This silent mourning blocks lovers, spouses, family, and friends from openly acknowledging the true circumstances of death and the special nature of the relationship shared with the deceased, and it leaves survivors feeling more alone and bereft. The grief process becomes further burdened when the survivor is excluded from burial and memorial rites by the deceased's biological family. Bereavement rituals have been shown to encourage the resolution of grief, and exclusion from these rituals can disrupt the bereavement process, leading to a delayed adaptation to the loss, protracted depression, feelings of invalidation, and anger. Second, most who die are either young adults or children. Deaths at these early developmental stages are typically deemed unusual and premature.
Premature loss is always shocking and, therefore, traumatic.
A third unique feature of AIDS bereavement concerns the HIV serostatus of the bereaved. As many as 30 percent of seropositive individuals have reported unresolved grief, as compared with 12 percent of their seronegative counterparts. Surviving spouses must prepare for life alone without their partner and must face their own dying process without the support of the deceased. This finding is of particular concern because unresolved grief has been associated with a poorer quality of well-being, psychiatric morbidity, increased loneliness, and immune suppression. Given the health implications of unresolved grief and its potential damage to an already compromised immune system, aggressive treatment to ameliorate distress is recommended.