a roadmap for spending priorities over the next decade. Gays and lesbians have been virtually absent from federal health priorities. This Agenda pushes for change.

Recommendations specific to gay men’s health include funding and expanding social, behavioral, and biomedical research; developing and collecting data on sexual orientation and gender identity in federal research; funding campaigns to combat homophobia, biphobia, and transphobia; and eliminating bans on "promotion" of any type of sexual behavior, which impairs effective health campaigns. Other recommendations include creating strategies to combat health disparities, funding sexual health and wellness, and removing barriers to health care for transgender people.

Similar efforts for lesbian health include the Lesbian Health Fund of the Gay and Lesbian Medical Association. Health care disparities continue to grow for all of us in the LGBTQ community. These efforts are an important step in making our voices heard. Whether you participate by contributing to a similar document or by calling or emailing your representatives, be sure yours is among them!

“Inspot” website lets you anonymously notify others about your STD

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Imagine receiving this email: “No one wants to be the bearer of bad news but I got diagnosed with STDs (sexually transmitted diseases) and you might have one too.” This email might be from someone you know, or it could be anonymous. While unpleasant, such a message has tremendous benefit because it notifies you of possible exposure. With such knowledge you can seek early treatment and hopefully avoid having to send such an email yourself. This new service is available through Inspot, a not-for-profit agency funded by the Florida Department of Health.

New options for notifying sex partners couldn’t come at a better time. Last week a CDC (Centers for Disease Control and Prevention) report announced that syphilis cases in the US were up a staggering 15.2% over the year before, and worse, gay and bisexual men (including a disproportionate number of African-American men) accounted for a whopping 65% of those cases.  These numbers represent an unfortunate continuation of a seven year rising trend in syphilis rates.

Syphilis, untreated, is dangerous enough, but it also increases exposure risk for HIV by causing breaks in the skin, giving these statistics an ominous significance. While there is a simple blood test for syphilis, the symptoms (sores on the genitals or in the mouth) often go undiagnosed and the disease is easily spread. The CDC recommends annual testing for those in a partner relationship, and every six months for others.

Why are these numbers so high for gay and bisexual men?” The CDC speculates that we are suffering from prevention fatigue (certainly true) and being less vigilant with safer sex. Dr. John Douglas, head of STD Prevention for the CDC, also suspects that a rise in serosorting, the practice of choosing sex partners with the same HIV status, plays a role. Such unprotected sex leaves men exposed to other sexually transmitted diseases like syphilis.

I suspect an additional factor: substance abuse, particularly methamphetamine. Meth is the perfect storm for STDs: it increases risky sexual behavior, leads to multiple sexual partners, and eliminates cares about protected sex. The clients I see in the Meth and Men program at Sunserve bear this out: tina, out of control sex, and STDs go together.

No one wants to tell a friend or even a trick that you have exposed them to an STD. And realistically, you may not even know his name or phone number. But chances are that if you hooked up online you can find that profile and send him (or them!) an email that can be anonymous or personalized. In Florida, you can do this knowing that no governmental authority is involved, and that there will be no reporting or follow up by the health department.

Inspot provides six templates with sharp graphics and catchy phrases (“It’s not what you brought to the party, it’s what you left with”). If you wish you can add a personal message. The site also has links for information about sexually transmitted diseases and testing locations.

Getting tested for HIV and other sexually transmitted diseases is essential. Most infections occur not because people lie (although some do) but because they don’t know their status. When you get bad news don’t let embarrassment keep you from notifying someone you might have infected. Use these Inspot notification emails to help stop this cycle and keep our community healthy.

For more information visit Inspot at http://inspot.org/florida.

 

Speaking of Sex

   Good sex involves more than technical skills. Despite a lot of experience, many people
don’t feel very competent with one important component of sex: speaking up
about it. Sexual competence must
include the ability to be comfortable with sexuality, discussions of sex, and
especially, expressing sexual needs. It
is one of the great ironies of a sex-drenched culture that sex, if it is spoken
of at all, is too often described with a buffer of code words and cute metaphors.

 There are
many situations where this can be a problem. Couples (gay or straight) often have trouble speaking frankly about
their sexual needs or concerns in their relationship. Revealing serostatus to a date or sex partner
is a big concern for many gay men. And
others, even after seeking out a gay physician, are reluctant to talk about
their sexual practices honestly with them, which jeopardizes their health. I have had clients who prefer to get tested
and treated for STDs at an anonymous clinic rather than at the office of their
gay doctor. This is not for insurance
reasons but because they are embarrassed about their sexual behavior.

 Sex still
carries shame for many people. This is
true of professionals, as well. I have
had clients who completed inpatient substance abuse programs tell me that while
in treatment they never spoke of their sexual practices, most of which were critically
linked to their drug use. Why wasn’t
this discussed? In many cases it was
because the counselor was uncomfortable speaking about sexual practices. When I train other therapists we pay close
attention to their sexual competence: the ability to be comfortable speaking
about sexual concerns and make it safe for their clients to do so as well.

 How is your
sexual competence? Here are some tips
for speaking up about sex:

1. Respect
yourself. Gay men and women need to work
at self love even harder than society at large simply because we are
consistently bombarded with negative messages, both overt and covert. You have a right to your feelings, a right to
speak up and be heard, and a right to have your sexual limits honored.

2. Minimize
embarrassment or shame when speaking about your sexual needs, concerns, or
problems. You’re not the first to have
such feelings and not speaking up could have fatal consequences. That goes for discussions with your doctor,
as well. I know one man who didn’t want
to speak to his physician about his anal warts which consequently went
untreated and developed into rectal cancer.

3.  Speak your
truth, whether it’s your HIV status, the need to use condoms, or your concern
that your sex life might be a little out of control.  Don’t keep it to yourself.  Speak up and be willing to listen to the
feedback you receive.

 4. Make your healthcare provider an ally. Be certain that you can frankly discuss your
sexual practices and concerns in a safe, non-judgmental atmosphere. Even if you want to ask what you might think
is a naive question, speak up, Believe
me, they have heard it before.

 Sex should
be fun, but anxiety, anger, or other negative feelings resulting from unspoken
concerns can quickly destroy the mood. When
discussing something as important as sexual needs or sexual health, everything
should be on the table. Your life depends
on it.   

   

Rising Rates of HIV Among Gay Men – What Does That Mean For Me?

HIV infection rates occur in the United
States at a far greater rate than previously thought,
according to a special HIV issue of the
Journal of the American Medical
Association
released to coincide with the XVII International AIDS Conference in Mexico City. The CDC utilized new methodology and
technology which differentiates new versus long-standing infections. They determined that in 2006, an estimated
56,300 new cases of HIV infections occurred, significantly higher than the
prior estimate of 40,000 cases.

Men who
have sex with men accounted for 53% of these new cases, and African Americans,
while only 13% of the U.S. population, accounted for 45% of the cases. These statistics represent a discouraging
trend for both populations, especially for gay men who for many years saw a
steady decline in new rates of infection.

Abstract
numbers are difficult to personalize and it’s extremely easy to disconnect our
daily routines from this deadly trend. But every gay man needs to ask himself “what do these numbers mean for
me?” Here are some things to consider:

1. Do I know
my status?
A significant number of
new infections occur because men who are HIV positive (but don’t know it)
inadvertently infect others. Having
unprotected sex with someone who claims to be negative is foolish. Many men don’t get tested because they don’t
want to know. Others may have not yet
converted or worse, they’re not being honest. Take charge of your health – get tested.

2. Do I
engage in safer sex?
Practicing
safer sex takes a little more thought and effort, but doesn’t necessarily rule
out an erotic experience.  It is
important to be informed about specific high risk behaviors, and with a little
creativity something like putting on a condom can turn into a two-man operation
that enhances the mood.  Use your
imagination!

3. Do I
party a little too much?
A major
factor behind the rise in HIV rates among gay men is substance abuse,
particularly methamphetamine. Meth
increases sexual desire while, ironically, causing erectile dysfunction. It also results in less impulse control and
inhibition which translates to risky sexual behavior. There are many men who first used “Tina” and
ended up with HIV. If you think you
might have a problem, check out Crystal Meth Anonymous (www.southfloridacma.org) or Meth and
Men South Florida (www.methandmen.org).

4. What’s
the big deal?
  Life with HIV isn’t
always as thrilling as it appears to be for the guy doing the rock climbing in
that medication ad. While living with the
virus has changed dramatically over the years, it remains a life-threatening
illness that cannot be cured. The
medications themselves can cause serious physical problems, including long term
damage to the heart, liver, and kidneys. People continue to die from AIDS. It is a big deal.

5. So what
can I do about it?
Make HIV your business,
whether you are negative or positive or not sure. HIV/AIDS affects us all. Whether it’s advocating for better public
policy, or giving service to the community, or being sexually responsible,
every one of us needs to get active. Let’s make it the community norm to stay involved with the issue of HIV.  This
is life and death, and we have the power to make a difference.