Three Questions About Coping and HIV Prevention Among Gay and Bisexual Men

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July 8, 2008 at 2:56 pm  •  Posted in HIV/AIDS by  •  0 Comments

By James I. Martin, PhD, LCSW

Introduction

Coping refers to the ways in which people respond, either consciously or unconsciously, to stress. For example, many people experience stress at their workplace. While Jack might respond to that stress by thinking through the situation and putting it into a more manageable perspective, Anthony might go to a bar and have a couple of drinks with his friends. Carol might have a discussion with her supervisor about ways to improve the working environment, while Stephanie might avoid thinking about the situation. None of these coping responses are by nature better or worse.

A coping response may be effective for one person but not someone else, and different situations may call for different coping responses. Jack tried to change the way he thought about the problem, and Carol tried to do something to change the situation causing the stress. These are examples of active coping responses. Anthony’s and Stephanie’s responses didn’t do anything about the cause of their stress, even though they might have felt better afterwards. These are examples of emotion-focused coping responses.

Anthony’s and Stephanie’s responses can also be considered avoidance forms of coping, which are responses that involve avoiding, denying, or minimizing the problem. It is often thought that active coping responses are healthier, but this is not necessarily true. For example, people who experience discrimination because of their skin color, sexual orientation, or how masculine or feminine they appear to others might not be able to do much as individuals to change their situation. Unless they join with others in social or political change efforts, perhaps the best they can do is to try to feel better emotionally.

Q. What does the way in which gay and bisexual men cope with stress have to do with HIV prevention?

Although coping with stress is something that everyone must do, the causes of stress vary from one group of people to another. In addition to the sources of stress that most people face, gay and bisexual men frequently experience stress due to prejudiced attitudes of others and discriminatory actions toward them because of their sexual orientation or gender expression.

Gay and bisexual men are more likely than heterosexual men to be victims of verbal harassment, physical attacks, and other crimes. It is not uncommon for them to experience stress due to estrangement from families of origin, faith communities, and other common sources of support.

Young gay and bisexual men are much more likely than their heterosexual peers to be victimized at school, especially if other people perceive them to be more feminine in their gender expression.

Gay and bisexual men of color, or those who are disabled, may experience additional stress because of race, ethnicity, or disability-related prejudice and discrimination. Those who are HIV-positive or who have AIDS may also experience stress related to HIV/AIDS-related prejudice and discrimination.

Finally, gay and bisexual men are much more likely than other men to experience stress due to the threat of HIV/AIDS and from efforts to maintain safer sex habits. Most gay and bisexual men cope successfully with such stress, especially those who have been able to develop sufficient sources of support. However, men who are less able to cope may experience depression, anxiety, substance abuse, or other mental health problems. Men who tend to use avoidance coping strategies may be more likely to engage in risky sexual behavior.

Q. What is the problem with avoidance coping?

Avoidance coping is not necessarily unhealthy. Sometimes there isn’t anything one can do to change the problem causing the stress, and not thinking about it might be the best one can do. However, relying on certain avoidance coping responses can increase the possibility of engaging in behaviors that risk transmission of HIV. For example, many people—including gay and bisexual men—use sex in order to cope with stress. Others may drink alcohol or use drugs. These avoidance coping responses help people to feel better and to avoid thinking about their stress. By definition, people whose coping efforts involve disengaging from or avoiding their stress are not likely to stop and think about the risks involved with their actions. Thus they may act without thinking, and they may seek experiences that are intense enough to remove their stressful feelings. In particular, some men may have sex with men they hardly know or don’t know at all, with whom they can forget their cares and simply enjoy an intensely pleasurable experience. Alcohol and drugs may be used to reduce inhibitions and facilitate the avoidance process. In these situations men are not likely to stop to talk with their sex partner about their HIV status or use condoms, especially since some men feel doing so interferes with the pleasure of the experience.

People may be more likely to use avoidance coping when they feel powerless to change the problem causing the stress, such as a difficult but unchangeable work situation. Because individual gay and bisexual men may not be able to change the prejudiced attitudes or discriminatory actions toward them, it is not surprising that some of them rely on avoidance coping strategies, including the use of sex and drugs, to feel better.

It is important to remember that the use of sex for avoidance coping purposes is only one of many reasons why gay and bisexual men may have sex. For example, they may have sex to express love or to feel closer to their partner, or to experience a sense of spiritual well-being. One should never assume that gay and bisexual men who have risky sex are doing so in order to cope with a problem.

Q. What can be done to help gay and bisexual men cope with stress?

Before implementing any action designed to reduce the incidence of risky sexual behavior among gay men, it is very important to determine what meaning that behavior has for them. Not doing so is likely to result in actions that are at best ineffective and at worst harmful.

If one is concerned about a gay or bisexual man engaging in risky sex, it would be valuable to learn how much and what kinds of stress he is experiencing and how he copes with it. If it appears that sex, alcohol, and/or drugs are being used for coping purposes, an intervention designed to expand the coping repertoire might be helpful. Coping skills training can be provided on an individual basis or in groups led by professional social workers.

However, this kind of intervention is usually designed to address only the ways in which people cope with stress in their lives, and not the causes of the stress. Gay and bisexual men may also benefit from interventions designed to increase their sense of empowerment to change a social and political environment that allows or encourages prejudice, discrimination, or violence against them. Consciousness-raising discussion groups, community-building activities, and leadership training programs are some of the ways that can help to empower such men.

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