Getting high on HIV

Drug use is often considered on a spectrum between recreational and self-medication. The latter end of the spectrum piques psychiatric interest, figuring the activity as indicative of self harm or symptomatic of underlying psychological issues. But here's a growing trend that muddies those waters: the uptake in using HIV medication as a hallucinogenic high. The antiretroviral medication Efavirenz is acquiring street value as a recreational drug. The practice was prevalent enough to draw the interest of recent pharmacological research into Efavirenz's psychoactive properties.

For the attention of all the psychonauts reading the research conclusions, you'll get better bang for your buck from established highs like LSD, but Efavirenz numbers among a range of medication that has helped change HIV from a death sentence into a chronic, but manageable medical condition. The cautionary tale is that this street culture significantly elevates the risk of the viruses evolving immunity. Viruses, should it need re-emphasising, are a dangerous partner to engage in a game of Russian roulette. Such an outcome would be devastating to the worldwide effort to get to an aids free generation (HIV/AIDs kills upwards of 2 million people in the developing world), especially in light of recent triumphs of curing susceptible infants through brute force antiviral treatment.

It would also bad news for another niche activity facilitated by Efavirenz and its antiretroviral ilk, that of bug-chasing. You may or may not have heard of the 'bugchasing' and 'giftgiving' sexual subcultures. It's a subculture where gay men wilfully contract the HIV virus. Most research, anecdotal and academic, ascribe the possibility of managing the disease through antiretroviral medical advances as an enabling factor in the subcultures development. Should your curiosity be piqued by this notion then Louise Hogarth's documentary 'The Gift' is the place to begin.

Why would someone willingly contract a debilitating autoimmune disease? Community-ascribed motivations for bug-chasing include the thrill of chasing the ultimate taboo. “I chase because it’s arousing. I like the rush I get from letting positive guys bareback me. The risk is a turn on. And as for the consequences, it’s very easily controlled with medication”. Anecdotal reports point to the importance of agency for the bugchasers: the rationale orbits around the following creed: contracting HIV was perceived as inevitable. Rather than have their personal lives haunted by the spectre of unwillingly contracting the virus, pozzing permitted young homosexual males a degree of volition over a tragic possibility of their sexual preferences. It would be also foolish to overlook perceptions of kinship in the homosexual community as a powerful driver.

I chase because it’s arousing...The risk is a turn on. And as for the consequences, it’s very easily controlled with medication

Contracting HIV to valorise ones lifestyle choice strikes many as confusing, if not abhorrent. But internalising the violence of an endemic virus could be understood as a masochistic empowerment Dr. David Moskowitz survey of 284 bugchasers and barebackers indicated that bugchasers “were far more likely to engage in sexually sadomasochistic activities”. This medicinally managed violence inverts the subtle violence that societal and cultural prejudices visit upon the gay community into something empowering, however paradoxical that might appear. 

While in some parts of the world we're moving toward a better place, with approved gay marriages enfolding the homosexuals among us into more heteronormative institutions like marriage (and it should be noted that this heteronormative move was not welcomed by all). Elsewhere the violence inflicted upon those outside the societies tolerance threshold turns the stomach. Contemporary scientific advances tentatively herald the arrival of a HIV vaccine sometime soon. 

Forget the simplistic condemnation of these nihilistic subcultures. What quantifiable facets of society and attitudes towards others are contributing to the risk of members of our society willingly inviting a debilitating virus into their bodies and the rest of their waking days? Maybe this is where psychiatric framing of the scene as self-harm and destructive compulsive behaviour makes sense. Is it so hard to imagine the first encounters with Efavirenz's sub-par trips were made by some fraction of those initial taboo smashing, risk absconding, bugchasing libertines after the thrill of the chase subsided? It's a speculation, but one that fits the sense of melancholy and fatalism that accompany each scene.