Career Concerns for People Living With HIV/AIDS

The purpose of this study was to identify the career concerns of people living with HIV/AIDS. The authors used qualitative research methodology to ask participants to discuss the impact their diagnosis has had on their career development concerns and their career goals. Based on participants' interview responses, the authors classified their concerns as relating to career or workplace issues, medical issues, or coping resources. Career counseling implications for each category are discussed.     

Health Beliefs and Attitudes Toward People Living With HIV/AIDS

The present study was concerned with the relationship between health beliefs and attitudes toward people living with HIV/AIDS. Measures of attitudes toward people with HIV/AIDS, beliefs about the transmission of HIV, and health locus of control beliefs were completed by 128 undergraduate students. In general, subjects who believed that HIV was transmitted through normal social contact wanted to avoid contact with people with HIV/AIDS, and showed other negative attitudes, such as lack of sympathy and blame. They also believed that their health was influenced by powerful others and chance. The findings are discussed in terms of fear of contracting HIV and the tendency to blame the victim.     

农村艾滋病人心理支持典型案例分析

艾滋病的防治不仅是药物治疗的问题,还应该重视病人的心理问题.介绍农村地区开展艾滋病人心理支持的三个典型案例,HIV检测确诊阳性后心理支持的案例、需要长期心理支持的案例、心理支持后自强不息的案例,进行案例分析,并探讨艾滋病人心理支持策略,为今后开展类似活动提供参考依据.     

农村地区PLWHA心理支持项目研究

农村地区PLWHA的心理状况不容乐观,为其提供以社区和家庭为基础的心理支持已成为艾滋病防控领域的重要内容.通过介绍在农村地区开展PLWHA心理支持项目的措施和活动,分析项目的效果和产出,总结项目取得的经验和存在的不足,为其它地区开展类似项目提供借鉴,并提供相关政策建议.     

Risk Reduction Therapy for Adolescents: Targeting Substance Use and HIV/STI-Risk Behaviors

This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth’s behavior problems. The treatment is criterion-based with treatment duration determined by the youth’s achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver’s participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population.     

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

An Investigation of the Determinants of Stigmatization and Prejudice Toward People Living With HIV/AIDS

The components and determinants of HIV/AIDS stigma and prejudice were investigated in an online‐questionnaire study. The results show that the components of the attitude toward people with HIV/AIDS consist of social distance, demands for political measures, negative stereotypes, and attribution of responsibility to people living with HIV/AIDS. Besides antigay attitudes and false beliefs about ways of infection, the HIV/AIDS attitude is connected to and depends on social dominance orientation (SDO) and right‐wing authoritarianism (RWA). Structural equation modeling indicated that antigay attitudes and false beliefs function as mediator variables for SDO and RWA. Implications of the results are discussed.     

Unable to be a Human Being in Front of Other People: A Qualitative Study of Self-Isolation Among People Living with HIV/AIDS in China

In China, acute stigma accompanying an HIV diagnosis can lead to self-isolation. In a cultural setting where family relationships are highly valued and contribute critically to well-being, such self-isolation can thwart HIV self-management and engagement in medical care, and so heighten risk for health disparities. To understand this phenomenon, we conducted individual in-depth interviews with 34 persons living with HIV/AIDS (PLwHA) in Shanghai and Beijing. Inductive content analysis revealed a range of forms of self-isolation motivation, beliefs, and behaviors influenced by: 1) internalized stigma and desire to avoid discrimination; 2) HIV-related factors such as HIV knowledge and disease progression; and 3) familial factors such as a sense of responsibility and family members’ reactions. Based on a proposed framework centering on dialectical family influences (whereby PLwHA are pushed away from, yet pulled toward the family fold), implications for provision of multidisciplinary care in medical settings are considered, including culturally appropriate strategies to decrease health disparities.     

Reasons and Justifications for Considering Pregnancy Among Women Living with HIV/AIDS

Despite the risks associated with pregnancy, available data suggest that HIV-infected women are no less likely to become pregnant than uninfected women. To understand HIV-infected women's reasons for wanting to have a child, focused interviews were conducted with a predominantly minority sample of 51 HIV-infected women in New York City. They were noted to actively weigh both the potential risks and benefits of their pregnancy decisions. Women reported three major reasons for wanting a child: (1) her husband/boyfriend really wants children, (2) having missed out on raising her other children, and (3) believing that a child would make her feel complete, fulfilled, and happy. Women also reported several justifications which they believed offset the risks of pregnancy, including: (1) other HIV-infected women were having healthy babies, (2) feeling optimistic about having a healthy baby due to the prophylactic effects of AZT (zidovudine), (3) having faith that God will protect the child, (4) being young and "healthy" will prevent transmission, and (5) feeling that she is better able to raise a child now. These findings suggest that to make fully informed pregnancy decisions, women should be encouraged to explore their reasons for wanting pregnancy, as well as discuss the potential risks.     

Attitudes Toward People Living With HIV/AIDS: A Model of Attitudes to Illness1

This study examined attitudes toward people living with HIV/AIDS within a sample of 220 young men and women. As predicted, a multiple regression analysis revealed that the fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. Attitudes toward homosexuality were also a significant predictor of attitudes toward people living with HIV/AIDS among women, who generally have a low risk of contracting the disease in Western societies. These results indicate that attitudes toward people with a serious illness may be strongly related to the perceived risk of contracting the disease.     

Stigma and Psychological Distress in People With HIV/AIDS

Using a community sample of 197 people living with HIV/AIDS, we examined how awareness of societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) are related to psychological well-being. Both felt stigma and self-stigma were significantly correlated with symptoms of depression and anxiety, but controlling for felt stigma reduced self-stigma's association with depressive symptoms to nonsignificance. Global self-esteem and social avoidance fully mediated the associations between self-stigma and distress but only partially mediated the associations between felt stigma and distress. Felt stigma mediated the relationship between distress and HIV-related changes in physical appearance.     

Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk

Treatment fidelity is a crucial consideration within randomized controlled trials (RCTs). The present study relies on data from a feasibility RCT conducted with 62 treatment-seeking suicidal college students. Issues of experimental fidelity were germane in this investigation because the same clinicians provided both the experimental (the Collaborative Assessment and Management of Suicidality—CAMS) and the control (treatment as usual—TAU) care. The first aim of the current study was to determine adherence to the CAMS model within the experimental (CAMS) and control (TAU) treatment conditions. A second exploratory aim was included to examine how treatment fidelity impacted treatment outcomes (i.e., depression, suicidal ideation, hopelessness, and potential treatment moderators). The CAMS Rating Scale (CRS.3-R) was used to determine treatment adherence to the CAMS model and to ensure between-group fidelity within the trial. The CRS.3-R was completed throughout the course of care based on reviews of a selected number of video recordings of both CAMS and TAU sessions to measure treatment fidelity. Mean CRS.3-R scores revealed differences across treatment conditions such that clinicians were successfully able to provide each treatment separately without contamination. Further, higher CRS.3-R scores in CAMS sessions resulted in decreased hopelessness over the treatment period. Higher CRS.3-R scores in TAU sessions resulted in an increased likelihood of suicidal ideation and less reduction in hopelessness over the treatment period. Overall, clinicians can serve as their own controls in a RCT and levels of adherence to the CAMS model have different effects on suicidal ideation and hopelessness.

     

Support Group Needs for People Living with HIV and AIDS (PLWHA) in Communities around Durban,South Africa

The study constructed a participant centred perspective of what members of a support group for people living with HIV and AIDS (PLWHA) desired from their group meetings. The study sample (n = 34) was from three support groups of PLWHA in a province of South Africa (males = 7, female = 27, mean age = 34.2 years, SD = 6.8 years). Participants completed a brief survey and participated in focus group discussion on views on the ideal support group, actual experience with the support group, and solutions for effective support groups. Findings suggest most members of the support group experienced a high degree of stigma at home and needed a so-called ‘safe space’ to escape to and discuss issues with people experiencing similar problems. Respondents wanted to acquire skills to allow them to help themselves and others in the community. They also desired HIV education so that they could properly understand the virus and help the community understand it to reduce stigma.     

Investigating Treatment Fidelity and Social Validity of a Peer-Mediated Postsecondary Reading Intervention

Reading opens many doors and students who do not comprehend well face serious barriers as they enter postsecondary academic institutions. Young people should be able to read and write when they graduate from high school. Such skills allow people to continue their education as well as increase their odds that they can earn an adequate salary. The percentage of 12th graders reading below grade level has remained remarkably stable over the years. A large number of students entering colleges and universities are unable to derive meaning from print at age-expected levels. The purpose of this study was to examine the treatment fidelity and social validity of a systematic and explicitly structured peer-mediated reading comprehension intervention on the reading performance of underprepared postsecondary students. Seven peer mentors and sixteen first-time college students participated in the study. Results indicated the peer-implemented reading program was implemented with high levels of treatment fidelity and social validity while also yielding statistically significant comprehension gains.     

Gender Roles,Power Strategies,and Precautionary Sexual Self-Efficacy: Implications for Black and Latina Women's HIV/AIDS Protective Behaviors

This cross-sectional study tested a conceptual model of women's HIV/AIDS protective behaviors using gender roles, relationship power strategies, and precautionary sexual self-efficacy as predictors in a predominantly Black and Latina community sample of heterosexual women (N = 125). Results revealed no support for the full model, but partial confirmation for several components of the model. Education significantly predicted gender roles, and gender roles and use of direct power strategies were significant predictors of sexual self-efficacy. Most of the participants were married or partnered and were unconcerned about contracting HIV, suggesting that if women perceive that they are at low or no risk, their gender roles, power strategies, and precautionary sexual self-efficacy will be inconsequential to their HIV/AIDS risk reduction practices.     

Comparison of Marine and College Women's HIV/AIDS-Relevant Sexual Behaviors1

This study compares the heterosexual risk behaviors, perceptions of vulnerability to HIV/AIDS, and predictors of condom use of two groups of women with very different sexual and contraceptive histories and habits–college women and women in Marine Corps recruit training. The Marines' s]exual behaviors put them at greater risk of contracting HIV than the college students; that is, Marines reported more frequent intercourse with more partners, used condoms less frequently, and had less knowledge about HIV/AIDS transmission. Consistent with these differences, college students displayed a larger illusion of unique invulnerability than did the Marines. In general, the women who had more sexual partners and more frequent sexual intercourse were less likely to report regularly using condoms. In addition, the data provide support for Weinstein and Nicholich's (1993) recent suggestion that the relation between risk perception and risk behavior is different for different groups of people.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

医务人员对艾滋病人态度及其相关因素分析——以北京两所综合医院为例

为了解医务人员对艾滋病人及病毒携带者的态度,选取北京市两所三级甲等医院392名医务人员进行自填式问卷调查.结果显示,医务人员对艾滋病感染者及病人的歧视严重,同时医务人员对经性途径感染患者的歧视高于其它途径感染患者,也高于乙肝或梅毒病人.道德化评价和对于艾滋病的认识有限是产生艾滋病相关羞辱和歧视的重要原因.     

The Perceived Benefits of Religious and Spiritual Coping Among Older Adults Living with HIV/AIDS

Although religious and spiritual beliefs and practices have been frequently associated with greater psychological well-being among illness populations, little is known about the specific benefits individuals perceive they receive from these beliefs and practices. This issue was examined in interviews with 63 older HIV-infected adults. Participants reported a variety of benefits from their religious and spiritual beliefs and practices, including: (1) evokes comforting emotions and feelings; (2) offers strength, empowerment, and control; (3) eases the emotional burden of the illness; (4) offers social support and a sense of belonging; (5) offers spiritual support through a personal relationship with God; (6) facilitates meaning and acceptance of the illness; (7) helps preserve health; (8) relieves the fear and uncertainty of death; (9) facilitates self-acceptance and reduces self-blame. These perceived benefits suggest potential mechanisms by which religion/spirituality may affect psychological adjustment.     

Feelings Matter: Depression Severity and Emotion Regulation in HIV/STI Risk-Related Sexual Behaviors

Human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention models may not address psychological complexities among adolescents with mental illnesses. This study examined contextual factors related to HIV/STI risk among heterosexually active Black adolescents with mental illnesses to inform the development of targeted HIV/STI prevention strategies. Black adolescent males and females (aged 14–17) were recruited from outpatient mental health programs in Philadelphia, PA to complete a computer-assisted personalized interview on sociodemographics, sexual behaviors, and emotion regulation (N?=?53). Two sample t-tests, Wilcoxon Rank Sum tests and regression modeling were used to examine differences in the study measures by gender and relationship status. Reports of sexual partner concurrency were high—both while already in a sexual relationship (67.3%) and multiple sexual partners in the same day (42.3%). Boys reported significantly more risk behaviors than girls. Sadness dysregulation predicted currently being in a relationship, older age at first oral sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters. Coping difficulties predicted a greater number of vaginal and oral sexual partners, and a lower age at first vaginal sex. Increasing depression severity was related to older age at first vaginal sex, fewer vaginal sexual partners and fewer unprotected oral sexual encounters in the past 3 months. This formative work suggests that coping mechanisms should be addressed in HIV/STI prevention research through the inclusion of activities targeted toward emotion regulation and decreasing sexual risk behaviors. Psycho-education and skills building may mitigate the psychopathology that contributes to HIV/STI risk in the target demographic.