Positive sex

I recently sat down with my colleagues, Rick Julien and Scott Simpson, the peer facilitators of the Gay Poz Sex (GPS) Study housed jointly at the HIV Prevention Lab at Ryerson University and the AIDS Committee of Toronto (ACT), to speak to them about the GPS program and how it addresses many of the competing forms of stigma that gay, HIV-positive men often face. Here are their responses:

Amy: Looking at the history of HIV & AIDS, it’s clear that people living with HIV &AIDS have faced stigma in both proximal and distal relationships. With breakthroughs in ARVS, activism and education, this stigma has dissipated a bit but the recent Canadian Supreme Court ruling around HIV non-disclosure has negated a lot of this progress.  Could you discuss the current experience of stigma and people living with HIV, specifically in relation to the new legislation?

Rick & Scott: In GPS, we see the emotional, cognitive and social impacts of HIV stigma and they are layered and complex. This complexity impacts our participants – gay, HIV-positive men - both individually and as a community. The effects include depression and isolation, and a community trying to understand and reconcile the larger hetero-normative messaging with our own identities and communities. The recent Supreme Court ruling further perpetuates HIV stigma and the marginalization of people living with HIV  – effectively sustaining the legal impact of HIV stigma and adding to its complexity.

Amy: How has the current ruling around disclosure impacted those living with HIV & AIDS?

Rick & Scott: In GPS, we witness fear – of prosecution, of public shaming, of incarceration – and this fear impacts communication and impedes relationships. For people living with HIV, the Supreme Court ruling perpetuates internalized HIV stigma, promotes concealment of HIV status, and increases expectations of rejection. All of these factors negatively impact individual mental health – and by extension, our communities’ health. GPS provides gay men the space and support to counter these effects while also working toward their own self-determined sexual health goa(s).

Amy: How is the GPS study addressing some of these stigma-related issues?

Rick & Scott: Mix sex stigma with the ever-present gay stigma, and then add HIV, and the stigma gay men experience gets compounded and more complex. GPS provides a safe space for gay, poz men to talk meaningfully about their sexuality. It is often the first time the men have been provided with the opportunity to have their thoughts, feelings and behaviours as gay men validated and it can be a profound experience, both on a personal and social level.

Amy: It can sometimes be difficult to see the effects of legislation on behaviour within a population, but with the recent ruling around disclosure, we are seeing immediate shifts in disclosure rates and stigma. Can you discuss this issue a bit more and how GPS is addressing the personal effects of this ruling?

Rick & Scott: In GPS, gay men are given the opportunity and support to develop their own personal approach to sexual behaviour in the context of the ruling. One of the great things about GPS is that we, the peer facilitators, use a counselling approach that supports autonomy so we don’t tell the guys what their behaviour should be – we collaborate with them so they can figure out what works best for them – so each guy will have his own plan that works for him.

Amy: How do you think homophobia and gay stigma impact choices around sex and sexual health?

Rick & Scott: Stigma undermines the validity of gay identity and the gay experience, potentially leading to low self-esteem and hope, isolation and avoidant coping, emotional suppression and rumination. These mental health and social stressors can make self-care behaviour a challenge, including sexual health behaviour.

Amy: How does the GPS program try to unpack some of this stigma?

Rick & Scott: GPS provides a safe space to express and talk about sex and life as a gay, HIV-positive man. We acknowledge and name the gay and HIV stigma in our lives and work to develop strategies which offset this stigma and not only affirm but validate our experiences and identities.

Amy: How do you tackle issues of stigma around sex in a culture (like ours) which is simultaneously hyper-sexualized yet creates shame around sex?

Rick & Scott: Through specific exercises in GPS that explore and clarify life stressors, the men gain a greater awareness of the impact of stigma in their lives, both personally and socially. This greater awareness facilitates strategies to lessen internalized (gay, poz) sex stigma while also reinforcing their personal values and goals.