HIV/AIDS and Multiple Bereavement: Is the psychological impact of multiple loss intensified by social factors?
“The advent of AIDS has created a new population of people who suffer multiple bereavements as well as threats to their own lives.” (Murray-Parkes, 1998, p. xii)
The populations most affected by HIV/AIDS live in two geographical locations: the USA and Africa (WHO, 1998) . In 1997 four million people in the Sub-Saharan Africa were newly reported as having seropositive status (WHO, 1998). In North America this figure was 44 thousand (WHO, 1998).
Seropositive rates among Gay men in New York City are reported at 36 to 67% (Dean L, 1995). Infection rates amongst young, urban males in Uganda range from 20 to 30% (Seeley & Kajura, 1995).
With these high figures and similar infection rates among males in mind, this essay will discuss the relationship between social factors and the psychological impact of multiple loss in an international context. The evidence I have considered principally comes from Uganda and the USA which will allow me to evaluate the commonality of experience and the usefulness of theories on multiple loss in differing cultural and economic situations.
The impact of the HIV virus is such that it creates ‘..
.a cycle of never ending perpetual grieving for individuals affected by HIV/AIDS and the professionals who care for them.’ (Cho & Cassidy, 1994, p.274). Yet, there seems to be no significant relationship between the number of individual losses and the intensity of the grief experienced (Cherney & Verney, 1996; Cho & Cassidy, 1994). Cherney & Verney (1996) also found that there was no correlation between age and intensity of grief.
This is unexpected since younger individuals are expected to show a higher intensity of reaction to grief (Sherr L, 1995).
Discussing this issue Ankrah (1991) and Seeley & Kajura (1995) suggest that young people may have become habituated to multiple loss because there is no cure for AIDS, ‘… the people to become immoderately tolerant of death.’ Cho and Cassidy (1994) offer a different explanation. They believe that habituation might reflect a state of protracted grief rather than a tolerance of death. This argument implies that people may have become habituated to multiple loss, and made adaptive emotional responses.
This suggests that multiple losses influence the grief process.
Cho & Cassidy (1994) found that those affected by HIV/AIDS showed common characteristics: Chronic Bereavement and Truant Grief, i.e., prolonged or delayed grieving. The effects of this are compounded if more than one loss occurred.
They argue that this creates a Multiple Loss Syndrome which is characterised by Truant Grief; a delayed grief response where grief is postponed until it can be coped with without the additional demands of the outside world. In this process, multiple loss influences the grief process in such a way as to create a threshold of intensity of grief which becomes established during early losses and then is not surpassed.
In order to discuss this explanation further, I will use two distinctive but comparable models of the stages of grieving (adapted from Cho & Cassidy, 1994 and Cherney and Verney, 1996). Cho and Cassidy (1994) describe a model based on the psychosocial tasks of grieving. Cherney and Verney (1996) use a model of the psychological processes of grieving based on the work of Sanders (1989). In these models, process and task mirror one another over five stages.
The grieving process for people living with HIV/AIDS can begin when diagnosis is made (e.g.
, Anticipatory Grief: Sherr, 1995; Cho and Cassidy, 1994). The first stage of this process is characterised by shock and denial (Cherney & Verney, 1996). Social issues may come to the fore. Being diagnosed as seropositive may force everyone involved to make reality adjustments to accommodate the lifestyle changes that the infection demands (Cho and Cassidy, 1994). At this stage the HIV positive person will often ‘be abandoned on disclosure of the diagnosis (Peterson, 1995). Crucially, the loss of social support means that care can then be limited or denied (Lupton, 1999; Seeley & Kajura, 1995).
One the shock has subsided there may be an emotional release, as an awareness of the (future) loss is realised (Cherney and Verney, 1996). There may .