Psychosocial factors related to long‐term survival with HIV/AIDS

Only a few studies of long‐term survivors of AIDS (those who survive more than twice the median expected time) have been done but these reveal a constellation of psychological characteristics including, but not limited to, those with active coping, social support, life involvement, ability to communicate, and active collaboration with one's doctor. Another related literature consists of longitudinal studies following people infected with the HIV virus to determine whether psychological characteristics are related to disease progression. These studies have focused on coping, depression, negative expectancies and social support as predictors. This article reviews and integrates the two bodies of literature combining the variables identified into four psychosocial strategies related to longer survival with HIV/AIDS: following healthy self care; maintaining connectedness; having a sense of meaning or purpose in life; and maintaining perspective. Affect, beliefs, and behaviour are all seen as important. Biological variables, SES and psychological resources that the person brings to the situation and external stresses are seen as important variables to consider in prediction studies. The pathways through which these four strategies may operate (both psychological and biological) to impact on health are discussed. Psychological pathways include distress and behavioural disengagement, while biological pathways involve the sympathetic nervous system, neuroendocrine and immune mediation. Finally suggestions for future research are given.