Partners of men with HIV infection and haemophilia: controlled investigation of factors associated with psychological morbidity

A relationship-oriented model of HIV-related stigma derived from a review of the HIV-affected couples literature

Previous research has focused on the influence of HIV-related stigma for the psychological adjustment and physical health of persons with HIV/AIDS. Few studies, however, have examined the impact of HIV-related stigma on close relationships where one or both couple members have HIV/AIDS. The current review will integrate previous research findings to substantiate a relationship-oriented theoretical model of HIV-related stigma that delineates interpersonal variables important for understanding the influence of types of HIV-related stigma on couple-level as well as relevant individual-level outcomes. In doing so, supportive evidence is presented from the extant quantitative and qualitative literature that has assessed or examined HIV-affected couple members' experiences with HIV-related stigma. Implications from this review are presented for researchers who examine issues related to HIV-related stigma.

The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: a controlled treatment outcome study

The present study examined the comparative efficacy of intervening at the caregiver/care-recipient dyadic level, versus the individual caregiver level, for caregivers and their care-recipients with HIV/AIDS. Participants were randomly assigned to a Dyad Intervention (DI), a Caregiver Intervention (CI) or Wait List Control group (WLC), and assessed by interview and self-administered scales immediately before treatment and eight weeks later. Participants in the intervention groups also completed a four-month follow-up assessment. Dependent variables included global distress, social adjustment, dyadic adjustment, subjective health status, HIV/AIDS knowledge and target problem ratings. Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress, dyadic adjustment and target problems than the CI and WLC caregivers. The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment. Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment, social adjustment, knowledge, subjective health status and Target Problem 1, whereas the CI and WLC care-recipients failed to improve on any of these measures. The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow-up. Findings support a reciprocal determinism approach to the process of dyadic adjustment and suggest that intervening at the caregiver/care-recipient level may produce better outcomes for both the caregiver and care-recipient than intervening at the individual caregiver level.

HIV-positive people, risk and sexual behaviour

For a long time, the sexual behaviour of HIV-infected persons did not receive any serious attention for a variety of reasons. Initially, diagnosis of HIV-infection appeared to imply a death sentence. In this context, the sex life of those infected seemed a secondary issue making prevention focused on sexual behaviour hard to imagine. Furthermore, the conviction that stigmatisation should be avoided also precluded an interest in the sexual behaviour of HIV-infected persons. From an epidemiological perspective and in the context of the developments in the medical treatment of AIDS it is important to address the sexuality of HIV-infected people. The scarce research done until now shows that there are various ways in which an HIV-infection affects people's sexuality. It seems that the sexuality of HIV-infected people can be compromised by their infection, inducing various sexual problems. Research also shows that there are HIV-infected people who do engage in unprotected sex, just as there are HIV-negative people or people with unknown serostatus who do so. Studies into the determinants of unsafe sex in HIV-infected people suggest that to some extent the same determinants are operative as among people in general. These include intention and self-efficacy regarding safe sex. Recreational drug use also affects safe sex regardless of serostatus. However, safe sex as well as sex in general is different for seropositive persons than for people who are seronegative or have an unknown serostatus. Among seropositive people, sex is also related to dilemma's involving disclosing their serostatus to potential sex partners, and their motivation to protect their partners as well as themselves against surinfection and STD. Furthermore, having to cope with a serious disease induces negative mood states (particularly depression) and may compromise sexual functioning. Comprehensive prevention aimed at HIV infected persons should address these various issues and should be an integrated part of general HIV-prevention.

Heterosexual couples confronting the challenges of HIV infection

Couples confronted with HIV infection face significant challenges. Little is known about the impact of HIV on heterosexual couples who account for the vast majority of cases worldwide and an increasing proportion of cases in the USA, especially among women. In this study, analysis of data collected on HIV-discordant couples participating in a ten-week support group revealed four major groups of issues: (1) dealing with the emotional and sexual impact on the relationship; (2) confronting reproductive decisions; (3) planning for the future of children and the surviving partner; and (4) disclosure of the HIV infection to friends and family. These findings have implications for the design of interventions to enhance adaptation to HIV for discordant couples.

Knowledge generation for the HIV-affected family

PURPOSE

To examine the current literature about HIV-affected families in regard to knowledge development and priorities for future research.

SIGNIFICANCE

The current view of HIV focuses largely on HIV-infected individuals. There is a paucity of relevant research and a need to make explicit the priorities for knowledge generation about HIV-affected families.

SCOPE

HIV family literature, 1980-1996, was reviewed and categorized and serves as the context for presenting future priorities for knowledge generation about HIV-affected families. Priorities identified were designing and testing family-level services; determining epidemiology of the phenomenon of HIV family caregiving; who gives care and why, what caregivers do, the outcomes of caregiving, quality of family care, and relationships

CONCLUSIONS

A critical need is to address in-depth the problems that have limited knowledge development about HIV-affected families. This explication of issues and questions to understand HIV-affected families can stimulate future research.