本研究主要的目的是在探討不為社會一般人所知道與關心的HIV感染者，在感染之後適應疾病的過程，面臨的困難，需要的服務，以及生活適應的問題。進而提出社會工作專業幫助感染者度過生命黑暗期的可能策略。只有當感染者不再因為感染而感受到生死的糾葛，不再因為感染，而被社會道德的節勒得喘不過氣來，防制愛滋的蔓延，才有可能。 本研究總結對HIV感染者的觀察與深入訪談後發現，感染者在知道自己感染之後，最能夠在它們身上感受到的是對曝光的擔心；孤獨的感受；死亡的陰影；以及階段任務受阻等心理層面上的壓力與現實上生活適應的困難交織而成的生死結。 感染者普遍說來，都十分擔心曝光。而孤獨的感受對感染者來說，一是因為擔心曝光、自殘形穢的自我封閉而造成；一是因為感到社會的遺棄，缺乏規屬感所產生。而由於感染的必死性，讓感染者不論目前的身體狀況如何，都生活在死亡的陰影之下，而這樣的死亡陰影，亦會影響到感染者求生與求死的意念。階段性任務受阻的感受，人生的任務無法達成，則是感染者普遍的遺憾。 而在心理層面的擔憂之外，感染者難以避免的會遭遇到實際生活適應上的困難。一般說來感染者會產生生活水準降低的問題；醫療相關的問題；擔心發病；空間剝奪的問題；因擔心曝光或告知所產生的心理壓力問題。 但是生死結並非在所有感染者身上都能起相同的作用，換句話說，不同的感染者對生死結的感受，會隨著他們的感染途徑；自覺社會烙印；原本的社會地位；感染事實被知悉的範圍以及得知感染的時間等前置因素而有所不同。這些前置因素，因為影響到感染者對生死結的感受，進而也會影響到感染者所採取的因應策略。感染者所採取的因應策略大致可以區分為幾種：改變生活方式與態度；告知；死亡的準備；特殊化以及利他。 針對以上感染者的生活適應困境本研究提出以下幾點建議，提供相關單位與實務工作者參考。給相關單位建議的部分有：1、基本生活水準的維持；2、健全醫療服務網；3、專業藥師提供用藥諮詢；4、在相關醫療院所聘用專任涉工員；5、義工的訓練與督導；6、設立協談專線；7、跨部會的定期會議。而對提供社會工作直接服務者的建議是：1、非批判式的接納；2、避免特殊化；3、多傾聽。

In this study, a model of cognitive behavioural therapy (CBT) was developed, implemented and assessed. The aim of this model is to assist HIV-positive women in dealing with internalised and enacted stigma. Since much of the research about therapies developed to deal with HIV-related stigma so far has been done within a western frame of reference, in the current study a model was developed to suit the local South African situation. Women were specifically targeted as they are more vulnerable to HIV/AIDS and are disproportionately affected by the epidemic. Because of culturally determined gender roles, women are not always in a position to take control of their sexual health. Furthermore, because of the negative experiences of HIV diagnosis, the stigma has a negative impact on women’s behaviour. As a result, there is a need for a therapeutic model to assist HIV-positive women in changing the experience of internalised stigma and discrimination. A CBT approach was used in therapy to challenge the women’s dysfunctional beliefs, to change their automatic thoughts and to promote more realistic adaptive patterns of thinking. All of these aimed to assist them in dealing with stigma. Eight therapy sessions (one a week for eight weeks) were planned for each of the women. This research was conducted in two phases. In Phase 1, data was gathered about the experiences of HIV-positive women to gain an understanding of their experiences of HIV-related stigma and discrimination. Various sources of information were used to identify not only the relevant themes contributing to the individual’s experience of internalised stigma, but also possible ways to change them. These sources included a study of the available literature, the researcher's own experience and focus group discussions with other psychologists in practice, and interviews with five HIV-positive women (in the form of case studies). Five women living with HIV/AIDS, who were experiencing difficulties in dealing with stigma, were recruited at Witbank Hospital, where they were interviewed and asked to complete five psychometric instruments. The researcher scrutinised the data gained from the psychometric scales to assess the validity of the instruments to identifying the feelings of the participants the researcher observed in the interviews. Rubin and Rubin's (1995) method was used to analyse the data. The findings that emerged from Phase 1 were used to identify common themes to be addressed in the intervention, for example feelings of powerlessness, feelings of guilt, behavioural implications of stigma, the experience of the reaction of others and uncertainty about the future. These themes were used as guidelines and were adapted according to the specific needs of each of the women seen in therapy so as to address negative feelings and behaviour. Phase 2 focused on the implementation and evaluation of the cognitive behavioural model. A purposive sampling technique was used for this study. The model was tried out with ten HIV-positive women who served as the experimental group. A quasi-experimental design was used, involving a pre-and post-test and a control group consisting of ten other women identified at the same hospital. The scores that the experimental group and the control group obtained before the intervention were compared to verify that the two groups were comparable prior to the intervention. Post-test scores were compared to investigate differences between the groups after the intervention. The process notes of the therapy sessions were analysed by means of qualitative analysis to understand the reactions of the women in therapy. This contributed to the researcher’s understanding of the appropriateness and effectiveness of various therapeutic techniques used with the experimental group. Findings of this research indicate that, when compared to the control group, the experimental group not only experienced less depression, internalised stigma and negative coping, but also higher levels of self-esteem and positive coping after having participated in eight therapy sessions. The study further revealed that being HIV positive and trying to cope with stigma and discrimination involve diverse experiences for women, although there are common themes for all participants. It was recommended that the intervention be altered in future use in the following ways: Those techniques that were found to be more effective with the majority of women (positive cognitive reframing, teaching of coping strategies, homework assignments, decatastrophising and assertiveness training) could probably be used with success in similar conditions. Only the techniques that worked well should be used, and care should be taken not to use too many techniques. Each client should be given the time to question the evidence for her automatic thoughts and to draw her own conclusions about her situation, feelings or thoughts and to grasp the cognitive strategies, rather than to bombard her with many different techniques. The therapist should also relate more to the individual client and adapt the model to her context, rather than to implement the model rigorously. / Thesis (PhD)--University of Pretoria, 2009. / Psychology / unrestricted