Abstract by author: A group of 21 HIV-positive gay or bisexual men was compared with a matched group of 22 HIV-negative individuals. All subjects were sexually active gay or bisexual males matched for age, as well as age at first intercourse with males. Subjects completed a detailed sexual history questionnaire as well as a series of standardized measures of psychosocial functioning. Results indicated that subjects engaged in a wide range of unsafe sexual behaviours, and frequently combined drugs with sex. Scores on the Michigan Alcoholism Screening Test (MAST) were significantly correlated with lifetime condom use. Social support was also found to be significantly associated with the lifetime number of homosexual partners. Regression analysis revealed a significant negative association between MAST scores and social support and a positive relationship between social support and CD-4 cell count. The groups were found to be similar in terms of clinical levels of anxiety and depression, self-esteem in interpersonal situations, and risk-taking personality.
Anderson SM (1994). Psychosocial factors predicting sexual risk behavior of homosexual and bisexual males. PH.D. Thesis, University of Missouri, Kansas City, DAI Vol. 55-07B, p. 3002, 98 pages.
Abstract by author: The current descriptive study involved an investigation of the relationships between psychosocial factors and sexual risk behavior of homosexual and bisexual males. One hundred-twenty-three volunteer participants supplied demographic information and completed the Paratelic Dominance Scale and two subscales from the Sensation Seeking Scale, Form V. The data were gathered from self- report questionnaires. Alcohol use prior to engaging in sexual relations and boredom susceptibility predicted sexual risk behavior in the multiple regression.
Results from a discriminant analysis procedure found no statistically significant difference between those individuals who underestimate their risk, from those who overestimate their risk for contracting HIV. The theorized causal path between sensation seeking, alcohol use, and sexual risk behavior was not supported. A follow-up discriminant function analysis, however, was statistically significant. Those males who reported unprotected anal sex in the last three months combined alcohol use with their sexual activities, and scored higher on the Boredom Susceptibility subscale of the Sensation Seeking Scale, Form V than did those individuals who had not reported incidences of unprotected anal sex during that same time frame. The findings were discussed in terms of limitations due to participant characteristics and instrumentation characteristics.
Recommendations for future research were discussed. Implications for counselors were also presented.
Avriette MG (1996). The impact of the AIDS epidemic upon the social support systems of gay men experiencing multiple loss to HIV. M.S.W. Thesis, California State University, Long Beach, MAI, Vol. 34-06, p. 2235, 83 pages.
Abstract by author: This was a qualitative study that explored the social support systems of nine gay men who have experienced multiple losses to AIDS. The study highlighted the emotional impact of the losses upon the men, the nature of their support systems, and the relationship of HIV status to social support.
The findings suggest that these men were affected by loss and that this has influenced the way they interact with their social support systems. The nature of the impact appears to be influenced by the emotional proximity of the loss and the men’s HIV status. Finally, the men’s kinship support systems appeared to include more female than male members
Baab DF (1997). Psychological well-being among gay and bisexual men with Immunodeficiency Virus infection. PH.D. Thesis, Arizona State University. DAI Vol. 58-04B, p 2108, 193 pages.
Abstract by author: The purpose of this study was to assess the extent to which seven factors of psychological well-being predict levels of Distress in a sample of gay and bisexual men with human immunodeficiency virus (HIV) infection. Participants were recruited from various public and private agencies in four states: Arizona, California, Oklahoma, and Texas. A stepwise regression analysis was conducted to predict the level of Distress in the sample. Independent variables included: Accepting, Being Active, Being Optimistic, Masterful Living, Relating Mind and Body, Participating in Health Care, and Experiencing Support. Results indicated that two of the independent variables, Accepting and Being Active, were inversely associated with Distress and significantly contributed its prediction. The regression model predicted 43% of the variance in reported levels of Distress. Implications for counseling and directions for research are discussed.
Bakelaar PJ (1997). The issue culture of the gay and lesbian religious controversy in the age of AIDS; moral argumentation in American mainline religious communities as a symbolic contest between competing interpretations, PH.D. Thesis, Temple University, DAI, Vol. 58-06A, p. 2188, 475 pages.
Abstract by author: The religious controversy over gay and lesbian persons in mainline American religious institutions can be conceived of as an issue culture in which six interpretive packages are operative. A sample of 116 articles from national print media spanning the period from October 1986 to October 1994 is examined for the signature elements which make up these interpretive packages. These articles and other sources provide a database of elements which is used to describe the argumentative practices of the packages as represented by the media. The issue culture is described in detail, with particular attention to the distribution and frequency of elements within and across packages. The argumentative practices are considered in light of interpretive perspectives on community. This analysis offers findings regarding the particular controversy itself, media practices, aspects of issue culture methodology in need of revision and the role of interpretive perspectives in moral controversy.
Barrett, DC (1993). The influence of multiple identities on the health behaviors of gay men. PH.D. Thesis, Indiana University, DAI, Vol. 54-04A, p. 1553, 440 pages.
Abstract by author: Identity-accumulation theory hypothesizes that the internalization as identities of multiple roles that confirm valued self-attributes is health beneficial. This benefit is proposed to be due to an increase in self-worth and other psychosocial resources that are related to health, and to a decrease in the likelihood of engaging in behaviors that endanger the occupation of the related roles. This research investigates the identity-accumulation effect in a sample of gay and bisexual men who attended an STD clinic (n = 416). Statistical analyses showed that subjects who had multiple role-identities used more support-seeking coping and scored lower on substance use measures. Use of support-seeking coping was also negatively related to being involved in HIV-risky sexual behaviors, but possessing multiple role-identities was not related to sexual behaviors. Qualitative interviews of a stratified random sample (n = 12) of subjects from the original sample showed stronger support for the theory indicating that possession of multiple self-confirming identities is related to good psychological adjustment, coping, and health behaviors. The qualitative analyses indicated that some of the weakness in the statistical analyses is due to measurement problems, but also brought into question the expected causal direction of the theory. Based on the qualitative analysis it is concluded that the possession of multiple identities is related to good health behavior when: the individual is committed to the identities; at least one of the identities is self-confirming of the subject’s status as gay; and the identities have diverse reference groups. It is also concluded that having a goal orientation and considering it important to express one’s status as gay is the apparent cause for a subject’s possession of multiple identities, thus reversing the hypothesized causal ordering. These results are hypothesized to be due to a high degree of choice in role adoption by gay men. Implications for identity and identity-accumulation theory are discussed as are the political and public-health implications.
Beatty RL (1997). Relationship of sensation seeking and HIV risk-related behaviors. PH.D. Thesis, University of Pittsburgh, DAI, Vol. 58-03A, p. 1089, 120 pages.
Abstract by author: To further understand HIV risk-behavior, this study examined the role played by the personality trait of sensation seeking explaining high risk sexual behavior. This analysis describes the HIV risk-related behavior of 168 self-identified gay and bisexual men from Pittsburgh. The mean age and education for the sample was 34.2 years (S.D. = 10.5) and 15.4 years (S.D. = 2.7) respectively. Eighteen percent were African American, modal annual income was in the $20,000 to $24,999 range, 95% were tested for HIV antibodies, and 15% were HIV seropositive. Risky Sex was a composite measure of the number of sexual partners reported, proportion of anonymous sexual partners, and proportional use of condoms during receptive anal intercourse. Alcohol use was defined as the product of quantity and frequency of drinking; and drug use was defined as use of marijuana only, or other use in the six months previous to the assessment. Substance use is represented by a series of dummy variables that were derived from the combination of the alcohol and drug use variables. Independent effects of high alcohol use with other drugs, and the disinhibition subscale and total score from Zuckerman's Sensation Seeking Scale Form V (1979b) were evaluated with hierarchical regression analyses. The results indicate that each predictor variable explained a small (2-5%), but statistically significant amount of the variance in the outcome measure of Risky Sex. The disinhibition subscale was found to independently explain as much of the variance as substance use. Social workers can play a critical role in AIDS-related research and practice because they have direct access to many of the most vulnerable populations affected by and infected with HIV, subpopulations that continue to be at risk. The expertise of direct practice social workers can be brought to bear on AIDS research through a variety of mechanisms including the development of collaborative projects, the strengthening of field practicum ties, and the use of focus groups. Social workers are in key positions to advocate for people with HIV/AIDS. Their knowledge of systems and familiarity with referral processes places social workers in a strong position to argue for necessary policy and service delivery changes.
Beaudoin M-N (1995). Contributors to high risk sexual behaviors of gay male adolescents in the era of AIDS. PH.D. Thesis, Pacific Graduate School of Psychology, DAI, Vol. 57-04B, p. 2900, 90 pages.
Abstract by author: The purpose of this study was to examine possible contributors to high risk sexual behaviors among a multiethnic group of 99 gay male adolescents, as this group is considered at high risk for the contraction of AIDS. Three sets of predictors of high risk sexual behaviors were considered: (a) gay male youth’s experience of the coming out process, (b) social support © future expectancies. Significant logistic regressions were obtained for all three sets of predictors. First, with respect to coming out, a small discrepancy between one’s remembered and present sexual orientation, disclosure of sexual orientation to one’s father, and disclosure to one’s father early in the coming out process, were found to be associated with an increased likelihood of engaging in high risk sexual behaviors. Second, with respect to social support, participants who perceived their fathers as having a negative attitude towards homosexuality and participants reporting that the coming out process had negatively impacted their family relationships were more likely to engage in high risk sexual behaviors. Third, with respect to future expectancies, participants who perceived their future plans as having been negatively affected by the coming out process and participants who reported plans for a more distant future were more likely to engage in high risk sexual behaviors. Results are discussed in terms of their contribution to AIDS prevention problems.
Bierman CM (1996). Examining AIDS-related bereavement in gay men: the effects of lack of social support, multiple loss, and participation in final arrangements. M.S.W. Thesis, California State University, Long Beach, MAI, Vol. 34-06, p. 2235, 66 pages.
Abstract by author: This exploratory-descriptive study examined bereavement in gay men. A sample of 11 adult gay men completed a questionnaire which addressed four areas: social support, grief scores, multiple loss, and participation in final arrangements. Lubben’s Social Support Network Scale was used to measure the respondents’ social support. The Texas Revised Inventory of Grief was used to measure grief scores at both the time of the loss and currently. A section devised by the researcher was used to ascertain the level of participation in final arrangements as well as the number of losses suffered. This study found a relationship between participation in final arrangements and lower grief scores. Also apparent was a relationship between very high numbers of losses and high grief scores..
Publication No.. 1380182
Blackwell PA (1994). African American homosexual/bisexual males and the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome: a study of racial identity and health care attribution. ED.D. Thesis, East Texas State University, DAI Vol. 56-02B, p. 088, 120 pages.
Abstract by author: Purpose of the study. The purpose of this study was to examine racial identity attitudes and health attribution locus of control conditions within a population of African American homosexual/bisexual males diagnosed with the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). This work was designed to add to the field of knowledge and to provide the basis for a future model of counseling that is sensitive to this population.
Procedure. A total of 129 subjects participated in the study. Subjects were Dallas-area African American homosexual/bisexual males diagnosed with HIV/AIDS. Subjects were administered the Racial Identity Attitude Scale, the Health Attribution Test, and a personal information data sheet. The data were analyzed using stepwise multiple regression.
Findings and conclusions. Data presented in this study revealed the following: (1) The Racial Identity Attitude Scale "internalization" subscale predicted the Health Attribution Test "external chance" subscale within the subject population. (2) The Racial Identity Attitude Scale "immersion-emersion" and "pre-encounter" subscales predicted the Health Attribution Test "external powerful others" subscale within the subject population. (3) The Racial Identity Attitude Scale "immersion- emersion" and "internalization" subscales predicted the Health Attribution Test "internal" subscale within the subject population. (4) The Racial Identity Attitude Scale "encounter" subscale did not predict any of the Health Attribution Test subscales within the subject population.
Bloom FR (1996). Living in the HIV spectrum: life stories and illness narratives of gay men. PH.D. Thesis, Case Western Reserve University, DAI, Vol. 58-01A, p. 202, 249 pages.
Abstract by author: This dissertation investigates the illness experience of gay men living in the HIV spectrum (n = 20). A reflexive approach serves as context for presentation of life story narratives. Emphasis is placed on psychocultural themes and stylistic orientations to living with HIV infection. Cultural values are identified in an exploration of the powerful influence of culture on the meaning of illness experience. Theoretical concepts of liminality (period of transition between states of being, e.g. neither sick nor well) and communitas (community of individuals without place attachment) are examined as a framework within which illness experience is better understood, particularly with regard to life events and social support respectively.
Two clusters of life events affected perceived quality of life, (defined as self-evaluation of everyday life experience): recurrent deaths of friends due to HIV-related illness (n = 10), and recurrent exacerbations or complications of HIV infection (n = 8). In one individual experiencing a cascade of both types of life events, there was a perception that a part of one’s personal history had lost its meaning resulting in a disturbance of the temporal orientation of the self. Unexpectedly, Twelve-Step programs were a source of communitas for some participants in this study (n = 5). Involvement in these groups influenced the content and structure of narratives which make up the life story. This involvement, along with limiting talk about HIV in social interactions of everyday life (n = 7) is presented as evidence of persons’ attempts to regulate the social course of their illness.
Recurrent themes were identified among the participants of this sample, such as overcoming obstacles and enduring hardships. Associated with this was a stylistic orientation of being a survivor (n = 15). This theme and stylistic orientation were extended to experience with HIV infection implying survival and endurance in this present situation. Core American (United States) cultural values of self-reliance and achievement are central to the meaning of this and other themes. These and other core American cultural values are shown to be implicit in the meaning attributed to illness experience and judgments of quality of life.
Bruce RG (1996). A coping skills intervention for newly diagnosed HIV-Positive women. PSY.D. Thesis, California School of Professional Psychology, DAI Vol. 57-08B, p. 5318, 300 pages.
Abstract by author: In the second decade of the AIDS epidemic, women now constitute the fastest growing segment of U.S. cases of a disease once labeled "Gay Related Immune Disorder." Statistics from the Federal Center for Disease Control indicate that while rates of AIDS infection in the general population have leveled at 3%, reported AIDS cases among women have grown 17% in the last two years. This alarming trend is believed to be fueled by the rise of heterosexual transmission as the fastest growing category of viral transmission. As the epidemic increasingly spreads into the heterosexual and bisexual population, experts predict exponential increases in female infection.
Disturbingly, HIV infected women are currently underserved by researchers, disease educators and the medical community at large. Widespread misdiagnosis, misinformation, as well as inadequate medical and emotional support are thought responsible for 27.5% of infected women who experience death as the "first observable event" of their illness, as compared with 12.2% of infected men. This dissertation first explores the nature and course of the HIV virus and presents an overview of the universal stressors inherent in receiving a seropositive diagnosis. An historical survey of the Mind-Body Connection in physiological health is offered.
The Mind- Body link is then considered in the context of new AIDS treatment trends away from 'cure' and towards a viral dormancy model. The discussion then turns to the significance of psycho-educational interventions in slowing disease progression. Research on coping and specifically coping with illness is presented. The work then narrows its focus to address stressors endemic to newly diagnosed women. A spectrum of coping needs for this population is explored.
In conclusion, an original psycho-educational coping skills intervention for newly diagnosed HIV positive women is presented. This intervention appears in workbook format and utilizes interactive skill building techniques to address issues of problem solving, stress management, negotiation, self advocacy, and effective support building. The workbook also includes 'user friendly' educational sections on gender specific HIV information, immune system functioning and the mind-body connection in stress reactions. Referrals to local and national AIDS support organizations and to educational publications are provided.
Burns DM (1993). Why didn't you use a condom? On the coherence of gay men's explanation for lapse behavior. PH.D. Thesis, University of Southern California, DAI Vol. 54-08A, p. 2795.
Abstract by author: Despite initial reductions in high risk behaviors, many gay and bisexual men now engage in an "on and off again" pattern of risky sexual behaviors, referred to as AIDS lapse behavior. It is difficult to imagine how gay and bisexual men who lapse can, in any coherent way, simultaneously understand the tremendous risks involved and also justify them. The goal of this research is to examine how individuals of differing HIV status, relationship type, risk level, and levels of sexual activity (e.g., numbers of sexual partners) differ in the coherence and thematic nature of their accounts of risky behaviors. Forty-five predominantly White, sexually active males (18 to 45), were interviewed concerning three sexual episodes (most recent, most regrettable, and most enjoyable). Participants were asked to listen to the audiotape of their most risky episode; for each "behavioral moment" participants were asked to indicate their own and their partner's feelings, beliefs, and goals. They were asked specifically why they failed to use a condom during their most risky episodes. Men most at- risk for lapsing (e.g., HIV positive, non-monogamous, high risk-takers, and many sexual partners) blamed their partners for lapses (arguing that they overlooked implicitly coded warning messages); Lower risk men tended to deny the risky nature of their behaviors or justify lapses as fostering a "steady" relationship. Computer simulations (PDP modeling) of detailed explanations of sexual episodes and multivariate analyses of variance revealed that (a) the accounts of men who were HIV positive, monogamous, or both were the most coherent, and (b) HIV positive men were more likely than HIV negative men to rely on visually oriented behavioral themes. These findings suggest that HIV positive men, who may have spent more time thinking about their risky behaviors, may have more detailed, integrated, and easily retrievable knowledge structures regarding their sexual behaviors. Implications of these findings for the development of targeted lapse interventions are discussed. (Copies available exclusively from Micrographics Department, Doheny Library, USC, Los Angeles, CA90089-0182.
Cassel JB (1995).Altruism is only part of the story: a longitudinal study of aids volunteers. PH.D. Thesis, City University of New York, DAI, Vol. 56-05B, p. 2937, 125 pages.
Abstract by author: This study of AIDS volunteers examined participants' reasons for volunteering, how their reasons changed, and the relationship between their reasons and the consequences of volunteering. The three-wave data set was collected from 587 volunteers at Gay Men's Health Crisis (GMHC) in New York City between 1988 and 1991.
Participants completed a scale that measured six different reasons for volunteering. Cluster analysis identified seven distinct patterns of reasons, or types of volunteers. For example, "self-sacrificers" seemed, relative to others, more altruistic in their pattern of reasons for volunteering. In contrast, another group was labeled "getters" because they sought mostly to gain certain experiences and personal growth for themselves through volunteering. The typology was moderately related to participants' demographic characteristics and previous HIV/AIDS experiences.
Several months after they started volunteering, participants again completed the same measure of reasons in terms of why they continued to volunteer. Most participants had a different pattern of reasons. Equal numbers of participants became more altruistic and less altruistic, and an increase in altruism was related to being a gay male volunteer and to more AIDS-related experiences prior to volunteering. Changes in reasons were unrelated to the volunteering experiences measured. Volunteers' patterns of reasons were not related to their volunteering behavior, including choice of role, but were related to their emotional reactions to the work. For example, the "self-sacrificers" in this study expressed the least amount of burnout, gratification, and personal growth; while behaviorally engaged in the work, they were emotionally disengaged from it relative to other volunteers.
This study breaks new ground for research on altruism: it was prospective and longitudinal, included multiple measures of reasons for volunteering, and was conducted entirely using people engaged in real, long-term helping behavior. Several ways of extending this research are discussed. This study also provides a methodological template for the use of cluster analysis as a tool for defining types of people; implications are drawn from this for further research on personality traits.
Finally, practical implications are discussed for AIDS organizations that rely on volunteers.
Chernyk BK (1990). Psychosocial predictors of safe and risky sexual behavior in gay and bisexual men at-risk for HIV infection. PH.D. Thesis, Ken State University, DAI Vol. 51-07B, p. 3344, 205 pages.
Abstract by author: Because there currently exists no cure for or vaccine against HIV infection, illness prevention in gay and bisexual men depends primarily on modifying unsafe sexual behavior. A comprehensive review of the risk reduction literature on AIDS yielded information regarding the correlates of AIDS risk reduction and methodological problems in previous investigations. Drawing from extant literature on health promotion and disease prevention, it was concluded that variables of import in this literature had not been sufficiently assessed in the literature addressing prevention of HIV infection. With exploration of variables related to the prediction of safe and risky sexual behavior as the goal, the purpose of the present study was to explore the relationship of variables which included: affect (anger, depression and anxiety), fear, homosexual attitudes, health locus of control and social networks to current sexual behavior.
Methodological flaws in previous literature which included: over reliance on retrospective reporting of behavior changes, inadequate use of psychometrically sound instruments to assess constructs in question, and selection bias (frequent use of settings such as gay bars and sexually transmitted disease clinics) were considered. To address such concerns, the 102 gay and bisexual men in the current study were solicited in a variety of settings, responded to psychometrically sound instruments to assess the constructs under study, and reported the frequency and typicality of their unprotected risky sexual behavior for the period of the most recent month. A stepwise discriminant function analysis (DFA) was conducted to identify a composite of psychosocial variables which could predict safe versus risky sexual behavior. Results of this analysis indicated that gay and bisexual men who engaged in risky sexual behavior could be significantly discriminated from their counterparts who engaged in safe sexual behavior on the basis of six discriminating variables which included: state anxiety, depression, gay social support, negative attitudes toward the disclosure of their homosexuality, internallocus of control and external locus of control.
Although results of the derivation analysis indicated that group membership could be predicted with an overall accuracy rate of 75%, results of the replication analysis suggested that prediction of group membership occurred at a rate which was notably less accurate than that observed initially. Relatedly, despite the emergence of a composite of six discriminating variables, only the variable of internal locus of control was statistically significant, and this finding was not in the predicted direction. The limited clinical utility of the DFA, questions raised regarding participants' denial of their risk vulnerability and methodological considerations of the current study are discussed.
Clarke CA (1995). AIDS, gays and drugs: a negotiated social order. M.A. Thesis, Queen's University at Kingston, MAI, Vol. 34-03, p. 1060, 156 pages, ISBN: 0-612-04674-5.
Abstract by author: This thesis explores the negotiation of social order between agencies of social control and specific marginalized groups. To illustrate this complex process of negotiation, I rely upon the current AIDS epidemic and the dynamic relationships that evolved between the medical sector, the gay community, intravenous drug users and, to a lesser degree, law enforcement. The marginalized groups negotiated and defined an interactive role within the AIDS crisis. More importantly, within this same process of negotiation, the corresponding social control sector made concessions while, at the same time, it strengthened and realigned its position of control.
In chapter one, I introduce a historical perspective of the AIDS epidemic and contextualize each of the above-mentioned groups. Chapter Two will examine the process in which the crisis of AIDS had been defined and the manner in which risk groups were identified and negotiated. Chapter Three consists of unpacking the theoretical positions from which I examine the negotiation of social order. These positions are represented by resource mobilization theory, Antonio Gramsci’s theory of Passive Revolution, and Michel Foucault’s examination of power. In Chapter Four, the concrete process of movement organization, the means of mobilization and the dynamics of coopting as they relate to Resource Mobilization theory, will be laid out within the context of the AIDS epidemic. Chapter Five examines, within an AIDS context, the struggle for ideological control as explored within Gramsci’s Passive Revolution. Chapter Six considers the interplay of power and resistance and the manner in which the struggles to control identity and behaviour occur. Finally chapter seven, the conclusion, will summarize the negotiation process and suggest that the process is one of governance supported by the intertwining of the above theoretical concepts.
Crosby GM (1993). Psychosocial variables distinguishing gay male substance abusers practicing risky and safer sex while under the influence of alcohol or drugs. PH.D. Thesis, The Wright Institute, DAI Vol. 54-05B, p. 2745, 165 pages.
Abstract by author: An association between substance use and high risk sexual behavior has been empirically demonstrated in the literature (Stall, McKusick, Wiley, Coates, & Ostrow, 1986). However, the strength of this link is not clearly understood. The purpose of this study is to examine factors that contribute to unprotected sex among gay/bisexual male substance abusers. Four hundred and fifty-five gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and interviewed using the Timeline Follow back Method (TL) on sexual behavior, substance use, and related variables. The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, or anal intercourse on each of the 30 days prior to the last date of alcohol or drug use.
Two patterns of substance use and concurrent sexual behavior are compared. Group 1 is composed of respondents who used alcohol and or drugs and always had protected anal intercourse (n = 43); Group 2 is composed of respondents who used alcohol and or drugs and always had unprotected anal intercourse (n = 88). The unprotected group was significantly more likely to not perceive that safer sex is the community norm (p < .001), not to have encouragement from friends to practice safer sex (p < .001), have less control of their impulses (p < .008), feel that sex without love is satisfying (p = .003), and perceive their risk of HIV infection (p < .001).
These findings suggest that one of the goals for risk-reduction efforts may not simply be to avoid sex while under the influence of alcohol or drugs but to develop social support which encourages a safer sex lifestyle. Substance abuse treatment facilities can play a major in this through group and individual work. In addition, suggestions for the continuing use of the Timeline Follow back Method are offered.
Daniel DR (1994).Counseling gay white men with HIV/AIDS: an ethnographic field study in Phoenix, Arizona. ED.D. Thesis, Northern Arizona University, DAI, Vol. 55-10A, p. 3137, 265 pages.
Abstract by author: To date the number of HIV-related deaths in the United States exceeds 200,000. Since 1981 current total cases of HIV infection is estimated to be two million. The needs of individuals infected with and affected by HIV expand as the virus extends to new sectors of the population. Counseling professionals often lack the training and experience to understand the HIV/AIDS epidemic and further, they lack understanding of the gay white male subculture which has been most adversely affected by the disease. This study investigated the phenomena of HIV in the gay community of Phoenix from the prospective of a straight, female counselor in an AIDS service agency.
Fifteen gay, HIV+ males receiving counseling at the Phoenix Shanti Group and Living Center became key informants for the study which employed ethnographic methods. These men provided information to the researcher about their perceptions of the gay "culture", their lifestyle, and the effects of HIV/AIDS. Structured interviews with nine of the informants were conducted and researcher observations of the daily activities of the subculture were recorded by subject matter as field notes and journal entries.
Research questions one and two investigated the knowledge and skill competencies need to provide effective counseling services to members of the gay white HIV+ and AIDS-affected male community. The study found that counselors needed to be knowledgeable about gay lifestyles, sexuality, kinds of intimate relationships, social life, and community networks.
Issues included nature versus nurture in gay development, realities and myths of "choice" of sexual preference, the coming-out process, spiritual beliefs, and sibling and parental relationships. Openness of mind and an accepting heart were found to be necessary and helpful attributes for the professional counselor, particularly because of the constant presence of death and dying issues in the client population. Group leadership emerged as a valuable skill, as counselors are called upon to lead a variety of support and therapy groups.
Question three investigated knowledge and skill competencies important in counselor education programs. A model course description and curriculum for training students to work with sexually diverse clients is provided; a syllabus for health education as early intervention in the clients' HIV process was also developed. Question four explored dynamics associated with being a straight, female in a gay white HIV+ male subculture.
Depalo RL (1997). Spirituality, dealing with illness, hopelessness, and multidimensional fear of death as perceived by gay men with Acquired Immune Deficiency Syndrome (AIDS). PH.D. Thesis, DAI, Vol. 58-06A, p. 2392, 211 pages.
Abstract by author: Using the four psychologies as theoretical framework, a comparative study identified levels of spirituality, hopelessness, coping and multidimensional fear of death in sixty-five gay men with AIDS. Five instruments were used to collect data: a demographic questionnaire that included alternative healing techniques used, Spirituality Assessment Scale, Hopelessness Scale, Dealing With Illness Inventory, and the Multidimensional Fear of Death Scale. Study data were analyzed using descriptive statistics, Pearson correlations, Dunn-Bonferroni correction, and multiple regression analyses.
How an individual deals with his illness emerged as a strong predictor of key variables, including spirituality and aspects of fear of death. Apparently an individual’s ability to cope positively via cognitive or behavioral strategies, or negatively via avoidant strategies can predict his reliance upon spirituality and fears associated with dying. Increasing positive coping strategies, decreasing avoidant strategies would therefore be crucial goals in the therapeutic process when working with gay men with AIDS.
Dey AM (1993). The relationship between the health belief model and condom use by gay/bisexual males as a means of HIV/AIDS prevention. PH.D. Thesis, University of Missouri, Kansas City, DAI Vol. 55-02B, p. 576, 180 pages.
Abstract by author: HIV/AIDS continues to be the most serious infectious disease epidemic of modern times. AIDS was first identified among gay/bisexual males in 1981, and this population remains the largest exposure category for HIV/AIDS in the United States. In the absence of a medical cure for HIV/AIDS, the development of psychosocial models to control infection rates is critical.
The transmission of HIV is behavioral with the most common means of infection between gay/bisexual males through unprotected sexual contact. Factors identified as critical in reducing transmission risk among sexually active gay/bisexual males include the adoption of the use of condoms during high risk sexual activities. HIV/AIDS behavioral change efforts rely upon individuals assessing risks associated with types of sexual behavior. Thus a general model of behavioral change has been hypothesized to be integral to the understanding of the mechanics of adopting and maintaining safer sex behaviors. The Health Belief Model (HBM) has been suggested as one such model.
Two hundred and fifty self-identified gay/bisexual males were recruited to complete an instrument designed to assess their Perceived Severity of HIV/AIDS, Perceived Susceptibility to HIV/AIDS, Perceived Barriers to condom use, Perceived Cues to condom use and Perceived Self- efficacy of condom use (components of the HBM). Subjects ranged in age from 25 to 49. Linear multiple regression was used to test the applicability of the HBM related to self-reported sexual behaviors. Only variables related to behaviors with a regular partner proved to be significant.
Perceived Severity was shown to be a negative predictor of the use of condoms (p <.05) when engaging in active and passive anal sex, as well as active and passive oral sex. Perceived Self-efficacy was shown to be a negative predictor of the use of condoms (p <.05) when engaging in active oral sex. The hypotheses based upon the relationship of the HBM variables and participation in unprotected high-risk sexual activities were not supported.
Dixon GA (1997). The play(s) of AIDS. PH.D. Thesis, University of California, Berkeley, DAI, Vol. 58-07A, p. 2466, 440 pages.
Abstract by author: The AIDS epidemic has destroyed millions of lives worldwide, but it can be perceived as beautiful. Jean Baudrillard has suggested that AIDS is a savior because it returns a sense of reality to a world mired in hyperreality. This dissertation examines AIDS as a Play within society and also AIDS drama (the plays of AIDS) in an attempt to examine whether AIDS can be viewed as a savior. Various critical methodologies, such as deconstruction and Chaos theory, are used in this examination.
People such as Rock Hudson, Gaetan Dugas and Peter Duesberg were transformed by AIDS. Some used AIDS for their own ends (Players) and others were used by the epidemic (Characters). The transformative nature of the epidemic is revealed in both groups. The major part of this work considers how AIDS has influenced a number of creative artists, with a concentration upon novelists and playwrights. Before AIDS Paul Monette was personally contented but professionally unsatisfied as a writer of film novelizations. In works such as Borrowed Time and Becoming a Man he catalyzed a renaissance in a deeply personal style of American literature. Similar positive transformations occur with playwrights such as Larry Kramer, Harvey Fierstein and Robert Chesley. But these transformations are temporary as most of the writers eventually died of AIDS.
Tony Kushner’s Angels in America is a watershed in American theatre. Its importance ranges beyond the theatre as it illustrates that AIDS has brought a visibility and apparent acceptability to gay people which previously did not exist. Small areas of hate do exist, but these are overwhelmed by a growing gay visibility and power. Paradoxically, AIDS has saved the gay community while simultaneously threatening to destroy it. But with AIDS films (Longterm Companion, Philadelphia) the positive transformation by AIDS has been diluted by commercial forces. The work ends with a consideration of Kids, a film which suggests that to the teenage generation who have never known a world without AIDS, the epidemic is merely one aspect in a kaleidoscope of nihilism. The time of AIDS as a savior was brief.
Domanico RJ (1994). Psychosocial distress among HIV positive ethnic/racial minority males. PH.D. Thesis, Loyola University of Chicago, DAI Vol. 55-05B, p. 2005, 180 pages.
Abstract by author: HIV infection is disproportionately more common among ethnic/racial minority members as compared to Caucasians. Yet, the vast majority of research on the psychosocial effects of having HIV/AIDS has primarily focused on middle-class, Caucasian gay males. This study was an attempt to evaluate the psychosocial correlates among African-American and Latino males infected with HIV. A total of 100 males infected with HIV participated in this study. All volunteers were drawn from the six Human Retroviral Disease clinics at Cook County Hospital in Chicago, IL. The sample consisted of 69% African- American, 15% Caucasian, and 12% Latino. The mean age of participants was 36.80 years (SD = 7.73).
A large proportion of participants reported having contracted HIV via homosexual sexual activity (45%); whereas, 18% reported contracting HIV via IV drug use and 15% reported contracting HIV via heterosexual sexual activity. A number of hypotheses assessing the relationship between various aspects of mood disturbance, coping methods, health locus of control, health value, spiritual well-being, and social/emotional support were analyzed. The results were variable. A number of analyses indicated that greater levels of spiritual well-being were correlated with increased positive mood and feelings of energy. In addition, individuals who primarily engaged in active-cognitive coping methods and strongly valued health possessed higher levels of positive affect as compared to individuals who primarily engaged in avoidant coping behaviors and strongly valued health.
Gay Latino males presented as having higher levels of psychological distress (i.e., overall mood disturbance, depression) as compared to their African-American and Caucasian gay counterparts. This finding was largely attributed to gay Latino males having a greater number of physical symptoms and encountering homonegative attitudes associated with Latino cultural norms and religious beliefs. The therapeutic implications from the research are presented along with recommendations for future studies.
Durvasula MS (1997). The independent and interactive effects of HIV-1 and cocaine use on neurological performance in African-American men. PH.D. Thesis, University of California, Los Angeles, DAI, Vol. 57-11B, p. 7222, 170 pages.
Abstract by author: The primary aims of this study were to examine the independent and interactive effects of HIV-1 serostatus and cocaine on neuropsychological (NP) performance and to test the brain reserve hypothesis in a sample of 237 gay and bisexual urban dwelling African American men.
Consistent with current evidence, it was expected that: (1) symptomatic seropositives (SSPs) would evidence poorer NP performance than seronegatives (SNs) and asymptomatic seropositives (ASPs) especially in domains affected by HIV (i.e., memory, psychomotor speed and frontal systems) and tests that are sensitive to subtle slowing; (2) individuals with more current or recent cocaine use would perform more poorly than those with no current or past use; (3) serostatus and cocaine would interact to yield poorer NP performance; and (4) brain reserve theory would predict greater NP impairment in seropositives and cocaine users with low education. The study sample was relatively young, lower SES, moderately educated, but mostly unemployed/underemployed and most were light-moderate drug and alcohol users, with few injection drug users in this sample. Multivariate analyses controlling for age and alcohol revealed that SSPs evidenced significantly poorer performance than SNs on tests of psychomotor speed, especially Trails B. A significant serostatus effect was also observed on reaction time (CalCAP Sequential Reaction Time) and nonverbal memory tests (Picture Memory Interference Test, Books C & D), with SSPs evidencing poorer performance than ASPs. A significant effect of recent cocaine use was found for psychomotor speed, with current users performing worse on Digit Symbol than individuals without current or past history of cocaine use. No interaction of serostatus and cocaine was noted for any NP domain. The expected serostatus and cocaine differences on verbal memory and frontal systems were not obtained. However, lower alcohol consumption appeared to benefit ASPs’ performance on tests of reaction time compared to SNs and SSPs. An interactive effect of education and serostatus was not obtained, but older age was associated with greater NP deficits. An attenuated range of education in this sample limited the sensitivity of the test of the reserve hypothesis.
Elfand LM (1996). Psychologists' beliefs around protecting third parties and maintaining confidentiality with HIV patients. PH.D. Thesis, Pacific Graduate School of Psychology, DAI, Vol. 57-08B, p. 5322, 163 pages.
Abstract by author: This study explored psychologists’ beliefs regarding the duty to maintain confidentiality and the duty to protect third parties when treating male HIV-positive patients who participate in high-risk sexual behavior without informing their partner(s) of the seropositive status. Survey protocols were mailed to 2100 randomly selected psychologists who are members of the American Psychological Association (APA). A total of 396 psychologists returned the completed survey. Each protocol included four hypothetical scenarios followed by statements soliciting beliefs about confidentiality, two questions requiring written responses, and a demographic questionnaire. The four hypothetical scenarios required the participants to assume their male HIV-positive patient engaged in high-risk sexual behavior without notifying the partner(s) of the HIV diagnosis. The scenarios were identical with the exception of the patient’s partner’s gender and the number of partners.
Participants responded to eight statements about confidentiality and duty to protect by rating their level of agreement or disagreement on a 7-point likert scale. Factor analysis of the hypothetical scenario statements yielded three distinct domains: willingness to breach confidentiality, partner responsibility, and decreased confidentiality as a result of intravenous drug use. The three factors comprised the dependent variables. Data were analyzed using multiple regression, analysis of variance (ANOVA), and t-tests. Psychologists who were more likely to maintain confidentiality were younger, lesbians or gay men, received their degree more recently, had professional HIV training, HIV consultation, experience with HIV patients, and treated a greater number of HIV-positive patients. Psychologists were more likely to maintain confidentiality when the patient was involved with multiple partners.
The results suggest that decisions about confidentiality and the duty to protect are in part related to identifiable background characteristics of the psychologist(s) who must make the decision. Implications for improving the caliber of treatment for HIV affected individuals include graduate training and continuing education. Recommendations are made for further research on the factors that influence beliefs and decisions about HIV, confidentiality, and the duty to protect.
Farenbach CM (1992). AIDS-related loss in uninfected gay men: an exploratory study of the psychological consequences of loss and change. PH.D. Thesis, California School of Professional Psychology, DAI, Vol. 53-06B, p. 3152, 373 pages.
Abstract by author: This study was an exploration of the impact of the AIDS epidemic on the lives of uninfected gay men. It was hypothesized that uninfected gay men would be experiencing grief related both to the illness and death of peers and to related profound social change in their community. In addition, it was thought that they would be responding to such change in greater or lesser measure by restructuring their lives and reconstructing the meaning they attribute to their lives.
Subjects were sought through gay-related social service agencies in the San Francisco area. Using a semi-structured interview, 12 uninfected gay men between the ages of 28 and 42 were asked to discuss aspects of their life history, experience of coming out, career development, and experiences of HIV, including issues related to loss, HIV testing, gay identity, health issues, sexuality and relationships, and changes related to lifestyle, self-perception, and life meaning.
Transcripts of the interviews were individually summarized and then analyzed as a group in order to identify and describe specific trends. The results suggest that uninfected gay men are experiencing the effects of loss of peers as well as changes in lifestyle. The men in this sample appear to be in a chronic state of grief due to loss. The experience a great deal of survivor guilt related to being HIV-negative, often feel unsure that they are truly negative, struggle with issues related to relationships, and are attempting with varying degrees of success to find ways to meaningfully adjust to the loss and change. Clinicians should be aware that issues of loss and grief may be difficulty for members of this population to address because of loss overload, denial, and survivor guilt. While there was impressive evidence of psychological resilience, the working through of grief, and the discovery and construction of new meaning in their lives, it is not clear how continuing protracted loss will affect this population. It may have significant impact on their ability to survive in a psychologically healthy way.
Furin JJ (1995). Becoming my own doctor: gay men, AIDS, and alternative therapy use in West Hollywood, California. PH.D. Thesis, University of California, Los Angeles, DAI, Vol. 56-05A, p. 1864, 371 pages.
Abstract by author: This dissertation is based on a two year ethnographic study done in West Hollywood, California. It focuses on the use of alternative therapies by gay men with AIDS. Results show that 69.2% of the men in the study are currently using some type of alternative treatment for their HIV disease. A majority of them also use some type of Western biomedical treatment as well. People use numerous types of alternative therapies to treat their HIV disease. These therapies range from acupuncture and herbal treatments to ozone therapy and bitter melon. In all, 89 alternative therapies were uncovered during the course of the study. In addition to describing these alternative therapies, this study looks at factors which impact how gay men with AIDS make treatment decisions. Alternative therapy use is ultimately seen as part of a larger AIDS activist movement in the gay community.
Gans AA (1992). An exploration of the relationship of oral sex and HIV transmission among gay and bisexual men. M.P.H. Thesis, San Jose State University, MAI Vol. 31-01, p. 299, 90 pages.
Abstract by author: This case finding study interviewed twelve gay and bisexual men who believed they were infected with HIV through oral sex. Personal histories were reviewed to rule out alternative routes of infection including blood contact, needle sharing, and anal or vaginal intercourse. Upon analysis, five men were found to have no other risk factors and were determined to be cases of oral sex transmission. Three men had engaged in some high risk behaviors and were categorized as likely cases. Through the interviews, other risk factors emerged in the histories of the four remaining individuals. The study examined which specific oral sex activities were associated with the cases. In addition, potential risk co-factors such as oral and dental problems, history of sexually transmitted diseases, number of sexual partners and substance use were examined. The case finding methodology and results are reported, along with implications for education, counseling, and future research.
Gillespie SL (1996). Toward an understanding of family relationships for HIV-positive gay couples. M.S.N. Thesis, The University of Western Ontario, MAI, Vol. 35-03, p. 790, 124 pages, ISBN: 0-612-14959-5.
Abstract by author: Little research has been conducted exploring the experiences of gay couples in which one or both partners are infected by human immunodeficiency virus (HIV). In this phenomenological study nine couples participated in a semi-structured audio-taped interview. Resulting verbatim transcripts were hermeneutically analyzed by the researcher to identify patterns in the experiences of these men. As a result, one central theme emerged: building bridges and risking relationships. This theme described the meaning of the complex process of maintaining and establishing relationships for these men. Double jeopardy was a term used to describe disclosure of sexuality and HIV status. The individual and the couple have the potential to benefit or lose through the act of disclosure. This process is explored between the couple and within the family unit. Implications for nurses on a personal and professional level have been discussed.
Golden JA (1995). Psychosocial factors in the progression of Acquired Immunodeficiency Syndrome. PH.D. Thesis, University of South Florida, DAI Vol. 56-12B, p. 7045, 100 pages.
Abstract by author: The purpose of this study was to examine the effects of emotions, personality traits, and coping styles on the progression of AIDS (HIV) in asymptomatic HIV seropositive adult men (n = 57) and women (n =10). The relationships of anxiety, depression, and the experience, expression and control of anger to the progression of AIDS were examined. The impact of an active coping style (fighting spirit) and utilization of lifestyle defenses on AIDS progression were also examined. This study was prospective in design. Psychosocial variables were assessed with self-report questionnaires at the beginning of the investigation. The clinical status of each participant, as indicated by T cell levels and the development of AIDS-related symptoms, was evaluated approximately six months after the assessment of emotions, personality traits, and coping styles. By the time of the follow-up assessment, 14 participants had developed symptoms including 4 who were diagnosed with AIDS. Participants who remained asymptomatic during the 6- month follow-up period reported expressing more anger towards other persons or objects in the environment, as reflected by significantly higher AX/Out scores, than the participants who were diagnosed with AIDS or developed AIDS-related symptoms.
This finding was further supported by the higher AX/Out scores of the asymptomatic participants who showed either an increase or only a small decrease in T cell levels at follow-up, as compared to those who showed a greater decline in T cell levels. In multiple regression analyses, AX/Out was the only psychosocial variable that predicted outcome status. Results also indicated that participants who reported receiving HIV through intravenous drug use had significantly higher RAT subscale scores than those reporting HIV transmission through either homosexual or heterosexual contact.
Contrary to expectation, more than 35% of the participants actually showed an increase in T cells over the course of the study. There was a great deal of variability in both the initial T cell levels and in the change in T cells over a relatively brief period of time. Limitations in this study and suggestions for future research are discussed.
Gudino A Jr (1996). Biopsychosocial correlates of HIV/AIDS infected African-American males. PH.D. Thesis, DePaul University, DAI, Vol. 57-10B, p. 6572, 109 pages.
Abstract by author: One of the objectives of the current study was to determine the relationship between altered psychological state (i.e., psychological distress, depression and hopelessness), social support, substance use, number of physical symptoms, and immune functioning among HIV- infected African American men, and secondly to further increase the visibility of men of color (e.g., African- Americans) within the HIV/AIDS literature. A total of 50 African-American males infected with HIV/AIDS were recruited for this research project. All participants were obtained from the six Human Retroviral Disease (HRD) clinics at Cook County Hospital (CCH), Chicago, IL, where they receive outpatient medical services. The median value age of the participants was 38.4 with an average t-cell count of 222.3. Of these fifty individuals, 28 were heterosexual and 22 were homosexual/bisexual. In addition, 20 reported contracting the HIV virus through sex with another man, 14 through sex with a woman, 14 through IV drug use, and 2 through blood products. At the time of initial intake, every patient was administered a set of inventories by a mental health professional. The list of measures is as follows: a Demographic Questionnaire, the Cage (deals with substance use), CES-D (assesses depression), the UCLA Loneliness Scale (deals with social systems), the Hopelessness Scale, the Profile of Mood States (assesses overall psychological distress), a Physical Symptom Checklist, and finally t-cell counts were collected from medical charts. Initially, the data of this research project was explored through a development of a correlation matrix that rendered all major variables, except t-cell count, as significantly correlated. Additional analyses, such as step-wise multiple regressions and t-tests were conducted to examine the various hypotheses put forward in this study. Findings indicated that higher levels of loneliness and substance use were correlated with higher levels of overall psychological distress and that higher levels of loneliness were related to higher levels of depression and hopelessness. Additional results suggested that higher levels of overall psychological distress were correlated with a higher number of self reported physical symptoms.
Supplemental findings suggested that heterosexuals possessed higher levels of substance use than did homosexual/bisexuals. To summarize, the onset and exacerbation of psychiatric symptoms for persons with HIV infection appear related to a number of psychosocial stressors. A formal diagnosis of HIV/AIDS seems to induce or increase psychological turmoil (i.e., depression, distress, hopelessness) due to the actualization of increased morbidity and impending mortality. Bereavement is further magnified by the death of friends, who are similarly HIV positive, decreases in social supports and increased levels of loneliness due to the death of friends or rejection or alienation by significant sources of social/emotional support. Other important stressors adversely contributing to the HIV/AIDS process include stigmatization, loss of housing and economic viability, decrease in self-esteem and body-image, and finally increases in physical debilitation (e.g., higher number of physical symptoms, deleterious effects on immune functioning) and increases in substance use (i.e., alcohol and drugs)....
Gurbuz G (1991). Effect of group intervention on women with HIV-related concerns. PH.D. Thesis, California School of Professional Psychology, Berkeley/Alameda, DAI Vol. 52-11B, p. 6084, 154 pages.
Abstract by author: Women
in the United States are increasingly affected by the Human Immunodeficiency
Virus (HIV). Education remains the primary method of preventing the Spread
of the virus until a vaccination or cure is discovered. Group interventions
have been proposed as helpful in inducing behavioral changes and alleviating
distress among other populations. However, there have been few systematic
efforts made to evaluate the effectiveness
of group interventions for individuals affected by HIV.
The purpose of this study was to evaluate the impact of group interventions offered at the UCSF AIDS Health Project for women with HIV-related concerns. Female intervention group participants were compared to a wait-list comparison group on measures of distress, health practices, coping, and social support. Female participants were also compared to a matched-sample of gay/bisexual participants. This provided a comparison of the men and women as they entered the program and after they participated in the group interventions. Results failed to support the central hypotheses.
There were no significant differences between female intervention and comparison group participants following the group interventions. While significant changes in psychological distress and sex practices for gay/bisexual men are noted in previous evaluation efforts, high levels of distress and continuation of risk behaviors were found among women even after group participation. Measures of coping and social support were similar for women in the intervention and comparison groups. Several explanations were proposed for these findings.
Women may not have fully benefited from Group interventions due to drug and alcohol use, difficulty with self-assertion, positive attitudes Towards pregnancy, and preoccupation with more pressing issues such as finances, domestic violence, and partners' substance use. Interventions should take into account the special needs of women affected by HIV. Several suggestions are presented including incorporation of assertiveness-training into the group format, addressing drug and alcohol use among women, recruiting partners of women into the interventions, and providing legal and social services to women.
Further research is needed to understand the relationship of the special concerns and obstacles women with HIV-related concerns face and their relationship to psychological distress and behavioral practices.
Hanjorgiris WF (1997). Gay male identity acquisition, community identification, internalized homophobia, and sexual risk-taking among gay and bisexual men. PH.D. Thesis, Fordham University, DAI Vol. 58-04B, p. 2179, 167 pages,
Abstract by author: Men who have sex with men (MSM) continue to be newly infected with HIV or diagnosed with AIDS each year despite considerable HIV/AIDS education and intervention efforts. While the overall rate of HIV infection among MSM has declined since 1985, MSM continue to account for a disproportionate number of AIDS-related deaths in the United States. Understanding the differences among MSM who do and do not consistently practice safer sex is essential if further cases of HIV-infection are to be avoided. The present study investigated sexual risk- taking behaviors of MSM as they relate to gay identity development, group affiliation, self-identification as gay or bisexual, and internalized homophobia. If potential barriers to safer sexual behavior could be identified among the variables investigated, the information gained could be used to efficiently target limited funds and resources toward developing effective HIV-prevention strategies that include concerns related to individual sexual and group identity development. An ex-post-facto design was utilized and 1,800 surveys were distributed to gay and bisexual men in New York City during June 1995 (Gay Pride Month). Completed information packets, which included a demographic questionnaire, a gay identity development scale (individual and group), an internalized homophobia scale, and a sexual activities questionnaire, were returned by 445 men. Participants identified as gay (n=397) and bisexual (n=48), aged 17-75, represented a variety of ethnic, religious, SES, educational, and occupational backgrounds. Chi squares, crosstabs, ANOVAs, and t tests were computed. While no significant relationship was found among sexual risk-taking behavior and the variables investigated, significant findings related to demographic variables did emerge. Study findings are discussed, limitations are enumerated, the importance of findings for counseling psychologists is presented, and suggestions for future research are offered.
Hayes RA (1995). Differences in social support, coping, and attitudes toward homosexuality between African-American and Caucasian men living with HIV. PH.D. Thesis, The George Washington University, DAI, Vol. 56-09B, p. 5171, 129 pages.
Abstract by author: Knowledge of ethnic differences in social support is a first step in advocating research which may assist healthcare workers to tailor interventions specifically to ethnic groups. In a descriptive study designed to gather that knowledge, 121 African American and Caucasian asymptomatic HIV+ men were recruited from the Baltimore-Washington corridor to report on their support networks, stress, coping strategies, depression, and attitudes about sexuality. All participants were homosexual or bisexual and had no history of intravenous drug use.
African Americans were expected to have support networks that contained more family members, a higher percentage of relatives, more conflict, and fewer resources than Caucasians. Additionally, African Americans were expected to have less favorable attitudes toward homosexuality and less problem-focused coping than Caucasians. Results indicated African Americans had smaller networks, a larger percentage of relatives, and less conflict within their support networks than Caucasians, however both groups were equally satisfied with the support they received and gave.
African Americans indicated more stress associated with being gay, less favorable attitudes toward homosexuality, and a higher severity of daily hassles. African Americans utilized more emotion-focused coping than Caucasians. It was concluded that while there were differences in network structure, social support was not lacking for these HIV+ asymptomatic ethnic groups. However, differences found highlight the importance of monitoring ethnic differences in social support and its correlates as disease progresses.
Heller KS (1992). Silence equals death: discourses on aids and identity in the gay press, 1981-1986. PH.D. Thesis, DAI, Vol. 54-02A, p. 574, 371 pages.
Abstract by author: This dissertation examines press coverage of AIDS in two gay newspapers in San Francisco and New York City between 1981-1986, when gay men first confronted the threat of a fatal disease in the context of major challenges to their personal liberties and sociocultural institutions. The ways in which they interpreted and responded to this disaster, individually and collectively, are visible in press accounts of three issues during that period: conflicts about closing gay bathhouses and restricting certain forms of sexual expression; the uses of HIV antibody testing; and the threat of quarantine.
Using interviews, participant observation, and content analysis of news, features, columns, editorials, and letters to the editor in the Bay Area Reporter and the New York Native, some elements in this process of sociocultural change in response to disaster were identified. Analysis of this discourse revealed that in the process of confronting and coping with AIDS, gay men forged a more complex social identity, founded on new bases of interaction with one another and the wider society. This process involved political action, through which gay people became recognized as a legitimate cultural minority group; personal and group changes in behavior and priorities; and the shared experiences of stigma, prolonged crisis and profound losses. It is suggested that AIDS accelerated the evolution of American gay social worlds into communities of solidarity and memory and encouraged the development of a sense of gay ethnicity.
Hoff CC (1995). Emotional states, attitudes, sexual behavior, and relationship factors among HIV discordant and concordant gay men in primary relationships. PH.D. Thesis, California School of Professional Psychology, Berkeley/Alameda, DAI Vol. 55-11B, p. 5054, 87 pages.
Abstract by author: To date, a majority of the AIDS prevention literature has explored sexual behavior differences among individual men with little attention paid to his relationship status or to his or his partner's HIV status. This study investigated differences in emotional states and attitudes and beliefs as well as sexual behavior and relationship factors among gay men in HIV concordant and discordant primary relationships. The data were gathered in 1992 from two household-based and two bar-based samples of gay/bisexual men gathered in Portland, Oregon and Tucson, Arizona.
Men in primary relationships of one month or more who knew their own and their partners' HIV status were included (n = 788). Comparisons were made between four groups: (a) HIV positive subjects/HIV positive partners, (b) HIV negative subjects/HIV negative partners, (c) HIV positive subjects/HIV negative partners, and (d) HIV negative subjects/HIV positive partners on sexual behavior, psychosocial and demographic variables. Men in concordant relationships reported higher rates of anal intercourse with ejaculation and without ejaculation than discordant couples. HIV positive concordant couples reported higher rates of depression, lower levels of self efficacy, lower commitments to using condoms, and were less educated than each of the other groups. Discordant couples had lower rates of receptive and insertive unprotected anal intercourse with ejaculation than concordant couples. Men in discordant relationships were also more likely than men in concordant relationships to feel a strong commitment to using condoms, and were far more likely to feel discouraged and seek support after having unprotected anal intercourse.
There were no significant differences among the four groups in regard to the type of sexual behaviors they engaged in with non-primary partners, nor were there differences in terms of condom use with primary partners. Given the low rates of unprotected anal intercourse there may be different prevention needs for men in primary relationships as compared to single men. HIV positive men with either positive or negative partners are more susceptible to depression than HIV negative men and should be screened routinely for depressive and vegetative symptoms by physicians and mental health providers. Prevention efforts must focus on the negotiations that are hypothesized to occur between men prior to having sex. Research investigating these negotiations may help shape prevention efforts for all gay men.
Holmes DL (1996). Sexual behavior as a function of self-disclosure, self-efficacy, and perceived invulnerability in young adult gay/bisexual males. PH.D. Thesis, California School of Professional Psychology, Berkeley/Alameda, DAI, Vol. 57-06B, p. 4056, 130 pages.
Abstract by author: Previous research has shown self-efficacy and self- disclosure variables to be correlated with greater HIV sexual risk-taking among gay men. The purpose of this study was to identify variables associated with HIV risk- taking among younger gay/bisexual men and extend the understanding of the AIDS Risk Reduction Model (ARRM). The sample consisted of 93 young adult, gay/bisexual men, aged 18-25, who attended a fair in San Francisco and completed self-report questionnaires regarding HIV-related behaviors and attitudes. Results from this study suggest that psychosocial variables alone cannot account for high-risk sexual behavior enactments in younger gay/bisexual men. Self-efficacy and self-disclosure variables were not significantly correlated with high- risk sexual behaviors in this sample. However, developmental variables appear to play a major role.
Perceived invulnerability was significantly influential on high-risk sexual behavior enactments in this sample. Consequently, in order to effectively intervene in this group, current results suggest that use of the ARRM for this age group include modifications that would add a strong emphasis on developmental variables, particularly for the Stage One tasks of recognizing and labeling high- risk sexual behavior This study indicates that intervention with young, gay/bisexual men must be a high priority in efforts to halt the AIDS epidemic, recognizes critical areas to be targeted in such interventions, and identifies necessary content of AIDS prevention interventions for young, gay/bisexual men. Research into the most effective formats for such intervention is an important next step.
Holloway EK (1996). Death anxiety in HIV-affected homosexual men. M.S. Thesis, California State University, Long Beach, MAI, Vol. 34-06, p. 2477, 128 pages.
Abstract by author: This study explores the relationship between HIV infection and anxiety. No cure exists for HIV disease, therefore ways to delay disease progression and promote quality of life are sought. Psychoneuroimmunology studies have demonstrated the negative effects of stress and anxiety on the immune system and the consequent impact on health. Additional interventions to reduce stress may support the health of HIV infected persons. The relationships between death anxiety and general anxiety were evaluated in 117 self-selecting HIV positive and HIV negative gay men. Two standardized measurements, demographic and behavioral data yielded information for analysis.
The State-Trait Anxiety Inventory and the Death Anxiety Survey revealed significant positive correlations at the p < .01 and p < .001 levels for both groups. HIV positive men, when compared to HIV negative men, demonstrated significantly lower death anxiety (p < .01). State anxiety was significantly correlated to death anxiety (p < .001) for HIV positive persons.
Honish A (1991). Relationship between HIV antibody status and the sexual practices of gay and bisexual men. Master’s Thesis, University of Alberta, MAI Vol. 30-04, p. 1324, 159 pages, ISBN: 0-315-66744-3.
Abstract by author: The purpose
of this study was to determine if information about human immunodeficiency
virus (HIV) antibody status changed the sex practices of gay and
bisexual men in Edmonton, Alberta. Two hundred and five gay and bisexual men were surveyed with an anonymous self-administered questionnaire. More than half (57.1%) of the sample reported their sex partners as "one night stands", 26.8% had a regular partner and 16.1% had a regular partner but had sex outside the relationship. Although the safer sex practices of this sample of gay and bisexual men have increased, a great number continue to engage in high risk behaviour. Approximately half (48.5%) of the subjects continued to practice unprotected receptive anal intercourse. However, 32 (15.6%) of the sample had abstained from sex for the six months previous to the study. Approximately half of the subjects who had an HIV antibody test reported inadequate pre and posttest counselling. Twenty-one (16.4%) of the 128 subjects who were aware of their HIV serostatus reported discriminatory practices as a result of being tested.
Hunter J (1996). Emerging from the shadows: lesbian, gay, and bisexual adolescents. Personal identity achievement, coming out, and sexual risk behaviors. D.S.W. Thesis, City University of New York, DAI, Vol. 57-05B, p. 3432, 233 pages.
Abstract by author: This exploratory study examines relationships between sexual identity status, coming out, and HIV sexual risk behaviors among gay/lesbian/bisexual adolescents in New York City. During adolescence, personal identity achievement is a central task for all youth, including gay/lesbian/bisexual youth, and is also a period of risk taking. To understand this most vulnerable period in their lives, lesbian/gay/bisexual adolescents (76 females and 81 males, ages 14-21 (mean = 18.2) participated in a structured interview to assess sexual risk acts (prior three months). Sexual identity achievement (exploration and commitment), was examined in relation to both the coming-out process and HIV-risk behaviors. The coming-out process was also studied in relation to HIV risk sexual behaviors. Questionnaires used were Coming Out Scales (attitudes toward own homosexuality, information about the lesbian/gay communities, disclosure of sexual identity to others);
SERBAS-Y-HM-M/F-1, to define self-label as lesbian, gay, or bisexual; Personal Identity Scale, to assess sexual identity status (defined as Achieved (high on exploration and commitment to a homosexual identity), Moratorium (high on exploration/low on commitment), Foreclosed (low on exploration/high on commitment), and Diffused (low on both); and the SERBAS-Y-SH-HM-M/F-1, to assess sexual risk behaviors. Sexual identity achievement is a process of exploration and commitment similar to the process of religious and ethnic identity achievement. Sexual identity does not determine or define sexual behavior. While there were significant gender differences, gay/lesbian/bisexual adolescents are having high-risk unprotected sex. This situation requires extensive HIV prevention efforts.
Jackson KW (1997). Risk factors associated with suicide probability in HIV-positive and AIDS patients. PH.D. Thesis, Loyola University of Chicago, DAI Vol. 57-12B, p. 7776, 149 pages.
Abstract by author: Since the identification of the Human Immunodeficiency Virus (HIV) and AIDS, the epidemic has received considerable attention. Medical researchers have directed their attention to finding a cure, and the social scientists involvement in education and prevention programs. Thus far medical researchers have focused on finding a vaccine to improve the quality of life for AIDS patients. As we now enter the second decade of the AIDS epidemic, the profession of psychology also needs to focus it's attention to the healing of the social consequences that is associated with the AIDS epidemic. The stigma, isolation discrimination, and depression associated with AIDS persists and may contribute to the hopelessness and the suicides of many people with HIV or AIDS.
Social constructions have an influence on the individuals in our society. AIDS continues to elicit a negative image and a negative attitude for a majority of people in society. Judgements are frequently made due to the pre-existing negative attitudes toward the marginalized groups of society that are at greatest risk for HIV infection and AIDS. These marginalized groups include gay men, IV drug users, ethnic and racial minorities, and women. Membership in one or more of these groups is associated with increased stress due to experiences of prejudice, discrimination, and violence. These factors place individuals with already compromised immune systems at great risk for negative health outcomes.
Violence was significantly correlated with hopelessness at p < .05 and with violence at p < .05. Depression, suicide, and external L.O.C. were significantly correlated with hopelessness at p < .01. Depression, external L.O.C., social support were significantly correlated with suicide probability at p < .01. Depression, suicide probability, external L.O.C. and Hopelessness were significant with social support at p < .01.
Also, t-tests revealed significant differences between groups experiencing high or low social value. Significant differences were noted for suicide probability at p < .01 and noted for hopelessness at p <.001. Significant differences between groups being treated like a person vs. a stereotype were also noted. Significant differences at p < .01 was identified for the variable hopelessness and p < .001 was identified for the variable suicide probability.
Publication No.. 9715243
Jacobs BA (1992). The AIDS epidemic: its effect on sexual attitudes and practices among lesbian and bisexual women. PH.D. Thesis, California School of Professional Psychology, Los Angeles, DAI Vol. 53-07B, p. 3775, 293 pages.
Abstract by author: Through
a self-report questionnaire designed for this study, correlations were
computed to assess relationships among and between the current sexual practices
of 50 Lesbian and 50 bisexual Los Angeles County women (ages 23 to 59 years),
and their relationship histories, past risky sexual behaviors with men
and women, perceived risk, partners' risk status, health histories, proximity
to persons with AIDS, general HIV knowledge, and knowledge of the degree
of HIV risk associated with certain behaviors. The study established baseline
data regarding the sexual and relationship practices of the two populations.
The study also began the task of researching the previously unexamined
issues of the impact of the HIV epidemic on Lesbian and bisexual women,
HIV risk in the two groups, and the risk of woman-to-woman transmission
of the virus. Results indicated that most Lesbian and bisexual women were
engaging in more frequent and casual sex, with more partners, than had
been believed previously. Significant correlations were observed between
current sexual practices and past sexual and relationship practices. Women
reported less than accurate information related to risk behaviors including
those associated with lactation, touching HIV infected persons, transmission
from mother to fetus, blood donation, and when HIV infection can
be transmitted and detected. Women were engaging in unprotected sex during menstruation, which is highly associated with HIV transmission. A high proximity to persons with HIV was reported, but was not significantly related to risk taking behavior. Further, while HIV infected women were excluded from the data analyses, one respondent stated she had contracted the virus from another woman. The study indicated the women tended to underestimate their level of risk given the risk levels of the behaviors in which they had been engaging. The study indicated, further, that these women had been placing themselves at risk, apparently without realizing it, and without taking precautions for safer sex. Implications for future research, and risk reduction in these populations, were discussed.
Jimenez-Sheppard (1997). Multiple loss and grief in HIV-Positive and HIV-negative gay men: catastrophic survivor guilt, proneness to survivor guilt, and coping. PH.D. Thesis, The Wright Institute, DAI, Vol. 57-11B, p. 7227, 119 pages.
Abstract by author: The relationships among multiple bereavement, coping, grief, catastrophic survivor guilt, and proneness to survivor guilt was examined in a sample of HIV seropositive positive (n = 22) and seronegative (n = 29) gay men. All subjects were administered the Bereavement Index (Jimenez-Sheppard 1995); The Grief Experience Inventory (Sanders, Mauger, & Strong, 1985); the Interpersonal Guilt Questionnaire (O’Connor, Berry, Weiss, Sampson & Bush 1994); AIDS Crisis Questionnaire (Jimenez-Sheppard, 1995), and The Ways of Coping Questionnaire (Folkman & Lazarus, 1988). This study found 4 main conclusions.
First among both HIV positive and negative gay men, there was a positive correlation between proneness to survivor guilt and several dimensions of grief while statistically controlling for number, closeness and recency of losses. These grief dimensions are Despair, Guilt, Somatization, Social Isolation, and Atypical Response. Second, proneness to survivor guilt predicted levels of survivor guilt related specifically to the survival of people who died of AIDS (termed catastrophic survivor guilt), again controlling for number, closeness and recency of losses. Third, catastrophic survivor guilt contributes to the current grief experience, over and beyond proneness to survivor guilt, and number of recent losses. These grief dimensions are Denial, Anger, and Depersonalization. Fourth, HIV positive and HIV negative gay men who experienced more recent losses of close relationships used Confrontive and Self-Controlling Coping strategies.
Additional analyses found that both HIV positive and HIV negative gay men experience similar levels of survivor guilt and catastrophic survivor guilt, and the loss of a close relationship was positively correlated with chronic manifestation of grief (Loss of Control, Rumination and Depersonalization). This study suggests that HIV positive and HIV negative gay men who experience survivor guilt and catastrophic survivor will experience deep expressions of grief.
Jolly DH (1993). An analysis of sexual practices among gay men attending gay bars in North Carolina. DR.P.H. Thesis, The University of North Carolina at Chapel Hill, DAI Vol. 54-08A, p. 2904, 354 pages.
Abstract by author: Risk reduction education remains the primary strategy for preventing AIDS and HIV disease. Effective health education efforts must be based on understanding the determinants of specific behaviors in the target population. While numerous studies have been conducted on HIV-related attitudes and behaviors among gay/bisexual men from large metropolitan areas in the U.S., much less is known about gay/bisexual men residing in more rural, low and moderate incidence areas. This study examined data on over 2,000 men from a survey conducted at gay bars in North Carolina in March 1990. In the descriptive portion of the study, an equal probability sampling method was used to describe the sexual risk-taking behaviors of men who attend gay bars in North Carolina. In the analytic portion of the study, a logistic regression model was applied to a conceptual framework based on Ajzen's theory of planned behavior in order to explore the relationship between the highest risk behavior (unprotected anal intercourse) and five psychosocial variables: perceived social norms, perceived behavioral control, attitudes, alcohol and drug use before or during sex, and personal acquaintance with persons who have AIDS or HIV.
The descriptive study corroborated two major findings from other studies: gay/bisexual men have made substantial changes in sexual behavior in response to the AIDS epidemic and a substantial minority continue to engage in some high risk behaviors. Unsafe behaviors were associated with less education and residence in a rural county. In the logistic regression model the strongest predictors of unprotected anal intercourse (UAI) were personal acquaintance and alcohol/drug use. These findings run counter to the theory of planned behavior, which predicts that the effects of these variables should be mediated by the major determinants of behavioral intention: attitudes, subjective norms, and perceived control. Nevertheless, significant associations between UAI and certain measures of perceived control, attitudes, and social norms offer some support for Ajzen's theory. Significant interactions are analyzed to explain how certain demographic variables modify effects that several of these measures have on UAI. Implications of findings for theory, research, and practice are also discussed.
Josephson SB (1997). Correlates of HIV/AIDS disclosure: psychosocial stresses; demographics; social support; coping; and quality of life. PH.D. Thesis, Columbia University, DAI Vol. 58-03A, p. 1093, 180 pages.
Abstract by author: Individuals with HIV/AIDS can experience profound stigma and rejection due to the etiology of the disease, primarily through homosexual contact and injecting drug use. This results in a dilemma of disclosure. On the one hand, disclosure can induce support and assistance; on the other, it can produce ostracism. Therefore, this study examines disclosing a stigmatized illness and the repercussions of so doing. It investigates to whom the subjects initially disclose; whether there is an association between social support and the number of people told; whether there is an impact of disclosure on coping and on quality of life. The sample of 163 subject is predominantly male (68%); with an average age of 36 years; mostly high school graduates; and overwhelmingly nonwhite (77%). The source of virus transmission is: 66 subjects through homosexual contact; 55 through heterosexual contact; 42 through injecting drug use.
Questionnaires were administered to the subjects asking demographic questions and a series of questions about disclosure. In addition, they were asked to respond to scales relating to their social support; coping; and quality of life. Polychotomous logistic regression was used to investigate whether it was possible to predict to whom subjects would initially disclose their HIV+ status. The three distinct groups to whom they disclosed were "agency", "friends", or "family". Results indicated that African- Americans and Latinos were more likely to disclose to their families, whereas whites more likely told agencies and friends. Males were more likely to tell friends as opposed to females who told agencies or families. Male homosexuals were much more inclined to tell friends, whereas injecting drug users told families. Heterosexuals showed no preference to any group. Hierarchical (simultaneous) setwise multiple regression was used for the remaining data analysis. Findings indicated that there was a positive association between social support and number of people told. Additionally, increased disclosure and increased coping were associated with a better quality of life. In summary, the results demonstrated that disclosure has a salutary effect on the lives of people with HIV/AIDS.
Kellerhouse B (1996). A loss of heart: AIDS-related bereavement in HIV-negative gay men. PH.D. Thesis, New York University, DAI, Vol. 58-01B, p. 418, 267 pages.
Abstract by author: Although the research literature is replete with studies and concerns about the psychological well-being of HIV-infected gay men and gay men living with AIDS, little attention has been extended to their HIV-negative brothers who have been the caregivers, volunteers, and pallbearers for a community devastated by AIDS. Interviews were used to generate first-hand knowledge of the bereavement experiences and present-day life concerns of a small group of HIV-negative gay men. The participants and I explored their experiences of multiple loss, grieving and coping, meaning-making, and visions of the future.
I collected data by conducting intensive, open-ended interviews. Data comprised audiotape transcriptions, analytic memos, and observer comments derived from the research process. I analyzed the data using principles of grounded theory and naturalistic inquiry. Analysis of the data revealed a coalescing of themes around ten discrete categories which expressed the essence of the participants’ experiences: Loss, Shared Experience, Caregiving, Grieving, Coping, Forgetting/Remembering, Present-Day Concerns, The Future, Making Sense, and Benefits/Gains. I presented the findings in participant profiles and thematic categories.
The participants’ experiences fit a pattern of experiences similar to survivors of traumatic, catastrophic events. They described themselves as fighting a battle against AIDS, searching for survivors like themselves, wondering if they would become casualties as well, witnessing atrocities to the human body and spirit, experiencing multiple losses of their peers, remaining vigilant against infection and the effects of future loss, experiencing intrusive thoughts and dreams, and feeling wounded by the deaths of their dearest and closest friends.
The findings suggested the need to develop a body of research literature which addresses the unique psychosocial concerns of HIV-negative gay men. A clearer understanding of how coping, personality, and relational styles mediate gay men’s ability to cope with traumatic loss is indicated. Directions for practice suggested the development and implementation of psycho-educational group interventions and prevention programs which would enhance psychological functioning in the midst of an enduring epidemic.
Kendall J (1991). Human association and wellness of homosexual men with HIV infection: a grounded theory. PH.D. Thesis, Georgia State University, DAI Vol. 53-06B, p. 2785, 407 pages.
Abstract by author: The purpose of this study was to develop a grounded theory of human association and wellness, focusing on the meanings, views, and perspectives of homosexual men with human immunodeficiency virus (HIV) infection in community support groups. The research design was a qualitative grounded theory design consisting of successive iteration of four elements: theoretical sampling, intensive interviewing, inductive analysis of the data using the constant comparative method, and development of grounded theory. The sample consisted of 29 homosexual males with HIV infection who had experience in at least one community HIV support group. Open-ended interviews were completed with each participant. Second interviews were completed with 15 of the participants, for a total of 44 interviews. Participants experienced a range of HIV symptomatology, from being asymptomatic to terminal. Six major themes were identified in the data: intimacy, alienation, self process, group process, synergistic community, and personal and societal conditions. Three grounded theory models were developed: (a) "The Alienation Model of Group Experience," (b) "The Intimacy Model of Synergistic Community," and (c) "The Model of Human Association and Wellness."
Conclusions were presented as working hypotheses. Study findings were compared with extant sources in the theoretical literature, and further abstraction of the data occurred yielding the major conclusion of the study: Expanding consciousness in synergistic community is the natural progression of self in intimate I-me/other human associations, whereas illness and social fragmentation is the consequence of the self in alienating I-other human associations. Results are discussed, and recommendations for nursing practice, research, and theory development are given.
Kerewsky SD (1997). HIV+ gay men's processes of making their own AIDS Memorial Quilt panels. PSY.D. Thesis, Antioch University, New England Graduate School, DAI, Vol. 58-09B, p. 5192, 250 pages.
Abstract by author: This study asked five HIV+ gay men about their understanding of the meanings and processes associated with making panels commemorating themselves for the AIDS Memorial Quilt. It was assumed that this panel-making was meaningful to the men, and related to their accommodation of the HIV/AIDS diagnosis. The focus of this study was the meaning the participants themselves ascribed to their panel-making activity, understood through a qualitative analysis of semi-structured interviews. Notably, the men construed this activity as more relational than individual. The meanings that they attributed to making their own panels were more local and personal than the available literature on the Quilt in general might suggest. This inquiry was situated within an extensive critical literature review that included recent gay U.S. history; the social-scientific and medical arenas of HIV/AIDS, illness, death, and living with a chronic or terminal illness; the tasks and needs of people with HIV/AIDS, including engaging in meaning-making activities; the Quilt’s history, characteristics, and ways in which it follows from the U.S. quilting tradition; a comparison of the Quilt and the Vietnam Veterans Memorial; the meanings ascribed to the Quilt by its advocates, critics and viewers; the experiences of panel-makers as they themselves describe them; and finally the few references to people who make their own panels. Participants’ responses primarily centered on relational activities (individual, interpersonal, and community). They described motives for and effects of making their own panels. They also described their initial encounters with the Quilt and the origin of the idea of making their own panels. Some participants discussed themes of mortality and spirituality. Suggestions for applications of this study include facilitating HIV+ people’s interaction with the Quilt as it is relevant to their own accommodation of the diagnosis. While making one’s own panel may not be a widespread phenomenon, it provides a valuable example of one way that people with HIV may ensure their inclusion in a ritual of community mourning.
Klich UI (1997). A study of social support variables in three stages of HIV illness. PH.D. Thesis, Indiana State University, DAI, Vol. 58-09A, p. 3429, 131 pages.
Abstract by author: Social Support (SS) has been shown to have an effect on health and well-being. Patients with the Human Immunodeficiency Virus (HIV) are particularly vulnerable to stigmatization which may effect SS. This study examined the SS networks of 155 gay men with HIV. It was hypothesized that (a) perceived SS differs according to stage of HIV-illness and time since diagnosis, (b) there are select factors that are associated with variations in perceived SS, and © level of SS is predictive of future functional capacity and mental health. To assess SS, the Social Support Questionnaire based on the General Social Survey (1995) was utilized. This questionnaire allows participants to complete information for up to nine individuals who provide them with SS. This format yields quantitative as well as qualitative information. The Health Status Questionnaire is a modified version of the MOS-30 adapted for use with persons with HIV. The dependent variable was the participant’s level of perceived support, and the independent variables were derived from the self report measures. Perceived support was found to differ across stage of illness and length of time since diagnosis. Gay men with AIDS perceived their support groups as significantly more supportive than individuals who were asymptomatic or symptomatic. Individuals who were diagnosed for less than six months perceived their support group as significantly less supportive than individuals diagnosed longer. Differing levels of SS were found for select factors including race and age of the provider, intimacy with the provider, and the relationship status of the participant. Perceived group support was not found to predict functional capacity or mental health six months later. Implications for health care providers and recommendations for future research are provided.
Lewis J (1994). Identity transformation: the experience of HIV positive gay men. PH.D. Thesis, University of Toronto, DAI, Vol. 56-07A, p. 2877, 267 pages, ISBN: 0-315-97219-X.
Abstract by author: This research investigation documents the processes of adaptation that people living with HIV and AIDS (PHAs) experience. The sample was obtained through snowball sampling. Using a semi-structured interview guide, 25 gay PHAs were interviewed in-depth about their experience of coming to terms with their HIV status. Analysis of interview data indicate that PHAs go through two distinct status passages: (1) HIV negative to HIV positive; and (2) HIV positive to a person with AIDS (PWA). The properties of status passages outlined by Glaser and Strauss (1971) and Ebaugh (1988) fit with the HIV status passages. Receiving an HIV positive diagnosis forces people into an involuntary, irreversible and undesirable status passage. In addition, the individual must deal with issues related to their own mortality.
A number of factors determine how an individual reacts and adapts to an HIV positive diagnosis, including: age, partnership status, religious or spiritual beliefs, and time period of diagnosis. Utilization of coping strategies (eg., denial, anger, bargaining, depression, redefinition, escapism, covering, blending and converting) and affiliation with similar others were found to facilitate adaptation. Fitting with the literature on stigmatization, affiliation with similarly stigmatized persons assists in reconstructing social reality for both the stigmatized individual and societal members through the development and dissemination of counter ideologies and public education strategies. Receiving an HIV diagnosis not only initiates a status passage for the individual; it also initiates a corresponding identity transformation.
For those experiencing PHA type status passages, the process of adjustment in some ways parallels Troiden's (1988; 1989) model which characterizes the process that gays and lesbians experience on their way to achieving a positive sense of self. Through combining aspects of Troiden's (1988: 1989) work with that of Gussow and Tracy (1968), Vaughan (1986), Ebaugh (1988), Glaser and Strauss (1965; 1968), Kubler-Ross (1969), and Pattison (1977a, 1977b, 1985), Marshall (1975a, 1975b, 1980a, 1980b, 1982, 1986a, 1986b, 1989) and Marshall and Levy (1990), I arrived at a model of the general processes involved in HIV-related identity transformations that takes into consideration the distinctiveness of the condition and its corresponding status.
Long TL Jr (1997). AIDS and American apolcalypticism: discourse, performance, and the cultural production of meaning in New York City, 1981-1996. PH.D. Thesis, Indiana University of Pennsylvania, DAI, Vol. 58-09A, p. 3525, 643 pages.
Abstract by author: When the medical phenomenon that was eventually to be called "AIDS" first entered into public discourse in 1981, the gay male population most visibly affected had already been configured for a decade by Christian fundamentalists as apocalyptic signifiers or signs of the "end times." This discourse grew out of a dense centuries-old American apocalypticism, which included images of crisis, warfare, catastrophic destruction, demonic Antichrists, and ultimate salvation.
With the discovery of a strange acquired immune illness among gay men and other marginal groups, the religious right employed a range of apocalyptic signifiers to stigmatize the phenomenon and further demonize those immediately affected by it. In turn, HIV/AIDS affected/infected communities appropriated this apocalyptic discourse in order to resist its marginalizing stigma and employ its mobilizing effects. However, the ideological constructs of Western apocalypticism—rigid binary oppositions and sexual anxieties registered around those oppositions—seem counterproductive to those communities that are attempting to resist the binarisms and sexual anxieties of the dominant culture. Thus, to employ Michel Foucault’s distinction, while apocalyptic discourse is tactically effective in mobilizing action, it is of questionable strategic value. Like all discourse, apocalyptic tropes are contingent and outlive their usefulness when societies take them as literal representations. In Robert Hodge and Gunther Kress’ terms, such tropes perform valuable work along a "semiosic plane" but their claims along a "mimetic plane" are dubious.
While some attention has previously been paid to AIDS and apocalyptic language, no other study has been grounded in an understanding of unique American apocalypticisms and the material conditions in which those tropes are produced. Moreover, few studies have attempted an analysis of quite as broad a discursive range, including printed texts, journalism, biomedical discourse, archival materials, interviews, visual arts, dance, video, and film, among others. The study applies a historicist social semiotic analysis to these materials, informed by critical theories of Hodge and Kress, Foucault, and Pierre Bourdieu. The social focus of this study is New York City’s AIDS-affected between 1981 and 1996. It examines issues related to five salient apocalyptic tropes: exile; the jeremiad; demons and pariahs; Armageddon; angels and paradisal bliss.
Luinenberg O (1994). Lesbians and safer sex discourses: identity barriers, fluid practices. M.A. Thesis, Simon Frazer University, MAI Vol. 34-02, p. 0624, 106 pages, ISBN: 0-315-01136-4.
Abstract by author: This thesis examines lesbians' positions in HIV/AIDS discourses. More specifically it will ask, how are lesbians negotiating their positions in safer sex within a discourse that is saturated with representations of lesbians as invisible, stereotypes and/or essential identities? The conditions of complete speech acts and the production of meaning are investigated in the context of lesbians' everyday lives and practices. The approach to this research has been facilitated by synthesizing concepts from what has become known as "queer theory", feminism, critical ethnography and anecdotal knowledge on lesbian existence. Theoretical, demographic and historical framings are followed by a participant ethnography and interview analysis. The manner in which power is negotiated within ethnographic projects such as this one is pursued in order to both raise critical questions about ethnographic methodology and demonstrate some of the issues involved when lesbians speak to each other. The interview data underlines the critical need for lesbian self-representations, in particular, for explicit articulations on experiences of identity, marginalization and sexuality.
Lynne CA (1995). Rationalizing risk: sexual behavior of gay male couples. M.A. Thesis, University of Southern California, MAI, Vol. 34-04, p. 1696, 48 pages.
Abstract by author: Gay male couples often practice especially risky sex. Why? To address this question, 46 long-term couples independently indicated their sexual practices, why they engaged in those practices, and their attitudes towards relationships. Three sets of findings suggest a paradoxical relationship between emotional intimacy and sexual risk: (1) love, trust, and commitment were used more often to justify riskier than safer sex; (2) safer sex had negative connotations (e.g., infidelity); (3) couples with more positive beliefs about relationships practiced riskier sex. If risk is indicative of closeness, why do some couples practice safer sex? Of those who practiced protected sex, 95% indicated "fear of AIDS." Implications of these findings for developing HIV interventions for gay couples are discussed.
Magee RBH (1996). Gay relationships and HIV: comparing relationship quality, predicting satisfaction and psychological distress in gay male couples of HIV-positive, -negative, mixed and unknown status. PH.D. Thesis, The Wright Institute, DAI, Vol. 57-07B, p. 4716, 108 pages.
Abstract by author: Little is currently known about the interaction between HIV status, HIV symptoms, and the relationship variables of gay male couples. Questionnaire data on 194 gay men of differing HIV status was collected as part of the AIDS Behavioral Research Project (ABRP), an ongoing longitudinal survey of gay men in San Francisco. An analysis of covariance of relationship information from the 1991 wave of data collection found differences in satisfaction with sex and sexual behavior depending on respondent and partner HIV status (HIV-positive concordant, mixed status, HIV-negative concordant, and untested/unknown status). In men in relationships where at least one partner was HIV-positive, partner support predicted relationship satisfaction, whereas partner symptoms, and partner conflict were negatively associated with relationship satisfaction. In these HIV-positive status relationships, relationship satisfaction was negatively associated with both subjective depression, and anger/hostility. The results are discussed in light of ongoing efforts to understand the psychosocial impact of HIV disease on gay men and their relationships, the ability of gay relationships to buffer psychological distress, and also in terms of implications for clinical intervention with gay male couples.
McCormick LJ (1997). A study of the dreams of AIDS hospice volunteers. PH.D. Thesis, California School of Professional Psychology, DAI, Vol. 58-05B, p. 2690, 196 pages.
Abstract by author: This study examined the dreams of ten individuals who provide volunteer hospice care to persons with AIDS (PWAs). A search of the literature did not find previous research on the dreams of caregivers. Literature on the dreams of persons facing other types of loss and trauma, however, did give rise to a number of hypotheses. It was predicted that the dreams of the participants would contain images of loss, separation, and persecution, as well as feelings of anxiety, guilt, and sadness. Following Jung’s theory of dream interpretation, it was predicted that there would be a high number of compensatory dreams and also archetypal images associated with death.
The sample was comprised of five men and five women who provide volunteer hospice care to a primarily gay male population in the San Francisco Bay Area. Participants completed a demographic questionnaire and kept a two week dream journal. They were each interviewed after submitting their journals to the researcher, so that clarity could be gained regarding their dream associations. The dream material was qualitatively analyzed by the researcher and another rater, who thematically categorized the material. Those themes which were most prevalent between participants’ dreams were the focus of the researcher’s attention. One of the primary findings was that caregivers experience their hospice work as more rewarding than stressful. This does not concur with their dream material, which was filled with images of boundary violation, aggression, and feelings of fear and anxiety. This suggests that the caregivers’ encounters with death are threatening to the dreamers’ psyches, and that the feelings of anxiety, which are denied on a conscious level, manifest on an unconscious level through their dreams.
Archetypal images of death, including embarking on a journey, vegetation, and themes of union, were present among the caregivers’ dreams. Images of caregiving and nurturance were also present, though ambivalent feelings often accompanied these images. It is proposed that the expression of ambivalence results from conflicted emotions that accompany such intimate encounters with death. The researcher concludes that caring for PWAS provides an avenue for working through past loss and trauma, while at the same time providing a transformative encounter with the rawness of death on an existential level.
Publication No. 9734302
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