Health-related quality of life among people living with hiv disease in small communities and rural areas

Abstract

While many studies have examined the life quality of HIV-infected persons in large metropolitan areas, few studies have investigated quality of life issues among persons living with HIV disease in America's small and rural communities. In the present study, 78 people living with HIV/AIDS in small and rural communities (i.e., populations <25,000) reported on their health-related quality of life. Many respondents reported decreased social, emotional, functional, and physical well-being. Results revealed that participants' emotional well-being and the quality of their relationship with their doctor were related to their overall quality of life. The majority of participants (73%) expressed interest in participating in a telephone-linked support group involving other people living with HIV designed to improve quality of life.     

Virginia Satir's Concepts of “Styles of Living”

SUMMARY

Any primary style of living is a self constructed cage. It is both isolating and alienating in its impact on relationships. It becomes a barrier against intimacy in a wanted togetherness. It limits personal growth. When growth in intimacy is a wanted goal in a relationship, change becomes a necessity. To create a bridge to another (a bonding process) involves risking vulnerability (a process of breaking through one's defenses). It also involves clear communication, confrontation of differences, learning negotiation skills, and establishing person specific ground rules of living in intimacy. This allows the freedom of being different and the discipline of compromise and mutual caring.     

Power and Pleasure

SUMMARY

In exploring issues of power and pleasure in relationships the author uses Erikson's (1965) developmental 'eight ages of man' as both a conceptual framework and a way of describing aspects of the developmental growth of boys as men, and he completes Erikson's (1968) epigenesis of the life cycle in relation to identity and intimacy. Drawing on literature on male psychology, his own experience and his experience as a counsellor and a Transactional Analysis (TA) psychotherapist in clinical training, the author focuses on male identity and men's capacity for intimacy in relationships. The use and abuse of power in achieving male identity, and the implications for mutual pleasure and interdependence in intimate relationships are outlined and practice issues for counselling and psychotherapy with men in relation to identity and intimacy issues are considered.     

Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis

Objectives: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses.

Design: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews.

Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews.

Results: Our analysis focuses upon the participants’ struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation.

Conclusions: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.     

Clinical Issues with Gay Male Couples

SUMMARY

Although gay male couples share with all couples three essential tasks of couplehood-creating boundaries in order to form a couple identity, negotiating closeness and distance, and accommodating to their individual differences-gay male couples face special complications in each task. These complications, examined herein, are largely the result of the marginalization gay men experience from living in a homophobic culture, and male gender acculturation that makes male-to-male intimacy difficult. A model of brief couple therapy for gay men is presented that is designed to honor, as well as challenge, the relationship the men have co-constructed and specifically addresses the difficulties men have in maintaining intimate bonds. A case study illustrates the treatment of clinical issues presented by male couples.     

Multiple approaches to the treatment of violent couples

Abstract

The relationship of the discrepancy between couple's actual level of intimacy and desired level of intimacy and marital adjustment was explored using data from 185 randomly selected couples who completed the Personal Assessment of Intimacy in Relationships and the Marital Adjustment Test. Multivariate and univariate regression analyses indicated that the discrepancy between actual and desired intimacy of husbands and wives was highly predictive of marital adjustment (R²=.665). Particularly interesting was that couples with low intimacy scores who did not desire more intimacy had good marital adjustment. The relationship between intimacy and marital adjustment was curvilinear, and wives' marital adjustment was more affected by intimacy than husbands'. Implications for marital therapy are discussed.     

Personal assessment of intimacy in relationships: Validity and measurement invariance across gender

IntroductionIntimacy is central in close relationships and a variety of definitions and instruments exist in scientific literature, making this concept complex to investigate. Furthermore, gender differences were identified in the definition and experience of intimacy.ObjectivesThis study aims to confirm the three-factor structure of the personal assessment of intimacy in relationships (PAIR, Schaefer & Olson, 1981), commonly used in research and marital therapy, developed by Moore et al. (1998) and to examine the measurement equivalence of the scale across gender.MethodA confirmatory factor analysis (CFA) was performed on the responses of 313 women and 251 men in committed relationships in a French population. Measurement equivalence of the scale across gender was then conducted with the best-fitting model.ResultsThe results of CFA and post-hoc analyses revealed that the three-factor model revised with 18 items was the best fit to the data: (1) engagement (10 items), (2) communication (5 items), (3) shared friends (3 items). PAIR-18 displayed a lack of metric and scalar invariance across gender but estimated means of latent variables is not very different between the full invariant model and the unconstraint models.ConclusionNevertheless, consideration of gender differences in the construct of intimacy is very important for theoretical research on intimacy in romantic relationships and for the interventions of marital therapists based on intimacy.     

Ageing and Isolation: Is the Issue Social Isolation or Is It Lack of Meaning in Lige?

SUMMARY

Social and spiritual isolation are growing issues for an ageing society that promotes the ideals of autonomy and high levels of individuation amongst its citizens. This chapter explores the issues of social and spiritual isolation for older adults and ways of addressing these issues both now and in the future. The need for intimacy with God and with others is illustrated using material from in-depth interviews with older adults who live independently and others who are residents of aged care facilities.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

A Needs Assessment of Transgendered People of Color Living in Washington,DC

SUMMARY

A needs assessment (N = 248) conducted in Washington, DC, revealed that trans-gendered people of color are at high risk for HIV/AIDS, substance abuse, suicide and violence/crime victimization. Overall HIV prevalence was 25%, with 32% in natal males (MTFs, i.e., male-to-females). Four predictors for HIV positive status were identified through logistic regression-male sex at birth, a history of substance abuse, sexual assault, and unemployment. Substance abuse was found in nearly half the sample (48%) but only half of those (51%) had sought treatment for it. Thirty-eight percent reported experiencing suicidal ideation, with 63% of those attributing it to their gender issues. Of those with suicidal ideation, nearly half (49%, or 16% of the entire sample), went on to make attempt(s) to kill themselves. Forty-three percent had been victims of violence or crime, including 13% who had been sexually assaulted.

Knowledge of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association was quite low (9%) and associated with white race, any higher education beyond high school, and access to sex reassignment surgery (SRS). Access to SRS, defined as obtaining vaginoplasties for natal males and chest surgeries for natal females, was just 4%. White race (versus all other races, p < .001) and female at birth (versus male, p < .01) were significantly associated with access to SRS.

Use of hormones at some point during their lives was reported by 51% of participants. Thirty-five percent were currently taking hormones, with 72% acquiring their hormones from friends or on the street. Among natal males, 25% had injected silicone.

Nineteen percent did not have their own living space, and employment, housing and job training were the most commonly-reported immediate needs of the sample. The results of this needs assessment provide evidence of an urgent need for increased medical and social services specific to transgendered people of color living in the District of Columbia.     

Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders

SUMMARY

Social discourses regarding gender are responsible for molding people's cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender socialization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people.

This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area.

Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis confirmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies.

Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities.     

Student essay competition prize winner a study of the breaking and remaking of affectional bonds

Abstract

This essay was originally presented as the author's final clinical essay for the Advanced Diploma in Psychodynamic Counselling run by the WPF (North) in conjunction with the Tuke Centre, York. It is a reflection on a year's counselling undertaken with a young man struggling with angry and violent impulses which threatened to wreck his relationship with his partner and their children. The work draws on psychoanalytic and attachment theories and examines the process involving client and counsellor as two men working together on issues of loss, relationship and intimacy.     

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice

Abstract

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in “clusters” of others with genetically similar strains. This is called “molecular HIV surveillance” (MHS). In 2019, “cluster detection and response” (CDR) programs that re-use MHS data became the “fourth pillar” of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for “HIV data justice.” The essay contributes to a “bioethics of the oppressed.”     

Writing Movements as Indications of the Writer's Social Behavior

Abstract

Two experiments investigated set size effects in self-disclosure behavior. In Experiment 1, subjects received information about the topics a partner was willing to discuss. Set size was manipulated by giving subjects bogus information that their partner had chosen high intimacy topics (2, 4, or 6 topics). Results show that the larger the set, the greater the partner's perceived liking, trust, and intimacy. In Experiment 2, intimacy level (high or low) was crossed with set size (2, 4, or 6 intimate topics chosen). High intimacy data replicated results found in Experiment 1. A set size effect was also found for low intimacy topics but in the opposite direction, in accord with additive model predictions.     

Facilitating marital intimacy through self-disclosure

Abstract

Intimacy is one of several interpersonal dimensions which describe the quality of a marital relationship. An operational definition of intimacy is presented. Evidence that a lack of intimacy is associated with nonpsychotic emotional illness, marital maladjustment and family dysfunction is reviewed. A technique is described which facilitates marital intimacy through self-disclosure. Evidence is presented that cognitive self-disclosure is a major determinant of a couple's level of intimacy. The assumption is made that facilitating cognitive self-disclosure will increase intimacy with subsequent improvement of neurotic symptoms and marital maladjustment. A case is presented which demonstrates that a structured technique for selfdisclosure of relevant assumptions in a reciprocal manner to a supportive listener can facilitate a couple's level of intimacy. The role of self-disclosure, modeling and cognitive restructuring as therapeutic factors are discussed.     

Ethical considerations in the supervision of applied sport psychology graduate students

Abstract

Some of the most important relationships that a sport psychologist experiences in his or her career are between the supervisor and supervisee in applied practica and internships. These relationships may become models for future professional and ethical behavior with colleagues, students, and clients, and thus deserve careful examination. Ethics form a foundation for practice, and while classroom discussions of ethical issues help educate graduate students, the supervisor-supervisee relationship may provide a hands-on experience of ethical dilemmas and ethical problem solving. Ethics in supervisor-supervisee relationships cover at least two broad areas. First, there is the supervisor's monitoring and mentoring of ethical considerations in the supervisee's relationship with the athlete-client. Second, ethical questions arise in the relationship between the supervisor and the supervisee. The present paper includes discussion of general supervisory issues (e.g., modeling ethical behavior, helping develop counseling skills) and explores the specific ethical problems of referring for counseling, intimacy, and exploitation. Also, three case examples illustrate ethical concerns that may appear in the process of applied sport psychology supervision. Broadening education in ethical issues in supervision for both psychology and exercise science graduate programs may help future practitioners better serve their clients.     

Predicting Marital Adjustment from Young Adults’ Initial Levels and Changes in Emotional Intimacy over Time: A 25-Year Longitudinal Study

Emotional intimacy has long been known to influence marital adjustment. However, little is known about whether emotional intimacy experienced and developed during early adulthood predicts marital adjustment at a later time. Using longitudinal data from a sample of recent university graduates (N = 144) at five data points over a period of 25 years, it was found that higher levels of earlier emotional intimacy with a closest other and change in emotional intimacy over the first 8 years predicted Wave 5 marital adjustment. On average, women reported greater emotional intimacy than men at Wave 1. Neither change in marital status nor gender moderated the associations between emotional intimacy intercept and slope with marital adjustment at Wave 5. These as well as cluster analytic findings are discussed in light of Erikson’s developmental theory and applied to the idea that emotional intimacy may be a skill that can be developed and potentially modified.     

Life With a Partner with ADHD: The Moderating Role of Intimacy

Adult attention deficit and hyperactivity disorder (ADHD) manifests itself through a variety of symptoms, some of which affect not only occupational and recreational activities but also intimate relationships. Previous findings have focused on the effects of adult ADHD on intimacy and relationships from the ADHD diagnosed person’s point of view. However, spouses of people with ADHD are a neglected population with regard to the effects that ADHD has on their romantic relationships. Our aim was to assess the effects of being married to a spouse with ADHD on marital relationships, and the moderating role of intimacy. We compared healthy spouses of people with ADHD to healthy spouses of healthy adults (M?=?38.23, SD?=?4.78) in their degree of self-reported intimacy and marital satisfaction. Our findings indicate that spouses of individuals with ADHD report significantly lower intimacy and lower marital satisfaction compared to spouses of individuals without ADHD. Moreover, our findings indicate that spousal reports about their degree of intimacy mediate the relationships between their spouses’ ADHD and their marital satisfaction. Results are discussed in relation to the broad implications that adult ADHD has for romantic intimacy. Our research addresses healthy partners married to a spouse with ADHD, suggesting that living with a partner with ADHD behaviors is challenging. ADHD symptoms negatively affect various qualities in the person experiencing them, but of equal importance is the damage occurring to his or her spouse. Implications for future research and recommendations for clinical work are suggested.