Being Positive: Lives of Men and Women with HIV: The Lives of Men and Women with HIV - Hardcover

The interviewees have adapted to their diagnosis in diverse ways. Some, like Roy Gifford, seek solace in volunteering for the AIDS service organizations that have helped them. "I do that because there is a need," he says. "A purpose. And without that, why go on?" Many of the younger PWAs refuse to get involved in the medical or social aspects of the disease. Unexpectedly, it's these men and women who reveal the most of themselves when talking to Klitzman.

Sociologists say that a shared language does mo! re to unite a community than any border ever could. Klitzman's research into what one subject calls HIV Land shows why the richest HIV positive woman and the poorest HIV positive man can have more in common with each other than with their own families. --Kevin O'Leary

From MICHAELANGELO SIGNORILE in Lambda Book Report: "Initially, I felt singled out to die young, having this monstrous, monumental disease," Roy Gifford, a gay man with HIV, tells Robert Klitzman in Being Positive: The Lives of Men and Women with HIV. "I didn't know anyone else with HIV. Since I've been diagnosed I've become reflective on my life - the good and the bad - and taken a philosophical view toward life and death. When I see myself as a human caught in a larger situation, I don't feel as alone. I'm part of this army, this group.

Gifford describes what Dr. Klitzman, an assistant professor of clinical psychiatry at Columbia University, terms "HIV-land," a sort of coping! mechanism that "provides a sense of being part of som! ething larger and more ongoing than oneself." It is one of six coping patterns that Klitzman identifies in this illuminating and well-written book.

Klitzman began treating men and women with HIV in 1989 shortly after he finished training in psychiatry. "In the clinic I addressed psychiatric symptoms and prescribed medications," he writes in the preface. "But I began to wonder how exactly HIV-infected men and women confronted death and such new stresses and still managed to find hope."

Through interviews with 38 men and women infected with HIV, Klitzman offers insightful anecdotes and razor-sharp analysis. Of particular value are the stories of many women and people of color, often overlooked in personal accounts of the AIDS epidemic. The diversity of the interview subjects strengthens the book significantly, as HIV is shown not just as a virus that transcends class and cultural differences, but as an experience that does so as well. The liv! es of people with HIV trying to maintain relationships with children, husbands and wives are brought to the forefront, interspersed with the experiences of gay men with HIV often reconciling with their own families or working through their own friendships and love relationships.

Commonalities are underscored, even as Klitzman shows us the individual journeys his subjects embark on. He has a complex understanding of this, and does not fall into the trap of sugar-coating the experiences for the sake of the afflicted. Yes, he tells us, many people with HIV find a sense of meaning and purpose, and over time enrich their lives in powerful ways. Bur others never quite come to terms with the trauma of learning their status, and spend much of their lives depressed and unhappy. And still others seem to oscillate between these two poles.

In addition to "HIV-land" - finding hope within a community of people with HIV - Klitzman looks at five other coping patterns that ! have emerged: finding or strengthening spirituality; volunt! eering time to causes, including the AIDS movement itself; strengthening ties to family; sinking into denial, and minimizing the seriousness of one's health status; and escaping through drugs, alcohol, and other risky behaviors, such as unsafe sex.

While Klitzman sees the first four patterns as having the potential for personal growth, the latter two, of course, concern him a great deal. He notes that even before protease inhibitors - drugs that have shown great promise but are far from a "cure," though some people with AIDS have articulated as much - many people with AIDS were denying to themselves that their condition was serious. Sometimes, Klitzman says, this is an important psychological defense, but often it enables people to forego medical treatments or to believe that certain medical treatments will "cure" them. And there are other problems as well.

"I only have a mild case," Yvette Bing tells him. "On paper I'm an HIV diagn! osis, but that's it. Sometimes I don't even believe I have HIV. I don't feel different. I don't have symptoms of it. I don't feel sick. I'm not sick." Bing, Klitzman notes, has continued to use drugs and share needles. "Her minimization," he observes, "has thus served her desires, removing her from any urgency or responsibility to stop her drug behavior. It has allowed her to continue to spread the virus."

Similarly, Klitzman interviews gay men with HIV who engage in risky sexual behavior, and he astutely uncovers the psychological, emotional, and cultural conditions that enable their decisions to practice unsafe sex. In that respect, Being Positive is a powerful contribution to the ongoing debates about gay male sexual culture and the future of the AIDS epidemic.

From ABRAHAM VERGHESE, M.D.: "These are compelling stories. At a time when public attention for HIV is flagging, Being Positive reminds us that we have so much to learn ab! out life and death from others who have extracted meaning f! rom this experience."

From MAYA ANGELOU: "Being Positive by Robert Klitzman has the power to put the people with AIDS and the people without AIDS onto the same communication line where we may be able to hear each other."

From CLIFFORD GEERTZ: "The voice of the ‘patient' is not much heard in medical writing these days beyond the mere description of symptoms. These three dozen self-absorbed but intensely alert gays and straights, men and women, activists and drug users, telling their individual stories in their individual ways, give definition not only to what is happening to them; they provide for the rest of us an unforgettable picture of what extremity looks like and how it is dealt with."

From ARTHUR KLEINMAN: "Robert Klitzman, a psychiatrist with an excellent ear for humanness, lets the voices of people with HIV express the diversity in their lives. This portrait of their suffering and the transformation of their worlds deserves to be t! he ground on which treatment and prevention is rethought. For that reason alone, this arresting work should be widely read (and applied) by practitioners, researchers, and policymakers."

From JAMA (April 15, 1998): The human immunodeficiency virus (HIV) epidemic has taught us many lessons. One clear message has been the need for a new partnership between people affected and those providing medical care. Being Positive: The Lives of Men and Women with HIV, by Robert Klitzman, MD, helps to bridge those two worlds. Dr. Klitzman, a psychiatrist, provides a framework based upon his professional experience for the stories of people living with HIV. His approach is refreshing in several regards.

First, he has organized the stories and experiences into a series of chapters with catchy titles, such as "The Last Disco" and "Free Like a Bird." Also, the stories are in the subjects' own words, unrestrainedly conveying their spirit and life experiences,! rather than fitting tidily into the preconceived notions o! f health care professionals. Thus, the book speaks - literally - with a veracity and power that draw directly from the sources - people living with HIV - rather than from formal surveys or protocols with prescribed, formatted responses.

The subjects are adults, mostly young to middle-aged, living in New York City, and to some degree, they represent the demography of the epidemic as it unfolded there. However, certain perspectives are not included. Specifically, there are no anecdotes or stories from adolescents or children (although there is an assertion that street theater is the "most effective" way of reaching young people, which is not supported by data); also, most of the people appear to be struggling with minimal incomes and often dependent on social programs. In this sense, the stories do not represent the full spectrum of people with HIV, though they are based on Klitzman's experiences as an adult psychi