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How do people respond to the news that they are HIV positive? To date, there have been few published qualitative studies of HIV diagnosis experiences, and none focusing on Caribbean people. Twenty-five HIV-positive Caribbean people in London, UK, related their diagnosis experience and its immediate aftermath in semi-structured interviews. Diagnosis with HIV caused profound shock and distress to participants, as they associated the disease with immediate death and stigmatisation. The respondents struggled with "biographical disruption", the radical disjuncture between life before and after diagnosis, which led them into a state of liminality, as they found themselves "betwixt and between" established structural and social identities. Respondents were faced with multifaceted loss: of their known self, their present life, their envisioned future and the partner they had expected to play a role in each of these. A minority of accounts suggest that the way in which healthcare practitioners delivered the diagnosis intensified the participants' distress. This research suggests that healthcare practitioners should educate patients in specific aspects of HIV transmission and treatment, and engage closely with them in order to understand their needs and potential reactions to a positive diagnosis.

Although Caribbean people in the United Kingdom are increasingly being affected by HIV/AIDS, there has been no examination of how they are coping with the illness. We investigate the coping strategies of HIV-positive Caribbean people using in-depth interviews with a purposively selected group of 25 residents of South London. The main coping strategies were more cognitive than behavioral: restricted disclosure, submersion, faith, and positive reappraisal. These strategies were intertwined in complex ways, and most were rooted in contextual factors, particularly cultural ones. Themes of loss, silence, and reinvention suffused respondents' narratives. Interventions should consider the high degree of stigmatization of HIV/AIDS in the Caribbean community, reluctance to disclose, the likelihood of an initial severe reaction to diagnosis, and external stressors. HIV-positive Caribbean people who are coping well could serve as mentors and role models for poor copers and newly diagnosed patients; establishing Caribbean-specific support groups might also assist coping.

Research has shown that living with sickle cell disease (SCD) can be a considerable challenge. Unfortunately, although it is Jamaica's most common genetic disorder, to date, no qualitative research has been conducted on Jamaicans' experiences of SCD. We conducted thematic analysis on transcripts of in-depth semistructured interviews with 30 patients and found two interlinked themes bound up in life with SCD: loss and control. Faced with important losses, respondents used cognitive and behavioral coping strategies to reestablish control over their response to SCD, others' responses to SCD, and SCD's physical manifestations. Although the adaptive nature of some of these strategies is debatable, many facilitate management of the illness. Health care practitioners should encourage positive coping strategies and have nonjudgmental discussions with patients about (potentially) negative ones. They should also share information with nonspecialist doctors and nurses to reduce stigmatization around the illness. More exploration of this underresearched topic is needed.

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