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Whether they "come out" or hide their sexual orientation, most gay and lesbian youth experience the effects of prejudice and stigmatization emanating from society's homophobia. Having to cope with a disparaging and oppressive society creates unique stresses and developmental variations in identity development that are cofactors for HIV infection and disease. These cofactors include cognitive, emotional, and social isolation; feelings of alienation and despair; suicidal ideation; alcohol and other substance abuse; and furtive sexual contacts. Nurses and other providers need to be informed about these cofactors so they may provide meaningful HIV/AIDS prevention education to gay and lesbian youth.
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PMID:Homophobia: a cofactor of HIV disease in gay and lesbian youth. 816 10

Survivors of multiple AIDS-related losses face threat to their identity because of the extreme disruption to their personal, assumptive, and interpersonal worlds. This article briefly explains the experience of multiple-loss survivors and includes a case history of a survivor. An individual's sense of self is transformed through identification with the disease. In the gay community, a particularly strong identification with AIDS arose. One outcome of the meshing of an AIDS and homosexual identity is the tendency for gays to assume an identity in relation to HIV ("I am HIV positive/negative.") Personality alteration is not uncommon and may include an inability to trust, labile emotionality, and diffuse anger. Erik Erikson's developmental stage model is used to clarify the confusion survivors face in maintaining and forming identity. Many survivors are catapulted into an integrity versus despair task, reporting many similarities with the situation of their grandparents. The survivor's interpersonal connection to the world, especially their connection to a community, is severely shaken. The article does not ignore the potential for positive identity growth arising from this tragedy. Conclusions from this experience may have applicability in other areas of multiple, ongoing losses.
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PMID:Threats to identity in survivors of multiple AIDS-related losses. 932 6

I was deeply moved by David Sanford's Wall Street Journal article, which follows. As David's story recounts, he came to me in deep despair. He believed that there was little hope to escape what is commonly termed a "death sentence" from AIDS. With state-of-the-art treatment, he has regained considerable health, as his HIV viral load has fallen to undetectable levels and his helper T-cell number has increased. How long these changes will be sustained and what the future holds are still unclear. But it is clear that David is pursuing life with great vigor and his sense of optimism and commitment to survive have been restored. I believe the hematologist/oncologist is in a particularly unique position in the clinical care of people with AIDS. Our history of conquering diseases which were, like AIDS, regularly associated with decline and death, gives us a perspective that engenders hope. I recall a friend and classmate in the fifth grade in Public School 187 in Queens, New York, who died of childhood leukemia. In those days, mentioning the word "leukemia" was forbidden, so our teacher informed us that Eric had died of "blood poisoning." We children all sat confused, wondering how to protect ourselves from such insidious "poisons." Childhood leukemia is now curable in the majority of afflicted children; I suspect that Eric would have been saved had the current treatment regimens existed in the early 1950s. Similar triumphs against lymphoma and testicular cancer are held up as real examples of progress in the field of oncology. I point to such victories in counseling patients with AIDS facing currently incurable diseases. AIDS is a moving target. Important breakthroughs in rational drug design provided us with the protease inhibitors, and laid the foundation for combination therapy which might potentially control the replication of the virus for decades and thereby restore longevity. Prospects for a true cure (full eradication of the virus from the system) are still hotly debated, but no one can deny that the clinical gains made in the last two years have been significant. We have witnessed the first clinical remission of AIDS. David Sanford's individual story is a mirror to the larger world of people with HIV. His restoration of health is not unique, not an isolated antidote, but a prototype of what is being seen in controlled clinical trials. Moreover, the importance of access to medical care, particularly new drugs, is evident from his tale. The impact of these new therapies on a humanitarian plane is the greatest, but its economic impact, with reduction of hospitalization, and increase in individual productivity, is also apparent. I find myself, as a physician, being importantly instructed by people like David Sanford. Our greatest gratification comes from science changing clinical reality, and restoring productive lives that become filled with realistic hopes.
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PMID:AIDS: A Personal Perspective That Engenders Hope. 1038 38

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.
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PMID:Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. 1045 58

Life threatening illness, such as HIV/AIDS, also threaten people's sense of identity and taken-for-granted assumptions about the temporal framing of their lives. In response, people often experience transformations in values, spirituality and life priorities. Drawing on a combined quantitative and qualitative study of people living with HIV/AIDS in Australia, three different narratives that people use to make sense of their illness experience are identified: linear restitution narratives, linear chaotic narratives and polyphonic narratives. Linear illness narratives colonise the future, assuming that the future can be controlled through human action. They emphasise a faith in medical science, tend to be secular and self-centred and assume the end of life to be in the distant future. Hope is focused on concrete outcomes such as improved health or material possessions. Linear narratives can be either restitutive or chaotic. Restitutive linear narratives anticipate a life that will mirror the narrative. Chaotic linear narratives anticipate a life that will fail to meet the linear ideal resulting in despair and depression. In contrast, polyphonic illness narratives are oriented toward the present, emphasising the unpredictability of the future. These narratives tend to include spiritual experiences, a communally oriented value system, and to recount increased self-understanding and the gaining of new insights as a consequence of their illness. Hope in polyphonic narratives is more abstract and focused on a celebration of mystery, surprise and creativity.
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PMID:Illness narratives: time, hope and HIV. 1065 42

The knowledge that her child is infected puts a heavy emotional burden on a mother. Despair or depression lead to difficulties in reacting to the options and advice given by health workers. The compliance of the mother also is largely dependent on her acceptance of the HIV status of the child. Additionally, the belief that the child might die any moment may cause her not to take proper care of the child anymore. Worries of the caretakers are frequently related to poverty. Counselling of caretakers at the health centre could and should be an important element in care for HIV-infected children. Psychological and material support and advice concerning HIV infection, proper childcare and material problems may empower the caretakers. This may lead to a better follow-up of the child by health care workers and to increased compliance of and better care by the caretaker, which will improve life and survival of an infected child.
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PMID:Psychosocial and economic aspects of HIV/AIDS and counselling of caretakers of HIV-infected children in Uganda. 1121 40

The purpose of this study was to describe voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS. Three focus group interview sessions were conducted with 10 voluntary caregivers in 1998. The data were analyzed using the grounded theory method described originally by Glaser and Strauss. Closing and opening emerged as the core categories in the dynamics of hope. Closing means closing down in despair and to the process of life, whereas opening means opening up to hope and the process of life. Nursing interventions that prevent closing and enable opening are helpful for these people. Conceptual clarification and the differentiation between the concepts of hope, wish, despair, and hopelessness presented in this study require further elaboration. Further research on the dynamics of hope in fearing HIV/AIDS or living with HIV/AIDS and being a significant other to a person with HIV/AIDS from different perspectives is also needed.
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PMID:Voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS: a focus group study. 1129 33

The field of post-traumatic stress syndrome, as it relates to disease survival and HIV/AIDS, is the subject of books, papers, and research. This reference section lists material related to patient outlook and despair, living with uncertainty, loss and grief, and survival mechanisms. Research contacts in Fremont, CA and New York City are listed.
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PMID:Clearinghouse: hope and uncertainty. 1136 43

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

Rwanda may represent the first example of an entire society breaking down because of the prevalence of AIDS. It was known that infection rates in Rwanda were among the highest in the world, yet few Rwandans, even those tested, were given a diagnosis. Analysts believe that this situation led to feelings of fear and despair which fueled the recent violence. It has been estimated that as many as 70% of sex workers, 30-40% of pregnant women, and 4-65% of soldiers were infected. The disease decimated the officer corps, leaving an unstable leadership and a lack of discipline. In addition, although 98% of the people in Rwanda were aware of the epidemic, only 5% changed their behavior as a result of this knowledge. Because the government failed to acknowledge AIDS as a problem, public discussion was prohibited. It is instructive that when the atrocities began, HIV/AIDS workers were among the first to be murdered. Although it will be impossible to pinpoint the amount of influence that this epidemic had on the breakdown of civilization in Rwanda, it is important to ask this question. Attention is also being paid to the appropriate strategies for dealing with AIDS in postwar conditions. Is it reasonable to hand out condoms, for example, to a population struggling with cholera? Also, how can AIDS awareness be maintained in a country which must deal with repairing the far-reaching damages of war?
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PMID:Did HIV contribute to the breakdown of society in Rwanda? A question worth asking. 1228 3


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