optimism raises a dilemma for the health care delivery system. Encounters with physicians will remind the person with HIV of his or her ultimate demise. Vitiated optimism and enhanced anguish are dangers. Empirical findings consistent with this view are available. Being tested for HIV and learning of a seropositive status (Ostrow et al., 1989) can create distress. People fear being tested, anticipating an inability to cope (Lyter, Valdiserri, Kingsley, Amoroso, & Rinaldo, 1987), and in fact learning of seropositivity does increase suicidal ideation (Pergami, Gala, Burgess, Invernizzi, & Catalan, 1994). Beyond bad feelings, evidence suggests that the process of testing and learning of a seropositive status can suppress immune function (Ironson et al., 1990). Early treatment too has potential for creating distress. In groups receiving preventive AZT (zidovudine) treatment, greater distress (Jacobsen, Perry, Hirsch, Scavuzzo, & Roberts, 1988) and greater realistic acceptance of disease have been noted (Reed et al., 1994). Perhaps the greater distress found in those receiving early treatment is attributable to decreased denial, attenuated optimism, or both. Of course, major gains can be achieved through early identification of the HIV virus, permitting, for example, interventions for delaying disease onset. The shorter longevity of women and African Americans with AIDS has been attributed to the fact that they have less access to health care than more affluent groups (Chaisson, Keruly, & Moore, 1995). Social workers should encourage HlV-infected individuals to seek health care. However, by recognizing the down side to the provision of health care, namely its psychological reminders of being an at-risk individual, social workers can respond by developing interventions to change the psychological impact of participating in the health care system. Evidence suggests that behavioral and psychological interventions can buffer the immune-suppress...
