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The introduction of combination therapies has changed HIV/AIDS from a terminal illness to a chronic manageable condition. The evolution of hope and hopelessness in the HIV/AIDS arena is tracked and related to the current treatment paradigm. Hope is often the essential element for patients coping with a diagnosis of HIV. Patients continue to construct belief systems that include hope and a positive outlook toward the future. The ability to maintain a state of hopefulness is seen as key to physical and emotional survival. The author, an HIV-positive psychotherapist in private practice, includes comments from patients to illustrate the impact that hope has had on their survival.
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PMID:A history of hope: the HIV roller coaster. 1136 44

Despite the President's directive on youth and HIV in 1997 to focus the nation's attention on adolescents and the battle against AIDS, prevention programs continue to be ineffective. The number of seropositive youth, ages 13 to 24 years old, is unclear due to inconsistent definitions of age ranges and inadequate access to testing. Youth have not sought testing for many reasons, including failing to perceive their vulnerability to HIV, confidentiality concerns, and not realizing the effectiveness of early treatment. Adolescents are creating independence, establishing relationships, and learning about drugs and alcohol. Young gay and bisexual men, drug-using youth, and youth of color are at high risk of HIV transmission. Identifying the population involved in risk-taking behavior and eliminating the behavior is an ineffective strategy for adolescent HIV prevention programs. Complicating the issue further, the goals and expectations of adolescents differ from the adults who design and deliver prevention programs. HIV education and prevention efforts need to address solutions to hopelessness, isolation, and violence, rather than focusing on the negative effects risky behaviors will have in the future. Effective programs combine a youth/adult partnership to take advantage of the strengths of each individual. Strategies for implementing prevention programs that address the specific needs of adolescents are suggested.
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PMID:Adolescents and HIV: creating partnerships. 1136 16

This study examines the influence of HIV-seropositivity and antiviral medications on cerebral blood flow in cocaine abusers. Forty-five HIV negative (HIV-) cocaine abusers, 36 HIV positive (HIV+) cocaine abusers (CD4; mean 378, +/-229) and 27 control HIV- subjects were studied. Blood flow velocity and pulsatility were determined for the anterior and middle cerebral arteries using transcranial Doppler sonography (TCD). Psychological assessments, which included the psychiatric symptom checklist (SCL-90R), hopelessness (Beck) and well-being (Ellison) questionnaires revealed greater psychiatric distress in HIV+ cocaine abusers than the other groups. HIV- cocaine abusers and HIV+ cocaine abusers not receiving antiviral medications (n=25 of 36) had elevated pulsatility values, indicating increased resistance in the cerebral blood vessels in comparison to control subjects. HIV+ cocaine abusers using antiviral medications (n=11 of 36) had pulsatility values similar to HIV- control subjects. Interestingly, there was no significant relationship between intensity of psychiatric distress reported by HIV+ cocaine abusers and perfusion deficits. Our findings suggest that unmedicated HIV+ cocaine abusers have cerebrovascular deficits, which are similar to HIV- cocaine abusers. In addition, the use of antiviral medications appears to be associated with a reduction of these deficits in HIV+ cocaine abusers. Nevertheless, more studies will be needed before any conclusion can be reached regarding possible beneficial effects of these agents on the cerebral vasculature.
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PMID:Cerebral blood flow pulsatility deficits in HIV+ poly substance abusers: differences associated with antiviral medications. 1177 74

Data from a prospective longitudinal study were used to investigate whether hopelessness mediates the association between social support and depression, as hypothesized by L. Y. Abramson, G. I. Metalsky, and L. B. Alloy (1989). Measures of hopelessness, social support, and depression were administered to 103 HIV-infected men and readministered 6 months later. Findings indicated that low baseline social support predicted increases in hopelessness and depression. Increases in hopelessness predicted increases in depression after controlling for baseline social support. Low baseline social support did not predict increased depression when hopelessness was controlled statistically.
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PMID:Hopelessness as a mediator of the association between social support and depressive symptoms: findings of a study of men with HIV. 1177 9

The purpose of this study was to describe the dynamics of hope in a) people fearing a diagnosis of HIV or living with HIV/AIDS and b) their significant others, from the perspective of caregivers working in voluntary organizations in Finland. Individual interviews with eight caregivers were analysed using the grounded theory method. Living with the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a person fearing a diagnosis of HIV, becoming aware of HIV contagion, and living with HIV/AIDS. Mirroring the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a significant other of a person fearing a diagnosis of HIV, or living with HIV/AIDS. It is important to take into consideration the dynamics of hope in taking care of people fearing a diagnosis of HIV or living with HIV/AIDS and their significant others.
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PMID:Dynamically fluctuating hope, despair and hopelessness along the HIV/AIDS continuum as described by caregivers in voluntary organizations in Finland. 1188 54

The purpose of this study was to identify psychosocial factors, including coping style, that are associated with quality of life (QOL) in Japanese patients with human immunodeficiency virus (HIV) infection and to clarify the difference in coping style between patients with hemophilia and patients with sexually transmitted infection. We administered the World Health Organization QOL-26 questionnaire, the Mental Adjustment Toward Cancer scale, and the Social Support scale to 50 patients with HIV infection. Regarding QOL scores, Fighting Spirit was the positive coping style; Helplessness/Hopelessness and Anxious Preoccupation were negative coping styles. Psychological QOL scores in patients with hemophilia were lower than those in patients with sexually transmitted infection. Patients with hemophilia had a significantly weaker Fighting Spirit than patients with sexually transmitted infection.
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PMID:Psychosocial factors associated with quality of life in Japanese patients with human immunodeficiency virus infection. 1192 53

We described the background and the development of a new measure of existential loneliness, the Existential Loneliness Questionnaire (ELQ). Specifically, we analyzed the items of the preliminary version of the ELQ (ELQ-P) using methods based on item response theory (the Rasch model) and examined the convergent and discriminative validity of the ELQ in a sample of 47 HIV-infected women. Item analysis produced an ELQ version consisting of 22 items that were internally consistent and performed well in measuring an underlying construct conceptualized as existential loneliness. In addition, the ELQ discriminated well between symptomatic and asymptomatic HIV-infected women. The ELQ correlated strongly with measures of depression, loneliness not identified as existential and purpose-in-life and moderately strongly with a measure of hopelessness. Holding constant depression scores, the correlation between the ELQ and loneliness not identified as existential was significantly attenuated. Limitations of the study include the small sample size, which precluded an analysis of the dimensional structure of the ELQ.
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PMID:The Existential Loneliness Questionnaire: background, development, and preliminary findings. 1220 73

International assistance for prevention of HIV infections has been requested jointly by the Southern African Frontline States and the Global Coalition for Africa. Sub-Saharan Africa has had more AIDS victims than anywhere else in the world. Over 8 million of the estimated 13 million HIV-positive adults worldwide are in sub-Saharan Africa, where transmission is primarily through heterosexual sex. The World Health Organization (WHO) estimates that 71% of cases worldwide are transmitted by heterosexual sex, 7% through injections or drug use, 5% by blood transfusion, and 15% through homosexual behavior. In Uganda, an estimated 1 out of every 6 adults is HIV-positive. The expectation by WHO is that 10-15 million children worldwide will lose both or at least one parent to AIDS by the year 2000. An extreme example was of a Ugandan grandmother who had lost 6 children to AIDS and cared for her 25 grandchildren. The consequences are far reaching. there is the cost of funerals, which many poor can not afford; there are orphans, lack of caretakers or overwhelmed caretakers, loss of productive workers, and drains on health services. There is contention about the extent of the AIDS incidence is Sub-Saharan Africa; some would argue that many deaths are due to endemic diseases. However, one consequence of the presence of the HIV virus is the damage to the immune system response to any disease. The actual cause of an AIDS death may be pneumonia, tuberculosis, or any other illness. The male high risk group is comprised of males aged 20030 years, away from home, a possible history of sexually transmitted disease, and contact with prostitutes. The female high risk group is comprised of single mothers aged 18025 years, with a history of sexually transmitted disease, and engaged in commercial sex. Lack of condom use is linked to alcohol consumption. An estimated 25% of patients attending sexually transmitted disease clinics in South Africa have HIV infections. In 1993, Tanzania had southern Africa's highest incidence of reported cases (37,719), followed by Zambia (29,734), Malawi (29,194), and Zimbabwe (25,332). AIDS has become so widespread that many feed a sense of hopelessness and engage in careless sexual behavior, seeking out teenage girls believed to be HIV-free. The high level of poverty in Africa makes AIDS difficult to combat.
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PMID:The scourge of HIV and AIDS in Africa. 1228 61

Hope is an important protective phenomenon in human life, particularly given that long-lasting despair or hopelessness may threaten human existence. However, previous knowledge on the topic related to people affected by HIV/AIDS is scant. The purpose of this study was to explore the dynamics of hope in significant others of people living with HIV/AIDS and persons living with HIV (PLWH) or AIDS (PLWA) from the perspective of significant others in Finland. Eleven interviews were conducted with six significant others. The data were analyzed using the grounded theory method. The dynamics of hope, as it emerged from the data, is constructed of three main elements: hope, despair, hopelessness, and their reciprocal relationships. An alternating balance between hope, despair, and hopelessness based on the factors contributing to them emerged as central in the dynamics of hope. The dynamics of hope are closely connected to the basic process of searching for one's own way with HIV/AIDS, in becoming HIV-positive, and living with HIV/AIDS. In significant others, the dynamics of hope are closely connected to the basic process of HIV, changing from abstract to concrete in a relationship with a PLWH/PLWA.
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PMID:Dynamics of hope in HIV/AIDS affected people: an exploration of significant others' experiences. 1465 73

There is a paucity of literature on suicide and cancer, especially cancer of the cervix. This study reports on suicidal behavior in these patients. The sample consisted of adult, black, Zulu-speaking women from palliative and radical oncology treatment groups who volunteered for the study. There were more patients in the palliative group who were younger, and had a more significant delay between cancer symptom presentation and seeking oncology treatment. Patients experienced: significant depression, anxiety, stress, hopelessness/helplessness, anxious preoccupation about their disease, poor current or delayed social support, feelings of being a burden to their significant others, beliefs that they would be better off dead, perceptions that they were stigmatized by society or that their communities suspected them of being HIV-AIDS positive, and suppressed anger. More patients in the palliative, compared to the radical treatment, group were inclined toward suicidal ideation with serious intent. Overall, most patients coped inadequately with their disease and its management. These patients are a high risk group for suicidal behavior and should be identified in time for appropriate psychological intervention.
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PMID:Suicidal behavior in patients diagnosed with cancer of the cervix. 1550 42


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