No doubt, it makes sense that you want to avoid contracting an STI like HIV.
But there’s a thin line between taking proper precautions to avoid contracting HIV and having an irrational fear of HIV that actively interferes with your quality of life, love, and love-making.
On one side of the line is a responsible sex-haver, and on the other side of the line is a person with HIV phobia.
HIV phobia can be a painful type of anxiety for both the person with the phobia and their loved ones. Know this: Help is available and there are solutions.
“HIV phobia is an intense fear of getting HIV,” says Dr. Emily Rymland, DNP, FNP-C, clinical development manager at Nurx.
Specifically, the fear of contracting the virus even if you are very low risk. In other words, the fear is both extreme and irrational.
“It’s a fear that can interfere with a person’s ability to engage in and fully enjoy sex,” she explains.
Although it’s wise for people to take measures to prevent contracting HIV — as you should aim to prevent contracting any virus or developing any chronic condition to the extent that you can — nobody should fear it, says Rymland.
Phobias are a specific type of anxiety. So having HIV phobia can lead to symptoms of anxiety and even cause panic attacks.
Anxiety and panic attacks can lead to a variety of physical symptoms, such as:
HIV phobia can lead folks to avoid spaces, places, and activities that they have deemed “higher risk” (even if those activities aren’t higher risk). So, another symptom is an aversion to certain things.
It can also lead to excessive consumption of news, information, and media about HIV and AIDs.
Some people with HIV phobia get tested for the virus an “excessive” amount or more than is recommended for their individual risk category. In many cases, they aren’t particularly soothed by their results.
Your testing frequency and emotions around testing and results could highlight another symptom.
HIV phobia simply names that the fear, specifically, is HIV.
Also known as health anxiety disorder or illness anxiety disorder, hypochondria is a generalized fear about (losing) one’s health.
People with hypochondria often find themselves preoccupied with anxiety that they are sick. But unlike people with HIV phobia, people with hypochondria usually aren’t preoccupied with one specific sickness or disease.
Instead, people with hypochondria usually are preoccupied with most or all of them.
In summary: Hypochondria is fear of general illness whereas HIV phobia is fear of a specific illness.
There are things that can contribute to the likeness of HIV phobia, of course. (Outlined below).
But phobias aren’t necessarily rational. That means that sometimes there isn’t a cause that you can point to and be like, “Aha! That’s the cause!”
According to Rymland, many people with HIV phobia are those who were alive in the 80s and early 90s when HIV *was* a death sentence. After all, it wasn’t until 1995 that the FDA approved antiretrovirals to help control the virus.
“It’s understandable that people who were alive [at that time] might have a lingering fear of it,” she says. “But now that HIV is a manageable condition, HIV phobia is unwarranted.”
Regardless of age, many other people who have HIV phobia are those who were raised in homophobic households. Specifically, homophobic households that have used fear-mongering around AIDs to police their family members’ sexuality and sexual activity.
Of course, homophobic caregivers aren’t the only things that can perpetuate these false messages. Schools, religious institutions, “sex ed” classes and media can also contribute to this.
“When somebody has an intense fear of getting HIV, it’s usually related to shame,” says Rymland. “Shame of being sexually active, shame of being queer, or some other type of shame.”
To determine if you have HIV phobia, you’ll need to spend some time reflecting on your relationship with blood, body fluids, safer sex barriers, and sex in general.
Think back to the last time you had, or almost had, partnered or multi-partnered sex:
- Were you thinking about the pleasure you were having or were you preoccupied with potential risks?
- Did your anxieties around the fear you were having physically or emotionally affect the experience for you?
- How did you feel afterward?
- Did you take any actions after you had sex to mitigate any potential risks of contraction?
You also want to think about your STI testing protocols and routines:
- How often do you get tested?
- Is it more than the recommended amount?
- How much more?
Healthcare professionals generally recommend getting tested for STIs at least once a year.
“Annual testing is the rule of thumb but many people should get tested more often, as often as every three months,” says Rymland. “If you have a new partner, multiple partners, or aren’t sure of a partner’s HIV status, get tested.”
Now think about your reaction to seeing other people’s bodily fluids:
- When you see a spot of blood on the pool deck, how do you react?
- If you notice urine on the toilet seat in the bathroom, what do you do?
- When you see excrement in the subway, what is your first thought?
You might also find it helpful to consider how you feel about being in spaces where bodily fluids are common. For example:
- public bathrooms
- locker rooms
- urgent care centers
Diagnosing HIV phobia cannot be done with a simple blood test the way diagnosing HIV is.
The only way a phobia of any kind can be diagnosed is by working with a mental health professional.
The professional will talk with and observe you to get a better understanding of your symptoms, as well as how the phobia is influencing your life.
They will likely diagnose HIV phobia if the phobia is negatively impacting your quality of life.
Phobias don’t always require a specific treatment plan.
But because HIV phobia can interfere with a person’s ability to exist in public spaces, have pleasurable sex, and enter and enjoy romantic and sexual relationships, HIV phobia usually does require treatment.
HIV phobia is usually treated with some form of therapy.
One example is exposure therapy. That doesn’t mean forcing you into unsafe situations where contracting HIV is a real risk, but instead doing things like:
- Spending time with people who live with HIV
- Having sex or engaging in other kinds of consensual physical contact
- Spending time in places you deem “higher risk”
Sometimes cognitive behavioral therapy (CBT) can be helpful.
Usually, CBT involves teaching you to recognize when your fears or thoughts veer toward the irrational and bring them back to the land of the realistic.
Reducing your risk of contracting HIV through safer sex practices and addressing the underlying phobia may help you find relief.
This path forward often includes the following.
1. Take PrEP
An oral prescription medication that’s taken daily, “PrEP is incredibly effective at preventing HIV transmission if you’re exposed to the virus,” explains Rymland.
“Now that we have PrEP there is truly no reason to fear HIV,” she says. “Most insurance plans are required to cover PrEP and the required HIV testing, and the budget announced by the Biden administration allocates nearly $10 billion dollars to make PrEP accessible to all who need it.”
2. Use barriers
Regardless of whether you’re taking PrEP, you may want to consider using condoms and other barriers.
“Condoms offer an additional layer of protection against HIV, and protect against other STIs as well,” says Rymland.
3. Communicate openly with your partner(s)
“One of the most important things you can do to both overcome fear and protect yourself is to communicate openly with your partners,” says Rymland. “Discussing your status and asking your partner’s status is key.”
Knowing a partner’s status can empower you to make the best choices for your individual situation.
Remember: If a potential partner is HIV positive and on treatment, the virus could be undetectable. If the virus is undetectable, it can’t be transmitted to you. This is called U = U.
4. Begin to address your phobia
One word: Therapy!
As a general rule, it’s wise to seek out the care of an LGBTQIA+ affirming therapist — regardless of your sexuality.
This is especially important for people who have or think they have HIV phobia because the fear is often rooted in a combination of sexuality and sex act shame, as well as internalized homophobia.
5. Expose yourself to queer joy
If you’re someone whose phobia is rooted in internalized homophobia or shame about the kind of sex you’ve had, want to have, or are having, surrounding yourself with queer educators, influencers, elders, and other individuals you admire can be helpful.
This can (and should!) be done both online and offline.
It’s natural to want to avoid contracting an STI you do not currently have. But avoiding spaces, people, or all or certain sex acts to avoid contracting an STI like HIV isn’t ideal.
If your quality of life is affected by this fear, consider working with an LGBTQIA+ affirming healthcare professional. Help is available — you don’t have to live with this kind of fear.
Gabrielle Kassel is a New York-based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.