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A substantial minority of men who have sex with men (MSM) engage in the exchange of sex for money, drugs, shelter, or material goods. This work carries risks for violence, sexual assault, and other kinds of harm such as robbery and threatening behavior by clients. Yet limited research has focused on the strategies that male sex workers (MSWs) use to prevent or manage these risks. To gain more insights into this matter, we analyzed qualitative interview data from 180 MSM recruited from eight U.S. cities who engaged in sex work with clients they had primarily met through dating/hookup websites and apps. Participants described the strategies they used to manage risks of interpersonal violence, both prior to meeting their clients and at the time of their encounters. Many of the strategies used ahead of the encounter relied upon information and communication technologies, such as negotiating the parameters of the exchange encounter, screening clients, sharing information about the client and meeting place with others, identifying safe meeting locations, and gathering information from social networks about problematic clients. Strategies employed during the encounter included: receiving payment up front; being prepared to protect oneself with a weapon or self-defense techniques; staying alert and sober; and planning an exit route from the location. Technology-based interventions through dating/hookup apps could play an important role in providing resources and skill building for MSWs to help them protect themselves during sex work.

The realization that many persons with HIV/AIDS are subjected to multiple layers of stigmatization because they belong to socially deviant and disenfranchised groups (e.g., injection drug users, racial/ethnic and sexual minorities) accounts for an increasing interest in the phenomenon of stigma layering. The stigma associated with hepatitis C virus (HCV) has also been conceptualized as layered. However, researchers have overlooked the fact that HCV adds a layer to the HIV stigma and vice versa. Qualitative interviews with 132 HIV/HCV-coinfected patients were analyzed to explore how they experience the two layers of stigma. Most participants hierarchically ordered the stigmas associated with each disease and regarded HIV as the more stigmatizing of the two. A small number perceived HIV and HCV as equally stigmatizing. The impact of the hierarchical and nonhierarchical ordering of the two stigmas on coinfected patients’ felt and enacted stigmatization is explored and implications for interventions are discussed.

Research has found that HIV-infected adults age 50 and older are more socially isolated than younger HIV-infected individuals. This study examines the perceived barriers to obtaining emotional and practical social support from friends and family among 63 older adults (age 50+) living with HIV/AIDS. Many reported they did not receive enough emotional support (42%) or practical assistance (27%). Barriers to obtaining support included: (1) nondisclosure of HIV status; (2) others’ fear of HIV/AIDS; (3) desire to be self-reliant and independent; (4) not wanting to be a burden; (5) unavailability of family; (6) death of friends to AIDS; and (7) ageism. These barriers may explain the greater social isolation of HIV-infected older adults and inform interventions targeted at reducing these barriers.

Focused interviews were conducted with a sample of 45 HIV-infected mothers to identify the reasons women offer for disclosing or not disclosing the illness to their uninfected children, the women's perceptions of their children's reactions to such disclosure, and what effects this disclosure may have on subsequent relationships with their children. Two-thirds (66%) of the mothers had disclosed their HIV infection to one or more of their children. Disclosure rates varied according to age of the child, mother's current disease stage, and whether the child lived with the mother. Mothers reported many reasons for disclosing their HIV infection to their children, including wanting to educate their children about HIV, wanting their children to hear it from them, wanting their children to know before they became very ill, and wanting to be honest with their children. Reasons for nondisclosure included believing that their children were too young or immature, believing it would be too much of an emotional burden for their children, not wanting their children to experience rejection, not wanting their children to fear losing their mother, and wanting their children to recover from previous losses. Although adverse reactions were reported in a few children, most mothers reported that their children, although emotional at first, experienced little, if any, lasting negative impact. Indeed, many reported that the relationship with their children had become closer following disclosure.

Despite the risks associated with pregnancy, available data suggest that HIV-infected women are no less likely to become pregnant than uninfected women. To understand HIV-infected women's reasons for wanting to have a child, focused interviews were conducted with a predominantly minority sample of 51 HIV-infected women in New York City. They were noted to actively weigh both the potential risks and benefits of their pregnancy decisions. Women reported three major reasons for wanting a child: (1) her husband/boyfriend really wants children, (2) having missed out on raising her other children, and (3) believing that a child would make her feel complete, fulfilled, and happy. Women also reported several justifications that they believed offset the risks of pregnancy, including: (1) other HIV-infected women were having healthy babies, (2) feeling optimistic about having a healthy baby due to the prophylactic effects of AZT (zidovudine), (3) having faith that God will protect the child, (4) being young and “healthy” will prevent transmission, and (5) feeling that she is better able to raise a child now. These findings suggest that to make fully informed pregnancy decisions, women should be encouraged to explore their reasons for wanting pregnancy, as well as discuss the potential risks.

While the managing of negative emotions has been identified as a central adaptive task for those living with chronic illnesses such as HIV/AIDS, little is known about the specific coping strategies used to achieve this task. The present study employed unstructured interviews to examine illnessspecific cognitive strategies used by an ethnically diverse sample of HIV-infected men who have sex with men (MSM) in their attempts to manage the negative emotions associated with the illness. Fourteen specific cognitive strategies were identified, many of which were specific to coping with chronic illness or HIV/AIDS. These strategies were categorized into four major conceptual categories: (1) distancing the threat of death; (2) reducing the sense of victimization; (3) gaining a sense of control; and (4) mentally preparing for emotional upset. The findings have implications for what coping assessments may be neglecting and may provide insights for therapeutic application.

The perception and evaluation of physical symptoms are central components of the illness and health appraisal process and affect subsequent health behaviors. This topic is explored within a study of the psychosocial adaptation of late-middle-aged and older HIV-infected men and women, age 50 to 68. Transcripts of in-depth interviews were read by an interdisciplinary team of investigators to detect prevalent themes. Thematic analysis revealed that older people with HIV often expressed confusion in trying to understand the cause of their symptoms. This symptom ambiguity was because they could attribute symptoms to a variety of other plausible causes such as normal aging, preexisting conditions, or drug side effects in addition to HIV disease. Symptom ambiguity appears to lead to both confusion and psychological distress and may influence subsequent treatment behavior.

Semistructured interviews were conducted with 63 HIV-infected late middle-age andolder adults (i.e., age 50 or older). An analysis of the narrative material revealed avariety of themes that reflected participants' beliefs about how their older ageadvantaged and/or disadvantaged them in living with this disease. Themes reflectiveof perceived advantages included (1) with age comes wisdom; (2) older people donot feel as cheated; (3) with age comes greater respect for health and life; (4) withage comes patience, contentment, and moderation; (5) older people are less psycho-logically threatened by disability and fatigue; and (6) older people can focus more ontheir own needs. Themes reflective of perceived disadvantages included (1) olderpeople's bodies are more worn down and less resilient, (2) older people are moresocially isolated, (3) older people get less sympathy and are judged more harshly, (4)doctors set higher goals when treating younger patients, and (5) older people are toocompliant and conservative.

To date, little empirical research on the association of coping style with mood in HIV-positive women has been carried out. The extant literature on HIV-positive men suggests that active coping is related to diminished distress while avoidant coping is associated with elevated distress. Previous research with HIV-positive women has not consistently confirmed these relationships. To add to this literature, scores from a sample of 145 HIV-positive women who completed the Ways of Coping Questionnaire and the Mental Health Inventory were analyzed. Correlations indicated that an escape-avoidance strategy was associated with more negative emotions. Other strategies related to negative emotions included accepting responsibility and a self-controlling approach. These findings are consistent with those previously reported for HIV-positive men, suggesting that similar kinds of coping strategies may be associated with positive and negative moods among HIV-positive men and women.

The findings from a qualitative investigation of HIV-infected African American and Puerto Rican gay and bisexual men's experiences obtaining HIV-related information; seeking HIV-related health care; as well as soliciting assistance from, and involvement with, HIV/AIDS service organizations are presented. Many men felt that their race or ethnicity-alone or together with their lower socioeconomic status-had been a factor in their experiences in seeking illness-related information, health care, advocacy, and social services. With respect to medical care, African American men held more critical and distrustful attitudes toward physicians than did Puerto Rican men. Both groups of men viewed the principal, high-profile, HIV-related advocacy and social service organizations as largely disinterested in non-White and non-middle-class clients. The men also viewed the minority-focused HIV/AIDS organizations as largely ineffectual.

With improved understanding of the natural history of HIV/AIDS and the availability of effective early intervention, HIV infection recently has come to be conceptualized as a chronic illness. As we enter the next phase of the epidemic, insights into the challenges of daily living faced by seropositive persons will aid in designing appropriate interventions to educate for adaptive success and to ameliorate adaptive difficulties. In our analysis of focused interviews with 55 seropositive gay men, we identified three major adaptive challenges: dealing with the possibility of a curtailed life span, dealing with reactions to a stigmatizing illness, and developing strategies for maintaining physical and emotional health. The men's descriptions of these adaptive challenges are discussed in the context of adaptation to other chronic illnesses.

Little systematic study has been undertaken concerning those factors that determine the impact of evaluation research findings on policy formulation. This article considers the major factors that shape an evaluation studys potential policy impact by examining 2 studies of the Community Mental Health Centers Program (CMHC) in various parts of the US. The primary goal of the program was to provide an effective alternative to the state mental hospital by creating services to treat people in their own communities. The program was to be administered by the National Institute of Mental Health (NIMH). Data used are a study of the CMHC program by the Ralph Nader-directed Center for the Study of Responsive Law and a 2nd one by the General Accounting Office (GAO). These studies represent 2 varieties of evaluation research differing in scope methodology and orientation. There were marked differences in the nature of the recommendations of the 2 studies. The GAO included concise recommendations stating where attention should be directed; the Nader report recommended broad fundamental changes with specific actions to take. NIMH officials and prominent psychiatrists fround the Nader recommendations irresponsible blatantly attacking and facetious. It is concluded that: 1) recommendations should all for incremental rather than global changes; 2) goals rather than specific courses of action should be recommended; 3) recommendations should flow directly from an appropriate amount of data in the report; 4) the researcher must be perceived as highly qualified 5) reports garner more attention in released at a time when a programs funding is about to lapse; 6) the report should avoid accusatory language; and 7) the researcher must mobilize the support of likely beneficiaries of the findings and reduce the level of resistance on the part of likely opponents.

In recent years societal attitudes toward suicide among the terminally ill have become increasingly tolerant. These sentiments have become embodied in “Rational Suicide” movements. The central underlying premise of the rational suicide position is that terminally ill patients (of which the cancer patient has served as the prototypal case) have a greater propensity for suicide growing out of their desire to escape overwhelming pain and despair. This assumption is found to be unsubstantiated when examined in light of existing statistical and clinical data. In addition, the implications of providing legal sanctions to safeguard the right of the terminally ill to end their own lives are explored.