How HIV-positive gay men make sense of AIDS: Grief, growth and the search for meaning

HIV-positive gay men face unique, and extreme, psychological stressors. They know they are infected with a virus of lethal and immedicable potency. They must tolerate the tremendous uncertainty of not knowing when, if, or to what extent their immune systems will falter. Additionally, many have experienced multiple bereavements (Martin, 1988), a trend that will escalate as the epidemic worsens. Given these profound psychological challenges, how, if at all, have HIV-positive gay men made sense of, or found meaning in, AIDS and their own HIV infection? Nineteen HIV-positive gay men participated in intensive semi-structured clinical interviews, to determine the strategies by which they ascribed meaning to their situation. The men ranged in age from 27 to 50 years old, and had known of their HIV status for between 18 and 106 months. Most were asymptomatic. Several had experienced some HIV-related health impairments. None had AIDS. All lived in urban settings with established gay communities. Interview data were analyzed primarily within the framework of Assumptive World theory (Janoff-Bulman, 1989), which holds that the ability to ascribe meaning to one\u27s life is necessary for optimal psychological functioning. Such a perspective is consonant with data on a vast array of traumatic life experiences (e.g., Frankl, 1959; Janoff-Bulman, 1989; Lifton, 1968, 1980; Parkes, 1988; Schwartzberg & Janoff-Bulman, in press; Wortman & Silver, 1987, 1989). The interviews revealed ten representations by which participants attributed specific meanings to HIV and AIDS: catalyst for personal or spiritual growth; belonging; relief; strategy; punishment; self-contamination; confirmation of powerlessness; isolation; and irreparable loss. Four general patterns typified the participants\u27 attempts to integrate HIV into a larger framework for ascribing meaning to the world: shattered meaning (inability to integrate HIV into a new worldview); high meaning (successful integration of HIV into a new worldview); defensive meaning (superficial integration of HIV into a new worldview); and irrelevant meaning (the minimization or denial of the impact of AIDS). Many subjects identified at least some beneficial aspects of their situation. For some, HIV was a dramatic catalyst for growth. Most had adapted well, suggesting that many HIV-positive gay men are coping effectively with the enormous challenges they face