Therapist and HIV counselor Sylvia Morales hears many stories of HIV infection and describes her work in the following way:

“As a therapist working with HIV clients, I deal with issues such as coping with test results … worrying, waiting and planning, and normal everyday issues such as low self-esteem, love, work, family, and friends.”

Most of Morales’ diagnosis centers on adjustment with anxiety or mixed emotions of depression and anxiety. “Once test results are obtained, the client can deal a little better with the loss of his or her health,” she says. “Clients often know that they need to change their lifestyle and focus on taking care of themselves. That may mean altering eating, drinking and drug-use behaviors and reducing any other stressors that may contribute to a high T-cell count. Major stressors tend to include family and partner relationship issues. There are often feelings of guilt and shame when an HIV client is living with a partner who is not HIV-positive. Clients often admit to staying home and isolating. It is difficult to have the same desires as they once had. Often it is very difficult to disclose to family members that they are HIV-positive and/or have full-blown AIDS. Friends seem to be more understanding and supportive in their attitudes. Eventually the client will share his HIV status in order to gain some support and hopefully some moral support. Another major issue is the loss of independence. Often male clients will state that they are used to being self-reliant and do not like having to ask for help. Not having the same income-job-career status is a major loss and takes time to adjust to. Another issue is the sense of invulnerability or immortality. I sometimes will hear a client say that ‘I’m going to die anyway, so why bother?’ Another is that, ‘life is going to be short for me and so I might as well use crystal or get high when I want to.’

“My job is to encourage the expression of feeling and facilitate emotional withdrawal. I have learned that being a good listener and sitting still with my clients while they grieve is an important process. Through this process, clients will develop a sense of personal responsibility for their health and start to find new meaning and purpose in life. My model is ‘breathe and be gentle with yourself.’”

Here’s the rest of the conversation:

Sylvia Morales: Yes. Drugs and alcohol. I hear time and again how someone goes out with no particular plans or intentions. They go out and have a few drinks or a little something to loosen up. They dance a little with someone, maybe they get interested in them or just start feeling horny, and then it happens.

SM: Many that I see are.

SM: I would say so. I speak with a number of men who are troubled at being gay. They’re afraid of being rejected by their families or of being left alone. They’re willing to put up with a lot just to know there’s someone there who will give them attention. Negative attention is better than no attention.

SM: It’s not a gay thing, but it’s common in gay relationships. I’m always horrified at the amount of abuse I find in gay relationships.

SM: I don’t mean hard-core physical abuse. I don’t mean holding someone down, getting up on his body and punching him out. It’s more often verbal abuse, a steady stream of “you’re stupid, you’re ugly, no one else will want you.” It’s a steady attack on their self-esteem.

SM: For one thing, I’m always surprised at how often I hear stories of childhood abuse from gay men.

SM: Definitely. I have one client now: His uncle started abusing him when he was 9 years old. It affects him still, and he’s in his late 20s. As a child, he was afraid to tell anybody. He wanted to, but he was afraid, because he didn’t think any adults would believe him. That’s tremendous pressure for a child to be under. He finally told his mother that his uncle, that’s her brother, was abusing him. They weren’t able to do much because the uncle is a big politician. To this day, he feels “unworthy”; he feels “soiled”. He’d like to have a relationship, but he wants to deal with his remaining issues first. Among other things, he still has longings for his uncle. He thinks of going back to him.

SM: No. Nearly all of them say they had a sense of being different before the abuse.

SM: That I can’t say. But it isn’t only gay men that I see. I see lesbians as well, and abuse is often an issue in their relationships, too.

SM: Yes. Lesbians get infected with AIDS, too. It’s the same mechanism.