African American Women and AIDS: Factors Influencing Risk and Reaction to HIV Disease

African American women represent the fastest growing group of individuals infected with HIV in the United States. Social and contextual influences on HIV risk vulnerability in this group are discussed, with particular emphasis on risk behaviors related to heterosexual contact and injection drug use. Social factors associated with the sex-ratio imbalance and low rates of condom use in the African American community are addressed, as are contextual influences related to environmental stress and psychosocial issues. We describe interventions that directly address both social and contextual influences on African American women’s risk behaviors. Finally, mental health and psychological concerns are presented as a framework for better understanding women’s reactions to HIV/AIDS and for developing comprehensive programs and services that better meet their needs.

Multiculturalism as a Force in Counseling Clients with HIV-Related Concerns

Multiculturalism has been described as a 'fourth force " in understanding human behavior This perspective recognizes the importance of cultural variables, such as gender and ethnicity, in all clinical work. A multicultural perspective is particularly important in understanding human immunodeficiency virus (HIV) disease because acquired immunodeficiency syndrome (AIDS) epidemic has been defined by cultural variables. This is so both in terms of the transmission of the virus and in the psychosocial issues that have emerged. The purpose of this article is threefold First, an existing model for assessing and counseling clients with HIV-related concerns is presented with an emphasis on how an increased focus on multicultural issues might enhance this model. This is supported by an overview of the literature on HIV from a multicultural perspective. Next, clinical cases are presented to show how counseling interventions might be enhanced by recognizing multicultural issues. Finally, an examination of institutional responses to HIV-related multicultural issues is presented

Lazarus and Group Psychotherapy: AIDS in the Era of Protease Inhibitors

A new class of medications, protease inhibitors, has dramatically improved the health of many people with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). This development has had a major impact on the lives of those affected by HIV/AIDS. This article considers how a group is affected by the larger systems of which it is a part. The article examines changes in the content, process, and salient leadership tasks of an ongoing therapy group for people with HIV and AIDS before and following the initial introduction of new medical treatments. It also considers how the group process continues to be affected by the more recent failure of these medications for many patients. Implications for research, practice, and training are discussed.

Health-related quality of life in HIV disease: achieving a balance

Using grounded theory methods, open-ended interviews were conducted with persons diagnosed with HIV disease to explore and describe how they adjust to living with their disease in relation to their health-related quality of life over the illness trajectory. A substantive theory was generated that describes the process of learning to live with the unpredictability of the disease to maintain life quality. "Archieving a Balance," the core process identified, describes the psychosocial adjustment process of persons with HIV disease from the time of diagnosis to their current circumstances. The process involves balancing the requirements of living with the progression of the disease with the desire to maintain control over one's life, to the extent possible, to maintain life quality. Achieving a Balance is described within the illness trajectory with four major stages--Disintegrating, Renormalizing, Coming to Terms, and Creating Meaning. Characteristics within these stages, which enhance or diminish life quality are described, and a definition of health-related quality, of life is proposed. Interventions are recommended for nurses who care for persons living with HIV disease.

The African-American Health Project (AAHP): study overview and select findings on high risk behaviors and psychiatric disorders in African American men

The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV-1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV-1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub-sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV-1 and substance use. An overview of the methodology of the AAHP and results on high risk sexual and substance use behaviors, and psychiatric disorders are presented and discussed. The sample was primarily HIV-negative (63%), heterosexual (49% gay or bisexual) and a high percentage used substances during the past year (56% used drugs and 30% moderate/heavy drinkers). High-risk sexual practices were relatively prevalent, and a high percentage reported a history of STDs and other infections. Finally, 25% had a current psychiatric disorder, with gays/bisexuals and HIV-seropositives evidencing greater psychiatric vulnerability. More research is needed to further explore the apparent greater risk for psychiatric disorders among gay and bisexual men, and to determine whether being African American and lower social class exacerbate this risk.