I used to work at a transitional housing facility for people living with HIV. But just 10 years prior to my arrival, it operated as a hospice where people went to die with dignity. At the time, as is the case with any terminal condition, HIV disease obviously assumed prominence, making other issues -- like mental illness or substance abuse -- recede to the background.
While these conditions were certainly a part of each resident's story, they were nearly irrelevant in contrast to the very real life-and-death reality of AIDS. Nearly to a person, the final cause of death for hospice residents was AIDS-related.
This is no longer the case today, at least in Western industrialized nations, where nearly all HIVers have access -- one way or another -- to lifesaving medications. As an HIV specialist recently told me, more and more people appear to be dying of factors unrelated to HIV, like smoking, alcohol and drug use, poor diet, or lack of exercise. In other words, as AIDS-related deaths have abated, other issues -- those that once seemed unimportant by contrast -- have become more pressing.
This fact has been an underpinning of my column from the beginning. I have always said that while HIV is ever-present in my life, it is not my only issue. Yes, I can become frantic when faced with a cold or with flu-like symptoms, to be sure. And yes, like the rest of us, I experience medication fatigue. But anti-HIV meds represent only half of the medications I take!
I have no need for an HIV support group, although admittedly I am fortunate as a gay man to have a number of HIV-positive friends in a large urban center with a large HIVer population. However, I do need support for other things, predominantly substance abuse issues and depression.
In other words, my life mirrors the dynamic being played out at my former employer, where there are moments when HIV is the most important issue and other moments when it is not.
Lately I have been in a space where HIV seems far less significant than my depression. And what makes depression baffling, especially for us HIVers, is that its symptoms -- lethargy, sleeping too much, appetite fluctuations -- mimic those of HIV itself.
Why am I, a therapist, mentioning my depression in a national publication? In part because I think depression is woefully underdiagnosed and undertreated in our community. And life becomes so much more livable once the dark and oppressive cloud of depression is lifted. What once felt overwhelming becomes manageable. What once brought despair now brings a sense of possibility -- and of hope.
I also write about this because the purpose of my column is to chronicle my experiences living with HIV, to essentially share my life. When I first started the column, I was tentative about revealing the more intimate details of my life, given that I am a therapist. However, in so doing, I was doing you -- the readers -- a disservice. The pieces were largely intellectual and abstract. And when attempting to connect with other HIVers, the last thing any of us need is abstraction.
So here's my story, with all the intimate details. And here's hoping that like me, you'll address the other aspects of your lives beyond your HIV -- including depression, if that's an issue for you -- so that you can live a full and happy life.
Fransen is a licensed clinical social worker who is in private therapy practice in Chicago. He welcomes feedback at firstname.lastname@example.org.