The people who WANT to get HIV

After 11 years of being a doctor nothing shocks me, absolutely nothing. At least, that’s a statement I would have made up until a few weeks ago. However, the years I had spent working in tertiary hospitals, general practice and sexual health weren’t enough preparation for what one of my patients was about to tell me.

Some people WANT to get HIV. They are known as “bug chasers” and those who want to give HIV to other consenting adults are known as “gifters”. The process is known as conversion. They actively seek each other out through advertisements online and through apps. They have a conversation about each other’s HIV status, whether the person living with HIV has a high viral load (meaning higher infectivity), where to meet and when to have sex. Conversion usually occurs under the influence of drugs, but not always. It is done one on one or at parties where many people are involved. It can also be done anonymously where neither person sees the other’s face.

I work at a beautiful general practice in Sydney city where about half my case load is general medicine and the other half is sexual health. We have made amazing advancements in preventing HIV transmission. This includes effectively treating people living with HIV with one tablet a day so that the virus is rendered untransmittable, by providing at risk groups with PrEP (Pre-exposure prophylaxis) and by providing PEP (Post exposure prophylaxis) for people who may have already had an exposure to HIV within the past 72 hours. So the practice of “conversion” is the complete opposite of everything I stand for as a doctor.

To compound the problem, drug and alcohol abuse increases the risk of transmission. People are less likely to take their preventative medication (PrEP), more likely to have sex without condoms, and more likely to act on their desires for conversion. The greatest culprit is crystal methamphetamine, also known as ICE. It heightens the experience and endurance of sex (chemsex) but is unimaginably addictive and brutally ruins lives.

My patient who we shall refer to as Mark is an intelligent, well spoken, respectful man. I have been providing him with PrEP for HIV prevention. This involves taking 1 tablet a day and even if he has condomless sex with a person who is living with HIV, the likelihood of him contracting the virus is virtually impossible. Unfortunately Mark relapsed after several years of abstinence from ICE and started to engage in sexual activity with multiple unknown partners. Mark was referred to a tertiary drug and alcohol service and was receiving counselling in addition to attending crystal meth anonymous meetings. However one week whilst high, he had multiple episodes of condomless sex with a man known to be living with HIV and not on treatment. This meant that he was highly infective. They had discussed the process of conversion, and the man ejaculated inside Mark several times. They were both using ICE by sharing needles. They met up over two days, and during this time they had decided to be bonded to each other by sharing the same strain of HIV. To ensure this occurred, Mark also took approximately 1ml of blood from the man and injected it directly into his own vein. He then repeated the process twice more the next day with 0.5mls each time. 1ml is the entire length of a diabetic syringe. He then came to see me the next day and relayed this story.

Mark whilst sober had not wanted to contract HIV, however whilst high had accessed a part of himself that did – and had acted on it. He explained to me that at the time of ICE use, sexual and emotional senses are often so heightened that connecting with one’s partner can be all consuming. There are other reasons why someone might make the decision to convert. This can be to alleviate the anxiety of getting HIV by just getting it over and done with, or because of a sexual kink of the ultimate submission.

Whilst the clinician in me sought to find every means possible to prevent transmission by finding out if he had been taking his PrEP tablets regularly and by adding more antiretroviral medication so that he was effectively on PEP, the human in me wondered what on earth Mark had been thinking. I have patients who have used ICE and had never even contemplated conversion. Or, had they?

What struck me though, was Mark’s innate need to feel connected to this man. Mark wanted his particular strain of HIV. Whilst Mark was under the influence of ICE, it had unlocked this desire to be converted. People use alcohol, drugs, gambling, food or sex when feeling lonely and depressed – I had never imagined someone could go to such lengths to connect with another person.

Many readers will likely respond by being outraged at such careless behaviour. To harm one’s self, to impact public health when we are actively campaigning to reduce HIV transmission and to cost the tax payer for treatment. Judging this choice is only natural, but it is not constructive. What deeply saddened me was that there are humans out there who feel so disconnected that they are choosing to self harm by giving themselves a life threatening infection. We need to find a way to help these people not only for their own good, but in the interest of public health as well.

The first step is an awareness of the issue. The second is to listen, ask our patients and try to understand them without judgement. After all, if we as doctors are not willing to help, who will?

*Mark consented to his case being shared and he has read this article. He was not under the influence of drugs or alcohol at the time of consent. He has insight about his actions having been extreme and is actively seeking help. Please be respectful in your commentary of this article and of Mark.