María Nicole Cantisano

Virginie Ferraud

María Teresa

Muñoz Sastre

Teresa Muñoz Sastre

Etienne Mullet
email: etienne.mullet@wanadoo.fr

Lay people's conceptualizations

Keywords: fear of death, lay views, determinants, France

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Lay People's Conceptualizations Regarding What Determines Fear of Death

The death of relatives and the death of close friends are common and painful experiences among people of all ages. Many people have accompanied a dying person until the very last moment. This experience may have raised durable questionings [START_REF] Becvar | In the presence of grief: Helping family members resolve death, dying, and bereavement issues[END_REF].

In many cases, dying persons seem to be at peace with themselves. They accept the idea of their imminent death and they may even call it in the hope of alleviating their caregivers' burden -the "escape acceptance" in Cicirelli's (2003, p. 67) terms. In some cases, however, dying persons seem to fear death extremely, until the last moment. Why do these persons fear death so much? Am I going to experience such a level of fear when my time will come? Fear of death has been defined as "the anxiety experienced in daily life caused by the anticipation of the state in which one is dead" (Cicirelli 1999, p. 569). Its determinants have been extensively examined [START_REF] Neimeyer | Death anxiety handbook: Research, instrumentation, and application[END_REF]. Several aspects of fear of death have been distinguished, whether, for example, it is fear of non-existence or fear of the process of dying [START_REF] Neimeyer | Psychological research on death attitudes: an overview and evaluation[END_REF]. Although the impact of these determinants vary as a function of the specific aspect considered, it can be stated that, generally speaking, young people and females report fear of death to a greater extent than older people and males [START_REF] Pierce | Gender differences in death anxiety and religious orientation among US high school and college students[END_REF].

Studies conducted in the framework of Terror Management Theory (TMT) have shown that fear of death was strongly linked with cultural values and self-esteem, and that, when activated, fear of death had an impact on a huge set of attitudes and behaviors such as prejudice and nationalism, interpersonal attraction and romantic love, or pro-war attitudes and legal decision making, to quote only a few (for a review, see [START_REF] Pyszczynski | On the unique psychological import of the human awareness of mortality: Theme and variations[END_REF]. It has also been shown to be associated with other personality constructs such as locus of control [START_REF] Cicirelli | Personality and demographic factors in older adults' fear of death[END_REF], with psychopathology (Thiemann et al.

Fear of Death 4

2015), and with physical problems [START_REF] Fortner | Death anxiety in older adults: A quantitative review[END_REF]. Some authors suggest that it may have negative consequences on mental health and well-being [START_REF] Iverach | Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct[END_REF]. Finally, religious people report fear of death either more [START_REF] Power | Predictors of fear of death and self-mortality: An Atlantic Canadian perspective[END_REF] or less [START_REF] Daaleman | Religiosity, spirituality, and death attitudes in chronically ill older adults[END_REF] than non-religious people, depending on a number of context factors, namely religious involvement [START_REF] Jong | Death anxiety and religious belief: An existential psychology of religion[END_REF] and religious affiliation [START_REF] Abdel-Khalek | The Arabic scale of death anxiety: Some results from East and West[END_REF][START_REF] Ellis | Religiosity and fear of death: a threenation comparison[END_REF].

The present study was conducted in France, a country in which life expectancy at birth is about 82 (INSEE 2017) and where people, in their majority, die in hospitals or medical homes [START_REF] Lalande | La mort à l'hôpital [Death at the hospital[END_REF]. In this country, patients' wishes regarding support care are protected by law (Legifrance 2016). As most studies reported above, the present study explored the determinants of fear of death but the perspective that we adopted was different: It explored fear of death from lay people's perspective. By lay people we mean people who are not experts in the field of study under consideration. In the present study the term refers to persons who were neither professional psychologists nor psychiatrists. As lay people usually don't read scientific psychology journals, and as the media are largely silent regarding findings reported by these journals, they have no other way to understand fear of death (expressed by loved ones or casual acquaintances) than to rely upon their own views about it.

These views are primarily derived from personal feelings --one's own attitude towards death, but also from personal experience, word of mouth, and the popular press.

In order to examine people's conceptualizations of what determines fear of death, a scenario technique was used [START_REF] Anderson | Unified social cognition[END_REF][START_REF] Anderson | Moral science[END_REF]. A realistic story that depicted a terminally-ill female older patient was written by an experienced nurse. This story provided information regarding the way this patient considered her life accomplishments, the quality of social support available to her (e.g., presence of a close relative), the existence of unresolved conflicts with family members, her beliefs in an afterlife, and her level of assurance that her end of life wishes would be respected by the medical team. The choice of information included in the scenarios was partly guided by [START_REF] Abdel-Khalek | Why do we fear death? The construction and validation of the reasons for death fear scale[END_REF] list of reasons to fear death: losing worldly involvements, parting from loved ones, transgressions and failures, and fear of pain. From this basic scenario, additional scenarios were composed by systematically varying the levels of the five factors mentioned above. Participants were presented with the whole set of vignettes and asked to judge of the level of fear experienced by each patient in each vignette.

As suggested by Neimeyer et al. (2004, p. 311), "human responses to the contemplation of or confrontation with death are remarkably varied, ranging from stark fear and threat to neutral acceptance or approach." As fear of death dramatically vary from one person to another and as a function of context (see also [START_REF] Pyszczynski | On the unique psychological import of the human awareness of mortality: Theme and variations[END_REF], we expected to find different positions regarding what determines fear of death among participants. Some of themprobably a minoritywould, as suggested by [START_REF] Becker | The denial of death[END_REF] in his early book on the subject, blatantly deny that fear of death may be experienced by the terminally-ill patient; that is, their ratings would always be low, and circumstantial factors (e.g., unsolved conflict with family members) would play no role. In contrast, other participants would, on the basis of their own experience, consider that fear of death is always present and strong [START_REF] Juhl | Putting the terror in terror management theory: Evidence that the awareness of death does cause anxiety and undermine psychological well-being[END_REF]; their rating would always be high but circumstantial factors would, for similar reasons, play no role. In these two cases, fear of death would, therefore, be conceptualized either as a myth or as an overwhelming phenomenon. Finally, other participants would, in the same way as most of [START_REF] Abdel-Khalek | Why do we fear death? The construction and validation of the reasons for death fear scale[END_REF] participants, consider that fear of death may vary as a function of the situation in which death takes place. Their ratings would change as a function of the levels of the five factors listed above. In other words, fear of death would, in this third case, be conceptualized as a situational construct.

Fear of Death 6

We also expected that people's positions would be associated with their demographic characteristics. We expected that (a) males, older participants, and regular attendees to the church or the temple would, more often than other participants, express a "no fear" position, and (b) females, younger participants, and atheists would, more often than others, express an "always strong" position [START_REF] Fortner | Death anxiety in older adults: A quantitative review[END_REF].

Method

Participants

Participants were unpaid volunteers. The study was conducted in the area of Toulouse, France. Authors contacted people walking along city sidewalks, explained the study, asked them to participate, and, if they agreed, arranged where and when to administer the experiment. Of the 400 individuals who were contacted, 212 (53%) participated. Authors tried to enroll people from both sexes (131 females and 81 males) and different ages (M = 41.46, SD = 16.87, range = 18-83 years).

Participants indicated whether (a) they were regular attendees to the church or the temple, believers in God, or atheists/agnostics, (b) they had a university degree (tertiary) or not (primary and secondary), (c) they were currently students, blue collars (persons who perform manual labor), white collars (persons who work in an office environment), unemployed, or retired. Detailed demographic characteristics are shown in Table 1.

-----Table 1 about here -----

Material

The material consisted of 48 vignettes containing a short story (a few lines), a question, and a response scale. The stories were composed according to a five within-subject factor design: (a) whether the person believes in God or not, (b) whether social support is available or not, (c) the level of the person's life accomplishment (low, intermediate or high), (d) whether unresolved conflicts with family members still persist or not, and (e) whether the Fear of Death 7 person's end of life wishes will be respected or not. Other information was held constant: All patients were identified as "Mrs.", and they were all suffering from final stage cancer.

An example of vignette is: "Mrs. Kellerman is currently suffering from cancer. She is aware that she is in the final stage. Mrs. Kellerman does not believe in God. She thinks that after death, the body immediately discomposes and that all we leave behind us after death are memories and personal accomplishments. Mrs. Kellerman is well supported by her children.

She knows that at the time of death, at least her oldest daughter will accompany her until the end. Mrs. Kellerman has lived a somewhat disorganized life. Her feeling is that she has not always fulfilled her duties regarding her family and society. She feels however that she has accomplished certain good deeds and that she has put her own house in order. She has discussed her last wishes with her children. Mrs. Kellerman doesn't have any unresolved conflict with anybody. She has reconciled with the people she could have harmed in the past.

The medical team in charge of Mrs. Kellerman has assured her that they will do everything to alleviate pain and suffering, and fully respect her last wishes. To what extent do you think that Mrs. Kellerman is currently experiencing fear of death?" The response scale was an 11-point scale with a left-hand anchor of "Not a lot" and a right-hand anchor of "Terribly."

Procedure

The site was either a vacant classroom in the local university or the participant's private home. The procedure followed Anderson's recommendations (2008Anderson's recommendations ( , 2018) ) for this kind of study. Each participant was tested individually. Firstly, the experimenter explained to participants that they were about to read a certain number of stories depicting a terminally-ill patient, and, for each story, they had to indicate the degree to which they feel that this patient may experience fear of death. Secondly, participants were presented with 12 stories taken randomly from the set of 48. They read each of them and made their ratings. Thirdly, they were allowed to go back at their responses, compare them, and make changes. The main Fear of Death 8 purpose of this familiarization phase was to enable the participants to develop a frame of reference for the task. Fourthly, during the following experimental phase, the whole set of 48 stories were presented one by one to the participants. The order of the vignettes was random and different for each participant. They made their ratings at their own pace, but they were no longer allowed to go back and make alterations. It took 30-40 minutes to complete the ratings.

By obtaining informed consent and maintaining strict anonymity, the study conformed to current law in France and to the Declaration of Helsinki. The study was approved by the Ethics Committee of the University of Toulouse. The Committee required only oral consent by the participants. Informed consent was given orally, once participants had fully understood the nature of the study.

Data Analysis

A cluster analysis was performed on the raw data in order to group participants into a reduced set of conceptualizations (Hoffmans 2013). Four clusters were identified. ANOVAs were performed on the data from each cluster, with the following design: Beliefs x Support x Accomplishment x Conflicts x Wishes, 2 x 2 x 3 x 2 x 2. In light of the multiplicity of comparisons, the level of significance was set at .005. Chi² were computed in order to assess the relationship between type of conceptualization and demographic characteristics.

Results

A four-cluster solution was retained (Sheperd and Hoffmans 2009). The four clusters are shown in Figure 1. The main results from the ANOVAs are shown in Table 2. In this table, all main effects but only significant interactions have been reported.

The first cluster (9% of the sample) was the expected Not Much Fear cluster. All ratings were low (M = 1.41). They were, however, slightly higher when respect for last wishes was not expected (M = 1.66) and all conflicts were not resolved (M = 1.56) than in the alternative cases (M = 1.16 and 1.27, respectively). Older participants (over 55 years), and Fear of Death 9 retired participants were more often members of this cluster than younger participants (less than 40 years) and students or white collars.

-----Figure 1 and Table 2 about here -----

The second cluster (63%) was the expected Depends on Circumstances cluster. Ratings were higher when respect of last wishes was not expected (M = 5.29), all conflicts were not resolved (M = 5.29), social support was inexistent (M = 5.07), and the patient did not believe in God (M = 4.95) than in the alternative cases (M = 3.90, 3.90, 4.12, and 4.23 respectively). Ratings were lower when life accomplishments were high (M = 3.77) than when they were moderate (M = 4.48) or low (M = 5.54). White collars were more often members of this cluster than blue collars, students, and retired participants.

The third cluster (16%) was the expected Fear Always Present cluster. All ratings were higher than the middle of the response scale (M = 7.16). Ratings were slightly higher when respect of last wishes was not expected (M = 7.88), all conflicts were not resolved (M = 7.63), and social support was inexistent (M = 7.65) than in the alternative cases (M = 6.43, 6.68, and 6.67 respectively). Ratings were lower when life accomplishments were high (M = 6.61) than when they were moderate (M = 7.11) or low (M = 7.75). The effect of life accomplishment was stronger when social support was absent (7.36 -6.00 = 1.36) than when it was present (8.14 -7.24 = 0.90). Females, very young participants (less than 25 years), students and atheists were more often members of this cluster than males, participants older than 25, white collars or retired participants, and regular attendees.

The fourth cluster (12%) was not expected; it was called Undetermined since all ratings were close to the middle of the response scale (M = 4.70). Ratings were, however, slightly higher when respect of last wishes was not expected (M = 5.10), than in the alternative cases (M = 4.31). Male participants were more often members of this cluster than female participants.

Fear of Death 10

Discussion

As expected, a "not much fear", minority conceptualization was found. This conceptualization was more frequently endorsed by older participants and by retired participants than by younger participants and by non-retired participants, which suggests that it did not necessarily correspond to an attitude of denial but was, rather, based on personal changes regarding attitudes towards death experienced by adult participants through their own aging process --the target was always an older person. This result was consistent with Neimeyer et al.'s (2004, p. 314) suggestions that "death anxiety decreases from mid-life to old age." This position was, however, not more often endorsed by males or by religious participants than by females and atheists.

As also expected, a "fear always present", minority position was found. For about one person out of eight in this sample, fear of death was considered as an irrepressible emotion that is present in everybody, and that is only slightly attenuated (a) when fear of terminal pain is reduced through assurance that the medical team will do everything possible to alleviate suffering and (b) when feelings of guilt are reduced through the resolution of conflict with others. As a result, it can be suggested that this position reflects genuine fear of death as conceptualized in TMT [START_REF] Pyszczynski | On the unique psychological import of the human awareness of mortality: Theme and variations[END_REF].

This position was frequently endorsed by very young participants (18-25-year olds) and by students, which was consistent with the view that it is the personal experience of a change in death attitude experienced as people grow older that matters when assessing fear of death. It was also frequently endorsed by females and by atheists, which suggests that this personal change (a) may be more pronounced among males than among females, and (b) may be fueled by beliefs in a corporal afterlife.

The majority position was the expected "depends on circumstances" position. Most participants considered that when a dying person thought that her life could be, for ideological Fear of Death 11 motives, maintained beyond the reasonable (e.g., using futile treatments) or her physical suffering would not be alleviated using strong painkillers (e.g., opioids), or when the dying person considered that her life has been a mess and she will be left alone, her fear of death could be intense. In other words, these participantsmostly white collars -considered that fearing death was not an irrepressible emotion but a reasonable attitude in extreme cases when physical suffering (pain) and/or psychological suffering (intense regret, solitude) had to be expected.

This view was consistent with Bonin-Scaon et al. 's findings (2009, p. 21) who reported that, in France, terminally ill patients' end-of-life preferences were articulated around the following factors: "leaving one's affairs in order, enjoying life until the last moment, feeling at peace with God, remaining able to oppose unwanted treatment, keeping close to loved ones, benefiting appropriate care, inspiring respect, being at peace with significant others." When these conditions are met, fear of death would be minimal.

The "undetermined" position was not expected but it was instructive. Some participantsmore often malesadmitted that they were not able to predict another person's level of fear. These participants may have felt uneasy to think about death (Tete 2010). This finding provides a methodological lesson. If the participants in this cluster had given only one response-to a single scenario or to a generic question -their responses would have been considered as expressing moderate fear of death. Having them respond to multiple stories allowed researchers distinguishing absence of opinion (or unease) from moderate level of fear; that is, it suggested that participants in this group did not actually make judgments, but merely put marks at the same place (more or less) in each case. Groups of participants without any definite views about important death issues have already been reported (e.g., [START_REF] Kamble | The acceptability among young Hindus and Muslims of actively ending the lives of newborns with genetic defects[END_REF].

Implications

Fear of Death 12

Only a small minority of participants viewed fear of death as an overwhelming phenomenon. Most participants considered that people tend to strongly fear death when it is likely to occur in undesirable circumstances (e.g., after a long agony or in complete solitude) but don't fear it much in circumstances that, in the Western world at least, are considered as normal (e.g., pain treatment, presence of close family members). As people's conceptualizations regarding fear of death are likely to be based on personal feelings about death and the dying process, and upon discussions with close relatives, the existence of three clearly contrasted positions suggests that lay people conceptualize fear of death either as a myth, or as a terrifying reality that reflects our own mortal condition, or as an emotional response to a more or less stressful situation; that is, as a reasonable response each time circumstances are far from what the dying person would wish.

It can thus be suggested that when assessing fear using conventional tools (e.g., questionnaires), the circumstances of death are systematically specified. Generic items assessing attitude (positive or negative) to the process of dying as part of everyone's life are likely to trigger very different ratings whether this process would take place at home, with the assistance of a competent medical team and the social support offered by family and friends or would take place in the ditch by the road.

Future studies should examine the link between people's conceptualizations of fear of death and personality variables such as self-esteem. As stated early, self-esteem has been shown to be strongly associated with existential fear of death [START_REF] Pyszczynski | On the unique psychological import of the human awareness of mortality: Theme and variations[END_REF]). As a result, it may be expected that people who conceptualize fear of death as a myth would have a much higher level of self-esteem --a fundamental anxiety buffer --than people who conceptualize fear of death as an overwhelming phenomenon. Future studies should also examine the link between people's conceptualizations of fear of death and specific forms of death representations [START_REF] Testoni | The ontological representation of death: a scale to measure the idea of annihilation versus passage[END_REF], specific aspects of personal values (Schwartz et al. Fear of Death 13 2012), or particular bioethical beliefs [START_REF] Stolt | Attitudes to bioethical issues: A case study of a screening project[END_REF]. Finally, and as the cultural dimension may strongly influence the ways in which the dilemmas around death and dying are handled, future studies should compare lay people's views regarding fear of death across different religions and cultures; that is among Jews (e.g., [START_REF] Lazar | Fear of personal death as a predictor of motivation for religious behavior[END_REF], Muslims (e.g., [START_REF] Dadfar | Death anxiety: Reliability, validity, and factorial structure of the Farsi form of the Arabic Scale of Death Anxiety in Iranian old-aged persons[END_REF]Bahrami 2016), Taoists (e.g., Zeyrek, and[START_REF] Abdel-Khalek | The Arabic scale of death anxiety: Some results from East and West[END_REF], Hinduists, Buddhists, and Animists, to quote a few.

Limitations

Our study has limitations. First, since we studied a convenience sample of adults in one area of France, our findings must be generalized with care and need to be confirmed both in France and, as indicated earlier, in other cultures. Second, the character in the vignette was always an older woman. Future studies show explore whether the current findings can be replicated using other characters such as an older man or a younger patient. Third, the list of reasons that inspired the scenarios was borrowed from a study (Abdel-Khalek 2002) that was conducted on a sample of Kuwaiti participants whereas the present study was conducted in France. Future studies should ensure that reasons for fear of death that would be specific to French people or westerners in general, have not been missed. Finally, information regarding participants' specific occupation was not assessed; hence, some participants in the present study might have been exposed to this type of scenarios in their profession.

  Regular attendees = Regular attendees to the church or to the temple. Undeterm.

	Unemployed	1 (10)	5 (50)	2 (20)	2 (20)	10
	Retired	6 (27) ab	10 (45) c	2 (9) a	4 (18)	22
	Total	19 (9)	133 (63)	35 (16)	25 (12)	212
	Note : = Undetermined.

Fear of Death 21

Table 2 .

 2 Main Results of the ANOVAs Performed at the Cluster Level. Only significant interactions have been reported.

	Cluster and Factor	df	MS	F	p	η²p
	Cluster Not Much Fear
	Wishes	1	55.51	12.56	.001	.42

Fear of Death 18

Thiemann, P., Quince, T., Benson, J., Wood, D., & Barclay, S. (2015). Medical students' death anxiety: Severity and association with psychological health and attitudes toward palliative care. Journal of Pain and Symptom Management, 50, 335-342. Ulrich, C. M., & Ratcliffe, S. J. (2008). Hypothetical vignettes in empirical bioethics research. In Jacoby, L., and Siminoff, L. A. (Eds.), Empirical methods for bioethics: a primer (pp.161-182). New York, NY: Elsevier. Zeyrek, E. Y., & Lester, D. (2009). A Taoist orientation and fears of death and dying. Perceptual and Motor Skills, 108, 81-82.

Fear of Death 19

Table 1. Demographic Characteristics of the Sample and of Each Cluster

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Conflict of interest:

On behalf of all authors, the corresponding author states that there is no conflict of interest.


Nicole Cantisano
email: cantisanonicole@gmail.com

Bernard Rimé

María T Muñoz-Sastre

SOCIAL SHARING OF EMOTIONS IN HIV/AIDS The Social Sharing of emotions in HIV/AIDS: A comparative study of HIV/AIDS, Diabetes and Cancer Patients

Keywords: AIDS, CANCER, EMOTIONS, SOCIAL SUPPORT, HIV, STIGMATIZATION

The social sharing of emotions in HIV/AIDS: A comparative study of HIV/AIDS, diabetic and cancer patients

Nicole Cantisano, Bernard Rimé, María Muñoz-Sastre

Introduction

Previous research on the social aspects of emotional regulation has shown that individuals communicate their emotions. The propensity to speak and share emotional experiences has been thoroughly investigated and denoted as the Social Sharing of Emotions (SSE) [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF][START_REF] Rimé | Long lasting cognitive and social consequences of emotion: Social sharing and rumination[END_REF][START_REF] Rimé | Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review[END_REF]. SSE has been defined as "the evocation of an emotion by the means of socially shared language, at the presence, at least symbolic, of an addressee to whom the emotion is evoked" (Rimé, 2007, p. 86). Evidence shows that 80% to 95% of emotional experiences, negative or positive, are object of SSE. This propensity to speak about emotional experiences is manifested during the hours, days, weeks or sometimes months following the emotional episode.

SSE studies have thoroughly supported that, following mayor life negative events, (e.g. [START_REF] Sydor | Conséquences psychologiques des massacres de 1994 au Rwanda [Psychological consequences of the 1994 massacre in Rwanda[END_REF] as well as daily life events (e.g., [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF], people look for the company of others to share and talk about the emotioneliciting event [START_REF] Rimé | Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review[END_REF]. Accordingly, SSE can result in positive outcomes both at inter-and intra-personal levels. As addressed by Rime et al. (1998), some of the benefits and functions served by the SSE are: (1) constructing and consolidating memory of important events, (2) processing and completing the emotional memory, (3) enhancing interpersonal relationships and social integration, and (4) constructing and disseminating social knowledge on emotion. On the one hand, at the interpersonal level, social sharing may bring forth emotional contagion, empathy, attachment and strengthened social ties between sharing persons and their listeners [START_REF] Rimé | Emotion Elicits the Social Sharing of Emotion: Theory and Empirical Review[END_REF]; [START_REF] Christophe | Exposure to the social sharing of emotion: Emotional impact, listener responses and the secondary social sharing[END_REF]. On the other hand, at the intrapersonal level, SSE may result in cognitive benefits such as making meaning of the situation when the sharing mode takes place in a cognitive reappraisal fashion [START_REF] Nils | Beyond the myth of venting: Social sharing modes determine emotional and social benefits from distress disclosure[END_REF].

As raised by [START_REF] Lepore | Talking facilitates cognitiveemotional processes of adaptation to an acute stressor[END_REF], talking about stressful experiences allows individuals to construct an organized narrative which becomes part of individuals' cognitive representation of the stressor. Therefore, succeeding the emotional impact linked to a physical illness, it is plausible to consider that SSE can provide a positive contribution to emotional adjustment as well as to social integration. For instance, previous research has shown that prostate cancer survivors who benefit from high quality social interactions cope better with cancer-related thoughts and present an enhanced mental health [START_REF] Lepore | Social constraints moderate the relation between intrusive thoughts and mental health in prostate cancer survivors[END_REF].

Research has shown that patients in general are quite eager to share their illnessrelated emotions. To illustrate, Cardiac patients anticipating surgery shared their emotional distress in 91% of cases [START_REF] Panagopoulou | Social Sharing of Emotion in Anticipation of Cardiac Surgery: Effects on Preoperative Distress[END_REF]. However, previous research has also shown that chronic illness patients encounter emotional inhibition and difficulties in the social sharing of illness-related emotions. [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF] observed that chronic pain patients frequently inhibited their emotions to protect themselves from rejection by their significant others. These findings confirmed previous research showing that people who suffer from life threatening conditions may face a self-threatening dilemma [START_REF] Silver | The role of coping in support provision: the self-presentational dilemma of victims of life crises[END_REF]: They feel the need to communicate their distress in order to incite others to provide social support, but at the same time, they run the risk of receiving negative responses from others when they express their suffering.

Social constraints (individuals' perception that others are unreceptive to hearing about their negative experience) linked to emotional disclosure in chronic diseases have [START_REF] Lepore | Social Constraints on Disclosure and Adjustment to Cancer[END_REF] and linked to diabetes management [START_REF] Braitman | Social COnstraints in talking about diabetes to significant others and diabetes self-care : a social-cognitive processing perspective[END_REF]. Likewise, previous research has been attentive to emotional distress in chronic conditions. For instance, studies have focused on emotional distress among diabetes patients (Snoeck et al., 2000;[START_REF] Decoster | The emotions of adults with diabetes: a comparison across race[END_REF]. Moreover, difficulties in the verbalization of emotions have been found among some diabetes patients [START_REF] Luminet | The Role of alexithymia factors in glucose control of persons with type 1 diabetes : a pilot study[END_REF].

Progress in anti-retro-viral (ARV) medication has led to the consideration of HIV/AIDS as a chronic illness [START_REF] Kelly | Implications of HIV treatment advances for behavioral research on AIDS: protease inhibitors and new challenges in HIV secondary prevention[END_REF]. However, stigma, social rejection and isolation still characterize HIV/AIDS infection. Previous studies have evidenced the difficult challenge faced by these patients when coping with negative emotions linked to the HIV/AIDS experience [START_REF] Siegel | Coping with Negative Emotions: The Cognitive Strategies of HIV-infected Gay/Bisexual Men[END_REF]. Moreover, individuals living with an HIV/AIDS condition experience the loss of social support and are rejected by their social network [START_REF] Muma | Zidovuline adherence among individuals with HIV infection[END_REF], which can result in isolation. Such social and emotional burdens can result in negative outcomes. To illustrate, [START_REF] Gore-Felton | The Influence of Social Support, Coping and Mood on Sexual Risk Behavior among HIV-Positive Men and Women[END_REF] have evidenced an association of social support and of emotion focused coping strategies with risky sexual behaviours in HIV-positive men and women. HIV/AIDS is thus a chronic illness suitable to an investigation from the perspective of SSE and social constraints.

Prior research conducted with HIV/AIDS populations [START_REF] Bigner | Parenting by Gay fathers[END_REF][START_REF] Doll | Failure to disclose HIV risk among gay and bisexual men attending sexually transmitted disease clinics[END_REF][START_REF] Moneyham | Experiences of disclosure in women infected with HIV[END_REF][START_REF] Derlega | Perceived HIV-related Stigma and HIV disclosure to Relationship Partners after finding out about the Seropositive Diagnosis[END_REF] has shown that these patients fear others' negative responses. For example, [START_REF] Derlega | Perceived HIV-related Stigma and HIV disclosure to Relationship Partners after finding out about the Seropositive Diagnosis[END_REF] observed an association between a heightened perception of HIV-related stigma and the anticipation of potential negative consequences of disclosing the HIV diagnosis to a friend or a parent (ex., fear of rejection). Even though individuals facing different chronic conditions or diseases can experience stigmatisation [START_REF] Van Brakel | Measuring health-related stigma: a literature review[END_REF][START_REF] Jones | Social Stigma: The Psychology of Marked Relationships[END_REF] have been as widely stigmatised as HIV/AIDS: despite the extensive mass-media and health campaigns, a fear of being infected with HIV through mere social interactions as well as the association of HIV to death, still remain [START_REF] Black | Calculating the risks and benefits of disclosure in African American women who have HIV[END_REF]. Therefore, in the particular case of HIV/AIDS, contagiousness [START_REF] Dijker | Interpersonal determinants of fear of people with AIDS: The moderating role of predictable behavior[END_REF][START_REF] Dijker | The influence of seriousness and contagiousness of disease on emotional reactions to ill persons[END_REF] of the disease and personal responsibility [START_REF] Weiner | An attributional analysis of reactions to stigmas[END_REF] associated to the sexual transmission of the disease, are specific factors that determine others' reactions to infected people. Therefore, perceived contagiousness, perceived seriousness, personal responsibility and norm-violating behaviours often associated with HIV infection colour HIV/AIDS related stigma [START_REF] Bos | Reducing AIDS-related stigma in deveopping countries: The importance of theory-and evidence-based inverventions[END_REF].

For instance, an important dimension of stigmas is the degree to which they can be concealed from others [START_REF] Jones | Social Stigma: The Psychology of Marked Relationships[END_REF]. In the case of HIV, even though the visibility of the stigma relies upon disease progression and symptoms, concealing serostatus can be an option for these patients (e.g. [START_REF] Black | Calculating the risks and benefits of disclosure in African American women who have HIV[END_REF]. A previous study (Frabble et al., 1998) suggested that when compared to individuals facing a visible stigma (ex. overweight), those facing a concealable stigma (ex. sexual orientation) were found to show more anxiety, depression, and negative affect, and less self-esteem.

Along another line, [START_REF] Fife | The Dimensionality if Stigma: A Comparison of its impact on the Self of Persons with HIV/AIDS and Cancer[END_REF] compared the dimensionality of stigma and its impact on the self in Cancer patients and in HIV/AIDS patients. They found HIV infected persons to report higher feelings of social rejection, internalised shame and social isolation. In a similar vein, [START_REF] Fernandes | Prejudice towards chronic diseases: comparison among AIDS, diabetes and epilepsy[END_REF], compared laypersons' stigma perception towards patients having Epilepsy, AIDS or Diabetes, and found AIDS to be the most stigmatised disease and Diabetes the least one. with respect to emotional inhibition linked to the perception of social responses (e.g., social constraints, self-disclosure, secrecy). The investigation reported in this article finds its roots in previous findings concerning difficulties with SSE amongst chronic illness patients [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF] and emotional inhibition of illness resulting from the perception of others' negative responses (e.g., [START_REF] Lepore | Social Constraints on Disclosure and Adjustment to Cancer[END_REF]). Yet, we hypothesized that the social aspects (ex. stigma, reject, isolation and ostracism) specific to this sexually transmitted infectious disease would differentiate HIV/AIDS patients with regard to SSE variables when compared to other (non-contagious) chronic illness patients such as diabetics and cancer patients. Do HIV/AIDS patients manifest distinguishing traits in the inhibition of illness and non-illness related emotions? This study's main objective was to examine the differences in SSE between HIV/AIDS, diabetes and cancer patients. Previous findings have evidenced low illness disclosure levels among HIV/AIDS patients as well as HIV/AIDS patients' fears concerning others' negative responses (e.g., [START_REF] Derlega | Perceived HIV-related Stigma and HIV disclosure to Relationship Partners after finding out about the Seropositive Diagnosis[END_REF]. We thus hypothesised that when compared to diabetes and cancer patients, HIV/AIDS patients would share less their illness related emotions. Furthermore, it was hypothesized that the HIV/AIDS group would differ from the comparison groups for negative emotions: for instance, HIV/AIDS patients would experience greater shame [START_REF] Fife | The Dimensionality if Stigma: A Comparison of its impact on the Self of Persons with HIV/AIDS and Cancer[END_REF].

As a result of the predicted heightened inhibition of illness-related emotions in HIV/AIDS patients, we expect two potential consequences. On the one hand, we hypothesize that when compared to diabetes and cancer patients, HIV/AIDS patients experience an excess of cognitive manifestations such as intrusive thoughts, mental rumination, and search for meaning. Evidence has shown that secrecy involves active inhibition and suppression of thoughts and feelings (e.g., [START_REF] Pennebaker | Confession, inhibition, and disease[END_REF][START_REF] Kelly | The Psychology of Secrets[END_REF]. For instance, [START_REF] Finkenauer | Socially shared emotional experiences vs. emotional experiences kept secret: Differential characteristics and consequences[END_REF] found that when compared to shared emotional events, non-shared emotional events resulted in greater search for meaning efforts to understand what happened, as well as in greater feelings of shame. On the other hand, the numerous social threats linked to HIV/AIDS, together with their inhibited sharing of the illness experience, leads us to expect that these patients should report reduced social support and a lower social integration.

Method

Participants

The following study was conducted in the Dominican Republic: 35 HIV/AIDS outpatients, 35 diabetes outpatients and 34 cancer outpatients were matched in age, gender and educational level. Table 1 displays the various characteristics of participants by group: age, sex, educational level, time of diagnosis and marital status. Marital status was not considered in the matching criteria, yet, no significant differences were found between the three groups (χ 2 (104, 2) = 3.13; NS). As to time of diagnosis, when measured in months, significant differences were found (F (2,101) = 11.85; p<0.01; η 2 = 0.19). Post Hoc Tests (p<0.01) manifested that the cancer group (M = 20.62; SD = 26.88) significantly differed from both the HIV/AIDS group (M = 66.40; SD = 64.89) and the diabetes group (M = 84.44; SD = 84.43).

All HIV/AIDS patients were under ARV medication, a precondition for enrollment in this study. The mean CD4 count in the sample was 233.20 (cells/mm 3 ) measured on average 5.27 months before the study. Within the HIV/AIDS group, 97.14% (N = 34) of patients reported having been infected with HIV through heterosexual sexual intercourse, and the remaining 2.85% (N = 1) reported having been infected with HIV through homosexual sexual intercourse. As to diabetes patients, 62.86% of them were undergoing treatment with insulin injections and the remaining 37.14% were not insulin dependent. Information on the type of diabetes diagnosis was not assessed. Within the cancer group, 44.12% were undergoing chemotherapy, 11.76% radiotherapy, 38.23% both chemotherapy and radiotherapy, and the remaining 5.88% were not undergoing any treatment. Within this group, all women (N = 20; 58.82% of the cancer sample) had a breast cancer diagnosis.

As to the remaining 41.18% of the sample (male participants), 5.88% were diagnosed with lymphoma, 14.70% had a colon cancer diagnosis, 5.88% were diagnosed with prostate cancer, and 14.70% were diagnosed with other types of cancer.

The existence of a certain level of heterogeneity in this sample can be argued.

For instance, the types of cancer diagnosis and treatments as well as in the type of diabetes diagnoses vary within these illness groups. However, it is important to recognize the difficulties that can be encountered when conducting this type of research.

For example, it can be difficult to respect matching criteria (e.g. HIV/AIDS populations can be quite young when compared to Cancer populations).

Insert Table 1 about Informed consent was obtained from all participants.

Questionnaires were administered in an interview modality to ensure comprehension, only the researcher and the patient were present at the time of the interview. One single researcher interviewed all patients at the different health care institutions. Interviews took place in doctors' examination rooms or at the waiting rooms before or after patients' medical appointments.

Measures

A questionnaire (in Spanish) was administered. Most measures consisted of items to be rated upon likert scales. Some items were developed in Spanish for this study, others consisted of existing SSE measures that were translated from French into Spanish, and an existing Spanish validation was used for the social support measure. As to illness-related cognitive manifestation, scores for mental rumination, intrusive thoughts and search of meaning were obtained by averaging scores for each of these three aspects of cognitive manifestations of the illness. A total of 10 items were translated into Spanish, and were scattered as follows: (1) three items [START_REF] Zech | Is talking about an emotional experience helpful? Effects on emotional recovery and perceived benefits[END_REF] assessed mental rumination (α= 0.82; Ex: During the past week, have you had through your mind thoughts, images, memories about your illness?; 1 = not at all; 5 = very much), (2) two items [START_REF] Zech | Is talking about an emotional experience helpful? Effects on emotional recovery and perceived benefits[END_REF] Participants' beliefs about benefits resulting from SSE were assessed through five items (α = 0.83; [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF]) translated from French to Spanish.

Patients were asked to rate on a 6-point likert scale (1= not at all; 6 = very much) to what extent they believed SSE to be beneficial: (1) to others, (2) to themselves, (3) to the person who shares the emotions, (4) to the person who listens to others' emotions,

(5) to themselves when sharing illness-related emotions.

In addition, five items [START_REF] Rimé | Beyond the emotional event: Six studies on the social sharing of emotion[END_REF] Lastly, three items (α = 0.88), were developed to assess the non-sharing of illnessrelated emotions and emotional aspects kept secret. Participants rated their answers for the fallowing questions on 5-point scales (1=Not at all; 5=extremely): (1) Are there thoughts, feelings or emotions linked to your illness that you have never shared with anyone? (2) Are there thoughts, feelings or emotions linked to your illness that you do not want to share with anyone? (3) Do you deliberately avoid talking about your illness? Social Integration was assessed through the three items of the Spanish short version [START_REF] Basabe | Salud, Factores Psico-sociales y Cultura[END_REF] of the Social Support Appraisals Scale [START_REF] Vaux | The social support appraisals (SSA) scale: studies of reliability and validity[END_REF]. Two other items assessed participants' satisfaction with their social support (In general, do you feel satisfied with the practical support that you receive from others? In general, do you feel satisfied with the emotional support that you receive from others?). These items were to be rated upon 5 point likert scales (1=Not at all; 5=extremely; α = 0.81).

Due to the important number of variables considered, as well as to the heterogeneity of measures of stigma linked to health (e.g. different measures for different diseases), it was decided to develop, in Spanish, a few items to evaluate patients' perceptions of others' stigmatising responses. Recently, Earnshaw and Quinn (2011) have addressed this issue. Therefore, four items (α = 0.84), to be rated upon likert scales (1=Not at all; 5=extremely), were developed to assess participants' perception of social exclusion linked to the ill ness (e. MANOVA, conducted for the three aspects of illness-related cognitive manifestations, yielded no significant group differences (F (6,198) = 1.65; NS).

g., To what extent do you feel rejected by others due to your illness?; To what extent do you feel alone due to your illness?).

Results

Illness perception, emotional and cognitive impact

Disclosure of diagnosis and social sharing of illness related emotions

Significant differences were found among the three groups for patients' disclosure of their diagnosis. The HIV/AIDS group reported a smaller number of people to whom they had disclosed their diagnosis (χ 2 (104, 2) = 41.23; p<0.01). Thus, 93.94% of diabetes patients and 96.88% of cancer patients reported having disclosed their Insert Table 2 about here.

Table 2 displays the various results pertaining to the social sharing of illnessrelated emotions for the three groups. MANCOVA (co-variants: guilt, shame, diagnosis disclosure and time of diagnosis) was carried out on three of the relevant items expected to vary in the same direction: (1) frequency of emotion sharing, (2) number of sharing partners during the week preceding the study and (3) number of sharing partners during the month are preceding the study. Results evidenced significant differences between the three groups (F (6,182) = 4.17; p ≤ 0.01; η p 2 = 0.12). ANCOVA results

showed that HIV/AIDS respondents had shared their illness-related emotions less frequently (F (2, 93) = 9.30; p < 0.01; η p 2 = 0. 17) and with a lower number of partners during the week preceding the study (F (2, 93) = 8.49; p < 0.01; η p 2 = 0.15) when compared to both the diabetes group and the cancer group (Post Hoc tests: p<0.01).

They had also shared these illness-related emotions with a lower number of sharing partners during the month preceding the study (F (2, 93) = 10.96; p ≤ 0.01; η p 2 = 0.19) when compared to both comparison groups (Post Hoc tests: p<0.01). Notably, no significant differences were found between the three groups regarding the social sharing of non-illness related emotions (F (2, 93) = 1.75; NS).

Likewise, ANCOVA (co-variants: guilt, shame, diagnosis disclosure and time of diagnosis) results confirmed the group effect for the non-sharing of illness-related emotions (F (2, 93) = 6.00; p ≤ 0.01; η p 2 = 0.11). This analysis showed that the HIV/AIDS group scored significantly higher for the non-sharing of illness-related emotions when compared to the diabetes and to the cancer groups (Post Hoc tests: p < 0.01; See Table 2). The three groups were found at comparable levels as to their desire to share their illness-related emotions (F (2, 93) = 1.99; NS).

Social Integration

No significant differences were found between the three groups in the perception of social support and social integration (F (2, 96) = 1.61; NS) when controlling for diagnosis disclosure. As to perceived social exclusion, ANCOVA (co-variant:

diagnosis disclosure) was carried out and yielded a significant group effect (F (2,96) = 6.12; p < 0.01; η p 2 = 0.11). Post Hoc tests (p < 0.01) showed that the HIV/AIDS group (M = 1.68; SD = 1.02) had significantly higher scores for perceived social exclusion when compared to the cancer group (M = 1.06; SD = 0.21).

Discussion

Chronic illness patients encounter inhibition and constraints in the social sharing of their illness-related emotions [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF][START_REF] Lepore | Social Constraints on Disclosure and Adjustment to Cancer[END_REF].

Expressing one's suffering and disclosing one's life-threatening condition can elicit negative responses from healthy others. We hypothesized that among chronically ill patients, those suffering from HIV/AIDS would be particularly at risk of experiencing negative social responses. HIV/AIDS, involving stigmatizing information and a linkage to sexual behaviour, is most likely to be kept concealed [START_REF] Kelly | The Psychology of Secrets[END_REF]. Furthermore, since HIV is a contagious disease, it represents a health threat to healthy others, therefore eliciting negative reactions [START_REF] Bos | Reducing AIDS-related stigma in deveopping countries: The importance of theory-and evidence-based inverventions[END_REF]. We thus expected that compared to other patients suffering a chronic illness, HIV/AIDS patients would manifest a distinctive propensity of holding back their need to socially share their We found that HIV/AIDS patients rated their illness as less severe. In spite of this, they were more concerned by other persons' negative perception of their illness than did the comparison groups. They expressed a higher apprehension that disclosing their illness experience would (1) reflect a negative image of them, (2) entail their social rejection, and (3) expose them to a lack of discretion of their listeners. These results are congruent with other studies evoked in the introduction showing HIV/AIDS patients to fear others' negative responses. Such observations concur to expect that these multiple external threats perceived HIV/AIDS patients affect negatively their social sharing of illness-related emotions. Motives in this regard resulted from internal sources.

HIV/AIDS patients differed markedly from the other two groups regarding illnessrelated emotions: they manifested higher guilt and shame. Past research demonstrated that shame, guilt and self-attribution of responsibility constitute as factors proper to favor emotional secrecy [START_REF] Kelly | The Psychology of Secrets[END_REF]Finkenauer & Rimé, 1998). Thus, altogether with the social ones, these emotional and cognitive factors should concur in affecting HIV/AIDS patients' sharing of their illness-related feelings.

The expected consequences were largely supported by this study's findings.

HIV/AIDS patients in this study disclosed their diagnosis much less than did cancer and diabetes patients. Moreover, the direct assessment of the social sharing of illness-related emotions revealed three remarkable facts. First, HIV/AIDS patients were perfectly comparable to diabetes and cancer patients for their usual SSE unrelated to their illness.

They thus respond to the general principle of the SSE in the same way as do other people. Second, HIV/AIDS expressed as much need to share their illness-related emotions as the two comparison groups. They thus clearly want as much as other the social sharing of their illness-related emotions. They shared these emotions at a much lower frequency and with a much lower number of persons. In sum, many elements confirmed HIV/AIDS patients to experience a constrained sharing of their illness experience. Thus, if a chronic illness exposes patients to social constraints and to a contained sharing of illness-related emotions [START_REF] Herbette | Verbalization of emotion in chronic pain patients and their psychological adjustments[END_REF][START_REF] Lepore | Social Constraints on Disclosure and Adjustment to Cancer[END_REF], the present study revealed HIV/AIDS patients to be particularly underprivileged in this regard.

On the one hand, it was expected that as a result of the predicted non-sharing of illness-related emotions, HIV/AIDS patients would experience more mental ruminations, intrusive thoughts and search for meaning. A known paradoxical result of the suppression of thoughts or feelings is the rebound effect. The very state of mind one had thought to avoid, tends to impose itself forcefully thereafter (see Wentzlaff &

Wegner, 2000 for a review). However, this prediction was not supported. On the other hand, the numerous social threats HIV/AIDS patients fear, together with the inhibited sharing of their illness experience, supported the expectation that these patients would report reduced social support and lower social integration. This prediction was only partially sustained. HIV/AIDS patients did not differ for perceived social support.

However, they rated themselves higher for social exclusion.

How can we account for these partially negative findings with respect to our two hypotheses? One possibility is that even if HIV/AIDS patients limit the sharing of their illness-related emotions, they nevertheless find around themselves enough listening for their illness-related emotions. In this manner, they would avoid the cognitive consequences of a rebound effect likely to follow from a total lack of sharing. Finding Nonetheless, it still remains that HIV/AIDS patients in this study reported higher feelings of social exclusion. Even if this would regard only their broader social circle, HIV/AIDS patients might incur damaging consequences form such a situation. Previous studies demonstrated that a lower social integration is associated with a higher mortality (Bekman & Syme, 1979;[START_REF] House | The association of social relationships and activities with mortality: Prospective evidence from the Tecumseh community health study[END_REF]. Social integration is considered a major risk factor for morbidity and mortality, and the level of risk involved was shown to

  : for example, social constraints linked to cancer

  stigmatising responses vary from one condition to another. Few modern illnesses

  , studies have not yet compared different chronic conditions

  here. Procedure Patients were sampled in six different health care institutions: HIV/AIDS patients in two different HIV units belonging to the National HIV/AIDS Control Program of the Dominican Republic's Ministry of Health, Diabetes patients in a non-lucrative diabetes clinic, and cancer patients in two private non-lucrative oncology clinics and in one private oncology clinic. Previous authorization was obtained from the pertaining direction board for each institution. A doctor, nurse or other medical staff informed patients about the study and proposed volunteer participation. Patients were informed that it consisted of research EMOTIONS IN HIV/AIDS 8 concerning emotional expression in chronic diseases, as part of an international university research program. The length of the interviews (approximately 40 minutes) and their confidentiality were announced. If patients volunteered, the researcher met with the patient. Respondents did not receive any kind of compensation for their participation.

  One of the researchers, fluent in Spanish and French translated the items. The final version of the entire questionnaire was reviewed by three Dominican lay-individuals to ensure the conceptual meaning of each question. General Information was obtained through questions concerning age, sex, level of education (last level reached) and marital status. Illness history, perception, emotional and cognitive impact were obtained. Some open questions assessed information about patients' illness history: time of diagnosis, time of treatment, and type of treatment. For the HIV/AIDS group, the last CD4 count was obtained from medical records under patients' consent.

  of others' negative evaluation of the illness was assessed.Four items, to be rated upon likert scales (1=not at all; 5=extremely), were developed to evaluate patients' perceptions of others' responses when disclosing about their illness: (1) fear of rejection (I rather not talk about my illness and my illness related emotions so that others do not reject me); (2) lack of understanding of the illness and illness-related experiences (I have the feeling that people around me are not capable of understanding my illness and what I am going through); (3) fear of indiscretion (I fear that if I speak about my illness and my illness related emotions with those around me, they will be indiscreet about my personal and intimate information); (4) fear to reflect a negative image of the self (If I speak about my illness and my illness-related emotions, others will perceive a negative image of me).

Furthermore

  , two questions (α = 0.72) were developed to assess patients' own perception of illness severity: (1) How sick do you feel, (2) Does your illness disturb your daily life? (1=not at all; 5=extremely). Illness-related negative emotions were assessed through 6 items developed for the current study. Participants were asked to answer on a 5-point scale (1 = not at all; 5 = very much) to what extent their illness caused in them: anxiety, worry, fear, anger, guilt and shame (e.g. When I think about my illness I feel shame).

  week I have tried not to think about my illness; 1 = not at all; 5 = very much), and (3) five items(Finkenauer & Rimé, 1998) assessed the search for meaning (α=0.86; Ex: Today, when I think about my illness I feel the need to understand why and how?). Disclosure of diagnosis and Social sharing of illness related emotions were assessed. To estimate diagnosis disclosure, an open response item was developed asking participants to mention the number of people to whom they had disclosed their diagnosis.

  assessed aspects of SSE specific to illness-related emotions: (1) desire to share illness-related emotions (During the past week, to what extent, have you felt the desire to share your illness-related emotions and feelings?; 1=not at all; 5=very much); (2) frequency of SSE during the previous week (During the past week, how frequently have you shared your illness-related emotions and feelings?; 1=not at all; 5=very much); (3) number of sharing partners during the previous week (During the past week, with how many different people have you shared your illnessrelated emotions and feelings?); (4) number of sharing partners during the previous month (During the past month, with how many different people have you shared your illnessrelated emotions and feelings?). One item assessed the SSE of non-illness related emotions(Usually, in your daily life, do you share with others your emotions and feelings not related to your illness?; 1=not at all; 5=very much). These items were translated from the(Rime et al., 1991) and the wording was adapted to the illness context.

  of others' negative responses when disclosing about their illness yielded a number of significant effects. MANOVA was carried out to evaluate group differences for the following set of variables: (1) fear of rejection, (2) lack of understanding of the illness and illness-related experiences, (3) fear of others' indiscretion and (4) fear to reflect a negative image of the self. Results showed significant differences between the three groups for these four variables(F (8,196) = 13.73; p<0.01; η p 2 = 0.36). Separate ANOVAs were then conducted in order to specify significant effects. Fear of rejection (F (2, 101) = 49.37; p < 0.01; η p 2 =0.49) was rated by the HIV/AIDS group (M = 4.29; SD = 1.53) at a higher level than both comparison groups (diabetes: M = 1.97; SD= 1.60; cancer: M = 1.17; SD = 0.76; Post Hoc: p <0.01). The groups also differed significantly as to their perception of others' lack of understanding of their illness and their illness-related experiences (F (2, 101) = 12.89; p < 0.01; η p 2 = 0.20). Post Hoc tests (p < 0.01) showed that the HIV/AIDS group (M = 3.77; SD = 1.81) and the diabetes group (M = 3.00; SD = 1.85) significantly differed from the cancer group (M = 1.76; SD = 1.21) concerning the perception of others' lack of understanding. As to fear of others' indiscretion (F (2, 101) = 38.94; p < 0.01; η p 2 = 0.44), the HIV/AIDS group (M = 4.43; SD = 1.36) reported a significantly higher fear than the diabetes (M = 2.06; SD = 1.57) and cancer (M = 1.74; SD = 1.21) groups (Post Hoc: p<0.01). Finally, the HIV/AIDS group (M = 3.86; SD = 1.59) manifested significantly higher scores for fear to reflect a negative image of themselves when talking about the illness (F (2, 101) = 30.47; p < 0.01; η p 2 = 0.38; Post Hoc tests: p<0.01) when compared to both the diabetes (M = 2.00; SD = 1.51) and the cancer (M = 1.32; SD = 1.01) groups.The three groups differed as to patients' perception of illness severity (F (2,101) = 8.88; p < 0.01; η p 2 = 0.15). Post Hoc tests showed that the diabetes group (M = 2.97; 46) had higher scores than the cancer group (M = 2.19; SD = 1.24; p<0.05) and the HIV/AIDS group (M = 1.69; SD = 1.13; p<0.01).Regarding negative illness-related emotions, MANOVA evidenced significant differences between the three groups for this vector of dependent variables (F (12.19) = 3.88; p<0.01; η p 2 = 0.20). Separate ANOVAs accompanied with Scheffe post hoc comparisons revealed the following effects. For fear, the cancer group (M = 1.79; SD = 1.37) showed significantly lower scores (F (2,101) = 4.25, p<0.05; η p 2 = 0.08; Post Hoc Tests: p<0.05) than the HIV/AIDS group (M = 2.74; SD = 1.69) and the diabetes group (M = 2.77; SD = 1.68). As to anger, the diabetes group (M = 2.23; SD = 1.54) was found significantly higher (F (2,101) = 4.34, p<0.05; η p 2 = 0.08; Post Hoc: p<0.05) than the cancer group (M = 1.30; SD = 0.88). For guilt, the HIV/AIDS group (M = 2.86; SD = 1.90) showed significantly higher scores (F (2,101) = 6.08, p<0.0; η p 2 = 0.11) than the cancer group (M = 1.53; SD = 1.05; Post Hoc: p<0.01). As for shame (F (2,101) = 12.94, p<0.01, η p 2 = 0.20; Post Hoc Tests: p<0.01), the HIV/AIDS group (M = 3.00; SD = 1.89) significantly showed higher scores, differing from both the diabetes (M = 1.86; SD = 1.46) and cancer (M = 1.24; SD = 0.82) groups. No significant differences were found between the three groups concerning anxiety (F (2,101) = 2.95; NS).

  more than ten people; whereas only 32.14% of HIV/AIDS patients reported having done so.Concerning the beliefs about beneficial consequences of SSE, the HIV/AIDS group (M = 2.61; SD = 1.30) evidenced significantly lower scores (F (2, 101) = 13.81; p<0.01; η p 2 =0.21) when compared to the diabetes (M=4.13; SD=1.42) and the cancer (M = 4.11; SD = 1.43) groups (Post Hoc Tests: p<0.01).

  emotions. Our study comparing HIV/AIDS patients to diabetes and cancer patients yielded abundant support to these predictions.

  share emotions resulting from their illness condition. Third, in sharp contrast with the two previous observations, HIV/AIDS patients differed markedly for

  also lead these patients to perceive the social support they receive as relatively satisfactory. The socio-cultural context in which the present study was conducted might play some role in this regard. In the Dominican Republic, family ties are of particular importance. The family forms the basis of stability and the individual derives a social network and assistance in times of need from the extended family which generally encompasses three generations. Loyalty to the family comes before any other social relationship. In such a socio-cultural context, it is possible that HIV/AIDS patients receive more attention, help and support from their closer family circle than would be the case in more individualistic cultures. Thus, the numerous threats these patients perceive from the disclosure of their illness might regard their broader social network only and might thus be less consequential for the emotional, cognitive and social variables examined here.Future studies might profitably compare the social situation of HIV/AIDS patients across individualistic and communal socio-cultural contexts. Likewise, future research can benefit from inter and intra disease comparisons regarding patients' perceptions of negative social responses. For example, differences concerning diabetes linked to obesity and diabetes mellitus, where causal and self-blame attributions can vary. The same could be explored among different cancer diagnosis and treatments or among HIV/AIDS patients with different infection modes.

  classic health risk factors such as obesity, sedentarity, and perhaps smoking[START_REF] House | Social relationships and health[END_REF]. Future studies should thus assess effects of interventions focused upon the various emotions which were found to be distinctive for HIV/AIDS: fear of social threats, shame, and guilt. In parallel, intervention programs should aim at modifying the representation of HIV/AIDS among people living in geographic areas with important concentrations of patients.

  assessed intrusive thoughts (α=0.71; Ex:

Table 1 .

 1 Age, sex, educational level, time of diagnosis and marital status per group. Educational level refers to the last diploma obtained.

	VARIABLE	HIV/AIDS (n=35)	Diabetes (n=35)	Cancer (n=34)
	AGE
	M	42.09	41.77	42.91
	SD	11.24	11.27	12.00
	SEX
	Male	45.71%	45.71%	41.18%
	Female	54.29%	54.29%	58.82%
	EDUCATIONAL LEVEL
	Elementary School	68.57%	77.14%	70.59%
	High School	11.43%	14.29%	17.62%
	Technical Degree	5.71%	5.71%	2.94%
	University Degree	8.57%	0	2.94%
	No Diploma	5.71%	2.86%	5.88%
	TIME DIAGNOSIS
	≤ 10 years	80%	62.86%	97.06%
	≥ 10 years	20%	37.14%	2.94%
	MARITAL STATUS
	Single	54.29%	37.14%	37.14%
	In a couple	45.71%	62.87%	35.29%
	Note.

Table 2 .

 2 Mean, Standard Deviation, ANCOVA results for the variables involving the social sharing of illness-related emotions. Post Hoc evidences significant differences between the HIV/AIDS group and both Cancer and Diabetes groups.

	VARIABLE	GROUP	M(SD)	F(2,93)	p	η p 2
	Frequency of Emotion Sharing	HIV/AIDS (n=35)	1.83(1.27)**
		Diabetes (n=35)	3.49(2.59)	9.30	≤0.01	0.17
		Cancer (n=34)	4.74(2.59)
	Number of Sharing Partners Past week	HIV/AIDS (n=35)	1.94(1.41)**
		Diabetes (n=35)	3.54(2.39)	8.49	≤0.01	0.15
		Cancer (n=34)	4.91(2.30)
	Number of Sharing Partners Past Month HIV/AIDS (n=35)	1.86(1.59)**
		Diabetes (n=35)	4.60(3.29)	10.96	≤0.01	0.19
		Cancer (n=34)	6.29(3.24)
	Non-sharing of illness related emotions	HIV/AIDS (n=35)	4.13(1.25)**
	(α=0.88)
		Diabetes (n=35)	2.43(1.53)	6.00	≤0.01	0.11
		Cancer (n=34	2.16(1.63)
	Desire to share illness-related emotions	HIV/AIDS (n=35)	1.94(1.59)
		Diabetes (n=35)	2.60(1.79)	1.99	NS	NS
		Cancer (n=34)	2.62(1.66)
	**

http://mc.manuscriptcentral.com/jhealthpsychology Journal of Health Psychology

We thank the National HIV/AIDS/STI Control Program (DIGECITSS) of the Dominican Republic's Ministry of Health for their collaboration in the realization of this study.