Thursday, February 11, 2010

Can spirituality enhance the lives of gay men living with HIV?

By Anthony Oltean MSW LCSW CADC*

...with respect to HIV+ gay men, spirituality as a coping style has been neglected.

Essay #1:  A Gap in Research

As HIV/AIDS enters its third decade, medical science is still without a cure.  Fortunately, the advent of highly active antiretroviral therapy (HAART) in the mid-90s has lead to the steady decline in HIV/AIDS related death.  HAART medication therapy is now the main treatment for HIV/AIDS.  Although it has made life for people living with HIV/AIDS (PLWHA) more manageable, HAART medication therapy is costly, lifelong, and often difficult to maintain.

The complex nature and numerous barriers to HAART medication adherence have been established within the literature.  Common barriers associated with lack of adherence to HAART medications are depression, experienced and anticipated severity of side effects, and perceived stress toward HIV and limited coping mechanisms.  Further, disruptions in one’s medication adherence, in the case of PLWHA, may result not only in the worsening of an individual’s health condition, but the potential transmission of a drug-resistant strain of the HIV virus.

In addition, it has been documented in the social science literature that internalized homonegativity constitutes an additional series of roadblocks to success in HAART medication adherence for gay men.  Internal homonegativity, historically referred to as internalized homophobia, can be considered the negative anti-homosexual attitudes experienced toward one’s own sexual orientation and identity, as well as the key conceptualization of stress unique to the lesbian and gay population as a minority. Discussed more fully later, internalized homonegativity complicates identity development, physical and emotional health, as well as has influence on self-destructive behaviors. 

Meyer found a significant relationship between internalized homonegativity and demoralization, guilt, sex difficulties, suicide and AIDS-related traumatic stress response.  Additional health outcome research has identified associations with increased rates of depression and low self-esteem, high levels of distrust and loneliness. Further, Ross et al suggested that internalized homonegativity might be a valid antecedent of a range of chronic and self-destructing behavior problems.

Aside from the inherent difficulties of chronic medication adherence, and the implications of internalized homonegativity, HIV/AIDS challenges the social, psychological, and often spiritual health of gay men.  Further, PLWHA often find themselves in search of meaning, purpose, and significance in life.  Findings from studies conducted on chronic life-threatening illnesses similarity to PLWHA, such as heart disease and cancer, have indicated that individuals turn to various forms of spirituality to help release stress and cope with their burden.  Further, Ironson  indicated that patients with generally high stress lives had a significantly greater risk of early HIV disease progression compared to those with less chronic stress.  Research suggests that religious and/or spiritual activities reduces stress, and may affect the course and rate of HIV progression under similar mechanisms to the impact of stress, though beneficially .

Since the on set of the disease, medical and behavioral researchers have focused their energy on the physical, psychological, social, and socioeconomic ramifications of HIV/AIDS.

However, with respect to HIV+ gay men, spirituality as a coping style has been neglected.  Why?
More to follow.

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* After a hiatus from all religion, coming out, building myself into a proud man (all of which were challenging chapters), I have only recently begun to reconcile my feelings about a higher power and their place in my life.  I know that many young LGBTQ people have had experienced similar, and often much worse, messages from religious figures in their lives.  Many have turned away from religion and/or any spirituality because of these experiences.  This is a great injustice.

Spirituality, at a minimum, is an important coping skill for millions of people around the world. Many of those people are LGBTQ’s.  However, researchers in the behavioral sciences have only begun to explore its utility for LGBTQ’s with regards to self-esteem, coping with chronic illness such as HIV/AIDS, and coping with an oppressive society.  The following essays are part of my dissertation.  They will discuss spirituality as a coping style, how it works, the academic dilemmas in examining these topics, and will hopefully spark more interest from researchers, and those of us still in hiatus from spirituality.

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