Acquired Immune Deficiency Syndrome Education on the College Campus: The Mandate and the Challenge

The incidence of human immunodeficiency virus (HIV), which is associated with developing acquired immune deficiency syndrome (AIDS), is increasing within the college population. College professionals share in the mandate to implement AIDS education programs designed to raise awareness and offer more effective decision-making and coping skills. One such program follows.     

HIV-1 Infection, Neuroendocrine Abnormalities, and Clinical Outcomes

Different lines of evidence suggest that human immunodeficiency virus type 1 (HIV-1) infection is complicated by a variety of adverse effects on neuroendocrine systems. Soon after the discovery of HIV-1, reports began to appear suggesting that a number of neurotransmitter and neuroendocrine activities were negatively impacted by this infection. In 1987 it was observed that fine-needle aspiration of the lung in patients with acquired immunodeficiency syndrome resulted in syncopal reactions. Subsequently, an abnormality in the autonomic nervous system was reported in these patients. However, investigations in this area have remained limited due to the assumption that HIV-1-mediated activation of various endocrine systems was related to the major life stressor of living with a fatal disease. Evidence accumulated over the years has indicated, instead, that there are various other mechanisms in addition to life stressors that also play an important role in negatively impacting the neuroendocrine systems in this infection. This article examines various developments that have taken place in this area in order to provide avenues for future research.     

Counseling Gay Men with AIDS: Human Dimensions

As the incidence of acquired immunodeficiency syndrome (AIDS) becomes more widespread, individuals with AIDS will present themselves for counseling in both public and private settings, and counselors will need to become familiar with the psychological manifestations of the AIDS virus. This article provides case material that demonstrates the emotional responses of gay men to AIDS. Specifically, denial, anger, rage, guilt, and shame are discussed with an emphasis on the human dimensions of AIDS.     

Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS).

In a cohort of gay men responding to the threat of acquired immunodeficiency syndrome (AIDS), dispositional optimism was associated with less distress, less avoidant coping, positive attitudes as a coping strategy, and fewer AIDS-related concerns. Men who knew they were seropositive for human immunodeficiency virus (HIV) were significantly more optimistic about not developing AIDS than men who knew they were seronegative for HIV. This AIDS-specific optimism was related to higher perceived control over AIDS and to active coping among seropositive men only and to health behaviors in both serostatus groups. There was no relation of optimism to risk-related sexual behavior. It is concluded that optimism is psychologically adaptive without necessarily compromising health behavior. It is also concluded that it is useful to distinguish between event-based optimistic expectations and dispositional optimism.     

Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior

An unprecedented number of human sexuality studies have been initiated in response to the acquired immune deficiency syndrome (AIDS) epidemic. Unfortunately, methodological developments in the field of sex research have been slow in meeting the demands of AIDS investigations focusing on the diverse populations at risk for infection with the human immunodeficiency virus (e.g., adolescents, gay men, intravenous-drug users, ethnic minorities, elderly transfusees). In this article, we review and integrate current literature on measurement error and participation bias in sex research, with an emphasis on collecting sexual information in the context of AIDS. The relevance of these findings for AIDS-related sex research is discussed, and recommendations are made to guide future investigations.     

Personality traits as predictors of intentions to seek online information about STDs and HIV/AIDS among junior and senior college students in Taiwan.

The purpose of this cross-sectional study is to examine how personality traits such as sensation- seeking and impulsive decision-making affect Taiwanese college students' intentions to seek online information about sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Five hundred thirty-five (n = 535) junior and senior college students in Taiwan were recruited and completed self-report questionnaires. This study found high sensation-seekers were more likely to seek information about STDs and HIV/AIDS on the Internet than low sensation-seekers. Impulsive decision-makers were less likely than rational decision-makers to seek information about STDs and HIV/AIDS on the Internet. These findings suggest that personality needs to be considered as an exploratory factor which potentially influences intentions to seek STD and HIV/AIDS information on the Internet among Taiwanese college students.     

Sexual Sensation Seeking: Scale Development and Predicting AIDS-Risk Behavior Among Homosexually Active Men

Sensation seeking, the propensity to prefer exciting, optimal, and novel stimulation or arousal, is a potential mediating factor in sexual risk for human immunodeficiency virus infection (HIV), the cause of acquired immunodeficiency syndrome (AIDS). However, the most widely used measure of sensation seeking, the Sensation Seeking Scale (Zuckerman, Kolin, Price, & Zoob. 1964). contains numerous culturally outdated items and items that do not pertain to sexual behavior, in this study, 106 homosexually active men completed newly developed measures of sensation seeking related to sexual and nonsexual experiences, as well as a measure of sexual compulsivity. Results show that the new scales were internally consistent and time-stable. Additional analyses demonstrated convergent, divergent, and discriminant validity for these scales, showing them to be of use as mediating variables in models of high-risk sexual behavior. Implications for HIV prevention and behavior change are discussed.     

Human lmmunodeficiency Virus Infection and the Gay Community: Counseling and Clinical Issues

The gay community has been and continues to be disproportionately affected by the acquired immune deficiency syndrome (AIDS) and the human immunodeficiency virus (HIV) infection. Need for risk-reduction education, mental health service provision, and assistance in grieving the ongoing loss of loved ones continues to exist among members of the gay community. Clinicians who work with gay clients should be aware of the critical issues confronting gay men who are at risk for infection, those who may already be infected with HIV, and their loved ones. This article highlights critical issues in introducing prevention in therapy and counseling, in supporting asymptomatic seropositive gay men and gay men with AIDS-related complex (ARC) and AIDS in their attempts to cope, and in assisting in the grieving process for those who have lost loved ones to AIDS-related illnesses.     

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus.

Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.     

Differential Risk Perceptions for Unintended Pregnancy,STDs, and HIV/AIDS Among Urban Adolescents: Some Preliminary Findings

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.     

Differential risk perceptions for unintended pregnancy, STDs, and HIV/AIDS among urban adolescents: some preliminary findings

Two pilot studies tested the hypothesis that adolescents perceive differential risks for unintended pregnancy (UP), sexually transmitted diseases (STDs), and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The 1st study used a college sample consisting of 14 adolescents (21 years or younger) and 64 adults (over 21) who rated the likelihood that they and others would experience 15 health problems. The 2nd study used a community sample of 48 adolescents between 16 and 21 years of age who rated 11 health problems in a similar manner. Optimistic bias and uniqueness of risk in adolescents' perceived susceptibility to adverse sexual outcomes were examined. Optimistic bias is the difference between ratings of risk to self and risk to others, reflecting lower risk to self. Uniqueness of risk is the difference between ratings of risk and a baseline risk estimate (i.e., the mean rating for all non-sex-related health problems). Consistent with the hypothesis, adolescents perceived differential risks for UP, STDs, and HIV/AIDS. Implications for adolescent prevention programs are discussed.     

Personalized Occupational Transformations: Narratives from Two Occupational Therapists’ Experiences with Complex Therapeutic Processes

Recovery and occupation-centered practices with persons with severe psychiatric disabilities involve many dynamic issues and processes. This study aimed to develop an understanding of how the therapeutic process unfolds in occupational therapy among persons with severe psychiatric disabilities living in sheltered or supported housing. Repeated interviews were conducted with two occupational therapists working in sheltered and supported housing facilities. Narrative analysis was used to analyze their stories. The findings reveal “personalized occupational transformations” describing significant events of interaction establishing therapeutic processes to promote personal agency and social recovery while targeting meaningful activities based on each resident’s wishes.     

Community Participation of People with Mental Health Issues within an Urban Environment

Photovoice is an action research methodology in which people create/share photographs with stakeholders to generate personal and community change. In this study, people with mental health issues used photovoice to explore questions about community participation within an urban environment. Identified areas of occupation include spending time with friends, daily living tasks, and managing symptoms. Facilitators to community participation include access to supports, transportation, and making friends. Factors limiting participation include the risks for stigmatization, homelessness, and medication side effects. Implications for occupational therapy intervention include supporting participants’ community participation by developing friendships/supports and addressing the ongoing demands of symptom management.     

The Relationship Between Attitudes Toward Persons Who Are Gay and Persons With AIDS,and HIV and AIDS Knowledge

A total of 86 counseling students were assessed on their attitudes toward persons who are gay, attitudes toward persons with AIDS (Acquired Immune Deficiency Syndrome), and level of HIV (human immunodeficiency virus) and AIDS knowledge. Demographic data consisted of sex, age, and HIV- and AIDS-related training. Results indicated that the attitudinal and knowledge variables were correlated so that positive attitudes toward both groups corresponded with high levels of knowledge. There were no significant differences among these variables on the demographic factors. Implications of these results are discussed, with special emphasis placed on counselor education.     

The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.     

Neuropsychopharmacologic treatment of depression and other neuropsychiatric disorders in HIV-infected individuals

How can neuropsychiatric disorders and syndromes be underdiagnosed and inadequately treated in individuals infected with human immunodeficiency virus? Depression in particular is among the most prevalent diagnoses and there is a solid foundation of data from controlled clinical studies that has begun to examine the efficacy of various antidepressants in HIV-infected persons. This article summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of immunodeficiency. This includes discussion of clinically significant treatment considerations (eg, efficacy, side effects, drug-drug interactions) derived from the existing literature. Taken together, there is compelling evidence that psychopharmacologic intervention can improve the quality of life of mentally ill HIV-infected individuals.     

Theory-Driven Interventions in Psychoneuroimmunology and HIV-1 Infection

Psychoneuroimmunology (PNI) is a rapidly evolving multidisciplinary field founded on the premise that psychosocial factors, the central nervous system, and the immune system are intimately linked. Following publication of scientific evidence supporting this link, a number of animal and human studies have been published, both inside and outside the area of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. These studies support the existence of bidirectional feedback mechanisms operating between the brain and the immune system. To date, however, there is no all-encompassing model that predicts individual differences in the relationship among psychosocial factors, immunologic measures, and clinical disease progression in HIV type 1 (HIV-1) infection. This variability in human response has been explained by a number of cofactors (host as well as environmental) that appear to accelerate the course of the disease. Since psychosocial factors are highly amenable to behavioral interventions, several models for intervention research have been proposed to evaluate whether such interventions can enhance immune functioning, thereby curtailing disease progression. Examination of these interventions in the context of PNI and HIV-1 infection, however, is rather limited. Therefore, researchers and clinicians must not only consider conceptualizations and paradigms in this area of research, but also focus on empirically testable, theory-driven models that allow for the unique characteristics of individual patients.     

Nurses' Anxieties about Biohazards as a Function of Context and Knowledge1

Final-year nursing students (N= 96) described their anxieties about biohazards, not only in relation to the occupational context of a hospital ward, but also in relation to their general life context. These contexts were reported to vary in the extent to which they permitted control over exposure to the two particular biohazards chosen for study: human immunodeficiency virus (HIV) and hepatitis B virus (HBV). The data showed that nurses' anxiety about contracting HIV infection varied significantly across the two contexts, while anxiety about contracting HBV infection did not. In the general life context, anxiety about HIV was greater than anxiety about HBV for all subjects. This difference was significantly greater for those with incorrect knowledge about objective HIV seroconversion rates than for those with correct knowledge.     

Neurobehavioral outcomes in diseases of childhood. Individual change models for pediatric human immunodeficiency viruses.

The growing incidence of human immunodeficiency virus-1 (HIV-1) and acquired immunodeficiency syndrome (AIDS) in children is a major public health problem. Current research emphasizes treatments for ameliorating deleterious effects on the child's neurological and behavioral development. This article outlines approaches to the assessment of individual change that may provide alternatives to more traditional approaches to the assessment of neurobehavioral outcomes in children with chronic diseases. These approaches provide more precise conceptualizations of changes that lead directly to statistical designs and measurement strategies for assessing effects of HIV-1 and AIDS on development. Such assessments can be superimposed on current clinical trial methodologies to evaluate the efficacy of pharmacological and behavioral interventions designed to improve quality of life in HIV-1 infected children.