The Nature and Correlates of Psychological Adjustment in Gay Men with AIDS-Related Conditions1

This study assessed differences in the psychological adjustment of gay men who tested positive for the antibody to the human immunodeficiency virus (HIV). Twenty-one were symptomatic for AIDS, and 27 were asymptomatic. A group of 15 gay men who tested negative for the HIV was included as a comparison group. Men in the three groups were equivalent on demographic variables. Symptomatic men reported more health problems than either asymptomatic or seronegative men. Relative to men who were symptomatic, those who were asymptomatic reported more death anxiety, less optimism, and greater severity of psychological distress, and reported more frequent use of avoidance and distancing as coping strategies. The poor psychological functioning of asymptomatic subjects was attributed to the uncertainty regarding their future health status. Generally, positive psychological well-being of symptomatic and asymptomatic men was related to the infrequent use of avoidance coping strategies and high satisfaction with perceived social support.     

Human lmmunodeficiency Virus Infection and the Gay Community: Counseling and Clinical Issues

The gay community has been and continues to be disproportionately affected by the acquired immune deficiency syndrome (AIDS) and the human immunodeficiency virus (HIV) infection. Need for risk-reduction education, mental health service provision, and assistance in grieving the ongoing loss of loved ones continues to exist among members of the gay community. Clinicians who work with gay clients should be aware of the critical issues confronting gay men who are at risk for infection, those who may already be infected with HIV, and their loved ones. This article highlights critical issues in introducing prevention in therapy and counseling, in supporting asymptomatic seropositive gay men and gay men with AIDS-related complex (ARC) and AIDS in their attempts to cope, and in assisting in the grieving process for those who have lost loved ones to AIDS-related illnesses.     

Spared at Random: Survivor Reactions in the Gay Community1

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered “survivors” since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N= 129) and HIV-positive (N= 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.     

Help-seeking for AIDS-related concerns: A comparison of gay men with various HIV diagnoses

Examined help-seeking and psychological distress among four groups of gay men (30 AIDS-diagnosed, 107 HIV-seropositive, 149 HIV-seronegative, 244 untested) in the AIDS Behavioral Research Project, a longitudinal survey of San Francisco gay men. The men reported high levels of anxiety, depression, and help-seeking from their social networks. AIDS-diagnosed and HIV-positives reported the most AIDS worry and were the most likely to seek help. High percentages of AIDS-diagnosed men sought help from all sources (peers, professionals, family), whereas nondiagnosed men were more likely to seek help from peers. Regardless of the men's HIV status, peers were perceived to be the most helpful source. Family members were less likely sought and perceived as least helpful. The strengths and limitations of peers as social support providers for AIDS-related concerns are discussed, including implications for the design of community programs to enhance the abilities of peer helpers.     

Primary relationships affect the psychological health of homosexual men at risk for AIDS.

Less is known about the effects of primary relationships on psychological health for homosexual men and women than for heterosexual men and women. Given the HIV/AIDS epidemic, the primary relationships of homosexual men are especially important to examine at the present time. Using questionnaire data collected from 259 homosexual men, this study examined the effects of status and quality of relationship on psychological health. Analysis indicated that homosexual men who are in primary relationships experience fewer depressive symptoms and greater well-being than other homosexual men but that being in a relationship does not predict changes in these outcomes over time. Men who report high quality of relationship show improvements over time in psychological health. These findings are discussed in light of the HIV/AIDS epidemic.     

Empowering lesbian and gay communities: A call for collaboration with community psychology

This article traces the history of empowerment efforts in lesbian and gay communities. Despite considerable progress, lesbians and gay men remain marginalized in American society. Their personal, family, and community development is hampered by social and institutional barriers to empowerment. Three powerful disempowering problems of contemporary lesbian and gay communities are detailed: (1) stresses related to coming out; (2) heterosexism; and, (3) difficulties identifying with a community. Four domains are suggested for future collaboration between community psychologists and lesbian/gay communities: (1) anti-lesbian/anti-gay prejudice, discrimination, and violence; (2) mental health and health enhancement; (3) the HIV/AIDS epidemic; and, (4) civil rights. Future collaborations must build on successful-social change strategies already used by activists in lesbian and gay communities.     

Group psychotherapy with the aging gay male: Treatment of choice

This article summarizes many issues facing gay men as they age. Aging for gay men is a complex phenomenon involving identity, self-esteem, internalized homophobia, stereotypes about older gay men, and the paucity of positive gay male images or role models to help direct their development. In this article, I will attempt to illuminate some of the complex variables of aging, as well as illustrate through case examples that group psychotherapy is a particularly helpful forum for skills development for middle age and older gay men. The themes covered include: 1) commitment struggles—especially anxiety management and conflict resolution, 2) self-esteem regulation, 3) projections and internalizations, 4) capacity for intimacy, and 5) unresolved grief and loss due to the impact of AIDS: Alone vs. Lonely.     

年轻男同性恋者内化同性恋嫌恶与主观幸福感的关系：自尊与孤独感的中介效应

通过网络抽样法,采用内化同性恋嫌恶量表、自尊量表、孤独感量表、主观幸福感量表对249名年轻男同性恋者进行调查,考察当代国内年轻男同性恋者内化同性恋嫌恶的现状,并探讨内化同性恋嫌恶与主观幸福感的关系及自尊与孤独感在其间的中介效应。结果表明：（1）总体上,国内年轻男同性恋者内化同性恋嫌恶处于中等偏低水平,且有较大比例年轻男同性恋者不存在内化同性恋嫌恶。（2）内化同性恋嫌恶与积极情感、生活满意度显著负相关,与消极情感显著正相关。（3）自尊与孤独感在内化同性恋嫌恶与主观幸福感间起完全中介作用。（4）内化同性恋嫌恶通过影响自尊间接影响孤独感,又通过影响孤独感作用于主观幸福感。     

The Impact of Multiple AIDS‐Related Bereavement in the Gay Male Population

During the last 15 years, society has been overwhelmed by the medical, social, and psychological impact of AIDS and HIV. One aspect of this issue is AIDS‐related loss, and the correlative epidemic of AIDS‐related bereavement. Individuals are considered particularly susceptible to such bereavement when loss is multiple, as is often the case in the gay male population. The research exploring the impact of AIDS‐related loss is reviewed, and counseling implications for working with individuals experiencing multiple losses are suggested.     

Social Support Provision to HIV-Infected Gay Men1

The study examined associations between attitudes toward homosexuality, fear of AIDS, blame of persons infected with the HIV-virus, and social support provision to these individuals. A sample of HIV-infected gay men reported on the support they receive from specific members of their social networks. These network members then completed questionnaires assessing the predictor variables. Homophobia, homosexual preference, and the interaction of these two variables were positively associated with blame. Blame, together with fear of AIDS and low levels of psychological well-being, were negatively associated with provision of emotional support. Fear of AIDS was also related to negative changes in the quality of recipients' and providers' relationships. Finally, emotional support was strongly related to adjustment to illness among support recipients. Results suggest important points for intervention to promote adjustment to HIV infection among gay men.     

Mental Health Stereotypes About Gay Men

Three studies were conducted to examine the mental health stereotypes about gay men among college student and therapist trainee samples. Results from Study 1 indicated that (a) college students and therapist trainees endorsed a stereotype of the mental health of gay men that was similar in terms of its content and strength, and (b) the stereotype was consistent with five DSM-IV-TR disorder categories: mood, anxiety, sexual and gender identity, eating, and personality disorders. In Study 2 and 3 we investigated whether homophobia or a tendency to report cultural beliefs could account for the lack of difference between college students and therapist trainees. Results did not support either explanation.     

Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.     

Perceived Control and Psychological Adjustment in Gay Men With AIDS1

The relationship of control beliefs to psychological adjustment was investigated in a sample of 24 gay men diagnosed with AIDS, participants in the University of California, Los Angeles site of the Multicenter AIDS Cohort Study (MACS). Distinctions between generalized contingency beliefs and specific competence beliefs and between personal and vicarious control beliefs were included in the questionnaire and interview measures administered. The results support these distinctions and indicate that beliefs in personal control over day-to-day symptoms and over course of illness were positively related to adjustment, whereas beliefs in control by others over course of illness and over medical care and treatment were negatively related to adjustment. These relationships appeared to be strongest for men who reported poorer health. These associations were not accounted for by locus of control beliefs, negative affectivity, or time since diagnosis with AIDS.     

Counseling in the Era of AIDS

The AIDS (Acquired Immune Deficiency Syndrome) crisis is affecting greater numbers of people, and counselors are being called upon to work with this population. Counseling roles have expanded, and counselors have been thrust into the medical, social service, and political spheres. In this article the authors describe the role of the counselor in the era of AIDS; psychological reactions to a chronic, stigmatized, and ultimately fatal illness; and the special needs of specific populations (gay men, families and friends of gay men, gay youth, significant others, people of color, heterosexual women and lesbians, college students, substance abusers, and the “worried well”). The authors also examine the effects of HIV (human immunodeficiency virus) illness and AIDS on the care giver. Counseling interventions are described throughout the article.     

Are Gay Men in Worse Mental Health than Heterosexual Men? The Role of Age, Shame and Guilt, and Coming-Out

Previous studies reporting that gay individuals are in worse mental health than heterosexuals have typically employed young or mixed-age samples, ignoring the role of age. Mental health problems may show greater age-related improvement among gay than heterosexual men as indicated by the findings of the present study. In this study, the following indices of mental health are examined, and found to be comparable, among 86 heterosexual and 81 gay men aged 18–48: depression, suicidality, anger, anxiety, negative self-esteem, emotional instability, and lack of emotional responsiveness. Most indices show age-related effects among gay men, with less severe symptoms reported by older individuals. Among heterosexual men, effects of age are less widespread, although older men do report fewer symptoms of anger. Chronic shame and chronic guilt are related to mental health problems and a lessening in shame accounted, in part, for the age-related decline in depression among gay men. Different approaches to disclosing/concealing sexual identity are also linked with shame, guilt, and mental health among gay men.     

Beyond Similarities: Cross-Gender and Cross-Orientation Best Friendship in a Sample of Sexual Minority and Heterosexual Young Adults

The research investigates differences between heterosexual (n?=?714) and lesbian and gay men (n?=?386) young adults regarding best friendship patterns, well-being, and social anxiety. Based on data from a paper-pencil survey of 1,100 Italian young adults aged 18 to 26, this study underlines the importance of the best friend in young adults’ psychological adjustment, highlighting patterns of friendship in heterosexual and lesbian and gay men young adults. Overall, the majority of participants declared that they had best friends; in the total sample, significant differences were found between women and men, and between lesbian/gay men participants and heterosexual young adults. Lesbian and gay men participants reported more cross-gender best friendships than heterosexual participants did, as well as more cross-orientation best friendships. Gender differences were found only with regards to cross-gender friendships: gay men reported more cross-gender friendships than lesbians did, while heterosexual females reported a higher percentage of cross-gender best friendship than heterosexual males did. MANOVA analysis, only in the gay and lesbian sample, showed the effect of gender, cross-gender, and cross-orientation on well-being and social anxiety. For the well-being dimension, gay men participants with female best friends reported higher scores. In terms of social anxiety, lesbian and gay young adults with cross-gender and cross-orientation best friends reported lower levels of social anxiety.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Stigma, social risk, and health policy: public attitudes toward HIV surveillance policies and the social construction of illness.

Data from a 1999 national telephone survey with a probability sample of English-speaking US adults (N=1,335) were used to assess how support for HIV surveillance policies is related to AIDS stigma and negative attitudes toward groups disproportionately affected by the epidemic. Anonymous reporting of HIV results to the government was supported by a margin of approximately 2-to-l, but name-based reporting was opposed 3-to-l. Compared with other respondents, supporters of name-based surveillance expressed significantly more negative feelings toward people with AIDS, gay men, lesbians, and injecting drug users. More than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future. Implications for understanding the social construction of illness and for implementing effective HIV surveillance programs are discussed.