Persons living with HIV disease are faced with a number of challenges, including whether or not to inform people in their social network about their seropositive status. Prevention experts have identified disclosure as a key factor in reducing HIV transmission. Disclosure to potential sexual and needle exchange partners allows for informed decisions about engaging in practices known to increase risk of HIV infection. In addition to reducing risk of viral transmission, disclosure of serostatus is often necessary in order to access health and social services. Nevertheless, deciding who to tell, when to tell, and how to tell can be a stressful process. Furthermore, it may be dangerous in certain relationships or circumstances to disclose one’s serostatus because of the possibility of becoming the target of physical violence. Factors that inhibit disclosure vary across individuals, but fear of negative responses and breach of confidentiality are common concerns. The social stigma associated with HIV disease prevents individuals from getting tested. For those who know their status, stigma can be
a barrier to seeking treatment and care, which often results in individuals being seen for the first time by a physician during advanced stages of disease.

Depression is one of the most common mental health disorders reported among individuals with chronic illnesses, and depression among adults living with HIV is well documented.¹ There is a relationship between the chronic effect of depression and HIV disease such that depressive symptoms predict an increased risk of developing AIDS.² There is also recent evidence that some of the association between depression and disease progression is due to a “protective” effect of positive affect or mood, such that positive affect is associated with decreased AIDS progression among persons infected with HIV.³ Moreover, research with symptomatic HIV-positive men that examined a cognitive behavioral stress management (CBSM) intervention identified the reduction of depression as a likely mediator of the therapeutic effects on reconstituting immunity.⁴

Traumatic and other stressful life events are highly prevalent among persons who become HIV-positive. Childhood sexual abuse and other traumatic life events appear to be risk factors for sexual risk behavior and injecting and other drug use associated with HIV infection.⁵ Clinical evidence suggests that stressful life events predict more rapid HIV disease progression. Indeed, research has found that for every severely stressful life event per 6-month interval, the risk of early HIV disease progression doubles.⁶ Among persons recently notified of HIV-positive serostatus, post-traumatic stress disorder (PTSD) symptoms of avoidance and intrusion have been associated with greater distress and avoidance was associated with lower CD4 percentages.⁷ Furthermore, both general perceived stress and the chronic stress of living in unstable housing conditions have been positively associated with physical health status in HIV-positive persons in the Deep South of the United States.⁸

The lives of HIV-positive persons are often complex, and their social as well as psychological needs often go unmet. There is substantial need for social support in the face of life-threatening illness. Under normal circumstances, social support can help individuals to mobilize their psychological resources, master their emotional burdens, obtain tangible resources like money or shelter, and acquire skills to handle situations optimally. Studies have shown that the mere perception that adequate support is available can serve to buffer situational stress as much as the actual social support itself.⁸

HIV-infected patients are confronted with high levels of stress related to their health status, and their social support systems are often burdened and impaired. An AIDS diagnosis is frequently linked to a decrease in the number of supportive contacts or a change in the pattern of those contacts. For example, AIDS patients report lower levels of practical and emotional support from family members.⁹ In fact, many AIDS patients report greater availability of emotional support from friends than from family members.

Problems with inadequate social support may have physiologic as well as psychological consequences. In general, greater social support has been associated with better immune system function. Among HIV-positive persons, those with more available social support had significantly less deterioration in CD4 cell count.¹⁰ Consistent with the research suggesting that more social support is associated with better immune function, bereavement (i.e., grieving the loss of an important source of social support) has been associated with two functional measures
of a decrement in immune function, namely, decreased natural killer cytotoxicity and decreased lymphocyte proliferative response to phytohemagglutinin.¹¹