Fatigue, a common symptom among persons living with HIV/AIDS, is often underreported and undertreated. However, given fatigue's pervasive effects on well-being and functioning, the identification of its physiologic and psychological causes and strategies to alleviate it are important to patients' quality of life. As part of a study to understand better how HIV-positive middle-aged and older adults (501) manage common symptoms, 49 participants discussed in depth their experience with fatigue. Most engaged in both self-care activities and sought the assistance of a health care professional. Frequent strategies included dietary changes, vitamins, modification of routines, rest, exercise, and prescribed medications for anemia, Vitamin B 12 deficiency, or testosterone deficiency. Complementary and alternative medicine (e.g., acupuncture, massage, herbal remedies, special juices) was also commonly used. Participants often used multiple strategies to alleviate their fatigue, possibly because of their tendency to attribute it to multiple causes. These HIV-positive older adults were also apt to view fatigue as an indirect indicator of their overall health status and immune functioning. This may explain why many of the coping strategies they used could be considered approaches to improving their overall health status as a means to increasing their energy levels. Health care professionals can play an important role in helping HIV-positive individuals manage their fatigue. The majority of participants tried to implement the coping suggestions offered by health care professionals, as well as those from family, friends, and support group members. 275
Although the experience of physical symptoms can adversely influence emotional well-being, the specific emotional reactions experienced in response to specific symptoms are not well understood. The current report examines the emotional impact of diarrhea among HIV-positive late middle-age and older adults (i.e., age 50 and over). In-depth interviews were conducted with 100 participants, of whom 29 had experienced diarrhea and spoke about the emotional impact it had had on them. Three principal themes emerged: (1) I don’t control the diarrhea, the diarrhea controls me; (2) I feel ashamed, dirty and tainted; (3) I fear what the diarrhea is doing to me and what it means. Their inability to control when and where their diarrhea would occur was a great source of emotional distress for participants. Almost all feared the possibility of fecal incontinence while out in public and the humiliation it would bring. To avoid this, many greatly restricted their time outside the home or where they would go to ensure access to a restroom. Others felt shame and perpetually “dirty” even when not dealing with a bout of diarrhea. Many also worried about the effect the diarrhea would have on their health and whether it signaled progression to end-stage disease. The data strongly support the need to aggressively manage diarrhea in HIV-infected adults as the social and emotional consequences can be profound. When it cannot be effectively controlled physicians and social service agencies should address the isolation by providing home-based opportunities for social support and interaction.
Although the attributions individuals make about what causes their physical symptoms are known to influence their care seeking and self-care behaviors, much less is known about the strategies they use to arrive at these attributions. The strategies employed to understand the causes of their symptoms were investigated using in-depth interviews with 100 late-middle-age and older adults with HIV/AIDS in New York City. The data revealed that most actively sought to explain their symptoms. The explanatory strategies identified included: relying upon illness or medication representations, lay beliefs about the body and aging, invoking pre-existing vulnerabilities, engaging in lay experimentation, social comparison processes, considering temporal ordering, and consulting authoritative sources. While most offered a single cause for their symptoms, some offered more complex multi-causal explanations. These findings provide understanding into the reasons why some older adults with HIV/AIDS misattribute symptoms resulting in delay in care or care over-utilization, suggesting the need for patient education.
A substantial minority of men who have sex with men (MSM) engage in the exchange of sex for money, drugs, shelter, or material goods. This work carries risks for violence, sexual assault, and other kinds of harm such as robbery and threatening behavior by clients. Yet limited research has focused on the strategies that male sex workers (MSWs) use to prevent or manage these risks. To gain more insights into this matter, we analyzed qualitative interview data from 180 MSM recruited from eight U.S. cities who engaged in sex work with clients they had primarily met through dating/hookup websites and apps. Participants described the strategies they used to manage risks of interpersonal violence, both prior to meeting their clients and at the time of their encounters. Many of the strategies used ahead of the encounter relied upon information and communication technologies, such as negotiating the parameters of the exchange encounter, screening clients, sharing information about the client and meeting place with others, identifying safe meeting locations, and gathering information from social networks about problematic clients. Strategies employed during the encounter included: receiving payment up front; being prepared to protect oneself with a weapon or self-defense techniques; staying alert and sober; and planning an exit route from the location. Technology-based interventions through dating/hookup apps could play an important role in providing resources and skill building for MSWs to help them protect themselves during sex work.
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