A decade ago, Dr. Susan Cochran at UCLA’s School of Public Health published  findings from a comprehensive study conducted on the mental health of gays and lesbians. In the November 2002 issue of American Psychologist, Cochran’s conclusions on depression were depressing themselves: gay and lesbian youth suffer from higher rates of substance misuse than their heterosexual peers; LGBT folks need to utilize mental health professionals more than heterosexuals; and, gay men seem to experience recurrent, debilitating bouts of depression more than almost any other group in the overall LGBT community.

Confirming these findings, Michael Kerr writes on a study conducted in 2009 that reinforced Cochran’s findings, pointing out that “research shows that things are even worse for [LGBT] people. Depression affects LGBT people at much higher rates than the general population.”

In addition, Northwestern University’s IMPACT Program focusing on LGBT health asserts, based upon an even more comprehensive study last year, “Taken together, these results indicate health disparities for…LGBT youth are strong and pervasive. Due to the presence of these disparities at such a young age, they are likely to influence to health and well-being of LGBT [individuals] throughout their lifespans.” 

I can always tell when I’m letting my own depression get the better of me because of the responsive actions of my friends. Truly, my better angels prod me to be nicer. More specifically, there’s a small group of friends I’m lucky enough to have, people who are quizzically good-natured in spite of the arguably self-centered nature of mankind, who either directly say to me “Be nice” or who implicitly say this by responding to my gruffness and misanthropy with emailed pictures of llamas visiting elderly hospice patients for pet therapy. Based upon the amount of animals I’ve looked at lately, I must conclude that I am in a very bad place emotionally. And, admittedly, I am.

Yet, I do not feel utterly hopeless about my future nor do I not have a long list of blessings in my life: in fact, I have a better life than most of the billions of homo sapiens walking the planet. Instead, I am tired.

Now, perhaps some of my depression, this tiredness, is indicative of the ennui of our age, of our complete and total dissatisfaction with institutions of power that we are supposed to trust. Indeed, with growing frequency we expose these people and governmental bodies as clownish caricatures of the worst motivations of man rather than accurate reflections of the grotesque, and compassionate, nature of humanity. Instead of allowing for the unpleasantness that is requisite to be labeled human, too often we as gay folks have taken our social lead from the very discriminatory and ridiculous institutions once subjugating us, including institutions rooted in the necessary evil of politics, a field which, upon mention, should elicit nausea in the thoughtful, common man. We have become dismissive, sometimes, of anything that does not fit into our Facebook and online personas, personas who are apparently all very well coiffed, doing very well with that new small business thank-you-very-much, and who are madly in love without any semblance of negativity or strife whatsoever. And, one of the most grave sins as a public figure is, apparently, admitting flaws, contradictions in character, poverty, or sadness.

I need only point out the fact that when I was homeless (a fact most people still are unaware of) very few individuals had the time of day to actually consider for a moment what it meant to worry everyday about how to maintain proper hygiene without showering or how to remain warm and dry at night to demonstrate our society’s general hostility toward unpleasant facts surrounding human nature. Indeed, I myself am guilty of this intolerable sin of selective ignorance; I would much rather focus on my work than consider how to reallocate my own resources to help others out of those figurative holes in which they find themselves.

Then again, life is a consequence of action, so if bad things are happening to people, then these people behaved poorly, right? Unnervingly, this oversimplification is completely contrary to fact; sometimes, bad things happen to good people for no apparent reason whatsoever. And, “bad things” often include, at least in the case of a disproportionately high number of LGBT folks, anxiety and recurrent bouts of deep depression like I’m going through right now.

Most interestingly, I know a great many individuals whose lives are divorced significantly from the general public understanding of who they are as men and women; their collective loneliness weighs on me to a profound degree. Part of me thinks that if everyone was more candid, offered more details surrounding his need to move (from couch to couch, not apartment to house), explained her decline to my dinner invitation (she cannot afford the meal or the inevitable awkwardness when the check comes), provided context to his anxiety (his father has cancer), then we’d all get along better.

Unfortunately, because we live in society and, as such, must navigate society on its terms otherwise we’ll soon stop being mentioned in society pages, we cannot talk about the fact that we are sometimes sad or sometimes poor or sometimes sick or, inevitably as human beings, dying.

Yet, when we provide these details, people are embarrassed for us; they consider such unsolicited personal details as inappropriate or awkward. Rather, they find anything aside from their unsolicited braggadocio, personal “fabulousness,” or maudlin revision of history to fit into a sentimental simplified narrative as completely out-of-bounds. Even worse, they go one step further and, at least in the case of a critic of mine, begin to publicly call you “psychotic” for no other reason than their own apparent pathological discomfort with facts.

Of course, these same folks portray a fabulous image that is completely divorced from the modest reality in existence; but, naturally, this is unimportant to society. Indeed, it is a curious world we live in when facts are presented and those embarrassed by the facts find comfort in dismissing the presenter as psychotic. Then again, I cannot imagine that the King of England felt much affection for Jonathan Swift after “A Modest Proposal” or that Christopher Hitchens received a warm reception from the Vatican after “God is Not Great: How Religion Poisons Everything.”

Inconveniently, these unpleasant components of humanity are inherent to the experience of being alive. Without our downs, we cannot identify our ups. And, there are some human beings with a propensity toward depression; interestingly enough, there seems to be a strong overlap between those with a sincere desire for man to do the right thing and a profound sense of sadness when this does not occur.

The fact that we as LGBT folks suffer from depression higher than straights might just mean that we care a little too much about the world, in that case. And, while that’s a quaint thought, I nonetheless think the reality is much less noble and much more banal. After all, as some of the most talented members of society, we as LGBT folks are, by our very nature, different and more sensitive. 

So, it’s no wonder that we would rather portray an image as well put together, successful, well-decorated, and fabulous. Who’s got time for reality when we’ve got the theatre?

This article originally appeared on Josh’s own blog here. 

Terrence Higgins Trust, generally considered the UK's leading HIV and AIDS organization, and the largest in Europe, is promoting treatment as prevention, including for gay men, on its new “It Starts With Me” campaign.

"England", it says, “can halt HIV within a generation”.  The campaign is the largest scale by THT to date, running until Spring 2015. Read their press release here. 

Cary James, Head of Health Improvement Programmes at Terrence Higgins Trust says “While a cure or vaccine for HIV remains stubbornly out of reach, what many gay men don’t realise is that medical advances mean it is now within our community’s grasp to stop the virus in its tracks. By getting as many people with HIV as possible tested and on effective treatment, we should see new infection rates fall rapidly

Says the campaign website “We are at the start of a new era in stopping the spread of HIV. We know that the combination of regular testing, HIV treatment and condom use is the key to success.

You can be part of something that changes HIV history. You are the key to stopping HIV in your own life and in the community.”

This kind of strategy marks a transition from what was commonly called poz prevention  - a concept that essentially suggested that HIVers maintaining good sexual and emotional health were better placed to make sound decisions and in doing so, help reduce new infections – to a more direct approach which stresses the benefits of treating HIV to both improve health and reduce viral load, and thus make transmission much less likely.

The campaign makes no specific mention of when to start treatment, although treatment as prevention advocates routinely suggest the earlier the better, not only as a prevention technique, but primarily because the weight of evidence now suggests it produces better health outcomes for the HIVer.

Current UK guidelines recommend treatment for all individuals with CD4 counts below 350, but if a patient with a CD4 cell count above 350 wishes to start treatment, this decision should be respected and treatment be started.

On the issue of infectivity, gay mens' sexual health sites, in the absence of hard data relating to MSM, are currently all over the map. THT says what most experts believe, that “Someone on treatment has an extremely low risk of passing on HIV if their viral load has been undetectable for six month and they are free from sexually transmitted infections. Unlike other sites, there is thankfully no talk here about that perennial red herring, virus in the semen, which tends to be found only in “trivial” amounts according to leading researcher Myron Cohen.

Using the slogan “We Can Stop HIV” the THT campaign is also interesting for drawing on issues of community solidarity and GIPA. Not that this hasn’t been employed before, but more traditional poz prevention campaigns like HIV Stops With Me worried some critics with the perception that they sent mixed messages about personal and shared responsibility. The THT campaign seems to avoid that trap.

One "off" note: the THT website includes the “official” recommendation that all gay and bisexual men test at least once a year. It's arguable that for sexually active men with multiple partners that isn’t nearly enough. Vancouver’s Health Initiative for Men (HIM) for instance says “guys who are more at risk should test every three months.”  We concur with the latter recommendations.

In Canada, only B.C. has adopted treatment as prevention strategies  in the form of test and treat and is enjoying some success in reducing new infections as are other jurisdictions such as New York, San Francisco and Washington, D.C. The issue of the efficacy of TasP for MSM is a controversial area, though, as it has been difficult to reduce incidence in that population.  Dr Julio Montaner, the leading proponent of TasP maintains the issue is not whether TasP works in MSM but how much.

“Some people are going to think, ‘Oh god, why did he not take steps to prevent HIV? Why did he act recklessly, and who the hell does he think he is, I saw people die from AIDS!’” A friend and colleague whose candor is always helpful said this to me over lunch recently, and his words have stuck with me over the past day

Most interestingly, I’ve noticed that those most receptive to my messages are under 30, those 30-50 are generally receptive but ask more poignant questions, and those over 50 are oftentimes, not always but often, openly hostile to my writing on bareback sex and HIV. In the next few months, I’m going to be speaking at several sexual health seminars and symposiums, and I’ve been assessing my own writing and essays on sex, barebacking, HIV, and personal responsibility, and I’ve reached the same conclusion that I originally had when I began writing on HIV and sex; that is, we are inadvertently sustaining HIV infections and continuing this epidemic because we are unable to confront our past honestly and without emotion.

I was born in 1984. Personally, I have no firsthand recollection of Ronald Reagan’s presidency, Ryan White, Arthur Ashe, the AIDS quilt’s beginnings, Rock Hudson, C. Everett Coop, or the obscene neglect the United States government took in relation to HIV/AIDS throughout the entire 1980s.  Rather, all of my knowledge of these things, people, and movements comes from oral histories from LGBT elders that are my friends, exhibits at places like the William Way LGBT Community Center’s stellar John J. Wilcox, Jr., Archival space, named after a man I am heartened to have called a friend, and from textbooks and documentaries. In addition, when I began to go through puberty and learn about the physical and sexual changes taking place in my body, it was the late 1990s, Bill Clinton was president, HIV/AIDS organizations and infrastructure had been in place for over a decade, and my teachers, parents, and mentors knew how HIV was transmitted, how HIV was not transmitted, and HIV’s timeline of progression in the human body.

When I was growing up, there was no plague where funerals were being attended every week. There were no candlelight vigils, there were no large scale protests interfering with traditional institutions of power and policy in the United States; rather, there was knowledge, there were early concepts of treatment that are still being used today, and there was a local, state, and federal government trying its best, guided and sometimes provoked by activists and advocacy organizations, to respond most effectively to HIV/AIDS.

Instead of learning about HIV through my own experiences or through seeing friends or loved ones suffer or die too early, I learned about HIV as an abstract concept far removed from my own life. Of course, this abstract viral boogeyman was as frightening as it was imaginary; after all, when our own innate fears are coupled with histories, real or not, of our elders and teachers, we manifest these fears in irrational terror and paradoxical behavior, like posting links on Facebook to condom campaign websites but barebacking someone we met on Adam4Adam because he said he was “clean.”

For years, I was terrified of this virus because it had seemingly no effect on me or my own circle of friends and family; rather, it was something that we knew existed, we knew how to prevent, and we knew how it attacked the human body, but this knowledge was predicated on the idea that I was born, luckily, at a time where I did not become a man or a sexual being until long after the early days of the virus spreading rapidly through the gay community. Of course, the only reason HIV/AIDS took off throughout the gay community is because gay men engage in anal sex which allows for easy access for the blood barrier to be crossed between sexual partners because of, often entirely unnoticeable, usually microscopic abrasions and tears around the skin on the penis or inside the anus.

Contrary to the belief of some misguided idiots who think HIV/AIDS was god’s divine judgment toward those of us who like to kiss men, HIV only seemingly “picked” the gay community because of this fact; if straight women were clamoring to engage in anal sex like gay men typically do, they would have been the ones who bore the brunt of HIV/AIDS. Instead, because gay men are the ones who engage in this, admittedly fun, activity, we were the ones who suffered the most during the early days of HIV/AIDS. And, to this day, the LGBT community overall, including transwomen and gay men, are dramatically disproportionately affected by HIV because of this fact.

So, like the Holocaust, the early days of the HIV/AIDS epidemic are a mere idea my generation and the generations after mine have to learn about from our elder peers, from our teachers, or from our books. We have no concept of the human tragedy endured by millions; we have no firsthand account of what things were like. And, this is why our experience as HIV+ people born post-AIDS outbreak is entirely different than that of those who lived during this time as sexual adults. Now, this is not to say that either experience is better or worse; rather, our experiences are equally as valuable and equally deserving of a seat at the table when it comes to outreach, prevention, and care.

Notwithstanding, if we are to successfully combat the tide of rising HIV infections brought on by what older folks like to call “recklessness” but what I like to call “natural human behavior,” we must be willing to honestly look at ourselves and admit that nobody has a monopoly on HIV/AIDS, and the fact that someone lived through something does not automatically give them deference on opinions just as the fact that I am HIV+ most definitely does not give me absolute authority on all things related to HIV. Rather, on the logical and science-based merits should we approach HIV/AIDS today without the baggage and trauma, both experiential on part of our elders and vicarious on part of my generation.

This is the current approach of the more misguided folks in our LGBT elder generation, generally, in relation to HIV: tossing out HIV stigmatic slurs like calling me, literally, a “murderer;” browbeating young men who bareback as “reckless;” advocating condom use over everything else; making people who bareback feel bad about themselves; shrilly obsessing over death when telling 20 year olds about the 1980s instead of honestly admitting that you were at the DCA club also getting topped on the truck bed at the bar; claiming falsely that dental dams are used widely to prevent hepatitis and so should condoms for anal sex; ignoring the fact that part of sexual liberation means engaging in natural human sexual activity like bareback sex; and, ignoring all scientific literature that refutes every single backward notion born out of 1990 and early treatment that effectively was more toxic than HIV itself.

If this approach worked, then we would not be seeing a steady rise in HIV infections.

 So, let’s stop damaging the lives and futures of young people today by taking a step back and stop forcing other people to obsess over our own memories, effectively refusing to allow these men and women to experience life on their own without the specter of a de facto Holocaust; the time of this period is over. We have antiretroviral treatment with no side effects that literally both gives us life expectancy into our 70s while simulanteously preventing us from being able to transmit HIV whatsoever (when we adhere to this medication); we are not dying, we are living. And, we are not frightened anymore because now that some of us have seen HIV for what it is. In particular, we know that HIV is a virus that will kill us if left untreated but that it is also a virus that is, today, incredibly manageable with the right governmental approach toward treatment availability like exists here in Philadelphia.

Human tragedy should never be swept under the rug or forgotten. And, we should strenuously remind folks that these things went on, that good men and women died needlessly and far too soon. But, we should not predicate our public health efforts and prevention efforts on the idea that we should force people to remember our dead friends or a tragic decade that future generations had nothing to do with. After all, if this fear-based approach was effective, nobody would get HIV anymore.

The fact that I’m writing this and HIV+ refutes that hypothesis.

This article originally appeared on Josh’s own blog here.

Recently I was invited to my friend Mike’s birthday celebration. He decided that he wanted to relive his childhood. For him that meant renting a soccer field at the local sports complex. For Soccer? No, for dodge ball. That’s right, dodge ball. 

Imagine, if you will, a soccer field filled with roughly fifteen gay men reliving their junior high gym class nightmares. We rocked out to Taylor Dayne, Michael Jackson, and Madonna and to top it off, some of us took the 80s reference to the max by wearing sweatbands and florescent tights. If you haven’t yet, do yourself a favor and just sit with that image for a minute. Now imagine us being gawked at by group of hard-core South American soccer players who just finished their game. 

As much as I would love to joke about the actual event, because it is kind of ridiculous, I can’t remember the last time I had that much fun! The fun increased doubly when halfway through our game, two new players arrived: Brad and Mark. Both were incredibly handsome, built, and just plain hot. I assumed that they were a couple and did what any adolescent minded person would do: I made them my constant dodge ball targets. What was it that our parent’s always told us? “Those who pick on you, like you the most.”  Soon it seemed that Brad felt the same way. Did they want me to be their Lucky Pierre? Well, either that or he was hired as some sort of dodge ball hit man and I was his only target.  I was so confused. 

After the last balls were thrown we decided to head to a local sports bar to boast about our day, like any good jocks would do. From across the table I heard Mark talking about his boyfriend. So maybe no Lucky Pierre, but there was still the possibility of Brad! Two beers down and as we were falling off our chairs reminiscing about the day, Mike looked at me with wide eyes and mouthed, “Look at your phone!” It felt like I was in study hall all over again when I picked up my phone and there was a text from Mike: “Brad is crushing on you. Hard.” I felt like writing on my napkin, ‘Do you like me? Circle yes or no.’ 

I didn’t even speak to Brad for the duration of our time at bar. Around 5pm and we all decided to disperse and meet up again later at another friend’s birthday party at Bamboo 52 in Hell’s Kitchen.  After much deliberation on what to wear, Mike and I arrived to the second birthday party. Brad finally showed up about an hour later and as if we were back in Junior High Mike said, “Brad, why don’t you sit next to me?” Which landed him right next to me. Unfortunately, the Junior High quality of our interactions did not end there.  All of a sudden, with no more than three words spoken to each other, we were a couple. There was no in-depth conversation.  There was no courtship. There was no copulation. Hell, we hadn’t even played MASH.  But there we were and he would be draped over me for the entire evening.  

At first I didn’t mind it: I actually enjoyed having all this attention being paid to me. Very soon it became quite annoying. I couldn’t go anywhere. I couldn’t talk to anyone else. Before too long I was trying to make eye contact with my other friends hoping they would rescue me. I assume they were trying to be polite and not looking at us afraid they might interrupt. 

As that party ended and we all left for another bar, I decided to make a break for it and head home. I thought at least this way I could finally find some peace. Alas, Brad said, “I have to get up early and I will go with you.” Mike patted me on the back and walked away without seeing the obvious look of distress on my face. 

We hopped on the train home and I made it obvious that I really was exhausted and had an early day, so I was going straight home. The one thing that kept on going through my mind was something that my father said to me when I was a teenager. I didn’t have the best relationship with my father, but god was he right…

‘Be careful what you ask for’.

This article by Michael Carter first appeared on aidsmap.com here.  

Aidsmap.com reports taking HIV pre-exposure prophylaxis (PrEP) does not lead to increased levels of sexual risk behaviour among gay men, investigators from the United States say.

Taking HIV pre-exposure prophylaxis (PrEP) does not lead to increased levels of sexual risk behaviour among gay men, investigators from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Numbers of sexual partners fell, as did the proportion of men reporting unprotected anal sex.

“We found no evidence of risk compensation among at-risk MSM [men who have sex with men] initiating PrEP,” comment the authors. “Mean numbers of partners and the proportion of men reporting UAS [unprotected anal sex] decreased significantly from baseline during 24 months of follow-up.”

PrEP is an emerging HIV prevention technology. It involves HIV-negative individuals taking daily antiretroviral therapy to reduce their risk of infection with the virus. In 2010, results of the iPrEx trial involving gay and other MSM showed that daily PrEP with Truvada (FTC and tenofovir) reduced the risk of infection with HIV by 44% overall, with high efficacy seen in people with the best treatment adherence. Although the results of PrEP studies involving heterosexuals have been mixed, the United States Food and Drug Administration approved Truvada for use as PrEP by adults with a high risk of HIV infection.

However, there is concern in some quarters that use of PrEP may lead to increases in sexual risk behaviour. Mathematical models suggest that even modest increases in the proportion of gay men reporting unprotected sex could wipe out the beneficial effect of PrEP at a community level. However, the precise impact of PrEP on sexual risk taking is highly controversial.

Data gathered during a PrEP safety study allowed investigators to explore the impact of PrEP on the sexual risk behaviour of HIV-negative gay men with a high risk of infection with HIV.

A total of 400 men were recruited to the study between 2005 and 2007. All reported anal sex with another man in the preceding twelve months. The study was double blind and placebo controlled. Participants were randomised either to start treatment immediately or to wait for nine months. The men were interviewed at baseline and then every three months about their sexual risk behaviour and use of recreational and erectile dysfunction drugs. The study lasted 24 months.

At baseline, the men reported a mean of 7.25 sexual partners in the previous three months. This fell significantly during follow-up to a mean of 6 partners between months 3 and 9 and a mean of 5.71 partners between months 12 and 24 (p < 0.001). These declines were similar in the immediate- and delayed-treatment arms.

The mean number of reported HIV-positive partners or partners of an unknown status fell from 4.17 at baseline to 3.51 partners between months 3 and 9 and 3.37 partners between months 12 and 24 (p = 0.01). There was also a significant fall in the number of reported partners believed to be HIV negative.

Use of poppers (p < 0.001), erectile dysfunction drugs  (p < 0.001) and a higher perception of the efficacy of PrEP (p = 0.04) were all associated with reporting higher numbers of sexual partners during follow-up.

At the start of the study, 57% of men reported unprotected anal sex in the previous three months. The proportion fell to 48% between months 3 and 9  (p = 0.001) and to 52% between months 12 and 24 (p = 0.03).

The proportion of men reporting unprotected sex between months 3 and 9 was similar between the immediate- and delayed-treatment arms.

There was also a fall in the proportion of men reporting unprotected sex with an HIV-positive partner, from 29% at baseline to 21% between months 3 and 9 and 22% between months 12 and 24 (p < 0.001). Declines in unprotected sex with HIV-positive partners were seen in both the immediate- and delayed-treatment arms.

Factors associated with reporting unprotected sex during follow-up included younger age (p = 0.01), use of poppers (p = 0.02), erectile dysfunction treatments (p < 0.001) and methamphetamine (p < 0.001).

Participation in the study did not lead to an increase in the number of reported episodes of unprotected anal sex, which remained steady between months 3 and 9 and months 12 and 24 in both the immediate- and delayed-treatment arms.

There was a fall in reported episodes of unprotected sex with HIV-positive partners from two in the previous three-month period at baseline to 1.37 between months 12 and 24 (p = 0.05). This was the case for both the immediate- and delayed-treatment study arms.

In contrast, the number of episodes of unprotected anal sex with partners thought to be HIV negative increased between baseline and months 12 and 24 (2.75 Vs. 4; p = 0.01).

“These changes may represent a possible increase in seroadaptive practices, in which men preferentially have more episodes of UAS with assumed HIV-negative partners,” comment the authors.

They also note “men in this study received risk-reduction counseling, condoms and lubricants, regular HIV/STI testing, and linkage to prevention services…which may explain the observed risk reduction and could explain the observed risk declines and could mitigate any potential for risk compensation.”

Despite this, the investigators were encouraged by their results, which they believe “provide important information on changes in risk practices among MSM in the US initiating PrEP in a clinical trial setting”.

Reference

Liu AY et al. Sexual risk behavior among HIV-uninfected men who have sex with men (MSM) participating in a tenofovir pre-exposure prophylaxis randomized trial in the United States. J Acquir Immune Defic Syndr, online edition, DOI: 10.1097/QAI.0b013e31828fo97a, 2013.

This article from This Positive Life by Warren Tong first appeared on TheBody.com here.

How did you find your HIV physician?

The vaccine program that I've been talking about at Vanderbilt, they're really connected with Nashville CARES. As a small business owner, I'd really supported all the events that the organization does every year; I've always been involved in that. I didn't ever think that I'd be a client.

I went over there, and they gave me a list of people; and then I just called around. And I found a doctor. It's been amazing. I think that the physician is kind, is warm, and is also very knowledgeable.

Little things: They said that there's more studies going on about just the neuroscience kind of stuff that goes on with your brain right after you get HIV. I remember during that amount of time, through January and half of February, that there were times I couldn't even remember conversations that I just had. And so there was a short-term memory kind of loss. My physician was able to talk to me about that. Because that's an area where more research is being done. She's always traveling to these conferences, and that sort of thing.

It's been awesome. I have a fantastic doctor! She's understanding, patient, informative, motivating and the best choice for me for treatment. At one of the visits -- you know, when I got to 550 -- I was really aching to discuss treatment. Based on the current numbers, I have made the personal decision not to begin medication -- however, I am also involved in a couple clinical trials that allow me to have access monthly to my viral load and CD4 numbers. Based on this participation and the volume of real-time numbers, I am comfortable making the decision to choose a path that is right for me.

But my hope is that they come out with like a once-a-week kind of pill at some point, because I'm absolutely terrible, even about taking a multivitamin every day. So I've been trying to do better. My physician has given me an exercise, to try to take a multivitamin every day at the same time. She's trying to prep me for when I have to start taking meds. But I'm just hoping that the longer that we wait, as long as my health is OK, or stable, that something new will come out.

How do you think you'll deal with adherence, once you do start treatment?

One thing that I have been real honest about, with all my physicians, is that I am a drinker. I like to have drinks when I go out a couple times a week. I've always been nervous that if I'm supposed to take a pill at 11 and I'm out till 3, whether I'm going to remember when I get home, or when that has to happen. I know there's tons of different little options, and different ways to do it.

But it's just going to be a commitment, once I'm at a position where I need to take medication. I've always been like that. I've never wanted to take any kind of medicine unless I just absolutely had to. But once I'm at that point that I'm going to have to, then it's just going to be a change of priorities. Then I'm just going to make it happen. So I'll probably use every one of those tools.

What do you do to keep healthy?

I eat healthy. I was smoking a pack of cigarettes a day. I've really cut back those. I'm not like a Nazi about it, where I won't ever have a cigarette. I'll have one if I'm out with somebody. But that was really an important discussion with my physician -- that I needed to quit smoking. So that was something that I did. And we discussed openly about me and my drinking. Then they were looking at my blood, and my liver, and making sure everything with that is fine.  

Also, knowing when to say no. If I'm tired -- and there were times that, within that six-month period, I was just kind of tired, and worn out from life. Before I was infected, I would just keep going and keep going. I wouldn't really take care of myself in that way. Now I've really learned how to say no. So if I can't do something, or if I just don't feel like it, for whatever reason, then it's a no.

I know everyone says exercising is important. But I'm not someone that is ever going to go to a gym; it's just always awkward for me to go to a gym. So I'll run. Or it's little things. Like, I live on the fifth floor of my condo, and so I don't take the elevator. I do the stairs.

I don't know if that answers your question. But there's no magic thing, I guess. That's what I'm doing. And I feel good. So . . .

That's good. Little tips here and there always help.

Well, I also think that a lot of what I've gone through is mental, you know? I decided how I was going to attack this disease. I decided how I was going to tell people. And I did it on my terms. Little things used to really bother me. I'm one of those people where everything can bother me. But since January 2012 I just don't let that stuff bother me, you know? If I can't change it then I can't worry about it. So I think that's part of it, too.

I've stayed really connected with things that really encourage me. I love Steve Jobs, so I was reading his book and his quotes. Getting involved with other people online through social media, just talking to them or checking up on them, and that sort of thing -- kind of investing, virtually through the Internet, in some other people's lives, to just check up on them and see how they're doing. It kind of took the focus a little bit off me and made it more about, you know, this is a crusade for everyone that is going through this.

A large part of the reason why I feel I'm doing OK is the way that I just decided to think about things and be positive. I've always laughed when everybody says, "Stay positive," because I'm always, like "Well, I am positive." But now I just said it!

Let's talk about your work. What kind of work do you do?

I'm a talent agent. I own a talent agency in Nashville. I deal with actors and hosts, children and their parents, for television, film, commercials, music videos, print jobs, that kind of thing.

How did you become involved in HIV? You mentioned doing prevention work before your diagnosis. How did you become involved in HIV activism?

Someone doing outreach about the HIV vaccine program approached me at an event at a bar. I really wanted to do it. Before that, there was a well-known female impersonator in town that passed away, and her name was Bianca. Mark Middleton was his name, and the personality was Bianca.

But she was HIV-positive and she was very, very vocal about prevention and the disease. When she passed away, I got my company involved with her memorial. Doing that really got me connected with people that were very sincere and honest and hardworking, when it came to activism and awareness. That's kind of how it started.

And then at one of those events, I saw information about the vaccine study. They said that they needed HIV-negative people that had sex with guys. And in my way, I was thinking, oh, this is so fantastic. This is my way to give back. So I got involved with the study.

From there I started doing some outreaches with them, looking for other volunteers. But I'm actually really glad that I got involved with the vaccine. I want to say this, because some people may wonder: With the HIV vaccine being studied, obviously, it's not a live virus. There's zero chance to get HIV from the vaccine. The way that I got HIV, even though I was in the vaccine study, was because I was exposed to it.

But once I got involved with that, and then Nashville CARES, and helping them raise funds and that sort of thing, I really fell in love with it. Whether people think that it's God or another power or whatever, I really think that it was orchestrated at the right time. Because I really got passionate about it at the same time that it happened to me.

I'd thought I was invincible. Other people have told me that, specifically: "Josh, we never thought this would happen to you. If it can happen to you, then it can happen to me." And that's kind of been their attitude -- which was surprising at first. But when I sat back and thought about it, it's absolutely true. I felt invincible. And so all of that year that I was involved in prevention and activism and that kind of stuff, it really prepared me to be able to tell my story and, now, raise money.

The last couple months I've been involved with some amazing fundraising people. And I'm proud. We've raised a lot of money in the past couple months for Nashville CARES.

Do you ever get sick of thinking or talking about HIV, or do you think you will?

I think I did. I went through a month in the beginning, to be honest, where every week I was doing something related to HIV or awareness or a doctor's office or something. And so in May of last year I kind of got a little tired. And so I just kind of stepped back a little bit. I didn't post any blog, and kind of stayed off Twitter, and even my Facebook.

Now, looking back at that, it was fine for me. It was a little selfish, I guess. What I'm doing is -- and what we're talking about, all of us -- is so much bigger than any individual person or any of our individual stories. We've just got to keep going and keep talking about it. Because the more we talk about it, the easier it becomes to be talked about.

What do you think are the biggest issues that need fixing in HIV today?

One, I think that HIV is not a "one disease fits all." I think there are regional things to think about. I think that people that live out West, in San Francisco, potentially deal with different issues than someone with HIV in Tennessee. I think that that needs to be approached.

After the pastor wrote me that unpleasant email, it really started making me think, why in the South are we having an epidemic, but we also have the highest number of churches? So there's a tremendous opportunity that is being missed in churches with a captive crowd, if you say, to talk about HIV or STDs [sexually transmitted diseases], or any of that. Some churches are against contraceptives or prevention, I guess. My church that I grew up in wasn't. They were OK with birth control and condoms. But they never talked about sex or disease, or any of that.

And so I think the first thing is to look regionally, maybe, at potential issues. And that's what I've been kind of looking at. I can't speak for anyone else in the country, except, you know, Nashville, or the South, really. Here, the stigma is very strong, still. And I was nervous about that.  

Because we're not talking about it enough, in my opinion, in the South -- HIV and prevention and even early on in schools, besides mixed in with every other STD that you can get -- what I think that it's doing is that it's making it harder to talk about later. When I was growing up, I don't really ever remember talking about HIV or STDs, beyond the one day in health class.

And the way to combat stigma: I was sitting in a group therapy, right after I was infected. Maybe I was a little bit green, and maybe the gentlemen that were in there who have had HIV for years, maybe they were a little bit jaded. But in that group therapy that I was in we talked about stigma. And they kept bringing up stigma, that it's so terrible and hard.

And then I just asked a simple question, but it really was a little bit of an epiphany to me before I released my blog. They said the stigma was so bad. And so my follow-up was, well, what have you guys done to combat it? What have you done to fix it? And almost everyone in the room said that they hadn't told anyone that they had HIV. Again, understand some people -- maybe a majority of people -- can't disclose it. I get it. With me, I could.

What was just an epiphany to me: The only way to attack stigma is to talk about HIV, and to talk about it in its face, and show that it's OK. And so those two things, the regional thing and really just keep on talking about HIV, because by doing that, it will become a little more accepted -- not accepted that you want to get it, or that it's OK that people have HIV, but that it's not a death sentence, and that we're not the scum of the earth because we have HIV.

Could you compare how you felt about having HIV when you were first diagnosed, as opposed to now? How has it changed?

I think it has changed. Right after I found out, I was very scared of what people would think. I knew that it wasn't a death sentence and that I would get on the medicine and that though my life expectancy may be shorter than if I was negative, that I would live a long, great life. But I was scared about if someone would love me, and I was scared about what people would say about me.

Right after that, I made a decision that if someone wouldn't love me romantically because of that, that I was OK with that. And I really meant that. I would rather talk about it, about this disease, and attack the stigma, than worry if someone is going to love me, or want to be with me the rest of my life. Because I will be fine.

But coming now, several months later, I respect and I understand the disease a lot more. So my attitude toward that has changed. The thoughts that have started going through my mind now are, you know, disclosure. Why is disclosing or not a criminal act? My mind has just started going down that road. It's not something that I'm going to focus on, but it's just starting to get into the sub-issues; after you get over the big issue of having HIV, it's just how to live with it, you know? Knowing when or not to disclose, or why people choose not to.

But I'm not scared for my life like I was right after I found out that I was positive.

How do you think having HIV has changed you?

It has made relationships that I have with people, in general, more important. It's humbled me tremendously. I mean, I was a cocky bastard. Last year and before that, I was a talent agent and was cocky, and cared less about people and more about myself. This disease really humbled me. I couldn't think of anything worse than contracting HIV, before I contracted it. That was the worst thing in my mind that could happen to me, as a gay man. And then when it happened, it was very humbling.

It was humbling to know that I had to reach out to people to help me, that I needed to go to a therapist and that I needed some of those services that Nashville CARES has provided, that I have supported for years but never thought I would use. So it was humbling, in that aspect.

The other thing is that -- and I don't know if you've heard this before, or what -- but after I found out that I was HIV positive, it made my life a lot richer. Things that don't matter do not matter. Little things don't make me go crazy like they used to. Relationships mean the world to me. My family: It got me even closer to them. So in a weird way it kind of refocused my life into being better.

It's really hard to explain and put that to words, but my life is totally different, in the way that I look at people and relationships; and how I even look at myself is a lot different. I mean, it took a while for me to really be OK with looking at myself in the mirror right after I found out that I was positive. I'm OK with that now. And I feel good about myself. 

What advice would you give to someone else who has just found out they are positive?

If they just found out that they're positive: One, that they are the exact same person they were the hour, the day, the year before they found out that they were positive. That they are still them. Now they just have something that is going to make them choose relationships more carefully and, really, how things are going to be valued.

The one suggestion that I would give is find at least one person that you feel that you can trust, and tell them. Don't try to do this by yourself. Whether it's a therapist, or somebody that truly loves you in this moment. Try to find at least one person to tell that you're positive.

Get online, create an anonymous Twitter account, and find other people like me that are able to talk about it, that you can communicate with, and that it's safe. If you email me anonymously then I'm going to respond. And I won't know who you are but you at least start that chat.

Read TheBody.com. Gosh, I've spent hours on the website. Learn as much as you can about HIV.

But the main thing is that you're still you and that the way that you think about yourself is as important as getting treatment for the disease.

Do you have any closing thoughts, or any takeaway messages you want to relay?

Yeah. First, thank you so much for asking me to just chat with you. Everyone knows their own personal story of the moment they found out that they were positive; and maybe they even have stories like mine, where they know the person that infected them, or that exposed them.

But what you guys are doing is simply amazing. And I know that the three weeks when I was not sure if I was positive or not, I did more research than I'd ever done about HIV. And it's websites like you guys' that I came to, and that I learned the information. And I heard other stories, and I was reading about people. And so, thank you. You know? You helped me tons.

That makes me feel very proud. Thank you for the kind words!

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