There is an interesting history of heterosexual HIV peer support in Victoria, and 2026 marks 10 years since Straight Arrows and Living Positive Victoria (LPV) merged. As an organisation founded ‘by/for’ heterosexual people, Straight Arrows was unique among Australian HIV organisations. Peer support was one of its strengths, and LPV became the custodian of its expertise.
I am a heterosexual man living with HIV and I joined LPV’s peer support team around the same time. It has been my privilege, along with my colleagues, to continue the work of Straight Arrows. If my presence has enabled more heterosexual men to access peer navigation, then I’m delighted; but I’m kept awake at night knowing how rare peer workers like me are, and how infrequently heterosexual men step forward to involve themselves as peers in Australia’s HIV response.
At the end of 2024, men who identify as heterosexual made up 13% of people living with HIV in Australia (with thanks to Richard Gray, Kirby Institute, UNSW). Even if heterosexual transmission is perceived to be low, it begs the question; to what extent might undiagnosed heterosexual men compromise Australia’s 2030 goals (Ninth National HIV Strategy, 2024 – 2030)? If Australia is to “virtually eliminate” HIV transmission, can we afford not to make more concerted efforts to understand the care needs and preferences of heterosexual men with HIV? Equally, how can we support them to find their voice, bring their lived experience to bear, and help shape the response in Australia more?
This is not an attempt to answer those questions, but to stimulate more ‘sector-wide’ conversations that center HIV+ heterosexual men. My own experience tells me that peer support seeds advocacy; but input from peers alone is not enough. To dial up the discourse, among experts from all quarters, I have crafted a range of fictitious case examples. They draw on a wide range of men, to describe those I work with, the stories I typically hear from them and some of the key themes that arise from working with them.
Take Shane, a recently diagnosed Australian-born white guy in his mid-40s working night shifts. He felt the need for a full STI screen after some heavy partying overseas. He is single, and keen to meet women living with HIV. In many ways, Shane is doing well. He quickly achieved “undetectable”, and adhering to treatment is straightforward for him. However, he is grappling with the new and terrifying prospect of dating with HIV and sharing (or not sharing) his status with potential female partners. Like many of my heterosexual male clients, he has carried HIV stigma into his diagnosis, and his sense of self-worth has taken a hit. He has developed the mindset that only a woman living with HIV will accept him now that he has HIV.
We meet at an outdoor cafe. Shane is grateful for the opportunity to meet with me, but he doesn’t feel the need to make connections within the diverse community of people living with HIV. He even expresses reluctance to join the events I host tailored to heterosexual men. I come away feeling like we’ve at least made a solid peer connection that could serve him well down the track.
Ken is an Asian man who migrated to Australia over 10 years ago. He was referred by a social worker at a public hospital who explained that a prolonged disengagement from care and treatment allowed his HIV to advance, causing him to become seriously unwell. He is returning to health, but his story reveals the stress, financial hardship and profound uncertainty commonly associated with migrating with HIV. An unfortunate disclosure has resulted in Ken avoiding all contact with people from his own country and language group. His employment is sporadic and his housing is insecure, but what weighs on him most is the sadness and loneliness he feels. He attributes being partnerless and childless to having HIV.
Ken is open and trusting and tells me his story in depth. His eyes fill with tears when I tell him my wife and I were able to safely have children. I wish I could offer him something more tangible than an empathetic ear. My training reminds me to trust the value of listening, and I hope that sharing his story grants him some relief. It becomes clear that Ken simply can’t contemplate attending events or engaging with peers beyond me. He will not gain the benefits of peer contact or get to experience the belonging that a community of HIV peers can offer. I maintain as much contact as possible, but he eventually stops responding to my attempts to stay connected.
Damien lives in regional Victoria but makes the journey to Melbourne to attend the small, ‘guys only’ events I host for heterosexual men. I’m grateful for the warmth and encouragement he shows to those who seem less sure. Privately to me, he voices a debilitating feeling of regret for passing HIV to his ex-wife, the mother of their (HIV-negative) children. He is a skilled tradesman, accustomed to earning well, but his feelings of guilt seem to intensify his commitment to be present for his kids, and he no longer accepts work that involves travel. The pressure on his mental health takes a toll, forcing him out of the workforce. One day, after years of phone-based peer support, he confides to me that he identifies as bisexual.
Damien brings me to the dilemma I want to address most, and the one I am least confident describing or discussing; it is the challenge of naming and understanding the intersection where groups of men who identify as heterosexual meet. And how conditions for quality group peer support can best be created there. At LPV, (and Straight Arrows before), we’ve long held the understanding that events for heterosexual people with HIV attract men from a range of sexualities much more diverse than straight-up heterosexual. Non-hetero men who present as straight have always accessed peer support alongside men who experience their heterosexuality as straightforward and fixed. But we’ve rarely observed these men speak to each other about sexuality. That men like Damien tend to confide in us away from the group, could suggest that they have reason to fear stigma in those contexts. What harm is done to someone whose access to peer support is reliant upon them concealing or suppressing their sexuality? We have experimented with promoting ‘het & bi’ spaces for men, but that has proved to be problematic also.
An aside on the (fantastically cumbersome) term ’heterosexually identifying’: clearly unsuitable for client-facing communications, could it also be impeding sector discussion? Exactly who are we talking about? The language gets convoluted very quickly, trying to delineate the diversity; heterosexual (or straight) men, men who identify as heterosexual, straight-presenting men who have sex with men (MSM), straight-passing MSM, bisexual men and so on. I have even caught myself saying “non-msm heterosexual men.” Does the language make it easier to hard-basket these men? Can we expect clarity to increase with more sector engagement? Can we benefit from creative attempts to evolve the terminology, like bi+ advocate Steve Spencer, who puts forward inclusive descriptors such as ‘men who love women’, and ‘men who have sex with women’ since attraction to women is the unifying factor regardless of identity? These novel descriptors of non-homosexual men in our community lend their form from well-understood sector terms such as MSM and WLW (women who love women).
Like most people living with HIV in Australia, these men exist in a world where “the lived reality of HIV remains unseen and hidden from the mainstream in Australian society” (Krulic et al., 2024). All people with HIV encounter stigma, but not in the same ways or to the same degree. Although heterosexual men may be more likely to report stigma, I do not believe we can claim to experience more, or worse, stigma than others. Rather, we face a breed of stigma that is uniquely our own: that of men who are heterosexual, or who look, act, or hope to be perceived as heterosexual, living with a virus that is (still) closely associated with male-to-male sex. Many of us appear to experience that stigma acutely. Also, we move within social networks where knowledge, beliefs, and attitudes relating to HIV lag far behind contemporary understandings of treatment, transmission, and health-burden. Many of us seek female partners from within such communities. Yet, as one insightful peer put it, “I’d rather be a pos het guy trying to educate a female partner about HIV than a woman living with HIV trying to do the same with a hetero bloke.” I share his sense that, fortunately for us, women are often more compassionate than straight, mainstream men.
The good news is that bi+ men appear to feel increasingly safe to own and celebrate their sexuality, as evidenced by vibrant new bi+ spaces, such as LPV’s bi++ network and NAPWHA’s BiPAN. Heterosexual men, however, appear disinclined to come together in the context of lived HIV. Men like Shane might express interest to meet with women living with HIV, but mostly decline opportunities to come together for peer support from each other. It would be helpful to gain a deeper understanding of the factors underlying this pattern. Our feeling is that in most cases, it does not reflect strong psychosocial health, or that het guys are thriving with a healthy sense of self-worth and a feeling of robustness facing stigma.
Events for heterosexual men are often so small they verge upon being unworkable, and I worry, wasteful of resources. Occasionally we see connection, sharing and support, but low numbers place undiluted pressure on the courageous few who attend, and amplify any awkwardness. If heterosexual men continue to indicate a preference for individual peer support, then we should focus there. When heterosexual male peers are unavailable, female peers provide an excellent alternative. Peer navigators and peer organisations must consult heterosexual men and experiment creatively, in the provision of safe spaces for them; but more research could help tease out what is happening and lead to more suitable interventions. The HIV sector could benefit from an improved understanding of all these phenomena.
So, where to from here, dear sector comrades? I’m fortunate to belong to a small network of advocates who provide essential insight into the lived experience of men with HIV who identify as heterosexual. But we rely upon your unique talents to build understandings and innovate solutions. We’re grateful to have the insights of Krulic et al. (2024), Njeri (2022), Norman et al. (2022), and others, and we appreciate the attention already dedicated to us. We recognise that we enjoy more privilege than anyone. We understand that resources are limited, and other important populations remain under-served. Still, our trust in your understanding of the landscape, and your ability to hold complex, competing demands, emboldens us to communicate what we need. We ask for your assistance and collaboration to bring our cohort further into focus.