Abstract
Although the medical treatment of HIV has improved dramatically since the introduction of effective antiretroviral treatment, people with HIV still face an enormous number of stressors. This chapter reviews the ways of coping that people with HIV use, and the effectiveness of these strategies. It is divided into four primary sections: coping and physical health, coping and psychological health, spiritual coping and physical health, and spiritual coping and mental well-being. There is evidence for the effectiveness of approach coping strategies such as active coping and proactive behavior, maintaining a fighting spirit, and planful problem-solving; for cognitive coping strategies such as positive reappraisal, finding meaning, and optimism; for more enduring personality coping styles, such as extraversion, openness, emotional expression, and altruism; and finally for spirituality. Research findings for the effectiveness of social support are mixed, though it appears to be most helpful as the disease advances. Finally, there is substantial evidence that avoidant coping has a detrimental effect on health and well-being. Clinical recommendations are discussed, including use of the Folkman and Lazarus strategy that matches problem-focused coping with changeable aspects of stressors and emotion-focused coping with unchangeable stressors, and introducing a functional component framework that expands the Folkman and Chesney view (Coping Effectiveness Training [CET]) to include a focus on changeable and unchangeable aspects of the self and the reaction to the stressor in addition to the CET focus on changeable and unchangeable aspects of the stressor alone. In addition, we recommend that emotion-focused coping be broken down into its component parts for clinical purposes: cognitive (reframing, positive outlook), emotion-focused activities to improve mood (relaxation, meditation, exercise), and emotional expression, spirituality, and substance use. Future directions are presented, including preliminary qualitative work from our group. The chapter ends with a summary and clinical suggestions.