Why Are So Many Mid-Life Gay Men Getting HIV?

[Guest guest]

03/15/2007

Why Are So Many Mid-Life Gay Men Getting HIV?

By: SPENCER COX AND BRUCE KELLERHOUSE, PH.D.

New data released by the city's department of health show that the highest rates of new HIV infections are among gay men 35 to 49 years old. These findings are alarming and, to some, perplexing.

Why are so many mid-life gay men who were able to avoid HIV infection for so long now taking risks that are exposing them to the disease?

We believe that one common thread runs through most of these men's life histories - they came out and/or lived during the death-saturated culture of the 1980s and early to mid-1990s.

Mid-life gay men have lived most of their adult lives during the worst of the HIV/AIDS epidemic, experiencing the loss of partners, friends, and people in their community. As witnesses to so much illness, death, and loss, their voices have seldom been heard and their needs largely overlooked. Having once been the activists, caregivers, and volunteers for our community, many mid-life gay men now feel invisible and isolated. Not only lives were lost, during this period, but entire social networks and ways of living disappeared too.

The traumatic effects of AIDS-related losses were closely studied between 1988 and 1996. By 1988, gay men had already on average lost six lovers, friends, and/or family members. Researchers have shown that people who had more experiences of AIDS-related loss also had higher levels of traumatic stress response symptoms and recreational drug and sedative use.

However, almost no effort has been made to study the long-term impact of the AIDS epidemic on mid-life gay men, or to determine whether current elevated levels of risk-taking behaviors in gay men are related to the trauma of surviving one of the worst epidemics in our history. That lack of attention may now have come home to roost - in rising rates of risky behavior that are secondary to the effects of unprocessed traumatic responses to decades-old losses that haunt our daily conscious and unconscious lives as mid-life gay men.

Friendships have been shown to play an important role in health maintenance and in provision of care during poor health. The relationship between friendships and health is particularly important for gay men, for whom social networks often take the place of missing biological families. Conversely, many health problems that are now common among gay men are made worse by loneliness and lack of social opportunities.

Having survived the HIV pandemic, urban gay men in mid-life may be particularly vulnerable to the negative effects of decimated social networks. Difficulty in making and sustaining relationships is a characteristic effect of traumatized people. The normal stresses associated with mid-life, together with the lingering effects of loss associated with survival through the epidemic, may make it difficult for these men to create and maintain new groups of close friends.

Furthermore, gay men have high levels of depression and anxiety disorders, another characteristic of people who have survived trauma. Studies estimate that gay men have about twice the levels of depression than are found in Americans generally. Depression is strongly linked to high-risk behavior, including drug use, alcoholism, and risky sex.

The methamphetamine epidemic that has swept through urban gay communities also contributes to high levels of new HIV infections. A recent study from the Los Angeles Gay & Lesbian Center, which offers HIV testing, found that one in three new HIV-positive tests was associated with meth use. About one in 10 gay men in New York City report recent meth use.

In some ways, gay men in mid-life are at the center of a "perfect storm," in which multiple problems converge to create a very high-risk environment. Dr. Ron Stall, one of the leaders in studying gay men's health, has shown that different kinds of psychosocial problems, such as depression, drug use, and partner violence, interact to create higher levels of risk for HIV - in other words, the more psychosocial problems that a person experiences, the higher their risk of getting infected.

We can't just address these problems independently, but need to understand the dangerous ways they work together.

If we are to lower HIV infection rates for this population, we need a renewed focus on HIV prevention for gay men. Many of our AIDS organizations are missing in action when it comes to gay men. They've assumed that, because we know how to have safer sex, their job is done. But these data show that the problem isn't lack of information.

Handing a 45-year-old man another safer sex brochure just isn't going to do the job. We urgently need to create programs that directly address the real reasons that gay men engage in high-risk behavior.

Our AIDS organizations need to be experimenting with new programs and new models to prevent HIV infection, but most of them are nowhere to be found.

The development of effective treatments for HIV disease has given many of us a new lease on life. But if we are to make the most of this opportunity, we will have to understand the legacy of this plague - what it has done to us. We owe that much to those who fought and died, and to those of us who are fighting and have survived.

Spencer is the founder and executive director of the Medius Institute for Gay Men's Health. Bruce Kellerhouse, Ph.D. is the co-founder of HIV Forum and a psychologist in independent practice.

©GayCityNews 2007

Regards, Vergelpowerusa dot orgAOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.

[Guest guest]

RE: Mid Lifers and Contraction of HIV. Just a few thoughts. I believe that the root of the problem is self esteem and the effects of the stigma that gays have and live with in our society. I would venture to say that most gay men have serious problems with self esteem.There is still a negative stigma attached to homosexuals not only from the general population but from our own community. We grow up in a culture where homosexuals are still treated as second class citizens and we ourselves treat each other in a manner which does not promote responsible behavior, giving one another the support, respect and compassion that helps one to develop a good self image. It takes a very strong individual not to internalize that stigma. I believe that the sexual freedoms that so many gay men exercise are a way to release that frustration. Knowing that one can attract men for sexual encounters sort of bolsters the self image while at the same time allows enjoyment

of the pleasures of sex. For those who have lived through the HIV epidemic since its inception and are now aging, perhaps the frustration is augmented with the issues related to aging and self image. It becomes more difficult to cope with those issues and men become more desperate for the reassurance and gratification, and in our gay culture sex has always been the outlet for that reassurance and gratification. Thus, risky behavior becomes more prevalent. Another way of saying this is that sex is the opiate and gay men need sex to cope with the underlying issues.

[Guest guest]

RE: Mid Lifers and Contraction of HIV. Just a few thoughts. I believe that the root of the problem is self esteem and the effects of the stigma that gays have and live with in our society. I would venture to say that most gay men have serious problems with self esteem.There is still a negative stigma attached to homosexuals not only from the general population but from our own community. We grow up in a culture where homosexuals are still treated as second class citizens and we ourselves treat each other in a manner which does not promote responsible behavior, giving one another the support, respect and compassion that helps one to develop a good self image. It takes a very strong individual not to internalize that stigma. I believe that the sexual freedoms that so many gay men exercise are a way to release that frustration. Knowing that one can attract men for sexual encounters sort of bolsters the self image while at the same time allows enjoyment

of the pleasures of sex. For those who have lived through the HIV epidemic since its inception and are now aging, perhaps the frustration is augmented with the issues related to aging and self image. It becomes more difficult to cope with those issues and men become more desperate for the reassurance and gratification, and in our gay culture sex has always been the outlet for that reassurance and gratification. Thus, risky behavior becomes more prevalent. Another way of saying this is that sex is the opiate and gay men need sex to cope with the underlying issues.

[Guest guest]

Well…. ly, I can no longer get

and keep it up as easily with condoms. The delay in putting them on, the loss ‘of

the moment’… AND they just don’t feel as good. They are a

nuisance.

When young, a nuisance was not an

impossibility, but now?

Viagra helps. Not for wild sex, but just

sex. I am in terrific shape, not over weight one little bit, good blood

pressure.. and still Viagra helps. Sex is not a top priority, nor even as much

a priority as it was when I was younger, but it is still damn nice, you know? Now

of course Medicare canceled coverage of Viagra. Neat. I may push it a bit to

see if I can get covered somehow, but I can’t afford to pay afford it

without insurance, and the on the net stuff that I have found is no cheaper.

So now condoms becomes, well, a lot more

problematical. What a terrifically foresightful public policy. Lord I get

tired of the US

hangup with sex.

Seattle

From:

[mailto: ] On Behalf Of GHS

Sent: Saturday, March 17, 2007

7:24 AM

Subject: Re:Why Are So

Many Mid-Life Gay Men Getting HIV?

RE: Mid Lifers and Contraction of HIV. Just a few thoughts. I believe

that the root of the problem is self esteem and the effects of the stigma that

gays have and live with in our society. I would venture to say that

most gay men have serious problems with self esteem.There is still a negative

stigma attached to homosexuals not only from the general population but from our

own community. We grow up in a culture where homosexuals are still treated

as second class citizens and we ourselves treat each other in a manner which

does not promote responsible behavior, giving one another the support, respect

and compassion that helps one to develop a good self image. It takes a very

strong individual not to internalize that stigma. I believe that the sexual

freedoms that so many gay men exercise are a way to release that

frustration. Knowing that one can attract men for sexual encounters sort of

bolsters the self image while at the same time allows enjoyment of the

pleasures of sex.

For those who have lived through the HIV

epidemic since its inception and are now aging, perhaps the frustration

is augmented with the issues related to aging and self image. It

becomes more difficult to cope with those issues and men become more desperate

for the reassurance and gratification, and in our gay culture sex has always

been the outlet for that reassurance and gratification. Thus, risky behavior

becomes more prevalent. Another way of saying this is that sex is the opiate

and gay men need sex to cope with the underlying issues.

[Guest guest]

Well…. ly, I can no longer get

and keep it up as easily with condoms. The delay in putting them on, the loss ‘of

the moment’… AND they just don’t feel as good. They are a

nuisance.

When young, a nuisance was not an

impossibility, but now?

Viagra helps. Not for wild sex, but just

sex. I am in terrific shape, not over weight one little bit, good blood

pressure.. and still Viagra helps. Sex is not a top priority, nor even as much

a priority as it was when I was younger, but it is still damn nice, you know? Now

of course Medicare canceled coverage of Viagra. Neat. I may push it a bit to

see if I can get covered somehow, but I can’t afford to pay afford it

without insurance, and the on the net stuff that I have found is no cheaper.

So now condoms becomes, well, a lot more

problematical. What a terrifically foresightful public policy. Lord I get

tired of the US

hangup with sex.

Seattle

From:

[mailto: ] On Behalf Of GHS

Sent: Saturday, March 17, 2007

7:24 AM

Subject: Re:Why Are So

Many Mid-Life Gay Men Getting HIV?

RE: Mid Lifers and Contraction of HIV. Just a few thoughts. I believe

that the root of the problem is self esteem and the effects of the stigma that

gays have and live with in our society. I would venture to say that

most gay men have serious problems with self esteem.There is still a negative

stigma attached to homosexuals not only from the general population but from our

own community. We grow up in a culture where homosexuals are still treated

as second class citizens and we ourselves treat each other in a manner which

does not promote responsible behavior, giving one another the support, respect

and compassion that helps one to develop a good self image. It takes a very

strong individual not to internalize that stigma. I believe that the sexual

freedoms that so many gay men exercise are a way to release that

frustration. Knowing that one can attract men for sexual encounters sort of

bolsters the self image while at the same time allows enjoyment of the

pleasures of sex.

For those who have lived through the HIV

epidemic since its inception and are now aging, perhaps the frustration

is augmented with the issues related to aging and self image. It

becomes more difficult to cope with those issues and men become more desperate

for the reassurance and gratification, and in our gay culture sex has always

been the outlet for that reassurance and gratification. Thus, risky behavior

becomes more prevalent. Another way of saying this is that sex is the opiate

and gay men need sex to cope with the underlying issues.

[Guest guest]

This is all too real to me, there was a period last Spring when so many 40+ men I hadn't seen for years called me to just to "catch up," that when I said to my partner that someone "wanted to do lunch," it nearly became a code for saying that person had recently been infected......as that was always the motivation for the call. I think that most men are practicing far less than 100% safer sex.   They probably don't use condoms for oral sex, may not use them for being a top, and from time to time, they slip up.Seroconversion is not like a coin toss, where every flip of the penny is 50/50.   Because once seroconverted, you can't reverse and try again, it's a decay curve-  do it long enough, you will seroconvert.  If you are 100% safe, you will die of something else before you seroconvert.As you get less and less safe, the time to seroconversion shortens........and I suspect that for many of these 40 somethings, it's really a question of luck running out.......although net sex and drugs may have accelerated the game. Barrowpozbod@...

[Guest guest]

This is all too real to me, there was a period last Spring when so many 40+ men I hadn't seen for years called me to just to "catch up," that when I said to my partner that someone "wanted to do lunch," it nearly became a code for saying that person had recently been infected......as that was always the motivation for the call. I think that most men are practicing far less than 100% safer sex.   They probably don't use condoms for oral sex, may not use them for being a top, and from time to time, they slip up.Seroconversion is not like a coin toss, where every flip of the penny is 50/50.   Because once seroconverted, you can't reverse and try again, it's a decay curve-  do it long enough, you will seroconvert.  If you are 100% safe, you will die of something else before you seroconvert.As you get less and less safe, the time to seroconversion shortens........and I suspect that for many of these 40 somethings, it's really a question of luck running out.......although net sex and drugs may have accelerated the game. Barrowpozbod@...

[Guest guest]

Well said, JB. I personally am getting tired of the self-esteem saw and the blaming of ASOs. If we're having cultural struggles with other underserved populations, then say so, instead of accusing them of doing what Queermen can be and should be doing for ourselves among ourselves.

The bottom line from my perspective, receiving far too many of the same "can we talk" calls and emails, is that Queermen have stopped reinforcing among ourselves the value of and preference for remaining HIV-negative. Sure, as HIVers we don't want to be stigmatized, but saying to another Gay man "You really don't want what this!" is a very different message. I have sex often with negatoids, and I make certain that a condom is always used AND that I don't cum inside a bottom. I have also ceased to have unprotected sex with other HIVers out of concern for all of the other STIs, consideration of my use in further research as an genetically determined LTNP (76 weeks off meds yesterday), and commitment to urging partners to take better care of their bodies. Heck, I'll even put my clothes back on and leave if a prospective playmate is acting erratic and I think I smell burnt meth, regardless of how unique the planned scene may be.

Queermen nursed each other for 15 years or so, and then it seems we lost our collective minds. We can start caring for our brothers again with very simple and frank talk about a gram of rolled latex, and setting a group norm of always, every time, again.

Peace,

In a message dated 3/18/2007 12:58:00 P.M. Eastern Daylight Time, pozbod@... writes:

Seroconversion is not like a coin toss, where every flip of the penny is 50/50. Because once seroconverted, you can't reverse and try again, it's a decay curve- do it long enough, you will seroconvert. If you are 100% safe, you will die of something else before you seroconvert.

As you get less and less safe, the time to seroconversion shortens........and I suspect that for many of these 40 somethings, it's really a question of luck running out.......although net sex and drugs may have accelerated the game.

AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.

[Guest guest]

"Well said, JB. I personally am getting tired of the self-esteem saw and the blaming of ASOs. If we're having cultural struggles with other underserved populations, then say so, instead of accusing them of doing what Queermen can be and should be doing for ourselves among ourselves. "I would also venture to speculate that the increased infections are most prevalent in urban gay centers, where gay men are subject to the lowest levels of anti-gay sentiments, just like the syphilis epidemic.People of all persuasions have sex because they like it, and it's easy to find when you live in a neighborhood with a high percentage of gay men and high penetration of broadband access to the net.If you have sex often enough or long enough, you will seroconvert.  The object of prevention is to get men to behave such that the time to seroconversion is more like 500 years, and less like 360  months. Barrowpozbod@...