A therapist discusses how to handle the stress, stigma, and isolation that often accompany living with HIV.

Contracting HIV is no longer a death sentence — but the fear of social and sexual stigma is alive and well for many people. The anticipation of judgment, discrimination, and rejection can be paralyzing and isolating. Because of the pervasive stigma still attached to the disease — in queer circles and beyond — many people who contract HIV battle with depression and anxiety.

Today, thanks to PrEP and HAART (highly active antiretroviral therapy), HIV has become highly manageable — as has protecting a partner from contracting it. But persistent social stigmas have not fully caught up to medical advances. We sat down with therapist Jeremy Ortman, who has worked in HIV treatment and prevention for over a decade, to discuss the toll that a positive diagnosis can have on queer patients’ mental health.

Read More: PrEP 101: Everything You Need to Know About Truvada

Making Sense Of An HIV Positive Diagnosis

“An HIV diagnosis can feel like an attack on your sense of self,” says Ortman. “You wonder, ‘will I ever find happiness in dating, sex, and relationships? Will I receive acceptance from friends, family, and employers? Will I be discriminated against by doctors or therapists?’”

Before disclosing your status to loved ones, Ortman recommends working through the grief, fear, shame, and anger that may accompany living with HIV. Part of this process also includes dealing with the medical realities of self care — through doctor visits, side effects management, and self- education, as well as finding the right gay-friendly doctor to assist with your treatment. Individual treatment of HIV depends on the stage of the disease, but the principal method for preventing immune deterioration (which is what leads to AIDS) is HAART therapy. This treatment plan consists of taking a combination of antivirals, sometimes in a single pill form, and sometimes as multiple pills per day.

Integrating this treatment plan into one’s daily life can feel daunting, but ultimately Ortman says that HIV can be “integrated as just one aspect in the context of a larger and richer life.” Rebuilding a sense of identity while living with HIV is a process, but ultimately it is a single facet of a much larger person and identity. As Ortman puts it, “HIV hasn’t diminished who you are as a person. You are still lovable and capable of loving others, just as you’ve always been.”

Read More: There’s a Silent HIV Epidemic Among Black and Latino Men. Here’s How to Help.

How To Tell Your Loved Ones Your HIV Status

“Secrecy and stigma are isolating. They contribute to low self-esteem — after being diagnosed some of my HIV positive clients began thinking of themselves as ‘dirty’ or ‘shameful’ and undeserving of love.”

While it can be terrifying to reveal your HIV positive status to another person — especially a loved one — it is healthy and normalizing to share this information with those close to you. “Consider reaching out first to those who you know will provide you with the love and understanding you need, instead of being put in the position of taking care of them and their reaction,” Ortman suggests. He notes that it may take some loved ones time to navigate their own emotions and educational journey around what it means to have HIV, though. “In those instances, it may be preferable to first come to terms with your diagnosis and gather information about HIV. That way, when you disclose to loved ones, you will be equipped with the resources to help them understand that you will be alright.”

Ortman helps his clients explore their hopes and fears about disclosing their HIV status to different people in their lives, and suggests running through best and worst case scenarios to help prepare for different reactions. When it comes to new or potential romantic partners, disclosing your status can serve as a litmus test — truly demonstrating who is compassionate, supportive and informed.

Read More: A Doctor’s Guide to Sex Parties

Living With HIV Isn’t A Death Sentence Anymore

Thanks to breakthroughs in treatment and prevention research, contracting HIV is not — and should not be perceived as — a death sentence. In fact, recent research indicates that the average lifespan of an HIV+ person is, on average, only zero to five years shorter than the general population (zero to one year shorter for men; up to four years shorter for women). With numerous treatment options available, a diagnosis can even serve as an opportunity to take control of one’s holistic health and wellness, resulting in more frequent exercise, healthier eating, more meaningful dialogue with healthcare professionals, and ultimately, a more intentional approach to their physical and mental wellness.

The increasing popularity of PrEP has also helped assuage anxieties about dating those who are not also living with HIV. “There is no longer the same expectation that people should only date or have sex with people of the same HIV status. People who are informed know that the chance of an HIV+ person with an undetectable viral load passing on HIV is effectively zero,” says Ortman — a fact that the CDC recently confirmed.

He continues: “The rhetoric on dating and hookup apps is shifting away from ‘HIV Neg for Same’ or ‘DDF UB2’ and more towards ‘on PrEP and tested negative as of this date. How about you?’ The conversation about status and precaution is more out in the open.”

That said, there’s still a long way to go — both in terms of research into HIV management and in reducing social stigma. “Using the word ‘clean’ to describe someone who is HIV negative is especially pernicious,” notes Ortman. “There is an expectation and responsibility often put on the HIV+ person to disclose their status but when the reception is so dehumanizing, it ultimately discourages open and honest communication on the subject.”

As more and more people adopt and normalize preventative treatments like PrEP, the burden of an HIV positive diagnosis will decrease. “HIV does not need to define your life. With proper treatment, being HIV+ is a manageable, chronic condition — one that does not preclude living a physically healthy and emotionally fulfilling life.”

Click here to find an LGBTQ+ AFFIRMING Provider In your Area

Every week we publish original content from top LGBTQ doctors and therapists.

Enter your email to subscribe to our newsletter.