Tap tap tap.
One of my students peeked her head through my office door. “Can I talk to you for a minute?” she asked.
It wasn’t my regular office hour, but I always keep my office door open if I’m in there, in case a student needs to talk to me (and lately, that’s been a LOT). Usually they want to talk about their grades (the real-life version of the YouTube video “I Am Worried about My Grade” gets played out a lot). Not infrequently, probably because I’m a psychologist, they come to see me because they need help with some mental health issue. And it’s never just a little end-of-semester anxiety, or something easy like that – it’s always something heavy-duty. I had a feeling that this was one of those times.
“So I have a friend,” she said. That’s what they all say, I think to myself. But as she continued, it was clear that she was talking about a friend – and that she was very concerned about him. He’s HIV-positive. He’s in denial. He’s African-American, and has sex with men. He’s partying, doing drugs, not taking care of himself. She suspected he was having unprotected sex, although she didn’t know for sure. And she was very, very worried about him.
“How old is he?” I asked.
“Twenty-four,” she said.
Sadly, this friend is a textbook example of the highest risk demographic for HIV. According to a recent report from the CDC, although AIDS diagnoses and deaths continue to decline because of the effectiveness of antiretrovirals, HIV infections continue to rise. Every year, according to the CDC, more than 50,000 people in the United States become infected with HIV. More than half are men who have sex with men, and about half are Black or African-American. What’s particularly scary is that about one-third of those who are diagnosed with HIV will develop AIDS within one year of that diagnosis – suggesting that they could have been HIV positive for as long as 10 years before they were tested and diagnosed. This young man, I thought to myself as my student was talking, may have been infected a long time ago – and just didn’t know it.
AIDS diagnoses and deaths may have gone down significantly since the mid-1990s, but HIV infection is another story. Hundreds and hundreds of studies have been done, looking at everything from identifying at-risk populations, teaching safer sex practices, working to increase access to health services, improving sex education curriculum in schools, decreasing behaviors that are associated with risky sexual practices. And over the last twenty years or so, the research paints a depressing picture. Because none of this seems to be working.
Many people aren’t practicing safer sex. Many people don’t have access to health services. Many people don’t get great sex education in school (my students have told me many horror stories about what they’ve learned – or what they didn’t learn). And what’s the common thread behind all this?
If you want a concrete example of how oppression increases the risk of HIV infection, take a look at Sacramento County, where I live. According to a recent article in the Sacramento Bee, Sacramento County has the highest rates in California of STD infection, including HIV as well as chlamydia, gonorrhea, and syphilis – all three of which commonly co-exist with HIV infection, according to the CDC. The highest rates of infection tend to be in the poorest and the most racially and ethnically diverse areas – South Sacramento, Oak Park, Del Paso Heights, and Florin. If we extrapolate from CDC data, it’s likely that many of those infected are gay or bisexual males, living in areas where there are few, if any, resources for LGBTQ people. Moreover, most clinics in Sacramento where people can get STD and/or HIV testing and treatment are located in the downtown or midtown areas – not in the neighborhoods where the highest percentage of cases are clustered. And young people between the ages of 14 and 29 are overwhelmingly overrepresented in these statistics. These are people who are poor, nonwhite, and lack access to health care, and, if they’re gay or bisexual, may also lack a direct connection to LGBTQ resources.
What’s interesting to me – and I don’t think this is a coincidence – is that this is the exact same demographic that’s at higher risk for depression and suicidality. In fact, when I asked my student if she thought her friend might be depressed, she didn’t hesitate.
Then she paused. “But I’m not sure if he’ll do anything . . . you know . . . .”
“He’s already doing something,” I said. People who are HIV positive are thought to be seven times at higher risk for suicide than the general population – and it’s common for these suicidal feelings to be expressed indirectly through risky, self-destructive behaviors.
HIV and depression seem to go hand-in-hand. And that brings us back to our common denominator.
Oppression. It doesn’t just increase the risk of HIV infection – it increases the risk of depression as well. No wonder they coexist so frequently.
You know what’s ironic? The same day this student came to see me (November 25th), David Huebner of the University of Utah published a research article in Health Psychology that, in a nutshell, told this young man’s story. The title of the article? “Social Oppression, Psychological Vulnerability, and Unprotected Intercourse with Young Black Men Who Have Sex with Men.” With a title like that, you almost don’t even need to read any further. What this article does, in my mind, is connect the dots. Among the 1,2o0-plus participants in the study, those who experienced higher degrees of racism, homophobia, and socioeconomic distress were more likely to engage in a range of risky behaviors – unprotected anal sex, multiple partners, sex in public places, etc. What’s interesting, though, is that depression appeared to be the missing link. If racism, homophobia, and socioeconomic distress were all on board, then depression was likely to be part of the picture as well – which in turn was associated with risky sexual behaviors.
To me, looking at the equation from that perspective paints a different picture. For decades, public health researchers have been trying to stem the tide of HIV infection by focusing on risky sexual practices. But if you think about it, they’re not just “risky sexual practices” – they’re indirect suicidal behaviors. Whether they’re consciously aware of it or not, many people with HIV walk the line and flirt with danger, putting themselves and others in harm’s way. It’s a cry for help.
My student wants her friend to go to an HIV support group, although he was lukewarm about the idea when she brought it up to him. I hope he changes his mind.