looking after your mental health as an HIV+ gay man

Looking after your mental health as a gay man living with HIV

The HIV/AID epidemic wiped out an entire generation of gay, bisexual and transgender men and women in the 80s and 90s.  Today, while becoming HIV+ can still be a traumatic event in a person’s life, it no longer has to be a death sentence.  HIV treatment has improved and there are less drug side effects. However, becoming positive can still affect a person’s life and mental health in a meaningful way.  

What is PrEP?

Pre-exposure prophylaxis (or PrEP) is a method in which people can take daily medication to prevent HIV from taking hold in a person’s body.  It has been shown to be highly effective at preventing the spread of HIV, according to the Center for Disease Control. In the Bay Area, and in other big cities across the country, PrEP is widely and easily available for those of us in the LGBTQ+ community.  This has greatly reduced the number of new HIV infections and has changed the landscape in terms of what “safe sex” means for a new generation.  

A Post-PrEP World

As HIV medications have improved and PrEP has become widely available, HIV is no longer the silent killer it once was.  There was a time when the United States government would not even mention the word AIDS in print or on the news. We have come a long way in fighting this disease. People are living longer, healthier lives being HIV+. However there is still shame, stigma and ignorance that is rampant in our community and can affect your mental health in a damaging way.  

Becoming HIV Positive

Seroconverting or becoming positive is still a life changing moment in a person’s life.  While a positive diagnosis no longer has to mean death, there is still shame, stigma and fear that can come up for a person newly diagnosed.  

It’s still a serious health diagnosis and will mean that you will have to monitor your health closely and likely take medication for the rest of your life.  Whatever your sexual orientation, having a health condition that you have to monitor can have an impact on your mental health and well being.


While I’m not a doctor, there is much research to prove that an HIV positive person cannot pass on the virus when they are taking the proper medications and the level of the virus in their bloodstream is undetectable.  This means that when one partner is on PrEP and another partner is HIV+ and undetectable, it would be statistically very difficult for the negative person to become positive from sex without condoms.

I should’ve been more careful

Ok, so now it’s more difficult than ever to become HIV positive, yet somehow you still seroconverted.  First things first, that doesn’t make you a bad person. It doesn’t mean you’re slutty, whorish, stupid (or any other negative adjective you can think of).  Even with the new advances in HIV research, things happen. While it may be tricky, try not to beat yourself up about whatever led to your diagnosis.  Yes, it’s important to have your feelings, but try and be kind to yourself in the process.

Even in the age of PrEP, new infections happen.  

People are still becoming infected with HIV, even with PrEP.  There are a number of ways you could become infected, including a lapse in PrEP medications, insurance change, drug use, or assault.  New infections still happen, and being hard on yourself for how you contracted the virus will not make it any easier to process.   

I’m a long-term survivor

If you’re someone who became positive in the early days of the epidemic and you’re still living with HIV, you have likely dealt with much loss in your lifetime.  There are plenty of studies and research about the long-term effects of living with HIV. The PTSD like symptoms that some survivors experience are similar to those who have lived through life in a war zone.  Think about it, at an early age you were exposed to death and dying in an extreme way. That will affect the way you form relationships with people on some level today.

Survivor guilt

Survivor guilt is a term that refers to the guilt that someone can feel after surviving a tragedy.  Again, this is another term that is often used to describe the aftermath of living through a war. If you survived the HIV epidemic, there can be an extreme amount of survivor guilt that you can carry with you.  Feelings don’t always make logical sense. And while it may not be reasonable to feel guilt about having survived, you may still feel it. Try and have compassion with yourself, if you can.  

Shame around being positive

There is still stigma around being positive.  Here are some of the questions that may run through your head when you think about your status. Do you put it on your dating profile? How soon should you tell someone that you’re interested in dating about your diagnosis?  Should you keep it private at work or with your family? Even though it’s not your fault, you have nothing to be ashamed of and you’re no less worthy than anyone else, the stigma around HIV is still present in the LGBTQ+ community.  


Dating is hard enough without having to add in the fear of sharing your HIV diagnosis with potential new partners.  When people use words like “clean” and “DDF”(Disease and Drug Free) to describe their HIV negative status on dating apps it’s hard not to feel shame about being positive.  

When should I disclose my status?  

This is a very personal question.  If you’re taking care of your health, meaning that you’re on medication and undetectable, when you disclose your status is really up to you.  For some people it feels better to put it out there on dating profiles to avoid ignorant responses. For others, they would rather wait and tell someone after a date or two if it seems like a potential match.  Trust your gut.  And honor the decision that is best for you.

How can being HIV+ affect my mental health?  

The simple answer…it depends.  Each person will have a unique reaction to becoming positive.  For some, there will be shame, depression or anxiety. For others, it may seem like a relief.  Listen to yourself and be really honest about whether or not becoming positive has an impact on your mental health, relationships or self-esteem.   

Support for living with HIV in San Francisco

In San Francisco, we are fortunate to have a number of resources that can help you cope, live and thrive as an HIV positive person.  SF AIDS Foundation has a number of resources listed on their website here.

It’s important to remember that whether you’re newly diagnosed or have been living with HIV for awhile, there is support out there and you are not alone.  

This is a topic that deserves continued conversation and hopefully we can work together to end the stigma around living with HIV today.  

Tom Bruett

Tom Bruett

Tom Bruett, LMFT is a licensed psychotherapist with an office in San Francisco, CA. Tom feels passionately about helping people have better relationships. The purpose of this blog is not to provide advice or to take the place of working with a mental health professional. For more information please visit the homepage.