Psychotherapy for Long-Term HIV Survivors

This blog is authored by Owen Morse, MA, LPC, a member of the IntraSpectrum Counseling clinical team.

_____________________________

During the 1980s, 90s, and early 2000s, the LGBTQ+ Community in the United States experienced a devastating HIV and AIDS epidemic that nearly erased entire generations of gay men and trans women and left their partners and loved ones mourning their loss. I grew up in San Francisco in the 1990s. Although I was only a kid, I recall learning about the epidemic happening in the city at the time, and being among the first wave of youth educated about HIV prevention. In high school, I learned more directly about the loss and struggle experienced by the community, making several close friends who had personally lost or nearly lost friends or family-members during the epidemic’s height.

As I began a career in healthcare, I continued to learn about HIV prevention and care, and bear witness to the pain and struggle HIV/AIDS created in SF’s queer community. For example, my professional mentor and boss for many years was an HIV-positive gay man who nearly died of AIDS in the early 1990s. So when I transitioned careers, moving from being a healthcare program administrator to becoming a therapist, it was a natural fit for me to continue my work with the queer community in SF working directly with clients with HIV as a therapist trainee.

I was accepted as an intern at UCSF Alliance Health Project (AHP), a clinic that was born out of the SF AIDS epidemic to provide high quality, affirming mental-health services to HIV-positive clients and others impacted by HIV. In my training at AHP, I gained valuable guidance and experience, providing individual and group counseling to a diverse group of gay men who were living with HIV, including co-facilitating a therapy group for long-term HIV survivors – which AHP defined as folks over the age of 50 living with HIV. While the memories I heard from my clients often included the above-mentioned loss and struggle, I also heard many stories filled with humor, love for community, and strength.

Due to advances in the development of antiretroviral medications in the 1990s and early 2000s, in the US HIV/AIDS is fortunately no longer the death sentence it once was, moving from a fatal disease to a manageable condition. While working at AHP, I learned that many of my long-term HIV survivor clients had gone through the profound trauma of being told they had 6 months to 2 years to live in their 20s, 30s and 40s, to now go on living into their 50s, 60s, and 70s. These men were the exception to the legacy of loss created by HIV, and sadly, most had lost their partners, friends, or communities to the disease themselves, leaving them with a unique set of presenting issues including complex medical concerns, PTSD, depression, anxiety, substance use concerns, and anger issues.

Along with my education and training, these long-term survivor clients taught me more than I can say about working towards overcoming oppression, stigma, and shame through sharing their empowering stories of self-advocacy and resilience. Some also taught me about how we can internalize these social pressures, processing ongoing fears about others learning their HIV-status and related feelings of low self-worth. Many of the long-term survivor clients I worked with told me they didn’t know what to do with themselves – that they had expected to die for so long and were honestly astonished to still be here. With those clients, I saw my role as to encourage and affirm their engagement in the lives they are leading today while also supporting their self-compassion around “survivor-guilt” they experienced – wondering why they were still here when so many others had passed away, and actually feeling distress because they are.

Over time, as my work with long-term HIV survivors has continued, I’ve realized that much of what we work with is complex or “prolonged” grief. My clients grieve not only for the loss of loved ones, but also for still being here without those loved ones, and for the near loss of their own lives too. These clients also struggle with how to express their grief while going on living. As a therapist, I have found that it is important to help such clients put their trauma and loss into words, assist them in developing insight into how that trauma might be impacting their lives today (for example: creating fear of intimacy, feelings of disconnectedness, anxiety, anger), and affirm their honest value in a society that many of them feel has forgotten about them. I can say for sure that I have not forgotten these clients, and working with long-term HIV survivors continues to inspire and inform my work. As a queer-affirming therapist and a gay man myself, directly addressing the legacy of loss and struggle created by HIV in my community through my clinical work has been empowering and incredibly rewarding. It is an honor to serve my community this way. I look forward to continued opportunities to work with HIV survivors, and am confident that my experience, expertise, and the training I received at AHP can help guide them to feel more self-assured, present, and content in their lives today.

______________________________

This blog is authored by Owen Morse, MA, LPC, a member of the IntraSpectrum Counseling clinical team. IntraSpectrum Counseling is Chicago’s leading psychotherapy practice dedicated to the LGBTQ+ community. Every day, we strive to provide the highest quality mental health care for clients of all ages and across the spectrum of identities. For anyone needing affirming and validating support or healing with any issue, please click here or email us at help@intraspectrum-chicago.com.