Psychology and the progression from HIV to AIDS

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334 HEALTH PSYCHOLOGY
in the bloodstream may increase the chances of contracting HIV. These viruses are also
thought to be associated with unsafe sex and injecting drugs. Therefore, unhealthy
behaviours may not only be related to exposure to the HIV virus but also the likelihood that an individual will become HIV+. However, much of the lifestyle literature
surrounding susceptibility to HIV virus was based on the beliefs about HIV that existed
during the 1980s, when HIV was still regarded as a homosexual illness. It therefore
focused on the lifestyles of homosexuals and made generalizations about this lifestyle in
order to explain susceptibility to the virus.
Psychology and the progression from HIV to AIDS
Research has also examined the role of psychology in the progression from HIV to AIDS.
It has been argued that HIV provides a useful basis for such research for the following
reasons: (1) there are large numbers of individuals who can be identified at the
asymptomatic stage of their illness allowing an analysis of disease progression from a
symptom-free stage; (2) as people with HIV tend to be young the problem of other coexisting diseases can be avoided; and (3) the measurement of disease progression using
numbers of CD4 T-helper cells is accurate (Taylor et al. 1998).
This research points to roles for both lifestyle and psychological state in the progression of the illness. First, in terms of lifestyle, it has been suggested that injecting
drugs further stimulates the immune system, which may well influence replication, and
thereby points to a role for drug use not only in contracting the virus but also for its
replication. In addition, research has also indicated that replication of the HIV virus may
be influenced by further exposure to the HIV virus, suggesting a role for unsafe sex and
drug use in its progression. Furthermore, it has been suggested that contact with drugs,
which may have an immuno-suppressive effect, or other viruses, such as herpes complex
and CMV, may also be related to an increase in replication. Second, in terms of psychological factors, Sodroski et al. (1984) suggested that stress or distress may well increase
the replication of the HIV virus, causing a quicker progression to AIDS. This has been
tentatively supported by the research of Solomon and Temoshok (Solomon and
Temoshok 1987; Solomon et al. 1987), who argued that social homophobia may well
cause stress in individuals who have contracted HIV, which could exacerbate their illness.
Furthermore, research from the Multi Center AIDS Cohort Study (MACS) in the USA has
suggested a role for forms of cognitive adjustment to bereavement and illness progression
(Reed et al. 1994, 1999; Bower et al. 1998). In the first part of this study, 72 men who
were HIV-positive, asymptomatic and half of whom had recently experienced the death
of a close friend or primary partner, completed measures of their psychosocial state (HIV
specific expectancies, mood state and hopelessness) and had the number of their CD4 Thelper cells recorded. They were then followed up over a six-year period. The results
showed that about half of the sample showed symptoms over the follow-up period.
However, the rate and extent of the disease progression was not consistent for everyone.
In particular, the results showed that symptom development was predicted by baseline
HIV specific expectancies, particularly in those who had been bereaved. Therefore, it
would seem that having more negative expectancies of HIV progression is predictive of
actual progression (Reed et al. 1999). In the second part of this study, 40 HIV+ men who
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