FOCUS Feb-06 Experiences of Seroconversion Clients

HIV in the United States are men who have sex with men. While the general consensus is that most people who know they are HIVpositive are careful to avoid transmitting the virus, some seropositive individuals continue to report unprotected anal sex with partners of unknown serostatus.1,2 Narrative therapy provides an alternative framework from which to explore new approaches to HIV prevention for HIV-positive people.3,4 Narrative therapy is based in the constructivist perspective that people’s lives are shaped by the meanings they ascribe to their experiences—not by the experiences themselves. According to narrative therapy practitioners, reality is created as an individual tells and retells his or her story or “narrative.”4 In counseling, through a process described as “re-authoring,” clients actively revise the meaning of previous events in their lives, suggesting a relationship between the rewriting of the narrative and the process of behavior change. Narrative therapy is the basis for the Seroconversion Narratives for AIDS Prevention (SNAP) study, a qualitative investigation of HIV-positive participants’ understandings of their seroconversion events. This article describes SNAP’s most compelling findings. An HIV-positive individual’s understanding of how and why he or she was infected could have an impact on how that person chooses to protect or not to protect sexual and needle sharing partners. This link between an individual’s personal theory about HIV infection and subsequent behavior is supported by several studies in which researchers found that attributions of blame for infection,5 and attributions of responsibility for protection,6 were both associated with HIV transmission risk behavior among men living with HIV. Given this connection, the modification of a seroconversion narrative (a person’s story about how he or she believes that he or she was infected with HIV) through specific counseling approaches may help reduce behavior that risks HIV transmission. A counseling intervention based on narrative therapy might involve collaborating with a client to author and then review and “reauthor” his or her narrative toward a more empowered perspective and to develop a more balanced and self-affirming set of attributions to explain the seroconversion event.