       FOCUS: A Guide to AIDS Research and Counseling
       Volume 8, Number 9 - August 1994
       ----------------------------------------------

       Editorial: An Elaborate Dance
       Robert Marks, Editor

       Denial must be an element in the response to HIV disease. Facing death
early in life requires a buffer to protect the psyche. Denial provides the
distance that enables people to come to terms with HIV disease, the changes
it brings about in their lives, and the hovering presence of death. 

       In this way, denial can be a tool for both client and therapist, a
shield against the currently unmentionable and unknowable and a diagnostic
identifier that marks the most difficult aspects of the HIV experience. But
denial inevitably interferes with what may seem to caregivers to be the most
appropriate responses to HIV disease, whether medical, psychological, or
interpersonal. 

       It is one of the greatest challenges for therapists to interpret when
and how to support denial and when and how to challenge it. 

       In this issue of FOCUS, Jody Reiss defines a range of situations where
denial is active and offers some insights into how therapists can recognize
its various faces and respond to it in therapy. Rocky Chun looks at denial
at the community level, focusing on the Asian/Pacific Islander response to
HIV disease, particularly in the Chinese American community. His exploration
uncovers some of the cultural and historical determinants of denial. 

       More than many other aspects of therapeutic process, denial raises
powerful issues for therapists, a clash between therapeutic duty and personal
values and feelings about the client's response. In this sense, HIV disease
and issues such as death, disability, and treatment becomes the 800-pound
gorilla in the therapeutic relationship. The result is an elaborate dance of
feelings and beliefs as therapist and client seek to confront and avoid this
presence. 

       Many people with HIV disease have entered therapy in order to deal
with the new circumstances of illness in their lives. But therapy is a fluid
process that inspires other explorations as it flows, and HIV-related
concerns may recede in the client's world as other issues become more
compelling. Counselors must accept this cycle, allowing denial and
disinterest their place in therapy, at the same time as they heed connections
between seemingly unrelated issues and HIV disease.

       **********
       Recognizing Denial Among HIV-infected Clients
       Jody Opper Reiss, LCSW

       Denial has been variously defined as a healthy psychological defense,
an avoidance of active coping, a stage in the dying process a primitive
defense mechanism, a potentially dangerous avoidance of reality, a component
of depression, and an essential ingredient of hope. Denial can be seen as an
unconscious process or as a conscious cognitive strategy. Whichever
definition is adopted, the challenge for clinicians working with people with
HIV disease is to differentiate between adaptive and maladaptive aspects of
denial. 

       There is no question that a certain level of denial is healthy when
coping with a life-threatening illness. When death is in full focus there is
little room for life. Denial is a mechanism that allows a person with HIV
disease to make plans for the future, to get beyond day-to-day cares, to
remain a participant in the world, and to be motivated to fight back.
Likewise denial may help the clinician to distance from inevitable loss and
focus on the here and now. 

       On the other hand, denial can put others at risk for HIV infection,
keep an infected person from seeking medical care, contribute to continued
substance abuse, or inhibit a client from reaching out to friends or family.
Although denial may be essential at certain stages of illness, it appears
that healthy adjustment and acceptance of the dying process includes a
shedding of this defense. Furthermore, recent studies of long-term AIDS
survivors "suggest that the absence of denial...[is] associated with
psychological resilience and self-reported satisfaction with one's life."[1,
2]

       This article examines different ways of conceptualizing and
identifying denial in clients with HIV disease. It presents examples of how
denial can be overlooked and suggests that better assessment of denial can
inform clinical practice. 

       Recognizing Denial

       Recognizing that denial is at work can help the clinician understand
the client's underlying feelings and when to reflect them back to the client
or intervene in some other way. For example, in his first therapy session,
a client describes fatigue and recent weight loss. He says he has never
wanted to get tested for HIV. "I just assume I'm positive, and I don't want
to be on all those drugs. I've decided to let nature take its course." 

       On the surface, this statement appears to demonstrate acceptance of
the client's likely HIV infection and an understanding of the consequences
of deciding to put off early medical intervention. Yet, further exploration
might reveal that the client's self-assured fatalism and outward denial of
fear is covering up the actual fear and anxiety he is experiencing. The
therapist should explore the client's feelings as well as his understanding
of his options to be sure he is not using denial to avoid more active coping.

       This example also brings up the importance of being aware of
countertransference, in this case a bias on the clinician's part toward early
intervention. Therapy within the HIV spectrum of illness is always time
driven, and it is easy to adopt a sense of urgency. In this case, the
therapist may feel a need to help the client work through his fears and get
on with the business of testing and medical care. The therapist's need must
not intrude into treatment to the extent that this response interferes with
other tasks of beginning therapy, such as building trust. The therapist must
contain his or her own fears about colluding with denial while helping the
client explore both sides of his ambivalence about testing. What is crucial
here is not the time left in the client's life, but the time the client needs
before he is ready to let down his defenses. 

       Conscious and Unconscious Denial

       Denial has traditionally been thought of as an unconscious process
whereby painful feelings are repressed to the point they are no longer
consciously experienced. For example, childhood sexual abuse may be repressed
and remain unconscious for many years or for a lifetime. In such a case,
denial serves as a defense mechanism whose effectiveness can be judged by how
well the painful experience is banished from conscious memory. 

       When it comes to HIV disease, denial is rarely capable of submerging
the reality of infection entirely. The person living with HIV disease, and,
in particular, the person with AIDS may find it impossible to avoid a whole
array of thoughts and feelings, and this may be what brings the person into
therapy. A preoccupation with death and disease can lead to emotional
overload and a need to "get away from AIDS." 

       While the unconscious process of denial may not be effective in
eradicating an awareness of HIV disease, many people will consciously attempt
avoidance. For example, a client may say, "There are so many horrors
associated with AIDS, so many things to be afraid of, that I try not to think
about the future too much." What the therapist wants to discover is whether
this strategy is working for the client. It may be that this client can use
therapy as a place to get away from HIV disease and focus on other concerns.
Or, it may be that therapy can provide a container for some of the feelings
that are spilling over into daily life. Thus, a client who uses the session
to discuss fear of dying or concerns about chemotherapy may find the burden
of these thoughts lifted at other times. 

       Often a client begins therapy after a change in health status, such
as a precipitous drop in T-helper cells or the diagnosis of a new
opportunistic infection. HIV-related complications have thrown the previously
emotionally healthy client into an adjustment disorder with concomitant
depression or anxiety. The therapist will likely react to the client as being
fragile and in need of support and the restoration of hope. 

       In such cases, therapists should not challenge denial lightly. For
example, a therapist should avoid confronting a client who says, "I'm going
to beat this thing," or "I think there will be a cure soon," by asking, "How
do you think you'll feel if they don't find a cure?" Hope is necessary for
life, and denial in the service of hope should be supported not by insincere
agreement but by calm silence. 

       Masking Feelings

       A client's presenting problem may serve to mask underlying feelings
that are being denied. In the following example the therapist becomes
sidetracked by what seems to be the central issue. A client comes into
therapy wanting help disclosing his AIDS diagnosis to his mother. He is
concerned he might hurt her, that she won't be able to handle the news. Over
time, he returns to the issue often. The therapist explores the client's
feelings towards his mother and his role as caretaker in the family. The
therapist suggests that the client's concern about his mother stems from a
belief that he is too much for others to handle. One day, however, the client
tells the therapist that he has told his mother and the real issue reveals
itself. "I told her this weekend," he says, "and then I went in the other
room, burst into tears, and told my sister, 'I just told Mom I'm going to
die.' Somehow telling her made it real for the first time." 

       Nondisclosure helped this client avoid the reality of his illness. He
had been able to compartmentalize the information, as if to say, "When I'm
home in bed I have AIDS, but when I go to a family dinner I don't have AIDS
because no one knows." While there are other reasons that keep people with
HIV disease from disclosing to their families, such as fear of rejection or
fear of being smothered, denial may serve as a healthy defense until the
client is able to face the reality of his or her illness. 

       What is missing in the treatment described above is an understanding
of how denial is being used by the client. The therapist has taken the
nondisclosure as a jumping off point to explore family relationships and
roles as well as the client's self-image. The therapist successfully masked
her bias toward family disclosure, but failed to look deeper into the meaning
of disclosure for this client. 

       Abandoning Neutrality

       HIV-related denial arouses countertransference in a unique way. The
client who continues to have unsafe sex, the young man who keeps riding his
motorcycle although blind in one eye from CMV retinitis, the mother who puts
off making plans for her child's guardianship, the client who chooses not to
take medication: all these situations have the potential for disaster. They
demand that the therapist consider abandoning neutrality in favor of direct
influence. The following is an example of abandoned neutrality gone awry. 

       A client with disabling HIV disease has been struggling with a pattern
of rejection she has faced each time she has disclosed her HIV infection
status to a potential partner. She tells her therapist that she's planning
to continue practicing safer sex but is going to delay telling partners until
after they have been dating a while. The therapist tells her, "Unless you
tell sex partners before sleeping with them that you're infected, I cannot
continue to be your therapist." Not unpredictably, this therapist loses his
client and the ability to use what influence he might have had. 

       In this example, the therapist appears to have incorrectly identified
the client's problem as her denial of risk. In doing so, he has failed to
focus on the client's experience and fear of rejection and has misjudged the
strength of the client-therapist relationship to withstand a direct
ultimatum. In writing about HIV risk intervention, Judith Rosenberger and
Marsha Wineburgh state, "Direct confrontation of the defense of denial will
be premature if the transference does not indicate strong positive alignment
between the therapist and those aspects of self the client is aware of
wanting to preserved."[3]

       Some of a therapist's reactions to a client may go beyond
countertransference to include a bias based in reality, be it against
substance abuse, for early intervention, or against motorcycle riding with
failing vision. Few therapists would want to remain neutral in these
circumstances, but clinicians must remain cautious when using their
considerable influence in the context of a trusting relationship. A client
who has developed a positive, or even idealized transference, toward the
therapist is more likely to be able to "borrow the superego" of the therapist
to make important life-style changes. 

       Denial Related to Grief

       Denial can be protective when it comes to grief and can be manifested
in various ways. For example, a newly bereaved client, whose lover died quite
quickly from HIV-related complications, related this story to his therapist.
"We always met at the apartment for lunch; we both worked close by. Last week
I went home at lunch and ran up the three flights of stairs. It wasn't until
I had my key in the lock that I realized he wasn't going to be there to meet
me." 

       Shock and denial are common for the newly bereaved. A clinician can
comfort the client by normalizing some of the common yet disturbing
experiences of early bereavement, for example, forgetting someone has died
or hallucinating their presence. The clinician does not collude with the
denial but gently educates the client about what to expect from bereavement,
including the idea that the mind uses denial to filter pain until a person
is ready to feel that pain. 

       Grief can be complicated by the effects of cumulative loss and, for
HIV-infected people, their own fears of death: denial of grief is denial of
personal vulnerability. This can be particularly true for gay men who may be
remembering past losses, grieving recent deaths, and anticipating future
ones.[4] In responding to cumulative grief, support groups may be
particularly helpful. A study of an ongoing group for people with AIDS found
that 'The group does not support denial of the diagnosis and fosters active,
reality-directed coping efforts"[5] 

       Conclusion

       This article has begun to identify some of the different ways denial
is defined and manifested in people with HIV disease. It appears that denial
is rarely a completely unconscious process and that conscious efforts can
only partially obscure the reality of illness. Rather, denial seems to
operate as a coping strategy to help compartmentalize and avoid painful
feelings, most potently, the fear of death. 

       Working with denial requires that the clinician be attuned to its
presence and able to continually assess and reassess how denial serves the
client. The clinician must contain his or her bias but not be afraid to use
gentle confrontation when bias is rooted in the knowledge that the client may
endanger him or herself or others. And the clinician must be able to walk
with the client the fine line between denial and hope. There are times when
supporting denial is the most healthy and appropriate course, times when the
clinician's grounding in reality allows the client to look into the future
with less fear, and times when the best stance for the clinician is simply
to support and witness as a client, accepting illness and the possibility of
death, finds that denial falls away. 

       References:

       1.  Remien RH, Rabkin JC, Williams JBW.  Coping strategies and health
beliefs of AIDS long-term survivors.  Psychology and Health. 1992;6:335-345.

       2.  Rabkin JG, Remien R, Katoff L, et al.  Resilience in adversity
among long-term survivors of AIDS.  Hospital and Community Psychiatry.  1993;
44(2):16-167.

       3.  Rosenberger J, Wineburgh M. Working with denial: A critical aspect
in AIDS risk intervention.  Social work in Health Care.  1992;17(2):11-26.

       4.  Schwartzberg, SS.  AIDS-related bereavement among gay men: The
inadequacy of current theories of grief.  Psychotherapy. 1992; 29(Fall,
1):422-429.

       5.  Field HL, Shore M.  Living and dying with AIDS: Report of a three-
year psychotherapy group. Group. 1992;16(3); 16(3):146-164.

       Author

       Jody Opper Reiss, LCSW, is AIDS Project Coordinator for San
Francisco's Jewish Family and Children's Services.  She provides
psychotherapy and case management for people with AIDS and disabling HIV
disease and their loved ones, facilitates a support group, oversees two
volunteer programs and runs a community education program.

       **********

       A Community in Denial
       Rocky Chun

       Why does the Asian/Pacific Islander community seem to be immune to the
AIDS epidemic? Is it because it is the oldest civilization in the world? Does
it have a magic potion that renders its members immune to any diseases? 

       Give up? Let me share with you a secret from ancient Chinese culture. 

       Denial! That's right. Denial! If no one talks about it, no one hears
it, no one reports it, it's not happening. There is an old Chinese saying:
"Cover your ears while you steal the bell." If you can't hear the bell, no
one can. So you can get away with it. In the API community, many have stopped
their ears to keep the reality of HIV disease out. But despite their
exertions, HIV disease exists in these communities much more than we know. 

       The Roots of Denial

       The API community doesn't talk about HIV disease because it is
associated with two evils: drugs and sex. Especially male-to-male sex. Taboo,
taboo, taboo! "You only sweep the snow on your front doorstep. You don't talk
about your neighbor's roof which has snow piled up on it" (ancient Chinese
proverb loosely translated). Even though you know about a danger to others,
you have no business warning them about it. 

       In the Chinese community, sex is something practiced only by others.
In my family, the story was that I was the result of a rock explosion, and
my mother just picked me out of the rubble one day! My parents, like many
Chinese people, would never admit to having had sex. Only prostitutes have
sex. And, if you would attempt to talk about male-to-male sex, they wouldn't
even let you finish saying the word "sex" they would change the subject
immediately! 

       Death is another taboo subject that hides HIV disease. The Chinese
don't say "death"; they say, "the body passed." It is too painful to talk
about death, it's too risque to talk about sex, so you deny HIV disease. You
put it in the back of your mind hoping no one knows about it, and believe
that because it is buried there, it will not happen. 

       "You don't talk about the living during the day and you don't talk
about the dead at night," meaning any gossip or rumors that you share with
others and any death that you acknowledge will come back to haunt you. If a
man starts to talk about HIV disease, he becomes an outcast and people begin
to isolate him. 

       This may begin in the family, where the preservation of the family
face" is all important. 1 was raised to believe that I had to do things so
well that my ancestors would be proud and my grandchildren would have a model
to follow, that my actions would make my family name known. In such an
atmosphere, dishonoring the family is the worst thing you can do. Asian
family ties are so strong that HIV-infected people will not risk breaking
them even by asking for help in the face of illness. 

       The Chinese say: "A colony of ants can kill an elephant." By ganging
up on those who have chosen to speak out, the community-beginning with the
family- overwhelms the truth. The community wields the club of isolation to
silence people talking about HIV disease, in some cases, extending this
treatment to friends. By not talking about it, however, the community not
only silences unpopular beliefs, it also denies itself the ability to do
something to keep others from becoming infected. 

       The Subject of Disease

       Given the fact that it is not wise to stick your nose into someone
else's business, and that it is wise to avoid taboo subjects, people in API
communities do not talk about issues like HIV disease. Denial of disease is
even supported by Asian medical practitioners in our communities. Most
Asians, particularly if they are recent immigrants, prefer Asian doctors.
Since these doctors are more likely to be concerned with the Asian's family
face, they would be more likely to diagnose HIV disease simply as "a terminal
condition," maintaining the silence around the epidemic. I had a classmate
when I was 14 who, being pregnant, committed suicide to save the family face.
Had my classmate chosen to keep the baby, she and the baby would have been
disowned by the family. 

       In addition, some Asian/Pacific Islanders shun conventional western
medicine, using alternative healers instead. But since alternative healers
may not be licensed as medical doctors, they are not required to report HIV
disease to the health authorities, and so many AIDS cases in API communities
remain hidden. In addition, herbalist practitioners see disease in terms of
symptoms and treat these, the root causes of illness being blamed on
deficiencies of diet or other causes, for example, the wrong water, the
weather, or sleeping in the wrong position. 

       The media contributes to the "hear no evil, see no evil, speak no
evil" situation by not devoting enough attention to Asian/Pacific Islanders
who have died from AIDS or talking about unsafe sex practices in API
communities. This portrayal also makes it seem that Asian/ Pacific Islanders
are immune. 

       I have heard some mainstream Americans say "Those nice Asian boys
always know how to take care of themselves and could not possibly have AIDS."
Even some of my Asian friends say this! That is my concern: sometimes Asians
themselves believe this great lie, so the disease continues to spread. 

       Overcoming Denial

       In order to overcome denial and the taboo of HIV-related subjects, it
is important to keep talking and presenting information about HIV disease to
API communities. Some may not be willing to listen, but when HIV education
and safer sex messages are all around them, API communities will not be able
to continue to avoid the epidemic. 

       I am an Asian immigrant. I am tired of watching other communities
respond to AIDS, while my own community is silent. The Asian community has
leaders: why haven't I heard from them? Saving "face" is important, but so
is saving lives. Somehow we have to "de-culturize" the subject, and get rid
of the taboos. After all we are now living in the United States, a society
that silences no subject. 

       The unfortunate Asian person who has contracted this dreadful disease
can no longer say, "Today I have the wine, I will get drunk! And tomorrow's
troubles, I will take care of tomorrow." We can no longer wait to face
reality later. The consequences of being drunk may be more than just a
hangover. Having stolen the bell, it is now time to hear it ring. 

       ***********

       Recent Reports

       Repression versus Realistic Appraisal

       Gladis MM, Michela JL, Walter HJ, et al. High school student's risk
       perception of AIDS risk: Realistic appraisal of motivated denial.
       Health Psychology. 1992;11(5): 307-16. (Medical College of
       Pennsylvania, University of Waterloo, Columbia University, and New
       York State Psychiatric Institute.) 

       Adolescents characterized as "repressors" perceived HIV-related risk
as decreasing when the actual level of behavioral risk they faced increased,
according to a New York study of high school students. 

       Researchers questioned 296 ninth and tenth graders from 14 public,
academic high schools in New York city and surrounding suburbs. They assessed
perceived risk, HIV-related risk behaviors, HIV-related knowledge, perceived
control, and intention to change behaviors. The race and ethnicity of the
students involved accurately represented the constitution of their respective
areas, with city dwellers more likely to be African American and Hispanic and
suburbanites more likely to be White. 

       Using the Modified Repression Sensitization Scale, researchers
characterized subjects as either "repressors," "neutrals," or "sensitizers."
Repressors use avoidance mechanisms such as denial to cope with threatening
stimuli. Sensitizers, on the other hand, are especially vigilant about
threatening circumstances and cope with them by seeking information about
them. Neutrals fall between repressors and sensitizers on the scale and were
considered the control in the study. 

       While sensitizers and neutrals used their behaviors as a basis for
assessing their actual risk, repressors engaging in risky behaviors actually
indicated that their risk was lower: the greater their behavioral risk, the
lower their perceptions of risk. Repressors' attempts to control fear
prevented them from forming a valid cognitive representation of the health
threat. Students from the suburbs were more likely than students from the
city to be repressors. 

       Neither HIV-related knowledge nor perceived control was related to
perceived absolute risk. However, both perceived control and perceived
absolute risk were significant indicators of future risk prevention
intentions. 

       ----------------------------
       Denial and Adjustment Styles

       Earl WL, Martindale CJ, Cohn D. Adjustment: Denial in the styles of
       coping with HIV infection. Omega. 1991; 24(1): 35-47. (Denver
       Department of Health.) 

       A small study of people who recently tested HIV antibody positive
found that denial focused on deceiving others was more authentic and stable
than denial focused on self-deception or delusion, and leads to more positive
adaptation and increased long-term thriving. 

       Fifty-three men and five women were randomly selected from HIV
counseling and testing sites, a long-term study of gay and bisexual men and
private physicians and therapists. Profiles administered within three weeks
of testing HIV antibody positive measured levels of anxiety, hostility,
paranoia, psychotic distress, obsessive/compulsive distress, interpersonal
sensitivity, and depression. The sample fell evenly into one of three styles
of denial, which were most clearly distinguished in terms of level of
interpersonal sensitivity, depression, and anxiety and hostility. 

       "Primary denial," characterized by self-deception, is the first and
natural adjustment to unwanted information. It is defined in terms of three
of four behaviors or beliefs: tolerance for discussion of the realities of
the situation, appropriate social behaviors, cessation of self-harming
behavior, and incorporation of significant others into support systems. 

       "Secondary denial" is a less conscious reaction, occurring about a
month after testing, and including three of four significant features:
rebellion against treatment teams, maintenance or escalation of self-harming
behaviors, guardedness, and manipulative behavior. "Denial without benefit"
is not true denial, but is a "style of suspended response," associated with
a 'sealing over" and clinging to four essential behaviors: lack of
involvement in treatment continued participation in high-risk practices,
secrecy and misrepresentation, and nonchalance about irresponsible behavior. 

       After a six-month follow-up, secondary denial appeared to be the most
stable adjustment style, while nearly one-third of the primary denial group
relapsed to lower levels of adaptation. This suggests that secondary denial
may be the more authentic adjustment, leading to acting out in anger and then
working through loss. Changes in adjustment style seemed to be associated
with alterations in health or death of associates, but not with treatment
interventions or information about personal risk potential, self-harm or
social harm. 

       --------------------------------------
       Influence of Denial on Estimating Risk 

       Sandfort TGM, van Zessen G. Denial as a barrier for HIV prevention
       within the general population. Journal of Psychology and Human
       Sexuality. 1992; 5(1/2): 69-87. (University of Utrecht and Netherlands
       Institute for Social Sexological Research.) 

       A large Dutch study defined two types of denial among people at risk
for HIV infection and confirmed that people who denied their histories of
risk were less apt to worry about the possibility of infection and take steps
to prevent transmission. 

       Interviewers questioned 1,001 male and female Dutch subjects between
the ages of 18 and 50. They assessed denial of risk, HIV-related knowledge,
social proximity to HIV-related issues, attitudes toward sexuality, concern
about HIV-related issues, and estimation of future risk. Seventy-three
percent of the participants were involved in steady, monogamous
relationships. 

       Researchers characterized denial in two ways: reasoning away risk and
minimizing or playing down risk. They defined reasoning away as agreement
with statements such as "I'm not the type of person that happens to," or "If
you trust the other person, then you don't have to do anything to prevent
infection" They defined minimizing risk as considering risky sex to be more
exciting than protected sex or believing HIV infection is the result of "hard
luck." 

       Subjects who expressed sexually restrictive attitudes, who knew little
about HIV disease, and who had few personal confrontations with HIV disease
tended to deny risk of infection more than subjects it, who did not fall into
these categories. Subjects who participated in risky behaviors but who did
not acknowledge this risk tended to reason away rather than minimize the
risk. 

       Reasoning away was more likely among subjects who were older, had a
lower degree of education, came from lower social classes, had a more
conservative political orientation, and were involved in steady monogamous
relationships or had no sexual partners in the preceding year. Minimizing
risk was more likely only among subjects who A came from lower social
classes. 

       ----------------------------------
       Denial among HIV-affected Children

       Halperin EN. Denial in children whose parents died of AIDS. Child
       Psychiatry and Human Development. 1993; 23(4): 249-257. (Leake & Watts
       Children's Home, Inc., Yonkers, New York.) 

       Three case studies from a home for inner-city youth suggest that
denial allows teens to temporarily ignore the pain and shame associated with
a parent's HIV infection. 

       The group foster home housed African-American and Hispanic youth
between the ages of 12 and 18. Of the 220 children residing at the home
during 1990, three were known to have had parents who died of AIDS. 

       The environments of the three teens before placement and in the home
taught the adolescents to defend against societal reproach by withholding
information and avoiding shameful issues. While they explicitly denied
HIV-related concerns, their further responses demonstrated deeper anxiety. 

       Counselors respected the teens' denial in order to establish rapport,
restore self-esteem, promote security, and foster optimism, tasks that could
not be achieved by dredging up painful experiences. When it did occur,
confrontation of denial with these adolescents created an impasse and proved
to be counterproductive. Instead of confronting denial, counselors monitored
the teens' behavior and tried to prevent more pathological developments. 

       *************
       Next Month 

       There was a quip that went around early in the epidemic: if AIDS was
God's scourge, then lesbians, of all people, must be God's chosen. The common
wisdom was, and remains, that lesbians don't get AIDS. But research demon-
strates that this question is much more complicated than the comics would
have us think. In the September issue of FOCUS, Amber Hollibaugh, Director
of the Lesbian AIDS Project in New York, examines the data on HIV
transmission and seroprevalence among lesbians and - women who have sex with
women. She offers suggestions about why transmission is possible and what
further research needs to be done to clearly define the risk. 

       Also in the September issue, Naomi Braine, a doctoral candidate in
sociology at the University of Chicago, examines the resistance of the
organized lesbian community" to accepting the reality of HIV disease. She
applies a feminist health perspective to the topic, identifying a schism
between a "dominant" lesbian culture which "appears" to be immune to the
virus- and other lesbian cultures in which HIV infection exists. 

       ************

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       Editor, FOCUS
       UCSF AIDS Health Project
       Box 0884
       San Francisco, CA 94143-0884

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