WE HEAR a lot about advances in HIV treatment, the use of Truvada or PrEP to prevent HIV infection for the sexually active, and the latest programs designed to promote safer sex. Largely unreported, however, has been a huge shift toward addressing “upstream” mental health issues—such as depression, substance abuse, or partner violence—because it has finally become clear that gay men who don’t feel good about themselves or their lives are less likely to protect themselves and more likely to take risks.
Programs like the MPowerment Project, created in San Francisco, or Seattle’s Gay City Health Project are examples of a new generation of what are called “strength-based” or “resilience-based” interventions. They don’t begin from an assumption that gay men are irresponsible and must be reined in by shaming or scare tactics. Instead they build on gay men’s strengths and resilience. It turns out that addressing mental health issues is key to helping HIV-negative men act responsibly to stay negative and to helping HIV-positive people adhere to their treatment regimens.
The evidence has been mounting for the importance of addressing mental health in a holistic way. In a 2011 Pediatrics article, Columbia University assistant professor Mark L. Hatzenbuehler reported that in “unsupportive” Oregon school districts—he looked where there were no school-based Gay-Straight Alliances—gay, lesbian, and bisexual youth were five times more likely than their heterosexual peers to have attempted suicide in the previous twelve months.