Undiagnosed depression sent Joe Chown,
29, on a fast-track to an HIV diagnosis at 23. Now working for a leading mental
health charity, he argues depression is a much over-looked HIV risk factor,
both before and after diagnosis
Words Joe Chown
Images Piers Allardyce
When I was going through puberty in the early 90s, the profile of HIV was
at its highest. Everywhere you turned there were ‘Don’t Die of
Ignorance’ posters. In fact, the first talk about sex I got from my
dad was about Aids. I don’t blame a lack of education or awareness for
the fact I was diagnosed with HIV at 23. I question what made me disregard
all the messages about self-protection that I had absorbed. I know I never
consciously set out to become infected. I just didn’t value my own life
enough to care about protecting myself.
Risk-taking and depression
I suffered from anxiety and low self-esteem from childhood and in my late
teens and early 20s this developed into deep feelings of depression. Although
depression can manifest itself in many ways, for me it was a case of feeling
utterly worthless and at times really wanting to die.
Most people will seek some form of escapism in their lives; looking for an
adrenaline rush is normal behaviour. But people living with depression, experiencing
feelings of despair and hopelessness, will often look in the worst places
to find it. Some develop eating disorders; finding an endorphin rush by starving
the body of food, some find release in self-harm; cutting or burning their
flesh, others numb pain by turning to drink or drugs. I found getting into
dangerous situations and engaging in reckless sexual activity was the thing
that provided a temporary respite from the endless negative thoughts that
filled my head. When your heart is pumping from the fear that the next encounter
with some shifty looking stranger could be your last, you can briefly stop
dwelling on the dreary pointlessness of your miserable existence. Risk-taking
can be a strong aphrodisiac and feel very empowering, so when you’re
not really bothered whether you live or die it can become all too easy to
find yourself down some dirty alleyway with an even dirtier bloke getting
buggered stupid with no protection. That in turn can lead to an HIV positive
diagnosis. That was the case for me anyway.
Kick up the arse
At some point during this self-destructive behaviour I realised the negativity
consuming me was, perhaps, caused by depression and that there may be a way
to get help and stop feeling this way.
Not long after embarking on this journey of self-discovery and healing, I
received my positive diagnosis. Maybe if I had received help with my depression
and low self-esteem at an earlier stage I wouldn’t have got myself into
the situations that caused me to contract the virus. Nevertheless, being told
I was HIV positive only made me more determined to confront my depression
and I was fortunate to receive counselling at my clinic. For me, HIV was the
final kick up the arse I needed to make me learn how to deal with my depression
and, since acquiring these skills, I have become a much happier person. I
now work for Depression Alliance, a charity that works to promote self-help
and reduce the stigma surrounding this condition.
A root cause of risky behaviour?
I often think about how worrying numbers of young, gay men are diagnosed every
year despite hard hitting awareness campaigns and free condoms in gay bars
and clubs. Why do people continue to put themselves at risk? Maybe what I
went through is at the root cause of many more HIV diagnoses.
Recently I was asked if I wanted to ‘breed in negative arse’.
It took a while to work out what I was being asked to do. Of course, when
the penny dropped, I politely refused. But it was the first time I had experienced
‘bug chasing’ first hand and found it sad. I don’t think
this phenomenom is unlinked to the fact that gay men between the age of 15
and 25 are one of the highest risk groups for depression and death from suicide.
It is frightening some young gay men actively and openly seek a positive diagnosis.
Is this due to a total lack of self-worth? A misguided belief HIV is some
kind of solution, that they will feel welcomed into the warm embrace of a
unified community and that life will be transformed from a spiralling pit
of unhappiness into one long round of charity fashion shows, intimate friendships
with Madonna and Elton John and a council flat in Soho?
Self-esteem for prevention
I adamantly believe in education about HIV and safe sex, but that is only
part of the battle. We need to address why people choose to disregard this
information. Everyone has the right to make an ‘informed choice’
about the sex they have but I can’t be the only person who thinks that
if someone is choosing the prospect of a lifetime of stomach cramps, diarrhoea
and muscle wasting over having sex with a condom they could really do with
working on their self-esteem. I strongly believe if more emphasis was placed
on mental well-being, tackling feelings of isolation and building a sense
of community amongst gay youth, fewer people would suffer from such a victim
mentality and the numbers of young men being diagnosed each year would fall.
Depression is set to be the biggest burden on the NHS after heart disease
by 2020. Yet in real terms, Department of Health funding for organisations
that provide much needed help and support to the people affected continues
to fall. With Primary Care Trusts keen to fund only organisations working
strictly within the local area, difficulties accessing what little funding
streams there are and the limited access to core funding, the ability of many
valuable organisations to survive is seriously under threat.
Immune crusher
HIV ceased to be considered worthy of ring-fenced funds years ago. The future
looks bleak for anyone living with HIV and experiencing depression. Considering
all the things HIV throws at you, surely that amounts to the majority of HIV
positive people? Depression can also be a side effect of medication. HIV and
depression are both potentially life threatening. The effect depression can
have on the immune system in anyone can be significant; the effect on someone
living with HIV can be devastating. Depression is a manageable and often curable
condition particularly when treatment begins early; it is imperative that
anyone with a compromised immune system takes their mental well-being
seriously and has access to a variety of treatment and support services.
Depression
in different guises
Terry, 46. DX 1994
I live in a quiet rural area just outside Carlisle. I have experienced periods
of feeling very low since I realised I was gay (I’m only out to a few
close friends) but three years ago I started to feel very depressed when my
clinic advised me to start medication as my CD4 count had become very low.
This scared me. I had read much about the side effects of combination therapy
and started to imagine myself wasting away and looking ill. I had hidden my
HIV status from everyone for so long and was worried that I would no longer
be able to do this. The thought of people finding out made me very anxious
and
I began to have problems sleeping. I was in a very bad way and knew I had
to find help.
While in Manchester I read in Out North West magazine about the services offered
by the Lesbian and Gay Foundation. I thought they may not be able to help
someone who lived so far away but they explained that they didn’t turn
anyone away. I received counselling and information about my medication and
this gave me a better perspective of my situation and a more realistic view
of taking combination therapy. It was a long way to travel but has definitely
been worth it. I now feel better than ever about myself and would like to
help others like me that live in rural areas but find it difficult to travel
to big cities for help and support.
Kate, 32: DX 2001
I had never experienced depression and admit I had even been unsympathetic
to a colleague who was depressed. I felt she was attention-seeking and couldn’t
understand what she had to be upset about. I now know how wrong I was to think
this way. I began combination therapy, including efavirenz, at the beginning
of last year. I paid little attention to the list of possible side effects.
After a few days I started to have difficulty sleeping and frightening dreams.
After a week I was totally lacking in energy and feeling full of self-doubt.
I have always been very confident and couldn’t understand what was happening.
I found it very difficult to believe the medication was the cause. It seemed
bizarre that a drug meant to help me was making feel more depressed than I
had ever felt before. Only when a very good friend became
so shocked by the dramatic change in my character in such a short time, did
I see sense. After three weeks of rapidly feeling more and more depressed,
I went to my clinic. My doctor told me that what I had experienced was extreme
and that a lot of people experience nightmares but that these often stop after
a week or so. I was prescribed a different combination and started to feel
much better after only a few days. I don’t want to put people off efaverinz
as I know many people have no problems at all. I would just advise people
to self-monitor closely when starting medication and see their doctor straight
away if they start to feel depressed. I have been doing really well on my
current combination therapy for over a year now.
• www.pacehealth.org.uk
• www.lgf.org.uk/our_services.php
• www.outonthursday.org.uk
• www.depressionalliance.org
