Working in sexual health is challenging for anyone. Let’s face it, asking a stranger to come into a clinic and confess all of their sexual exploits is a difficult thing. Of course, it’s harder for the patient, but there can still be awkwardness on the part of the clinician as they leave no stone unturned with their probing questions. It definitely requires a flexible attitude and there is no place for judgement. you have to be able to deal with transgender issues, drug abuse, unsafe practices sexual abuse, prostitution and even reckless endangerment. Not to mention infidelity.
Despite this, there are many rewards, including earning trust in a situation where individuals allow themselves to be completely vulnerable.
One of the challenges for me is being a gay man in sexual health. If you are able to ignore it in the real world, there is no denying that homosexual men comprise a large proportion of the client base. There are a lot of mixed feelings for me when I see gay patients, particularly the large number of HIV+ men that come through the clinic.
A lot of the literature regarding HIV in the clinic is aimed towards gay men. There are sometimes pamphlets with a lot of sexy images in them, as well as language better suited to gay erotica. It seems as though a large percentage of the literature is written in lingo, and while this is obviously used to connect with the members of the gay community, it can sometimes leave me with a sour taste. Sometimes, it’s almost offensive. Still, the fact remains that homosexual men are the most prevalent group affected by HIV. It is a group within the population that struggles with recreational drug use and unsafe sexual practices, from unprotected sex, to multiple casual partners to sex-on-premises and even sexual assault.
My discomfort that sometimes arises around these cases does not stem from my desire to separate myself from the gay community, but because I am a part of this community, and I feel like – in general – we’re just not getting the message.
Discussions in the clinical meetings about people’s understanding of post-exposure prophylaxis (PEP) and when and how to utilise it are just depressing. PEP is essentially the morning after pill for people who believe or know they have been exposed to HIV. It is a one-month course of combined HIV meds, and must be started within the first 72 hours from contact. I have seen people present a week after exposure seeking PEP, only to be turned down because it’s too late. These guys have to wait weeks and weeks until they get tested, while knowing there’s nothing they can do in the mean-time.
There are the patients who think their risk is low because they were not the bottom. They think their risk is low because they didn’t cum in their partner. They get high on weed or poppers and just don’t bother with a condom, and their anxiety over their practices when they’ve come clean depresses them. The didn’t ask the guy they met in the park if he was positive; they just assumed he was, but the guy in the park assumed he was positive because he didn’t ask.
PEP costs approximately $1,200 for the 1 month course. A years’ worth of HIV medication costs about 10 times that. But none of that compares to the price you can pay.
Why are we so prone to HIV infection? I don’t believe it’s because we are somehow sluttier
than our heterosexual counterparts. If women were as sexually preoccupied as men, we’d have a much larger problem on our hands. Heterosexual women are the fastest growing group of people infected with HIV each year.
I believe that the past rejection and persecution of homosexuality forced the underground gay sex scene. The bath-houses, the cruising parks, the sex clubs. While all of that is unnecessary now, it has become part of the gay culture to some extent. There is still a large group of closeted men who leave their wives and seek the intimacy of other men in all the wrong places.
I believe that the prevalence of HIV in the gay community is symptomatic of the history of homosexuality, a product of the underground sex culture. We need to throw off the self-loathing of the past and embrace the normality and natural aspects of our sexuality. We need to stop the shame, stop hitting the self-destruct button, and learn to love who and what we are.
We’re gay. Bisexual. Lesbian. Transgendered. Queer. Intersex.