Our voices

A straight man speaks up for HIV awareness

Before Joshua Middleton was diagnosed with HIV, he thought the chance of a straight man acquiring HIV during sex with a woman would be on par with the chance of winning a Powerball lottery. In fact, the risk of HIV transmission from a female to a male sex partner during vaginal sex is lower than the risk of HIV transmission between male partners during anal sex. But it is not zero.

After being diagnosed with HIV in June 2012, Middleton realized there was a need for him to speak out about his experience. In January 2016, Middleton was honored as one of “16 HIV Advocates to Watch” by HIVPlusMag, for his website PozitiveHope, which includes articles about disclosure and family, plus educational videos and content about treatment as prevention and pre-exposure prophylaxis (PrEP).

Joshua Middleton

Middleton was diagnosed with HIV in June 2012, during an appointment made for an unrelated health condition. He’d been tested for HIV by his primary care physician earlier in the week, hadn’t received his results yet, but wasn’t worried that it would come back positive.

“When I was told my test came back positive, I was completely caught off guard. I didn’t have time to prepare myself for it—not that I think it would have changed my reaction either way. It was definitely a shock. For a while, time just felt like it was going in slow motion.”

Middleton immediately sought support from friends and family.

“I needed compassion, and someone to give me hug. I needed people to be there for me, to say, ‘Hey man, that totally sucks. I’m sorry.’ I didn’t hesitate to be open about my status, and I think that has a lot to do with my personality as more of an extrovert. I put everything out there—I carry my emotions on my sleeve.”

He hesitated to tell his parents about his diagnosis, worried that they would be disappointed or feel like they failed in some way to guide, educate or protect him. But he did tell them, as well as his colleagues at work, and said he was surprised by everyone’s love, support and compassion.

But people had questions about what living with HIV would be like, and that’s when Middleton realized he had a lot to learn.

“Before I was diagnosed, I didn’t know anyone who was living with HIV. I had all of these stereotypes about HIV in my mind. About certain types of people that HIV would affect. Or what HIV and AIDS ‘looked like.’ As I started to educate myself, I realized that those perceptions didn’t really match reality. I jumped right in—to try and learn as much as I could.”

He joined a support group on Facebook, read about HIV online, and talked to his brother—an internal medicine physician—about his diagnosis. He started HIV medications, and within a month his viral load dropped to undetectable levels.

After taking steps to care for himself, Middleton decided that he wanted to share his story more widely—to help educate others about the fact that HIV can affect anyone.

“I watched a lot of videos online where people talk about living with HIV. And I saw that there weren’t a lot of straight people who were speaking up. I saw a need for it, so I started sharing.”

He found that some of the misconceptions he had previously held about HIV were common.

“When you live with HIV as a straight man, you get people who make assumptions about you. Who put you in a place where you feel like you have to prove your sexuality. People assume that maybe you’ve slept with someone who’s gay or bi. Or maybe that your girlfriend slept with someone who is gay or bi. People still think that HIV is a ‘gay condition.’ So that’s challenging.”

Since coming out about his status, Middleton has met and made friends with people all over the world who are living with HIV. He sees that HIV isn’t a ‘straight’ or ‘gay’ issue. And although he understands why public health efforts target “higher risk” groups of people such as men who have sex with men and people who use injection drugs, he says that it’s important not to cut the straight community out of the HIV conversation.

“There may be different issues for prevention and HIV care in the straight community. For example, one thing I’ve thought a lot about since being diagnosed is how, or if, I’m going to be able to have children.”

Middleton says he is invigorated by his new role as an HIV advocate and that although it’s not easy to live with HIV, he tries to focus on the good in his life.

“I don’t have a choice now, so instead of being bitter I try to live life better; and to encourage other people to know about HIV, and to educate themselves about things like treatment as prevention and PrEP. Knowledge is power.”


Read more about Joshua Middleton’s story on his website, PozitiveHope. Watch his story on YouTube about finding out about his status and living with HIV.

About the author

San Francisco AIDS Foundation

San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.