HIV: Therapeutic Strategies for Guilt. Uncertainty, and Taking Control Abbreviated, Part II

Relationships
Responses of the participants that fit into this category reflect difficulties they have experienced in their social and emotional relationships. Difficulties occur in the establishment of relationships with people who do not know the participant has HIV as well as difficulties in their existing relationships since the diagnosis. Five participants (2 males, 3 females), 63% of the sample, indicated that they had some type of difficulties with relationships. Because the difficulties experienced may be specific to the type of relationship, three subcategories of relationships are delineated: friends/peers, families, and intimate/dating relationships.

Friends and peers. The responses in this subcategory represent the difficulties the participants have experienced in their relationships with friends and/or peers within the context of HIV. Self-isolation and distancing from friends appear to be common themes voiced by the participants. This distancing appears self-protective in that by avoiding friendships the participants can avoid the pain that may be inflicted by friends who are unsupportive of their HIV status. "Since I was diagnosed, I never usually interact with people that much, I interact but not on a friend to friend basis ... I don't keep a lot of friends." "So, by being positive, you look at people a lot different ... now I know I really need to get my life together and start looking at my friends ... the kind of stuff so-called friends have used hurts you."

Families. Responses in this subcategory reflect the difficult experiences that the participants have had with either their own family members or their significant other's family. Rejection by family members appeared to be a theme for the participants. Some participants felt exiled, either from their own families or the families of their significant others. "I think maybe, well, everybody [in my family] is turning against me and trying to push me away," said one. Another commented, "[His mother] loved me at first ... then once she found out, she didn't want me in her house anymore. It's like I'm killing her son."

Intimate/dating partners. These responses reflect the difficulties that the participants have had either in contemplating or establishing intimate relationships. One theme that appeared concerns infecting a partner. This concern might reflect the participant's fear, or perhaps the participant is being told by those around him or her that he or she should not become sexually involved with a partner. "I mean, personally, I don't want to get in no relationship, especially that I'm HIV positive and can infect somebody. I don't want no relationship at all." "The difficult part of it is, okay, it's like I found somebody but certain people are trying to stop us from being together [because of HIV], and that's difficult for me."

Another theme that is related to the difficulties of intimate relationships is the fear of rejection by a partner due to HIV status. Participants voiced concerns about having to tell a partner, with the fear that a partner will find out about their status from someone else, and that the partner will ultimately reject them because of their HIV infection. "Dating is a pain. Such a pain. No matter if I, if I find this special person or something, I'll always have to worry about them not falling in love with me because I'm positive. Or having to find out that I am. That's what worries me."

Finally, one theme questions whether anyone would be willing to be in an intimate relationship with an HIV-infected person. One participant mentioned the difficulties inherent in such a relationship, as well as the risks.
   
"This disease isolates you ... it's so definite, so final. And it, you don't know if you could, give a person, if they find out, I think this is one of my ultimate tests of love. That I could love you so much that I could die and leave you alone. I love you so much that I could inadvertently kill you myself. I don't know that any man is willing to put up with that. And that scares me."

Psychological Burden of HIV
Responses made by the participants that are included in this category represent some of the psychological manifestations of HIV. These psychological symptoms are often associated with the difficulties of having a chronic illness, particularly living with HIV. Five participants (2 males, 3 females), 63% of the sample, had responses that fit this category. Two themes are presented within these responses: HIV and stress, and HIV and negative affect.

HIV and stress. These responses allude to the stressful nature of living with a life-threatening illness. Participants indicated that life was stressful before they found out they were HIV-positive; the HIV diagnosis either created stress or compounded the stress they were already experiencing. "I was going through a lot of stressful things and then I found out I was HIV positive, that just made it harder for me." Another response was, "I got an attitude problem now ... I guess with all the stress and everything."

HIV and negative affect. This theme encompasses some of the psychological responses to HIV, particularly those that create negative affective states. Negative-affect responses can include depression, anxiety, loneliness, and helplessness. Most of the participants report having experiences with these emotions. Some of those responses were: "My life was different, it wasn't a lot different, but it was different because I didn't have to think about this, to take special care and stuff like that ... when I found out about this, I was depressed and stuff like that, that make it worse." "I mean, it's kinda, it's not, it doesn't really give you a headache, but when you think about this life that you have now and your life that you had before, it was, well, it was just so much easier, that other life." "I think I'm more tolerant toward certain things ... it definitely changed my views of sickness ... I understand that kind of helplessness," and "You know, I don't want to stay alone all my life. I want to stay with somebody. Yeah, friends or relationship, or somebody. I don't want to stay alone."

Discussion
Based on these results, it is evident that many of the difficulties that have been identified in adult HIV populations also impact adolescents. All of the adolescents interviewed had experienced difficulties in at least two of the response/thematic categories that were developed. These results imply that there are still a tremendous number of difficulties and obstacles for individuals with HIV to overcome. Understanding these difficulties is the first step toward making changes.
- Hosek, Sybil, Gary Harper, and Rocco Domanico; Psychological and Social Difficulties of Adolescents Living With HIV: A Qualitative Analysis; Journal of Sex Education & Therapy; 2000; Vol. 25 Issue 4
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #4
The preceding section contained information about treating HIV positive adolescents.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 10
In Hosek’s study, what are three themes common to HIV positive adolescents’ concerns regarding intimate relationships? Record the letter of the correct answer the Answer Booklet