Chronic sorrow in the HIV-positive patient: issues of race, gender, and social support.

This study used Olshansky's (1962) concept of chronic sorrow to examine social support needs of 21 human immunodeficiency virus (HIV)-positive men and women in a southern U.S. city. The methods of inquiry consisted of narrative interviews and a quantitative assessment of depression (the Center of Epidemiological Studies on Depression [CES-D] Scale). This combined approach indicated that chronic sorrow in HIV-positive persons is related to illness, fear of death, poverty, and social isolation, especially for women with children. More than half of the subjects scored as depressed, with African American women scoring significantly higher than Caucasian men or women. Social isolation often resulted from the effects of stigma, as framed in Erving Goffman's theory of discredited identity. The women were likely to be stigmatized because of their association with "dirty sex," contagion, and moral threat in heterosexual communities. Most of the men had been protected from the worst effects of stigma because of their ties to the gay community and associated health networks. Based on these preliminary findings, stigma should be considered a marker of chronic depression in the HIV-positive, and support services should take account of the stigmatizing contexts of HIV-positive persons.