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HIV: Therapeutic Strategies for Guilt, Uncertainty, Taking Control
The impact of being diagnosed with a life threatening illness is significant and far-reaching. People with a positive diagnosis of HIV must integrate their diagnosis into their self-concept and career goals while they also continue investing in their relationships, their careers, and their overall well-being. Moreover, many people who are HIV positive encounter discriminatory treatment at work, leading them to seek new career opportunities or to withdraw from work altogether. For most people, however, completely separating from work is not financially feasible. In addition, many people find a sense of meaning, purpose, and dignity in their work that enables them to live effectively. Thus, people who are HIV infected must retain their interest in working while living lives that have been altered significantly as a result of their diagnosis.
Maintaining active involvement in work is even more important due to recent medical advances in treating HIV, including new drug combinations, earlier intervention, and improved treatment regimens. For example, highly active antiretroviral therapy (HAART) allows many people living with HIV disease to live longer, have a better quality of life, and experience fewer illnesses related to their HIV status (Bettinger, 1997; Centers for Disease Control and Prevention, 1998, 2001; Jones et al., 1999; Kohlenberg, 1997; Martin, 1999). As a result, there are people living with HIV/ AIDS who are either able to maintain employment because of these treatment regimens or become employed again as their health situation improves. Clearly, the continuous development of medical treatments to fight the complications related to HIV/AIDS increases the need to understand the career concerns confronting people living with this disease.
As with any chronic illness, people living with HIV disease must incorporate the disease into their career identities and career goals (Hoffman, 1997). Career development issues for people living with HIV/AIDS are many and varied. For example, on receiving an HIV-positive diagnosis, some people may despair that they do not have time to attain their goals (Morin, Charles, & Maylon, 1984). These feelings may lead them to minimize their accomplishments, label their lives as unimportant, and resist identifying long-term goals. Other people may "respond with a deep desire to make a long-lasting contribution to society and leave some legacy of their lives" (Hoffman, 199l, p.508).
To learn more about the career concerns of people living with HIV/AIDS, Brooks and Klosinski (1999) led focus groups consisting of people living with HIV disease who were unemployed at the time but who had a stated interest in returning to work. When asked why they wanted to return to work, the group members identified the financial, emotional, and psychological benefits of employment. They also noted physical activity and being with other people as incentives to return to work. Some of their concerns related to returning to work included possible losses or changes in health benefits, possible negative effects on their health, concerns about disclosing their HIV status, insufficient job skills and education, and possible prejudice and stigma related to their HIV status.
On the basis of participants' interview responses, we classified their concerns as relating to career or workplace issues, medical issues, or coping resources. Concerns related to career or workplace issues were prevalent in this study, including concerns about accommodating their medical treatment in the workplace. These concerns focused on feeling the need to be discrete in taking medication throughout the day and whether to disclose to supervisors and coworkers why they were taking regular and frequent medication. It was not surprising that participants were also concerned about having insurance benefits to cover the cost of their treatment. Several noted that they had encountered difficulty in securing insurance coverage for their treatment. Thus, the participants were confronted in various ways with the dilemma of disclosing their illness to others. Clearly, a significant aspect of this dilemma related to the fear of encountering discriminatory treatment, after disclosure, from their coworkers and supervisors.
Additional career concerns experienced by the participants related to how their diagnosis influenced their career goals. Some were forced to change their jobs because their health status could not be accommodated in their work (e.g., flight attendant, nursing assistant). Others attempted to integrate their illness into their work by becoming actively involved in AIDS awareness initiatives (e.g., speaking to school and community groups about HIV/AIDS). Some of the participants who were forced to leave work due to their health status experienced negative reactions from their family members and significant others (e.g., "My family has had a very difficult time with my not working").
It is not surprising that the participants expressed a significant number of medical concerns. A common concern expressed by the participants related to the treatment they received from medical personnel. They expressed frustration and anger due to insensitive treatment from physicians and nurses in particular. The participants believed they were treated as objects rather than people. They noted that the physicians seemed to "not listen" to their concerns. The participants also expressed frustration related to the lack of information they received from their physicians concerning their treatment protocols and the overall management of their medical treatment.
It is evident that for both categories discussed thus far (i.e., career or workplace issues and medical issues) a common theme is the lack of support experienced by the participants. The importance of support emerged in the third first-stage classification category labeled as "coping resources." One of the strategies used by the participants for coping with their illness was to seek social support from others who were in a similar situation (e.g., joining an AIDS support group) and to offer support to others coping with HIV/ AIDS and other chronic illnesses. Participants also coped with their illness by engaging in good self-care activities. For example, participants noted the importance of getting sufficient rest, eating healthy diets, and drawing on a spiritual or religious perspective to cope with their disease.
Reflection Exercise #3
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