The experience of testing HIV–positive is now a common one amongst gay men in the UK, but it is important that counsellors do not make the assumption that all gay men are the same.

A positive result can also reawaken feelings of self–hatred which many gay men thought they had dealt with, and for someone who still harbours such feelings, it can be especially devastating. Finding out how a client feels about being gay during pre–test counselling, if done sensitively, can often be helpful in preparing the counsellor for delivering a positive result. For example, some gay men may see a positive result as the inevitable consequence of their lifestyle and a confirmation of all the negative messages about gay men in our society.

For some gay men, a positive result may bring with it the fear of the loss of a particularly important part of their identity – their sexuality – or fear about the limiting of potential for relationships.

Safer sex counselling with HIV–positive gay men must stress the need to protect against other sexually transmitted infections which could place a burden on the immune system. This may require the adoption of certain safer sex guidelines which are discussed in Safer sex: Safer sex for people for with HIV.

Gay men who test positive may be in a relationship with a partner who is also HIV–positive, and may want to know whether unprotected anal intercourse is considered safe between men who are both infected. This question is discussed in Safer sex for people with HIV.

When discussing safer sex with men who identify as gay, it should never be assumed that their sexual partners are exclusively male. Although many gay men will not identify themselves as bisexual, they may have female partners too. The importance of safer sex with any female partners should be stressed.

People diagnosed with HIV who discover themselves to have a low CD4 count may have an especially severe shock, since they will be faced with pressure to make immediate decisions about treatment In these circumstances it may be better to counsel caution rather than encouraging an immediate rush to commence treatment. It is important that anyone who commences anti–viral or prophylactic treatment does so after a process of self–education, not solely because the treatment has been recommended by a doctor.

Some gay men may have reactions of guilt, shock or disbelief after a negative result. For many, this is the result of seeing many of their friends or peers affected by the disease. They may question why they are exceptional, and experience long-term feelings of guilt which they find difficult either to acknowledge or discuss with people close to them. This phenomenon has been labelled `survivor guilt', and is a reaction that was also noted amongst those Jews who escaped the Holocaust, especially those who left Europe just before the Second World War. Sensitive acknowledgement of these feelings by a counsellor may be more helpful than an encouragement to go off and celebrate. Some gay men who test negative may be just as much in need of long-term counselling support as those who test positive.

A desire not to survive the epidemic when so many of one's friends have died has been reported by American psychologists as a factor which may subconsciously contribute to the practice of unsafe sex amongst some gay men. Many gay men find it difficult to acknowledge or discuss the long–term stress of living through an epidemic, especially if they remain healthy.

In this situation it is also possible that gay men will be unable to accept a negative test result, and will seek a repeat test. Others may seek repeat tests for reasons which cannot simply be labelled as `worried well' behaviour. In a social group with such a high HIV prevalence, anxiety about coming into contact with HIV is likely to be heightened by anecdotal information – for instance about the safety of oral sex – and feelings of distress or horror at the effects of AIDS on friends.