Magazine Featured Gay men and the battle to be happy Words by Stuart Haggas @GetStuart Photo by Chris Jepson: © www.chrisjepson.com | @chrisjepson “I felt I was worth nothing. I hated myself, I hated being gay and suicide seemed like it was the best option.” The gay community has made many giant strides forward in recent years, but in certain areas we continue to stumble and make little progress. In terms of our mental health and well-being, survey after survey tells us that we, as LGBT people, are much more likely to suffer from issues like depression, self-harm and suicidal tendencies than our straight peers. It nevertheless appears to be a stagnant situation, devoid of any significant breakthroughs. Perhaps this is unsurprising, because mental health in the population overall remains shrouded in taboo. Those with mental health challenges are often failed by health services, not receiving the same understanding and empathy as someone with a physical health challenge. Gay men and women can similarly feel that health services fail their needs – so for a gay person with mental health challenges, the situation can be amplified. FS surveyed over 600 gay men who all admit to having experienced mental health issues. Ranging from 17 to over 65, their different lives and experiences have common threads which echo throughout, which only serves to show that this issue still isn’t being duly addressed. Yet it’s a situation that all too often leads to a tragic outcome. Of the gay men who filled in our survey: 24% said they’ve tried to kill themselves, 54% have contemplated suicide. These results may or may not be a reflection of the general gay population but they do put focus on the challenges gay men go through. Surely it’s time to face up to this crisis in mental health? TOXIC CYCLE Of the 606 gay men who told FS of their mental health challenges, some described universal problems like struggling to find employment, money worries, stress, loneliness, or personal traumas like the loss of a loved one or the end of a relationship. Others identified factors that are more rooted in their sexuality: sharing memories of feeling isolated or being bullied at school or work for being gay, the fear of coming out to family and friends, or the overwhelming guilt or shame they felt after enjoying intimacy with someone of the same sex. In most cases it’s usually not one solitary thing but a toxic cycle of factors that lead to mental health issues. “I think my depressive episodes are often triggered by failings in my relationships, which in turn are often caused by my extremely low self-esteem,” says Tom, 22 from Birmingham. “From that point it becomes a vicious circle of my depression lowering my self-esteem, making me more depressed, and so on. It caused me to lose most of my appetite which, combined with my very low self-esteem and poor body image, led me to develop anorexia.” “Everything is connected,” agrees Nathan, 24 from Oxford. “I have very bad days when I don’t feel comfortable doing anything at all, including getting out of bed. All my money seems to be spent paying off debt. I don’t have any money to buy food or clothes or anything for myself, and when I feel low it impacts on my self-esteem which in turn impacts on my sex life with my partner.” “I’ve recovered from a handful of episodes so far,” Tom adds, “but it seems to come back so quickly and so frequently that I’m not sure I’ll ever fully escape this black cloud hanging over me.” LOW SELF-ESTEEM We asked: What were the main factors for you when you experienced depression or mental health issues? (please tick all that apply):70% - low self-esteem56% - relationships53% - isolation49% - not feeling attractive42% - sexuality38% - finances33% - employment27% - homophobic bullying 23% - sex life22% - struggling with coming out21% - bullying (other)21% - rejection by family18% - living with HIV 17% - death of loved one16% - prejudice15% - rejected by gay community14% - addiction (drugs)14% - fear of HIV12% - addiction (alcohol)12% - religious reasons5% - other Nuno Nodin is a research co-ordinator for LGBT mental health charity PACE. “Your findings are not surprising at all,” he says. “Several of these match our own that have come out of the RaRE study. For instance, low self-esteem was found to be a relevant predictor for almost all of the mental health issues we studied, including for suicide and self-harm amongst young LGBT people, as well as for body image concerns amongst gay and bisexual men. “Although some of those factors are not unique to LGBT people, a number of them are, including homophobic bullying and struggles to come out. These are well known issues that LGBT people still face, and have clearly been identified as relevant causes of distress within our community.” HOMOPHOBIC BULLYING Conducted from 2010 to 2015, PACE’s RaRE study involved over 2,000 participants. Among its findings was the fact that LGBT people under 26 are more likely to attempt suicide and to self-harm than their straight peers (it found that 24% of young LGBT people had made at least one suicide attempt in their lives, compared with 18% of heterosexual young people) – a fact echoed by our own survey. If the LGBT community is more susceptible to these issues, we have to ask why. Gay men young and old shared with us their experiences of being bullied – are these all-too-familiar stories a root of the issue? Many gay men we spoke to think so. “I was physically and verbally bullied at school for being gay, before I even knew I was gay myself,” says Nigel, from Brighton, “and I had to listen to homophobic comments from my parents when growing up, which caused me to withdraw into myself and question the person I am. When my father found out, he refused to talk to me and wouldn’t be in the same building as me for well over twenty years.” This still impacts on Nigel’s life today. “I have very little confidence and suffer from panic attacks on a daily basis. The messages from my childhood have been hard-wired into my DNA. After lots of counselling I still find it difficult to believe I’m not an awful person.” Paul is 32 and from London. He avoids relationships, and often struggles to cope with debt resulting from drinking binges. “I was bullied constantly at school because of my sexuality,” he says. “This has had a significant impact on my long-term self-esteem. I often get drunk to try and block it all out.” LESSON LEARNED? Young guys in their teens and twenties shared similar stories, demonstrating that the situation for today’s LGBT youth in Britain still needs improvement. “Coming out at school was a decision I made, but I was bullied for this,” says James, 25 from London. “I eventually went into therapy because I was experiencing depression when I was 14. I explored the scene at a very young age and met older guys off the internet. I self-harmed by overdose several times and by cutting.” “When you see the extraordinarily high rates of suicide and self-harm among gay and bi men and lesbian and bi women, especially among the very young, of course it’s shocking,” acknowledges GMFA’s Matthew Hodson. “It’s a terrible indictment of our society that so many young people feel that they are unable to envisage a happy and fulfilled future for themselves. However much things have changed with regard to social and legal acceptance of LGBT people, it’s still rare to meet someone who hasn’t been placed under some stress in coming to terms with their sexuality. “It has to be remembered that factors such as financial stress or bereavement are also experienced by lesbians, gay men and bisexuals. So we have to address all of those challenges in addition to other ones that are specific to being gay. For us, our ability to remain emotionally healthy is all too often challenged by rejection by our family, our community or our church.” DOMINIO EFFECT Not everyone who was bullied at a young age will grow up suffering from mental health issues, but for some this does have a domino effect that can be both devastating and far-reaching. “My depression and social anxiety are long standing and affected by many factors,” says Warren, 31 from London. “One of them is feeling isolated by and from the gay community.” Bullied throughout school, he came out at 15 – and soon after that his family kicked him out. “I was homeless at 16, and spent some time sleeping rough in hostels and foyers. I had no doctor so no access to treatment. It utterly destroyed my self-esteem and self-harming is a recurrent problem. At 24, I was diagnosed with HIV. I’m slowly rebuilding my life in the shadow of my demons. At 28 I went back to college and got my A-levels with good grades. I’m now studying philosophy at Uni and I hope to be a teacher or academic.” Although Warren now has hope for his future, his past demons remain with him. “My poor mental health and mental hygiene still cause me to struggle every day.” “I’ve always been very socially difficult, and don’t recall a time when I wasn’t depressed,” says Nate, 24 from Warwickshire. “I don’t go out any more. Every failed social encounter, which is damn near every encounter, causes me a lot of pain whenever I think back on it. It’s just not worth it. I also don’t seem to enjoy anything now, and am unable to concentrate on things. I get very anxious when I have or think about sex, even though I want to be having a lot more of it.” The root of Nate’s problem can also be traced back to school. “I wasn’t very well liked at school since I was rather odd,” he explains. “I always had a fondness for boys but was, in every other regard, the opposite of what ‘gay’ was supposed to be – so I suppressed it as best I could. I was very lucky when I met my boyfriend online at age 18. I love my boyfriend, but I am still not happy – which makes me feel worse.” FEAR OF LIFE AND LOVE Self-imposed isolation, eating disorders, and issues with intimacy and relationships are just some of the factors that can go hand-in-hand with depression. “Fear, and my inability to face it for years caused my depression,” says Gary, 32 from Dublin. “I feared being gay. I feared being bullied, I feared telling anyone about it. I was afraid of all those things for too long, but I couldn’t face them. By the time I finally did face them, my personality seemed to have been set. Even though being gay is now a non-issue for me, I still feel a bit helpless when I find things difficult or scary. In my head I go right back to the teenage me, and get afraid and isolate myself. I hate myself for it.” “I was anorexic for many years, and when I recovered, I stupidly came out,” says David, 21 from Sunderland. “Some family members disowned me, but thankfully those closest to me, my parents and brother, accepted me. My grandparents can’t find out. This causes arguments with family as I hate lying about who I am. I’m also still a virgin and have been single for two years.” He admits to contemplating suicide. “I still sometimes feel suicidal, or wonder if I’d be better off hurting myself.” “I was abused as a child and that has led to a life of insecurities,” says Tim, 25 from Cork. “I have difficulty being intimate with men, and this has had an impact on previous relationships. I have also had body image issues my whole life, and have had an eating disorder on and off since puberty. I am always hiding part of myself: not my sexuality, but I put on an appearance of a happy person and it is exhausting. Twice this year I have been unable to leave the house, the first for about six weeks and the second for just over a month. I did not earn any money during these periods, which only intensified the anxiety I felt to make ends meet.” RELIGION Some identified their religious upbringing as a contributing factor. “From a young age I knew I was different but didn’t know why. From about 12 years old I was bullied and called queer, poof, and pansy non-stop. I had no idea why until I was about 17,” says David, from Dublin. “Growing up Catholic you are told that being gay is wrong. When I was 17 I realised I was gay but it was hard because I felt alone. It led me to want not to leave the house. When my family found out, it was hard at first because they didn’t understand.” “Religious upbringing had a negative impact on my confidence,” says Tom, 22 from Birmingham. “I hid my sexuality away and tried to force myself to be straight. The result? A very unhappy adolescent.” Tom adds he was bullied and mocked by people around him, and found no support in school. “I had no confidence and no self-esteem. I didn’t want to leave the house or meet people. I was living in fear of constant rejection. I also had very little education about being gay and the risks that go with it. I was constantly battling with myself over what I’d been forced to believe through the church. My childhood was pretty damaging.” “At 19 I tried to commit suicide, and again when I was 30,” adds David. “I wasn’t aware I suffered with depression until I was in my 30s. I tried medication for a number of years and went into counselling. There were times I just couldn’t face daily tasks, but I learned how to cope and to live with depression. I have had no suicidal tendencies for over 15 years.” DAILY IMPACT Those who completed our survey told us how these challenges impact on their day-to-day lives. Key points mentioned include self-isolation, severe social anxiety, feelings of inadequacy, mood swings, panic attacks and lack of interest in life. “Insomnia is causing me severe problems due to depression and stress,” says Seb, 29 from London. “My GP doesn’t give a damn, and I’ve been through several different GPs and surgeries and it’s all the same attitude. I cannot socialise easily with people, and if I’m already feeling quite low I tend to stay away from groups. I will often be by myself too much, and this makes me less likely to go out and do anything.” “I wouldn’t go to work,” says Jordan, 45 from Birmingham. “I was eventually signed off sick for a month and lost myself in chems and casual sex, neither of which helped in the long run. I eventually stopped getting out of bed and doing anything at all.” “Any joy is taken out of the world,” says Warren. “Even simple pleasures like eating or sex are meaningless. The place where you should be angry or upset or happy is just empty, devoid of any power to impel you to any sort of action. Bathing, eating and sleeping become very significant challenges – I have to remind myself that, some days, coming out alive and not giving in is a victory.” If you are living with depression, just getting out of bed in the morning can be an act of heroism – but one that few will recognise. BETTER OUTLOOK Despite a seemingly pessimistic situation, many of those who completed our survey have a surprisingly optimistic outlook, as well as advice to share with others. This advice includes finding support, finding someone to talk to, staying healthy, and taking it day-by-day. They do however stress the importance of getting help as soon as possible – don’t put it off. “I’m trying to focus on the future. I’ve left my home town, started a new life. There are ups and down, that’s normal, but it’s so much better”, says Michael, 32 from London. “That chapter in my life is over. I take antidepressants each day and have done for eight years now. Right now life is good,” says Craig, 30 from Glasgow. “I have fully recovered. I have a whole new life in a different place and a long term gay relationship”, says Graham from Yorkshire. “I still have suicidal thoughts, but they are less frequent. I don’t think I would ever act upon them but I don’t like having the thoughts either,” says Stuart ,32 from Newcastle. “I’m in a good relationship now and feel supported and loved,” says Ian, 48 from Battle “I still struggle occasionally but I’m surrounded by good friends,” says Brett, 22 from Blackburn. “I still have thoughts of my own death and thoughts of harming myself. I get these thoughts very often but they are less intrusive and don’t really mean much any more. I feel I have learnt to live with them,” says James, 25 from London. “While I continue to be prone to periods of moderate depression and still often find it difficult to participate in social activities, I am now better able to accept these episodes and to realise that they will pass,” says William 50, from Oxford. “I recognise when my depression is trying to take hold and I am not scared of it. Years ago I never knew what that feeling was and it terrified me. I take each day as it comes and I try to live it to the best of my ability and try to keep busy. I have great friends and family who are very supportive,” says David from Dublin. ADVICE What advice do these men give? “Find something that makes you feel good, something that you are good at. I’m extremely patient, and I started working with people with mental health issues. It’s very rewarding, helping others I mean,” says Michael. “Speak to someone if you’re having these thoughts. I thought suicide was the only thing to end my hell, but I was wrong. I got the support I needed and life is good. Never suffer alone,” says Craig. “It’s only by reaching out that assistance can be accessed. Help is out there and, regardless of how it looks at the time, things can get better,” says James, from Cardiff. “Tell someone you trust. Ideally a professional, but tell someone. Explain why you feel that way. If all else fails, contact the Samaritans,” says Warren. “Firstly, do not act on your thoughts. Instead, recognise that planning to kill oneself is not a sign of weakness but requires immense self discipline. Use this strength instead to go to your GP and be open and completely honest about your thoughts and your need for help,” says William. Ken says, “Seek professional help. Today might be a bad day... but tomorrow is another day and there will be good ones. Rest. Say no to things. Make small but realistic plans... it might just be going out to get a sandwich or organising a short trip, but don’t expect too much of yourself. NEED HELP NOW? If you are in danger of taking your own life, call 999 and ask for help. If you want to talk to someone call Samaritans on 08457 90 90 90 or email [email protected]. Or visit, www.gmfa.org.uk/need-help-now THE LINK BETWEEN DEPRESSION AND HIV A recent study by University College London showed that HIV-negative gay men who have several symptoms of depression are more likely to have sex without a condom. Some American studies have also found an association between depression and risky sex. Researchers analysed data from a survey of people attending sexual health clinics. Only untested or HIV-negative people took part. Based on the answers of 1,173 gay men, 12.5% of HIV-negative gay men attending sexual health clinics had depressive symptoms at the time (this is considerably higher than in the general population, but roughly half the rate seen in a comparable survey of HIV-positive people). While for most, the symptoms were moderate, 5.5% had more severe symptoms. Depression was more common in men who were younger, had money problems, did not have a university degree and were not in an ongoing relationship. It was also more common among regular smokers, heavy drinkers and men who used multiple recreational drugs. Among those with depressive symptoms, 58% said that a doctor had told them they had a mental health condition and 52% were receiving treatment. The data showed strong associations between men currently experiencing depression and risky sex, but not for men who no longer experience depression - other than they were more likely to have group sex. This study suggests that your mental health and self-esteem has a HUGE impact on whether you take care to look after your own health, including avoiding HIV infection. Body image, alcohol, drugs, depression, relationship problems, work problems, loneliness... the list goes on. The battle against HIV doesn’t start and end with finding the right condom size or getting you to think condoms are the best thing since sliced bread. HIV prevention isn’t even about getting you to the clinic to test for HIV. There is a lot more to it than just that. HIV prevention activities, including FS, can only work if you care about yourself and care about your own health. Self-worth is the key to a happy and healthy life. This goes for everything and not just remaining HIV-negative. Self-worth brings confidence, and confidence will help you stay in control of your life. If you are HIV-negative and would like to remain that way, the best ways are as follows: Condoms: Condoms are one of the most effective and reliable ways of preventing the spread of HIV (and many other STIs) when you fuck. We recommend the use of condoms with plenty of water-based lube to prevent the transmission of HIV, especially if you are not certain of your partner’s HIV status. If you don’t use condoms when you fuck, and you have not been diagnosed with HIV, we recommend that you test for HIV regularly. Partner selection: It’s estimated that one in twelve gay men in London has HIV. There are no visual signs or sexual behaviours which guarantee someone will be HIV-positive or negative. There are many reasons why someone may not want to tell you their HIV status and lots of men don’t know their HIV status, or believe it to be different from what it actually is. Around 16% of HIV-positive men don’t know that they have HIV. If you are HIV-negative you cannot safely or reliably find partners who are also negative if you have just met in a bar or through internet sites/apps. Having condomless sex will also expose you to other sexually transmitted infections (e.g. hepatitis, syphilis, NSU, gonorrhoea and herpes) which can be harder to treat in men with a compromised immune system. Can I have bareback sex with someone who is HIV-positive? Gay men who are HIV-positive and are on medication are less likely to pass on HIV. This is because the medication that they are on helps to reduce the amount of HIV in their body. It’s not impossible for them to pass on HIV but it’s very unlikely if they are undetectable. HIV-positive? If you are HIV-positive, and on medication, the best thing to do is to keep on taking your medication. Sounds patronising, we know, but many people ‘forget’ to take their medication and a break in your cycle could mean your viral load increasing fast. The best way to remain undetectable is to make sure you keep on taking your medication. PEP: If you have unprotected sex with someone who you think is positive, or if you’re not sure of their status, then PEP is available from your local GUM clinic or A&E department. PEP, which is a month-long course of medication, may stop you becoming positive if you start to take it within 72 hours of exposure (the sooner the better) and keep to the medication for the whole course. PrEP: Pre-exposure prophylaxis (PrEP) is a promising new way of preventing HIV infections. PrEP involves HIV-negative men taking a daily dose of one or two of the drugs that are used to treat HIV. Studies suggest that this can prevent infection if the user is exposed to HIV. At present in the UK PrEP has only been available to men in a clinical trial for the PROUD study. This study is now over and groups like GMFA are campaigning to make PrEP available to all gay men who want it on the NHS. To keep up-to-date with PrEP, visit www.gmfa.org.uk/prep. Test for HIV and STIs: Having an STI can make you more vulnerable to HIV infection. All sexually active gay men should test for STIs at least once a year. If you are having lots of sex, and especially if you are having lots of unprotected sex, then you should test more frequently. It takes roughly ten days for most STIs to show up in a test. It takes about four weeks for HIV to show up in a test. For more information on HIV, STIs and sexual ahead advice, visit www.gmfa.org.uk/sex To find your nearest GUM clinic visit www.gmfa.org.uk/clinics For more information on depression, mental health or to find support, visit www.nhs.uk/depression To talk to someone now about sex, sexual health or HIV call THT Direct on 0808 802 1221. THIS ARTICLE WAS TAKEN FROM ISSUE #149.