Chapter 9: Telephone Group Counseling in Reducing AIDS Risk in Gay and Bisexual Males

We have designed and are currently delivering an AIDS risk-reduction counseling intervention for gay and bisexual men having difficulty changing to and maintaining safer sex (Project ARIES). The intent of the project is to lower barriers to help-seeking by offering service entirely by telephone and not requiring particpants to give identifying information. The 14-session program is delivered in groups composed of six participants and two co-facilitators. This article describes the cognitive-behavioral models on which the intervention is based, components of the group sessions, marketing strategies, and evaluation methodology. A case study illustrates typical participant motivating factors and behavior changes. If found to be effective, this modality of service will likely have considerable promise ini the fight against AIDS as well as with other social and health problems.     

Negotiating Emotional Support: Sober Gay Latinos and Their Families

This study explores how sober gay Latino men obtain support from their families. Familial ties can be a protective health factor, yet many gay Latinos experience rejection from family members because of their sexuality. There are very few studies that examine the extent and quality of emotional support from kin for this population. Understanding family dynamics within the context of recovery and sexuality can increase our understanding of how to leverage family ties to develop alcohol abuse interventions. The study was conducted via semistructured interviews with 30 sober gay Latinos using a grounded theory approach. Analyses of the qualitative data identified the following themes: family values shaped the participants’ perception of their range of choices and emotional responses; participants reported feeling loved and supported even when sexuality was not discussed with parents; and family support for sobriety is essential. Findings suggest that familial ties shape perceptions of support and importance of disclosing sexual identity. Family support often results from agreements about sexual identity disclosure, and some families can overcome cultural and religious taboos on sexuality. Future studies should investigate families that negotiate acceptance with their gay members, and whether they exhibit heterosexual biases that may influence the psychological stress of gay Latino men who wish to be sober.     

Counseling Gay Males with AIDS:

As the incidence of acquired immune deficiency syndrome (AIDS) increases, persona with AIDS will present themselves for counseling in both the private and public sector. Counselors will therefore need to be aware of psychical issues affecting gay men who have the virus. This article highlights some of these critical issues. Specifically, the author discusses informational needs, management of distressing feelings, hope and denial, physical intimacy, and psychosocial interventions     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Chapter 14. Older Lesbian and Gay Caregivers

SUMMARY

This chapter will explore the experiences of older lesbian and gay men caregivers by examining the socio-historical times in which they have lived, the impact of a lifetime of adverse societal messages about homosexuality, family rejection, and internalized homophobia, as well as their development of resiliency and psychological well-being. Once the contextual issues have been identified, the research on older lesbian and gay caregivers for families of origin and families of choice will be explored.     

Chapter 8: AIDS Service Organziations:

AIDS Service Organizations (ASOs) adopted a mission that included advocacy for public policy and private service agency response to the AIDS epidemic, prevention education efforts and provision of personal social services to people with AIDS (PWAs). This mission was shaped by stigmatization and marginalization of PWAs, the inadequate response of governments and health and social service agencies, the developing relationship between ASOs and diverse populations, especially communities of color, and by developments in medical research and treatments for HIV disease. ASOs thus emerged as new contexts of helping and as such had to create organizational structures appropriate for the problems faced, arrange for constructive relationships between helpers and those receiving services, and establish and maintain constructive relationships between the ASO and the larger community. Future challenges facing these new contexts of helping are discussed.     

Chapter 3: Social Services and Bereavement in the Lesbian and Gay Community

Social service programs to address multiple loss in the gay and lesbian community must incorporate an understanding of the relationship between bereavement and the gay and lesbian experience including issues of stigma, homophobia, and the cumulative effects of stress. To address the collective experience of multiple loss, individual, family, and group interventions should be conducted in conjunction with social supports, community rituals, and political activity. Agencies need to prepare by instituting staff education and specific organizational policies to address HIV and bereavement, and provide organizational support to social service staff to facilitate the effective delivery of bereavement services.     

Chapter 6

No abstract available for this article.     

Chapter 7: Lesbians and Gays of Color and HIV/AIDS:

Motivated by a desire to determine if the human service literature reflected the "changing face of AIDS," we reviewed 40 articles addressing needs and issues of gays and lesbians of color. Our review of the multidisciplinary literature confirmed our initial assumption that, despite considerable discussion about the particular needs of lesbians and gay HIV-infected people of color, we could not find an extensive qualitative or quantitative body of research about those needs. An additional finding was the total neglect of minority lesbians and their need for HIV-prevention information. The articles specific to minority gay men were few in number. The majority of studies reviewed dealth quite generally with the risk of HIV transmission among people of color, without specific reference to sexual orientation.     

Chapter 2: The Ecological Context of HIV/AIDS Counseling:

The HIV/AIDS epidemic has brought on social changes bearing considerable impact upon the lives of gay and lesbian communities. An ecological perspective on the counseling process in human services for those impacted by the epidemic is recommended. Issues in counseling which are shaped by the epidemic include fostering support systems within the context of an often hostile social environment; addressing the essential need for shifting assessment paradigms to those which emphasize strengths; recognizing the impact of multiple traumatic occurences and multiple losses on everyday life transactions; and using interventions which promote empowerment, self-acceptance, and healthy lifestyles.     

Chapter 6: Effects of Paternal Involvement on Fathers and Mothers

In the last two decades, average levels of paternal involvement in childcare have increased significantly (Lamb, Pleck, Charnov, & Levine, in press), albeit more slowly than many in the media would have us believe. Most professional discussions of these secular changes have focuscd on the effects of increased paternal involvement on children. In this brief chapter, we discuss the likely effects of increased paternal involvement on mothers and fathers.     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

Chapter 6. Issues in Caregiving

SUMMARY

Some 10 to 29% of persons over 65 in the United States are sufficently physically, cognitively, or emotionally impaired to need some level of caregiving from their informal and formal support systems. Unfortunately, there are still some older persons who need care, but care is either not provided, inadequate, or involves some form of mistreatment. This chapter discusses the difficulties of maltreatment and substance abuse.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

Stigma Management Among Gay/Bisexual Men with HIV/AIDS

People with HIV infection are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. To manage the stigma of their disease, they mount complex coping strategies. This paper reports results from a qualitative study that examined gay/bisexual men's experiences of living with HIV infection. Unstructured interviews from a diverse sample of 139 men were analyzed to examine how men coped with AIDS-related stigma. We discerned a variety of stigma management strategies that could be arranged along a continuum from reactive to proactive based on the extent to which they implicitly accepted or challenged the social norms and values that underlie the stigmatization of HIV/AIDS. Reactive strategies to cope with stigma involve defensive attempts to avoid or mitigate the impact of stigma, but imply acceptance of the underlying social norms and values that construct the stigma. Examples of reactive strategies include hiding one's HIV status, presenting one's illness as a less stigmatizing one (e.g., cancer), or distancing one's self from more damaging aspects of AIDS-stigma (e.g., attributing infection to blood transfusion). Proactive strategies challenge the validity of the stigma and imply disavowal and resistance of the social norms and values that underlie the stigma. Examples of proactive strategies include engaging in public educational efforts that address misperceptions about HIV transmission and social activism to change the social and political conditions that affect PWA/HIV.     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Chapter 6: University of Arizona Life & Work Connections

SUMMARY

The concept of integration has emerged in recent years as a strategy considered by providers of employee assistance, wellness and work-life services to meet the changing needs of the organizations they serve. There continues to be much discussion, however, about what exactly integration is, and how to do it. Beginning with a definition of integration, this article seeks to contribute to the discussion by describing the University of Arizona (UA) Life & Work Connections, a program that was conceived from its development to be an integrated service model. The theoretical and philosophical backgrounds of the program are presented and translated into the UA Life & Work Connections model. Advantages of the model and challenges to integration are discussed, and a detailed case study of a critical incident response is presented.     

Gay Husbands and Fathers:

This paper reports on an exploratory study of motivations for marriage among fifteen actively homosexual men who were either currently or formerly married to women. The middle class sample had married young and most had at least one child. Currently divorced and openly gay, most believed that cultural and religious socialization were the major forces behind their behavior. One third claimed to have had no awareness that they might be homosexual at the time on marriage and one-third reported love for the wife as an important motivating factor. Implication of the results for theory and for social work practice are presented.     

Gay and Lesbian Youth:

Social policy tends to reflect community standards regarding a population's individual rights, expected conduct, and entitlement to public services. Populations, therefore, must be defined and acknowledged by their communities and by their policy makers if they are to be included in these codified standards Lesbian and gay youth have yet to be clearly defined as a population. The origins and subsequent development of the current lesbian and gay movement offer a framework in which to consider future efforts to change social policy regarding lesbian and gay youth. The lesbian and gay community, despite the significant loss of leadership and experience as the result of AIDS, have continued its development as a force for social change. Organizations such as Parents and Friends of Lesbians and Gays, and other groups focused on combating bigotry and expanding civil rights, are of crucial importance to the future of lesbian and gay youth and to the development of enlightened policy. The sooner enlightened policies are developed, the sooner these youngsters will be able to lead happier, healthier, and more productive lives.