“It took me nine years to really begin processing my diagnosis.”
When I was first diagnosed with HIV, I didn’t fully grasp how traumatic that moment was. I understood the medical facts, but what I didn’t understand was the grief – the dreams I thought I lost, the fear of stigma, and the quiet loneliness that followed me for years.
It took me nine years to finally begin dealing with my diagnosis. Nine years before I let myself acknowledge the loss, the shame, and the resilience I would need to rebuild my life. Looking back, I can’t help but feel that the system failed me—or at least, it could have done better.
We don’t just need medical care after a diagnosis. We need mental health care too.
Imagine if, six months after someone tests positive, their care coordinator or peer HIV navigator sat down with them for a simple mental health screening. Not a rushed checklist, but a real conversation. A chance to ask: How are you coping? What’s hardest for you right now? Where are you finding strength, and where do you need support?
I recently used a tool that reminded me how powerful those questions can be. It’s a simple worksheet that invites people living with HIV to reflect on different areas of life: identity, health, stigma, relationships, hope, and emotional wellbeing. In a support group, we each scored ourselves, shared our highs and lows, and talked about what mattered most. The therapeutic value was extraordinary – not because of the paper itself, but because of the way it opened space for one person to help another. HT to Robin who helped author this tool.
That’s why I want to share this tool, not as a solution in itself, but as a conversation starter. It can be used by providers, peer navigators, or anyone supporting people living with HIV. It creates an opening to talk about the emotional journey, not just the lab results.
For me, it shouldn’t take nine years to reach that point. If we build mental health check-ins into HIV care – whether at six months, a year, or whenever someone is ready – we can help people grieve, heal, and find resilience much earlier.
Because living with HIV is not just about managing a virus. It’s about reclaiming hope, rebuilding purpose, and reminding people: you are more than your diagnosis.
Keep tellin’ the story,
Professor Peacock
Note: These are my thoughts and my story. I used AI to make helpful edits to my ramblings and online journaling, including some organization to be more blog-friendly.AI created the featured image used in my blog.
When I was first diagnosed with HIV in 2012, the idea of seeing anyone other than an infectious disease specialist would have felt reckless, even dangerous. This was before PrEP, before U=U. Specialists were the gatekeepers – the people who knew the ever-changing science, the ones who gave me the sense of being in the safest possible hands. For a long time, they were the difference between life and death.
So when I learned today at my routine HIV lab follow-up that the Damien Center is shifting away from relying on infectious disease doctors, and instead training primary care physicians to handle HIV, my first reaction wasn’t celebration. It was shock. Fear. Even a little sadness. A part of me wanted to feel special, to believe that my care required the highest tier of expertise, that my condition set me apart in a way that demanded more than “just” primary care.
But sitting with that discomfort, I realized something important: this change is a milestone.
It’s not about being less cared for. It’s about HIV care becoming ordinary in the best possible sense. What was once an emergency requiring specialists is now a chronic condition that can be managed alongside everything else. Just like diabetes, high blood pressure, or asthma. And just as most people with diabetes don’t see an endocrinologist every month, most people living with HIV don’t need an infectious disease doctor at their side for every check-up. We need skilled, compassionate primary care providers who are equipped with the right training. That’s exactly what this new model is delivering.
The truth is, the biggest factors in HIV health today aren’t whether you have access to a specialist; they’re whether you can access care at all, whether your doctor treats you with dignity, whether you have support for housing, food, mental health, and transportation. Medicine has advanced so much that the day-to-day fight isn’t with the virus itself – it’s with the systems that surround care. And if we’re honest, it’s with stigma itself. Stigma kills.
When I was first diagnosed, I was in the hospital. A case of misdiagnosed stage-2 syphilis landing me in the ER. Thankfully, my visit to the ER is the reason I was diagnosed so soon after being exposed to the HIV virus. My infectious disease doctor told me they caught my HIV very early – he only saw a handful of cases each year like mine. I was lucky to be in his hands.
Around the time I was diagnosed in 2012, newer medications were available, and the medical advice began to shift towards starting treatment right away. Why? Because the side effects of the latest antiretroviral treatments (ARTs) were much milder, making it smarter to begin medication quickly to lower the viral load. This was all before the idea of U=U was introduced.
So, I’m very thankful for my infectious disease specialist, because he caught me “on the forefront of change.” Looking back, that was huge step forward.
Now, 13 years later, the fact that I don’t “need” one anymore isn’t a downgrade — it’s proof of progress. It means that medications work so reliably, and outcomes are so good, that HIV can finally be seen for what it is: not a death sentence, but a manageable chronic condition.
Of course, specialists still exist for rare or complicated cases – and that’s important. But the default has shifted. HIV no longer requires a small elite circle of experts. Instead, it belongs in the hands of everyday doctors, woven into the fabric of routine healthcare.
That’s not loss. That’s victory.
So yes, there was some grief in letting go of the idea that I needed a specialist. But in the end, this shift means something profound:
I am not defined by HIV. My care is not extraordinary because of this virus.
This disease is not terminal. It’s ordinary.
And that’s extraordinary.
Keep tellin’ the story,
Professor Peacock
Note: These are my thoughts and my story. I used AI to make helpful edits to my ramblings and online journaling, including some organization to be more blog-friendly.
I’m preparing thoughts for an upcoming podcast conversation with Halle Pino on recovery and harm reduction. I want to bring in the aspect of Chemsex recovery & harm reduction, since that has been a part of my story and is something I don’t think we talk about enough – especially in the queer community.
I also fired my last therapist because I don’t respect him or his approach to therapy. After a month of waiting, I finally heard from my new therapist. So I feel like I’m going out on a first date, and it might be helpful to capture some of my story to know where to pick back up with therapy. So welcome to my TedTherapyTalk. Enjoy the ride!
Chemsex: How I Got Here
“Chemsex means using drugs as part of your sex life, and it’s most common among gay and bi men. There are typically three specific ‘chems’ (drugs) involved: Methamphetamine (Crystal Meth), Mephedrone (Meth), GHB and GBL (G).” – Source: The Rainbow Project
Chemsex is often referred to as “party and play” or “pnp” on gay hookup apps.
People participate in chemsex for various reasons. For many of us, these party drugs enhance our sex drive or allow us to keep at it for extended play sessions. For others like me, substances help reduce inhibitions. I have a lot of hangups about gay sex from my upbringing and society in general. So, using a substance helps me push off some of that internalized homophobia and stigma around gay sex, around butt sex, around sex in general.
Gay sex still makes me uncomfortable sometimes, but we need to get more comfortable talking about sex and sex education. My ignorance, fear, chaotic substance use, lack of routine STI testing and bad timing led to my HIV diagnosis in 2012. I’ve been undetectable ever since but living with HIV is an entirely different level of stigma, even today in the LGBTQ+ community. That’s why authors like Dr. Fawcett call this “the perfect storm” – the intersection of men, drugs and a virus. (I bring up his research later…) It shows up on all sorts of levels for many of us, particularly on a deeply personal level. So no wonder I choose to use substances that help me overcome all of these layers.
When I was hard into the party scene, I found that chemsex also gave me a heightened feeling of intimacy – at least in moderation or in the beginning. Sadly for many like me who may not be able to control our use of certain substances, it often leads to the antithesis of intimacy. In recovery from chemsex substances like GHB and meth, I’ve had to slowly relearn – or if we’re totally honest, learn for the first time in my adult life – what true intimacy is.
Like many gay men, I have always chased beauty and youth almost to a fault. I’m far from a natural beauty, so I’ve also struggled to connect with guys – particularly as I age. (Yes the irony of those two statements is not lost on me. I’m a product of my generation, coming out as a gay man in the 1980’s and 90’s). I’m socially awkward and not very good at flirting. Alcohol is a good social relaxer for me, and my drinking doesn’t cause major consequences in my life. But, when “pnp” was involved, everyone’s inhibitions were lowered and guys who might not otherwise want to play around with me were more likely to get naked with me if they were high. And since I was often the privileged white guy who bought the meth or GHB, I found a lot of beauty and youth!
The other aspect of my life that contributed to my addictive choices that led to a chemsex addiction can be summed up as relationship grief & loss as an adolescent and young gay adult, coupled with religious trauma during my college years. From my research, it isn’t uncommon to find some sort of abuse, loss, or trauma in the gay community that contributes to the higher rates of addictive behaviors.
Intersectionality: LGBTQ+ & Addiction
I know. Terribly cliche. But here’s what I found in my research:
Gay and bisexual males and females were two to three times more likely than their straight counterparts to have used illicit drugs other than marijuana in the past year.
About one third of bisexual females, bisexual males, and gay males had a substance use disorder (SUD) in the past year. About one fourth of lesbian females had an SUD in the past year.
Bisexual females were three times more likely than straight females to have had an opioid use disorder in the past year.
I recently wrote an Arts for Awareness around Harm Reduction. I did a fair amount of research on harm reduction, particularly in the gay community and particularly in the Black community with men having sex with men. Sadly, we didn’t get the grant award but it was an amazing learning process for me to research more and form more of my own beliefs around harm reduction. I should publish parts of it some day just because of the research. But here are some quotes from what I learned.
“Together, we can challenge stigma, promote safer substance use practices, and pave the way for a future where harm reduction is not just an option but a fundamental aspect of addiction recovery”
Harm reduction is an evidence-based approach to addressing substance use disorder (SUD) that emphasizes minimizing the negative consequences of substance use rather than solely promoting abstinence. This strategy is supported by research, practical interventions, and endorsements from public health organizations. Harm reduction initiatives, such as needle exchange programs, have been effective in reducing the transmission of HIV and hepatitis C among injection drug users by providing access to clean needles. Additionally, naloxone distribution programs have significantly reduced overdose deaths by equipping individuals at risk of opioid overdose with life-saving medication and training. (I think I had help with that from ChatGPT…just being honest.)
Today, I stick to weed and poppers – so California sober I believe, that’s my harm reduction. And I do enjoy true sober sex – it just doesn’t come naturally for me anymore. It’s something I’m working on.
For me, harm reduction extends to almost every facet of my life. I’ve even navigated to a point where I’m ready to do some deeper work – and I’ve found a combination of choices and experiences around harm reduction and recovery that works for me. So let’s keep digging…
Harm Reduction & Chemsex Recovery
My journey wasn’t just about overcoming addiction; it was also about confronting the realities of ChemSex, a facet of my past addiction and recovery journey that remains largely unspoken, particularly within our local harm reduction landscape. Known colloquially as “party and play,” ChemSex presents unique challenges, especially within the LGBTQ+ community, where it’s prevalent among men who have sex with men. I’ve witnessed firsthand how much of our harm reduction efforts focus on injection drug use and needle exchange programs, often overlooking the complexities of ChemSex-related harm. – Todd Fuqua
Many individuals who combine sex and drugs do so safely, employing harm reduction practices to protect their health and that of their partners. These individuals often feel satisfied with their drug use and its effects on their sex life, seeing no need for change. Source:https://ourhealthyeg.ca/chemsex
And then there are the rest of us. For me, I am unable to combine sex and drugs like crystal meth or GHB and do so safely anymore. For me, it’s the combination of the two – the chemsex – that can be so debilitating and a difficult choice to recover from. I didn’t discover the concept of chemsex until around 2021 – a good number of years into my recovery journey. I discovered the book “Men, Meth & Lust: A Gay Man’s Guide to Sex and Recovery” by David Fawcett Phd – and got connected with a weekly online support group for chemsex recovery. There’s been a lot of growth since then, and I am always in a state of recovery and growth. But let’s go back to the early days!
When I first got into recovery, we didn’t know about chemsex – at least not here in Indiana. This was 2010. So like many who struggled with what I now know to be a chemsex addiction, I was stuck with siloed recovery settings. I could go to one twelve-step fellowship for my drug addiction, but to really understand and take control of my sexual addiction, I went to another fellowship. And people in one fellowship didn’t always understand or want to understand the other addiction. Like much of American healthcare, we act in silos in much of our recovery community, particularly here in Indiana.
For 11 years, I struggled with this “disconnect” until I came across the term “chemsex” in my own research. My therapist at the time and I brought Dr. David Fawcett’s research and book into our therapy sessions. We learned together how fused these two addictions really are and why it’s such a touch one to overcome, because it’s literally about rewiring our brains. I found insight, support and growth attending an online chemsex support group for a period of time in 2021-2022. The only thing I haven’t done yet is sit down with a licensed sex therapist or sexologist, to explore some of my sexual patterns and fantasies to grow as sexual person. Sadly, insurance doesn’t pay for that level of work. So, no sex education in school – leaving us all to stumble our way through and figure it out…but don’t help us unlearn the fucked up stigma that contributed to my own mental, physical, emotional and sexual health. It’s a wonder so many of us in the queer community struggle with complex addictions.
So I’ve come to a point that works for me that would get me kicked out of traditional 12-step groups if I were to be honest. So, I choose not to go anymore. But, I will say that I learned a LOT of recovery in each of the fellowships, and for the first 5-10 years of my life in recovery, I learned new skills and patterns for showing up in the world, in community and in relationships. This was all through the twelve step fellowships. So although I don’t practice it today, I found a strong foundation for my recovery today. Fortunately today, a good foundation can be found in many paths to recovery.
One of the tools I learned is The Three Circles, where we have an inner, middle and outer circle of behaviors that are literally “shades of grey” to help define tends or patterns in sexual health (or other forms of recovery and addiction, even substance use!) They’re not just circles, they are a part of your plan to avoid slipping back into old habits. (Check out this article on The Three Circles).
There are elements that are healthy for us (the outer circle) that we try to practice to the best of our ability. Then there are the hard boundaries or things we want to avoid or stop doing – these are the inner circle. In traditional twelve-step language, these would be considered a relapse. In harm reduction, I’m much softer with myself – but that’s with a strong foundation in more traditional “black and white” thinking. I’ve grown, as has our collective understanding. Then there are the “middle” circle behaviors, which can be thought of as warning signs or grey zones – things that could lead us to our inner behaviors or thinking. Some call this the in-between zone.
With sexual addiction and recovery, you can’t think “all or nothing” because we are sexual beings – one can’t give up sex completely. It’s about knowing our boundaries. Same holds true for chemsex recovery. For me, the inner circle would be using a chemsex substance during sex. But I’m ok with using weed – it helps me relax, reduces my inhibitions and feels good! I might put weed in the middle circle – a warning sign, but not an unhealthy practice. For me.
In true harm reduction form, a person might define “having anonymous sex” as any of these circles – depending on their life circumstance, beliefs, wants or needs. Where something falls, or if it’s even on the map, varies for each person. For me, pornography was never a thing – so it wasn’t even on the map. It just wasn’t part of my sexual patterning. For me, my middle circle might include time spent chatting on the apps. It’s not a bad thing – there are no real consequences in my life other than a lot of wasted time. But, it’s a bit of a warning sign. It’s a signal for me to catch myself and ask the questions – what’s going on? how am I feeling? why might I be feeling that way? Interrupt the cycle, the addiction thinking, the desire to numb or check out. That for me is what I’m wanting to avoid.
Another way that harm reduction shows up for me as a recovering chemsex addict is I practice ethical non-monogamy with my partner. He is my primary sexual and romantic partner, but we both have outside interests, sometime shared. I have a high sex drive, and haven’t found monogamy to be a helpful “black and white” thinking for my recovery. Dr. Fawcett talks about sexual patterning, and for me, much of my sexual patterns were formed in my early 20s, in reaction to deep relationship and religious trauma. I’m working on balancing that sex drive and curiosity with connection and intimacy – but I’ve come to accept that there are certain patterns I can’t change, or choose not to at this time. So, I’ve found a middle ground that works for me, keeps me in a healthy, balanced recovery.
With harm reduction from a chemsex addiction, the three circles can become quite complex to map out – but very helpful to do so! I think I just found my first assignment to do with my new therapist – a Three Circles on my harm reduction approach to chemsex recovery and ethical non-monogamy! I have it in my mind, and we’ve talked about it at home. But it would be helpful to write out.
My consequences have always been during times of chaotic substance use with meth and/or GHB. My consequences in 2009 were much worse when I first entered treatment for an addiction to meth. I lost my career and my house. My consequences were difficult in 2012, when I was diagnosed with HIV and stage 2 syphilis. My consequences were rock bottom for me in 2014, when I was robbed twice and physically assaulted on once of those instances of robbery. Since then, I’ve crawled out of the meth pipe, finally putting it down in 2018.
Today, my consequences are much less severe. Worst case, seeking out new sexual encounters online adds to my depression, self-confidence and anxiety – or I might get an STI. I’m at least getting tested every six months, so that contributes to my health. Best case, it wastes a lot of time! And I’m ok with that – just for today.
Life in Recovery: We Do Recover
Even before I picked up my first substance at 33, I struggled with connection. I suffered from severe religious trauma during college, and suffered a tragic breakup with a guy I was dating at 22. I was a romantic at heart who boarded up his heart and didn’t let anyone get too close. I’m “attachment avoidant” and learning about true intimacy has been difficult to put in practice at times. Recovery is slow, and really a lifelong practice for me because my default it is to chase sexual activity over friendships, connections or intimacy. My therapist helps, as does my understanding and patient husband. And that book and those support groups.
Call to Action
Get help. Check out your area for in-person harm reduction support groups. Look online for harm reduction support groups, especially under the keywords Harm Reduction Works. There is an awesome Facebook group. I’ve found other local resources online. And if there is nothing in person, consider starting a Harm Reduction Support Group! I did in partnership with BU Wellness Network. We are currently reforming, and are meeting on the 1st and 3rd Tuesdays at noon at BU Wellness Network, 1712 N. Meridian, Indianapolis.
If you’re reading this and you’ve had experience with chemsex and are in any form of recovery, I strongly encourage you to get a copy of Dr. Fawcett’s book and integrate his approach into your own recovery program. It changed the lens through which I see my life in recovery and helped move me to a deeper understanding of chemsex addiction and recovery. When you’re ready, try out the weekly support group too. There are others – and other books. These are just the ones that worked for me.
The Magical Storybook of Professor Peacock 