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As the number of older adults with HIV/AIDS increases, new challenges are emerging that threaten their ability to age with this disease. Threats of particular concern are depression and suicidal ideation. Studies show that those aging with HIV/AIDS have a number of stressors that tax their coping mechanisms, increasing vulnerability to depression and suicidal ideation. These stressors can be categorized into three areas. First, there are psychosocial stressors that can contribute to depression. Second, there are health and biochemical stressors that can contribute to depression, as well as compromise cognitive abilities needed to adapt to such stressors. Third, cognitive stressors may create predispositions to depression. In particular, certain cognitive abilities needed to cope with depression and suicidal ideation may be compromised by aging with HIV/AIDS. A model of these stressors is provided for didactic purposes, as well as to suggest implications for social work practice and research. KEYWORDS HIV/AIDS, aging, depression, suicidal ideation, cognition, stress DOI: 10.1080/01634370903415692

Purpose: To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)-positive, pregnant women in Thailand. Design: Correlational, cross-sectional study. Methods: Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty-seven HIV-positive pregnant women completed questionnaires in Thai on depressive symptoms, self-esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms. Findings: Seventy-eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms ([beta]=.192, p Conclusions: The study results have added new knowledge about depressive symptoms and their predictors in HIV-positive pregnant women in Thailand. Clinical ReLevance: Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV-positive individuals. The high rate of depression in our study suggests that HIV-positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self-esteem should be strengthened for HIV-positive pregnant Thai women. Key words Depressive symptoms, HIV-positive pregnant women, Thailand

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2008.10.033 Byline: Edward Kumakech (a), Elizabeth Cantor-Graae (b), Samuel Maling (d), Francis Bajunirwe (c) Abstract: Accumulating evidence suggests that AIDS orphanhood status is accompanied by increased levels of psychological distress such as anxiety, depression, intense guilt, shame, and anger. However, few studies have examined the possible reduction of psychological distress in AIDS orphans through the help of interventions that promote well-being. The objective of the study was to evaluate the effects of a school-based peer-group support intervention combined with periodic somatic health assessments and treatment on the psychosocial well-being of AIDS orphans in the Mbarara District of southwestern Uganda. In a cluster randomized controlled design, 326 AIDS orphans aged 10-15 years were assigned to either peer-group support intervention combined with monthly somatic healthcare (n =159) or control group (n =167) for follow-up assessment. Baseline and 10 week follow-up psychological assessments were conducted in both groups using self-administered Beck Youth Inventories. Complete data were available for 298 orphans. After adjusting for baseline scores, follow-up scores for the intervention group in comparison with controls showed significant improvement in depression, anger, and anxiety but not for self-concept. This study demonstrated that peer-group support intervention decreased psychological distress, particularly symptoms of depression, anxiety and anger. Thus, the use of peer-group support interventions should be incorporated into existing school health programs. Author Affiliation: (a) Nursing, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda (b) Department of Clinical Sciences, Lund University, University Hospital UMAS, Malmo S-20502, Sweden (c) Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda (d) Department of Psychiatry, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda

Abstract: AIDS-related bereavement has been linked in recent studies with rapid HIV-symptom onset and increased mortality among people living with HIV. Social support and social environments are important elements in [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.08.016 Byline: Felicity Thomas Keywords: Namibia; HIV/AIDS; Stigma; Solicited diaries; Caring; Well-being Abstract: It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a 'private' household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through 'seeing for yourself', i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks. Author Affiliation: Department of Geography, University of Sheffield, Winter Street, Sheffield S10 2TN, UK

As the number of children and adolescents who have or are affected by HIV disease increases, so does the need to examine the preparation of counselors to work with this [...]

HIV and AIDS are serious health threats in the United States and throughout the world. Persons with HIV/AIDS continue to contend with the stigma associated with their condition, and this is especially the case in the United States, where higher rates of infection are evidenced in the lesbian, gay, and bisexual (LGB) community, adding a second stigma to an illness that already isolates and marginalizes so many families in our society. This article introduces the reader to several of the major issues in treatment and prevention of HIV/AIDS, as well as clinical and ethical considerations facing marriage and family therapists (MFTs) today.

This article presents the results of a study aimed at describing African American youths' attitudes toward peers with HIV/AIDS and identifying correlates of these attitudes based on the contact theory. Baseline data from a sample of African American, urban mothers and their youth (n = 197) participating in a family-based HIV prevention program were analyzed. In support of contact theory, preadolescents' close relationship to persons infected with HIV/AIDS was highly related to their attitudes. However, no relationship was found between maternal attitudes or communication variables and youth attitudes. The implications of youths' experience with persons with HIV/AIDS as part of prevention programming are discussed.

High levels of depressive symptoms and poor mental health quality of life significantly reduced probability of use of highly active antiretroviral therapy (HAART) among HIV-seropositive women. A prospective cohort study in which women reported use of HAART, health and mental health status, demographics and social and behavioral factors was carried out. CD4 count and viral load were assessed.

Many women infected with HIV or AIDS regarded family violence, drug use, or mother-child separation as more significant elements in their lives. Assessment of HIV compared to other disruptive events was affected by drug use and abuse histories, social support, and race.

The article explores the concept and perception of time in art, focusing on the works of filmmaker and AIDS activist David Wojnarowicz. Topics include the expression of a revelatory turning point or epiphany and the subsequent denouement.

The Willingness to Care Scale that assesses informal caregivers' attitudes about caring for people with AIDS is a reliable way for social workers to monitor how this relationship functions. This tool was developed through interviews conducted with 155 caregivers of persons living with AIDS.

Research presented concerns the impact of health education on male and female prisoners' perceived risk of AIDS. Topics addressed include HIV risk in prison, designing education programs for inmates, and the relationship between risky behavior and risk perception.

A personal narrative is presented that describes living with a brother dying from AIDS and a mother who becomes mentally ill. Subjects include emotional trauma and self-actualization.

This article presents research on how bereavement and disease expectancies affected asymptomatic HIV-positive gay men. This study confirmed that negative HIV-specific expectancies combined with bereavement significantly predicted symptom onset.

The victim-blaming tendency toward people with AIDS was examined in relation to gender, fraternity-sorority affiliation, classification (freshmen vs. others), religion (Catholic vs. others), and academic major (business college vs. others) in a survey of 818 students at a midwestern state university in the United States. Desired social distance from gay men and lesbians, the intervening variable in these relations, significantly mediated the indirect effect of fraternity-sorority affiliation, classification, and gender on the victim-blaming tendency. Gender and desired social distance were found to be significant direct determinants of the victim-blaming tendency toward people with AIDS. The study suggests that attitudes toward gay men and lesbians must change if attitudes toward people with AIDS are to change., A number of studies have suggested that there is a human tendency to attribute other people's successes to external factors and their failures to internal factors (D. T Miller & [...]

437 nursing staff members in seven AIDS residential health care facilities in New York City were asked to complete a questionnaire consisting of the Death Anxiety Scale, the Coping Resources Inventory, the Comfort with Dying Patients Scale, and a Demographic Section. 197 usable questionnaires were returned. There were statistically significant racial or ethnic differences in scores on physical coping resources, with African-Americans reporting the fewest resources. No significant relations were found between scores on death anxiety, coping resources, and comfort with dying patients. Multivariate analysis of variance was used to assess the interaction of the Nursing group (professional or paraprofessional nurses), Death anxiety, and Coping resources with Comfort with dying patients. There were no statistically significant differences for death anxiety, coping resources, and comfort with dying patients by the Nursing group.

This study investigated AIDS awareness in secondary school pupils (mainly Northern Sotho and Xitsonga) in the Northern Province of South Africa. The randomly chosen sample included 622 Standard 9 pupils (254 boys and 368 girls) in the age range of 17 to 24 years (M of 19.3), who were administered a questionnaire on awareness of AIDS and socioeconomic status. Over 72% of the questions about AIDS were correctly answered, which suggests a fair amount of accurate information about AIDS; however, 18% were of the opinion that 'AIDS does not exist' and 19% that 'there is a cure for AIDS.' Analysis of variance indicated no relationships for sex, age, ethnicity, or socioeconomic status with correct answers.

Nurses can support spiritual needs of patients with chronic illness. Specific methods have been found to be useful for those with HIV-related illness and AIDS. A comprehensive overview of spirituality that goes beyond religious considerations has been developed to this end. The view takes in multidimensional and existential perspectives important in maintaining well-being in the chronically ill. With greater understanding of spirituality, nurses can better identify spiritual needs and use spiritual caring as part of their practice.

HIV/AIDS has held a prominent position in the public consciousness for less than 20 years, vet many people can give answers about the ways in which HIV/AIDS is transmitted that […]

This study examined whether maternal depressive symptoms serve as a mediator, moderator, or both, between maternal HIV status (absence vs. presence of HIV) and child depressive symptoms. Participants were 224 noninfected children, ages 6 to 11, and their mothers, 38% of whom were HIV-infected. Initial analyses indicated that HIV-infected mothers and their children reported more depressive symptoms than noninfected mothers and their children. The primary analyses suggested that maternal depressive symptoms play a moderating, but not a mediating, role as the direction of the relationship between maternal depressive symptoms and child depressive symptoms differed between HIV-infected and noninfected groups. Explanations for the findings are offered and implications for prevention and intervention programs are considered.

Acquired immunodeficiency syndrome (AIDS) has become an epidemic in the United States. AIDS dementia complex (ADC) is a neurological dysfunction which has been indicated in 25-90% of AIDS patients, 30-40% of HIV-infected patients, and may be the only presenting manifestation of AIDS. Researchers have investigated many aspects of ADC including clinical features, etiology, epidemiology and prevalence, diagnosis (psychological parameters and laboratory investigations such as CSF, EEG, CT, MRI, PET, and ERP), assessment, neurological features (including neuropsychiatric and neuropsychological measures, and neuropathology), prognosis, and treatment. The research is controversial, complex, and contradictory. A discussion of the many areas of ADC and many hypotheses will be included.

Street children in South Africa are, in the main, between the ages of 11 and 17 years. Rape, prostitution, sexual bartering and exchange, casual sex and romantic sexual relationships all occur in the experiences of young people who live and work on inner-city streets. In this study, the AIDS-related knowledge, attitudes and behaviour of 141 street youth, living in seven large cities in South Africa, were elicited in focus group discussions. At the time of the study, 79 boys (56%) were living in shelters run by nongovernmental and welfare organisations, while 62 boys (44%) were sleeping 'rough'. The results, both qualitative and quantitative, indicated that the AIDS knowledge of South African street children was comparable to levels reported for groups of 'hard-to-reach' youth in other parts of the world. Fear of HIV infection did not appear in a list of day-to-day priorities constructed by the children, a list dominated by survival concerns with food, money and clothes. However, more than half of the boys conceded that they engaged in sex for money, goods or protection, several boys indicated that they had been raped, and most reported being sexually active with 'girlfriends', who themselves frequently engaged in transactional sex. The findings are interpreted in terms of the relationships between power dynamics surrounding race and age, and how they affect self-initiated controls over sexuality and sexual protection. Key words - AIDS, street youth, South Africa

This paper explores the perceptions of HIV/AIDS held by a group of women working as prostitutes in San Jose, Costa Rica. Adopting the theoretical perspective of critical medical anthropology, the analysis of the prostitutes' constructions of HIV/AIDS is linked to the political and historical context of power that constitutes a medical cultural hegemony. The way in which the research participants associate threats of HIV/AIDS with violence to create a complex of contagion that both perpetuates and challenges the hegemonic model of disease is discussed. Specifically, biomedicine's designation of the prostitute as the 'vector' of disease is contrasted with the position that the prostitutes create for themselves. Through a critical analysis of this complex of contagion, oppressive power structures come into sharp focus. Key words - Costa Rica, contagion, prostitute, HIV/AIDS, violence

In my hard times, I felt I knew Death well. Once I wrote, 'I have courted Death so often/He lives with me.' But for some years now, my life has [...]

We investigate the role that instrumental and symbolic functions of attitudes play in the rejection of people infected with HIV. In a series of studies (total N = 431), we manipulate the symbolic component of AIDS, by comparing it to a fictitious disease that is identical in every way to AIDS, excepting its symbolic association with homosexuality and IV drug use. Two studies indicated that the symbolic component had no effect on either social distance or perceptions of disease severity. A third study indicated that instrumental aspects of severity, contagiousness, and treatability were significant determinants of social distance. A fourth study found that the stigma of association with homosexuality increased a mild disease's stigma. A fifth study showed that previous research showing the importance of a symbolic component in AIDS-related attitudes may have relied on a confounded measure of the symbolic component of attitudes. These 5 studies suggest the importance of both instrumental and symbolic attitudes in illness. Instrumental functions seem to outweigh the impact of symbolic functions of AIDS-related attitudes.

Scales were developed to measure the tendencies to blame AIDS victims or the society in which victims live. Data from a sample of 874 students were used to examine the construct validity and reliability of the scales. The list-wise deletion reduced the sample size to the usable sample size of 824. The data showed satisfactory validity and reliability of the scales so they may be used to study attitudes toward those who are suffering from AIDS and related problems.

The impact of AIDS on families has received little attention, and the impact of multiple AIDS-related loss has received almost none. Yet the numbers of families affected by multiple AIDS-related loss continues to grow along with the numbers of AIDS-related deaths. This disaster offers an opportunity to appreciate the importance of families of choice as an alternative or augmentation to families of origin. Multiple AIDS-related loss affects many families, most severely the families of hemophiliacs, homosexuals, and intravenous drug users. Family therapists are in an ideal position to help families cope with multiple loss and should be aware of the unique concerns faced by survivors. In addition to addressing these unique concerns, this article offers suggestions for clinical work with families and individuals affected by multiple AIDS-related loss.

The study investigated the effect of adding a recommendation to use condoms to fear-arousing AIDS public service announcements (PSAs) on subjects' intentions to use condoms and taking of free condoms. Sexual content of the AIDS PSA and subject gender were also varied. A sample of 112 men and 107 women rated the effectiveness of 1 of 8 fear-arousing AIDS PSAs. Four PSAs ended with a message to 'Use condoms to reduce the risk. For more information call _____.' An identical set of PSAs ended with only the telephone number for more information. Results showed that the recommendation had no effect on intentions to use condoms. However, men exposed to a fear-arousing PSA with the recommendation took significantly more condoms than men in the no-recommendation condition. Men also took significantly more condoms than women in the recommendation condition. The results are interpreted in terms of the AIDS risk reduction model (Catania, Kegeles, & Coates, 1990).

Using survey data of a Dutch national sample, the present paper examines how people's willingness to engage in personal contact with persons with AIDS (PWAs) is influenced by different emotional reactions to PWAs. Results indicate that each of the three measured emotional reactions to PWAs (fear, irritation, and pity) independently predicts subjects' readiness to have personal contact with PWAs. Disconfirming the often assumed relationship between 'homophobia' and fear of PWAs, it was found that attitudes toward homosexuals are unrelated to fear of PWAs. Instead, these attitudes are associated with emotions of a more aggressive nature (irritation). Risk perception seems to be related to the emotions of fear and irritation, whereas responsibility attribution seems to be negatively associated with pity.

Teenagers in the United States are one of the populations whose HIV infection rates are increasing most rapidly. This study was designed to measure college students' knowledge of HIV transmission methods using Kittleson and Venglarcik's HIV Transmission Survey. Participants (N = 167) were divided into two groups, 99 students from a rural background and 68 students from an urban background. Students from an urban background were significantly more knowledgeable about documented HIV transmission modes than students from a rural background. Men were significantly less aware of documented HIV transmission modes than women. These results suggest that education about AIDS needs to be improved. The current educational procedures do not properly inform students in a fashion which exhibits the true risk of infection and those behaviors which increase risk. Fifteen years after the discovery of the HIV virus students are still largely unaware that they are at risk for contracting a fatal disease.

Results of 21 studies determined the degree of stigma associated with AIDS compared to the degree of stigma associated with other comparable conditions. Focused contrast analyses indicate a greater degree of stigma expressed toward individuals with AIDS than toward individuals with other comparable illnesses (r = .22), with college students (r = .23) expressing a slightly higher degree of stigma than health professionals (r = .10). A greater degree of stigma was obtained with scales measuring intended social interaction (r = .26) than was obtained with scales containing items measuring attitudes and values (r = .16). Effect sizes did not differ significantly as a function of the type of control condition used.

The present research assessed the relationship between therapists' beliefs and ethical decision making when working with clients who are HIV positive and who refuse to warn sexual partners or use safe sex practices. The sample consisted of licensed psychologists in Florida. Results demonstrated a significant relationship between homophobia and likelihood of breaching confidentiality. In addition, scenarios depicting highly dangerous clients yielded higher breach scores than scenarios depicting less dangerous clients. The study demonstrated that personal bias may affect professional ethical decision making. Discussion focuses on the need for continued education and self-monitoring in work with highly sensitive and often stigmatized client groups.

This paper shows how the co-creation and telling of narratives helped members of an AIDS support group transform their unique and separate experiences of suffering into shared insights, intense connections and comfort. Examples of narratives are drawn from the author's experience as a co-leader of a support group for gay men living with AIDS. Current literature on group work with persons living with AIDS is embedded in a modernist orientation in which the therapist is the scientist/expert, the client has the problem and the therapist helps the client's through exploring and interpreting the client's story according to a superseding theory (Gergen and Kaye, 1992). This approach emphasizes the need for leaders to maintain objectivity and emotional distance to avoid burnout (Gabriel, 1991; Grossman and Silverstein, 1993; Tunnell, 1991). In contrast, in a post-modern therapeutic approach, there is no privileging of the therapist's narrative and the traditional hierarchical relationship is replaced by a mutual effort as therapist and client together develop stories that translate and transcend experience. Using the AIDS work as illustration, this paper offers a post-modern, narrative approach to group work and shows how persons living with AIDS can use narrative to move beyond finite structures and the limits of life.

Weiner's attributional model of helping behavior is used to examine the relationship between the perceived controllability of the onset of AIDS, the affective reactions of pity and anger, and helping judgments. In this model, the effect of the perceived controllability of another person's need on helping is mediated by pity and anger. In the present study, respondents read one of five scenarios describing a friend who had just been diagnosed with AIDS. The cause of the disease was manipulated in the scenarios. Knowledge about HIV transmission measures and respondent's gender were added as control variables to the original model, which was tested by using path analysis. The findings partially support Weiner's model. The effect of the perceived onset controllability of AIDS on helping judgments was mediated by pity, but not by anger. Respondents' anger toward a friend with AIDS did not inhibit help-giving.

In view of the high mortality rates associated with a diagnosis of AIDS, we investigated gay and bisexual (G/B) men's levels of death fear and threat and their relation to religiosity. Participants were grouped into three categories: forty-three who were seropositive for HIV (the HIV + group), sixty-eight who were seronegative but who were involved as volunteers or professionals in AIDS hospices, wards or organizations (the AIDS-involved group), and fifty-five who had no direct involvement in AIDS other than their risk group membership .the uninvolved group). We found that 1) the HIV + group reported greater fear of premature death, 2) the AIDS involved group demonstrated significantly lower levels of death concern than the other two groups, and 3) both the involved and HIV + groups reported higher levels of religious belief than the uninvolved group of G/B men. Finally, intrinsic religious orientation was negatively related to both overall death threat as measured by the Threat Index and fears specific to the possibility of an afterlife, but not to other components of death concern as measured by the Multidimensional Fear of Death Scale.

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered 'survivors' since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N = 129) and HIV-positive (N = 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.

The present article highlights the mental health needs of children living with loved ones who have AIDS or HIV infection. In addition the article describes an intervention program which is being developed to meet the needs of the children and their families. Children who live in families affected by AIDS and HIV infection, like children who live with other life-threatening illnesses, are vulnerable to psychological distress. They experience numerous separations from parents, changes in the nature and predictability of emotional nurturing, concerns about loss, disruptions in routine and contact with peers, and economic hardship. AIDS and HIV infection present the additional stressors that stem from discrimination, stereotyping, and social ostracism. Finally, many families living with AIDS or HIV infection are disenfranchised, living under the pall of poverty and substance abuse. The intervention program described is being implemented in an urban community mental health clinic to meet the diverse mental health needs of the children living in these families. Preliminary implications of the program are discussed so as to begin a dialogue with other agencies who are challenged to meet the needs of this heterogeneous population.

The dominant image of an intravenous (IV) drug user in U.S. society is that of the unbridled 'dope fiend'. It is common in treatment literature to refer to users as diseased and pathologically unable to control their lives. Female IV drug users, as the bearers of children, even more than males, are faced with the paradox posed by conflicting social messages labeling them as irresponsible, dirty 'dope fiends' while approaching them as responsible citizens who need to 'clean up their act' for their children. The paradox of these messages creates a profound moral dilemma involving agency - the ability to develop a flow of conduct by reflexively monitoring intention, purpose, and accountability of actions in the pursuit of a goal - and the social identity of 'junkie'. This article examines this social condition and how it affects the life and options of a woman diagnosed HIV positive. Using narrative discourse and analyzing it through the study of voice I show how an IV drug using woman uses her diagnosis to redefine her life and her social identity, as she changes a negative 'deviant' image into a positive one.