Usuario: Desarrollador

People living with HIV/AIDS, as shown in the overview in Chapter One, are obviously confronted with life-threatening situations and faced with extreme distress. They have much higher suicide rates than the general population and those with other life- threatening illnesses (Cooperman & Simoni, 2005). Hence, they need spiritual care for comfort. Spirituality has been shown to have a direct relationship with cognitive and

social functioning and is inversely related to HIV symptoms (Coleman, 2003). At the same time, the literature also reveals that although the experience of living with

AIDS is a critical problem in people’s lives, its challenges can produce growth and stimulate spiritual reflection as well as a sense of spiritual well-being (Szaflarski et al., 2006). Therefore, spirituality and HIV/AIDS have a reciprocal relationship.

The significant role of spirituality in buffering the torment and turmoil for people living with HIV/AIDS is similar to its role in other kinds of chronic illness and life-altering situations (as discussed under the subheading “Significance of spirituality for health”). Several studies illustrate the complex nature of spirituality’s positive relationship in people living with HIV/AIDS (Banks-Wallace & Parks, 2004; Coleman & Holzemer, 1999). In fact, many researchers have reported that persons living with HIV/AIDS indicated that their spirituality/religion was helping them to love or help others, facilitating direct communication with God, making them better spouses, helping them to love themselves (Woods & Ironson, 1999), and helping them to live longer (Belcher et al., 1989; Cotton, Puchalski et al., 2006; Cotton, Tsevat et al., 2006; Tsevat, 2006; Tsevat et al., 1999) or slow the disease’s progression (Ironson, Stuetzle, & Fletcher, 2006). Solomon, Ironson, Balbin, and Fletcher (2002) emphasise that religious/spiritual behaviours are one factor that has an impact on health and survival with HIV infection and AIDS. On the other hand, a lower level of spiritual well-being was related to significant depressive symptoms (Yi et al., 2006). This is confirmed by the study by Fryback and Reinert (1999) who found that spirituality was viewed as a bridge between hopelessness and meaningfulness in HIV/AIDS patients.

32

Spirituality influences people through self-empowerment, giving courage and knowledge of how to heal, making them optimistic, and more relaxed (Woods & Ironson, 1999). This is consistent with the fact that spirituality has a significant relationship with hardiness that leads people to find meaning and purpose in their lives (Carson & Green, 2004). Having a sense of meaning and purpose is indicative of their state of psychological well-being (Coleman & Holzemer, 1999). This was supported by women who are living with HIV/AIDS in New York city who also exhibited considerable strengths as they had high levels of spirituality, a sense of mastery and good social support (Simoni & Cooperman, 2000). This result was consistent with that in another study by Kotarba, Haile, Landrum, and Trimble (2003) who found that inner strength improved the managed care for HIV positive women who had reliance in a higher power, including both spiritual and religious aspects. In addition, an African- American gay man living with AIDS used his spirit, religion, and cultural strength to struggle with his AIDS condition. By using these strengths he was able to refuse to accept his physician’s prediction of death, and develop his spiritual activity (Miller, 2005).

Also, spirituality is a major theme in the lives of those who were able to face an HIV/AIDS diagnosis with equanimity (Kendall et al., 1989, cited in Holt et al., 1999). Furthermore, people who perform daily spiritual rituals develop a personal philosophy to deal with unanswerable questions (Hall, 1998). These findings from Western research literatures are consistent with the finding that some people living with HIV/AIDS in Thailand feel safe and balanced, accept the prospect of their untimely death and

perceive that death is a natural part of life as guided by Buddhist teaching. They achieved a sense of equilibrium or balance in a mode of being that is central to

Eastern traditions (Balthip, 1999).

In the same time, not only does spirituality help people living with HIV/AIDS overcome life crises and live with harmony, but also life-threatening situations – living with HIV/AIDS – provides positive impacts on spiritual development and human beings as well. Many people, who live with life-threatening diseases such as HIV/AIDS, can master their diseases and develop new life goals as well as have spiritual growth. Women with HIV/AIDS also described several forms of positive changes resulting from their illness. They noted that their illness was a motivating factor to make positive

33

behavioural changes. They recognised that HIV/AIDS had contributed to their religious and spiritual growth. They also described growth in relationships with children, family, friends, and lovers, saying that these became closer and more important. Furthermore, HIV/AIDS was seen as a catalyst for resolving past differences and using their remaining time to express and affirm their love for one another. Many women felt that HIV/AIDS changed the value of their life. They had greater appreciation of life, and often reported helping others through AIDS advocacy and education (Bouthillette, 2001; Moser et al., 2001). Some women who are living with various stages of HIV have repeated that certain components important in their psychological and spiritual growth are life affirmation, creation of meaning, self-affirmation, and redefining relationships (Dunbar, Mueller, Medina, & Wolf, 1998). Additionally, some people living with HIV/AIDS in Thailand changed their life style by doing good and regularly practising meditation (Saeloo, 2000). Through starting a new lifestyle and preparing for their own death, they made a harmonious life (Balthip, Churprasilp, & Chailanga, 2001).

As a result of becoming more spiritual (and/or religious), people living with HIV/AIDS reported that their lives were in a better condition than they had been before they were diagnosed with HIV/AIDS (Szaflarski et al., 2006; Tsevat, 2006; Tsevat et al., 1999). Therefore, it is possible to draw the conclusion that there is a positive relationship between spirituality and well-being in persons living with HIV/AIDS. However, there has not yet been any research focused on how people living with HIV/AIDS in the Thai context develop their spirituality.