Note: The below case is only one instance of someone deliberately trying to be infected with HIV. Various reports and experts have suggested that bug chasing is largely an isolated fetish among a small minority of people, and a fantasy that often isn’t acted upon.

If you’re seeking support or would like further information on HIV prevention or crystal methamphetamine, visit community HIV movement The Institute of Many (TIM) for online resources: theinstituteofmany.org

Sydney-based doctor Shiva Rayar reflects on a recent patient’s story about deliberately seeking HIV infection.

***

After 11 years of being a doctor nothing shocks me, absolutely nothing. At least, that’s a statement I would have used up until a few weeks ago.

The years I’ve spent working in tertiary hospitals, general practice, and sexual health weren’t enough preparation for what one of my patients recently told 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.
I work at a general practice in Sydney city where about half my caseload 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, providing at risk groups with pre-exposure prophylaxis (PrEP), and providing post-exposure prophylaxis (PEP) for people who may have been exposed 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.

Under the influence of drugs, people are less likely to take their preventative medication like 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 (known as chemsex) but is unimaginably addictive and brutally ruins lives.

One of my patients, who we’ll refer to as Mark, is an intelligent, well spoken, respectful man.

I have been providing him with PrEP for HIV prevention. This involves taking one 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. He was referred to a tertiary drug and alcohol service and was receiving counselling in addition to attending crystal meth anonymous meetings.

However, one week while high, he had multiple episodes of condomless sex with a man known to be living with HIV and not on treatment.

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 decided to be bonded to each other by sharing the same strain of HIV.

He then came to see me the next day and relayed this story.

While sober, Mark had not wanted to contract HIV, but while high had accessed a part of himself that did – and had acted on it.

He explained to me that while using ice, his sexual and emotional senses were so heightened that connecting with his sexual partner became all consuming.

There are other reasons why someone might make the decision to convert; it might be to alleviate the anxiety of getting HIV by getting it over and done with, or because of a sexual kink.

While 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.

What struck me though, was Mark’s innate need to feel connected to this man. Mark wanted his particular strain of HIV.

People use alcohol, drugs, gambling, food, or sex when feeling lonely and depressed – but I had never imagined someone could go to such lengths to connect with another person.
Many readers may 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 taxpayer 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. Please be respectful in your commentary of this article and of Mark.

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