h AIDS, reported that the worst thing a physician can do is to tell the patient that there is nothing that can be done and to provide an estimate on longevity. Haney suggested that a profitable focus is learning to live with AIDS and eschewing the role of victim. Some clinicians have expressed concern that denial of the threat of AIDS might result in risky behavior and the attendant transmission of the disease (Rosenberger & Wineburgh, 1992). The findings on this issue are mixed. Taylor et al. (1992) found that among people with HIV, those who were high in AIDS-specific optimism were not more likely to engage in high-risk sexual activity. Rather, a fatalistic attitude was related to having more sex partners. Taylor et al.'s results were consistent with Kelly et al.'s (1995) finding that higher perceived probability of contracting AIDS was associated with higher levels of unprotected sex in a cohort of gay men. Kelly et al.'s (1995) findings are counterintuitive. A more expected finding is that of Bauman and Siegel (1987), who reported that gay men who more frequently participated in unsafe sex more often underestimated the risk associated with anal receptive sex with a limited number of partners. Similarly, Folkman, Chesney, Pollack, and Phillips (1992) found that gay men who achieved higher scores on their positive reappraisal scale (endorsing greater reliance on prayer, finding a new faith, and changing and growing as a person) were more likely to engage in unprotected anal intercourse. Viewed collectively, although the research findings of Taylor et al. (1992) suggest that an optimistic view when a person is infected will not be associated with risky sex, other investigators working with men not selected for HlV seropositivity have found that risky behavior is associated with a more optimistic view about potential dangers. IMPACT OF HEALTH CARE DELIVERY ON PSYCHOLOGICAL STATES Littrell (1994) pointed out that the concern to encourage...
