Sleep disturbances associated with age and HIV

Sleep disturbances are common in normal people of several age groups and those with Human Immunodeficiency Virus (HIV) disease. In a secondary analysis of data, 50 HIV-positive and 50 HIV-negative adults between 30 and 65 years old responded to 5 items about sleep. No statistically significant differences by HIV status or age group were found.     

Spared at Random: Survivor Reactions in the Gay Community1

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered “survivors” since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N= 129) and HIV-positive (N= 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.     

Predicting intention to use condoms in homosexual men: an application and extension of the theory of reasoned action

A questionnaire based upon the Theory of Reasoned Action was developed and tested to identify predictors of intention to use condoms. Behavioral intentions, attitudes and subjective normative beliefs, behavioral norms, and age of HIV-positive status were included on the questionnaire. Internal consistency of the four components was high, with Cronbach's alpha coefficients of 0.76-0.87. Qualitative data were collected over 2 months from 194 homosexual men who participated in Sydney's homosexual community. Participants aged 17-64 years of mean age 29.5 attended individual interviews or small focus groups to discuss their views concerning condom use. 15% reported having tested HIV-positive, 59% tested negative, and 26% reported not knowing their HIV serostatus. According to logistic modeling, the significant predictors of intentions to use a condom were attitudes and behavioral norms, while HIV antibody positive status and age directly influence behavioral intentions to use a condom. About 50% of men over age 25 years intended to use a condom, irrespective of HIV status. Overall, 59% of men aged 25 years and younger intended to use a condom; 22% of HIV-positive men and 63% of HIV-negative men.     

Adult Attachment and High-Risk Sexual Behavior Among HIV-Positive Patients

The present study investigated the relationship between adult attachment style and sexual behavior among HIV-positive patients. HIV-positive (HIV+) participants ( N = 48) completed questionnaires assessing number of sexual partners, adult attachment, self-esteem, and depressive symptoms. Results revealed that insecure attachment styles (particularly negative attachment representations of self and fearful attachment) were associated with having multiple sexual partners, including at-risk HIV-negative (HIV-) partners. These relationships remained significant after controlling for sexual orientation, self-esteem, and depressive symptomatology. These results suggest that interpersonal issues may play a key role in high-risk sexual behavior among HIV+ individuals.     

Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

Parentification and Maternal HIV Infection: Beneficial Role or Pathological Burden?

Parentification, along with parenting and child adjustment, were examined in 23 9-through 16-year-old youth from families affected by maternal HIV infection and 20 same-age peers whose mothers were not infected. Children whose mothers were HIV-positive reported to more often engage in parental role behaviors, relative to children of HIV-negative mothers. This difference remained even after controlling for the effects of current drug use, number of adults per child in the household, and marital status. Findings revealed a beneficial relationship between parentification and both child adjustment and parenting, particularly among families affected by maternal HIV infection. When relationships were examined separately by HIV status, the pattern of results suggested that parentification, which involves increased emotional closeness, rather than role-related tasks, which may involve increased responsibility of household maintenance, seems to foster an association with concurrent positive parenting and child adjustment among families coping with HIV/AIDS. Directions for future research, including the need for methodological advances in the field are discussed.     

Relationship between duration of HIV disease and diagnostic history

The duration of being infected with HIV, i.e., chronicity, is a unique factor that can affect coping and psychological outcomes. In a secondary data analysis, 50 HIV-positive adults between 30 and 57 years were administered the Centers for Epidemiological Studies-Depression scale, the UCLA Loneliness Scale-Revised, and the HIV Stigma Scale, along with questions about their diagnostic history. Analysis indicated that those diagnosed longer with HIV reported ruminating less on the events leading up to their diagnosis (r=-.36), reported less trauma by their diagnosis initially (r=-.31), and reported fewer depressive symptoms (r=-.30). Implications for addressing chronicity in research are posited.     

Spiritual and Religious Implications of Aging with HIV: A Conceptual and Methodological Review

ABSTRACT

Spirituality and religious practices can buffer people from stressful life circumstances and promote positive biopsychosocial outcomes. The beneficial effects of spirituality and religious practices have been documented in aging and HIV. Unfortunately, little is known about spirituality and religious practices in older adults with HIV. As the number of older adults with HIV increases, with an estimated 91,000 adults over 50 being diagnosed with this disease in the United States, spirituality and religious practices may help HIV-positive people to age successfully. Crisis competence and spiritual trajectories are ways of conceptualizing spiritual development when confronting aging with a life-changing event such as a being diagnosed with HIV. Methodological issues in studying spirituality in adults aging with HIV are identified including defining spirituality and religiosity, heterogeneity of the population, timing of diagnosis, mode of transmission, sexual orientation, religious and cultural stigma, and hardiness. Implications for possible interventions are also posited.     

The relationship between HIV disclosure and adjustment

In many cases, sharing the diagnosis of HIV can help people to adjust to their diagnosis. However, several factors may impede this process. A secondary data analysis of 50 HIV-positive adults found that African Americans delayed sharing their diagnosis with others longer than Euro-Americans. In addition, those who perceived more stigma against HIV took longer to tell someone and took longer to adjust to their diagnosis. Implications for practice and research are posited.     

Correlates of relationship, psychological, and sexual behavioral factors for HIV risk among Indian women

The rate of HIV/AIDS among women in India is expected to rise yet few studies have examined factors related to HIV risk among Indian women. The objective of this prospective, cross-sectional study was to characterize similarities and differences in the relationships, psychological well-being, and sexual behaviors among Indian women (N=459). Both HIV positive (N=216) and negative (N=243) women from urban and rural areas in India were included in this study. Chi-square, analysis of variance, and logistic regression analyses revealed that in both geographic groups, HIV-positive women were significantly more likely to report marital dissatisfaction, a history of forced sex, domestic violence, depressive symptoms and husband's extra marital sex when compared to the HIV-negative women. Findings also indicate that specific factors related to the quality of the marital relationship such as domestic violence, martial dysfunction, and depressive symptoms may be related to HIV-related risks for women. Implications for future research and culturally relevant interventions are discussed.     

HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: manifestations, consequences and coping

HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological consequences of HIV-related stigma among those diagnosed with HIV reported were emotional pain, sadness, loneliness, anger, frustration and internalised stigma. The social consequences included decreased social network size, limited social support and social isolation, and resulted from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was a health-related consequence. People living with HIV employed both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies included selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification and acceptance. HIV-related stigma clearly permeates African and Afro-Caribbean communities in the Netherlands, and should be targeted for intervention.     

Gay Identification and Psychological Health in HIV-Positive and HIV-Negative Gay Men1

This paper reports a study of HIV-positive and HIV-negative gay men focusing on comparisons between the HIV-positive and HIV-negative on gay identification, the interrelationships among gay identification variables, and the psychological correlates of gay identification. We hypothesized that better psychological health would be related to gay self-acceptance, participating in gay organizations and groups, socializing with other gay men, and parental disclosure and acceptance of being gay. The sample was composed of 169 gay men, including 98 asymptomatic HIV-positive and 71 HIV-negative men. The findings are largely consistent with our hypotheses. A strong and consistent relationship of the gay identification measures with psychological variables was observed, explaining up to one fifth of the variance in current level of mood and self-esteem. Among the HIV-positive subjects, participating in gay organizations and groups and having parents who accepted their sexual orientation were important correlates of psychological adaptation. Despite this, 36% of subjects had parents who disapproved of their sexual orientation, and 69% of HIV-positive subjects were not in any gay organizations or groups. Among the HIV-negative subjects, gay self-acceptance and disclosing their sexual orientation to parents were associated with better psychological adjustment. These results suggest that the psychological health and outlook of gay men may be influenced by gay self-acceptance, participation in gay groups, and parental disclosure and acceptance of their children's sexual orientation.     

Development and implementation of a spiritual coping group intervention for adults living with HIV/AIDS: A pilot study

The aims of the current study were to (1) describe a spirituality-oriented, group pilot intervention for HIV-positive adults, and (2) examine the preliminary impact of the intervention among a sample (N?=?13) of adults living with HIV in an urban city in northeast United States. The 8-session intervention, based on the cognitive theory of stress and coping and the framework of spiritual coping, addressed stressors unique to HIV disease. Changes in spiritual coping and mental health were evaluated using a within group pretest-posttest design. Results revealed that, at post-intervention, participants reported higher self-rated religiosity, more use of positive spiritual coping, lower use of negative spiritual coping, and lower depression. Studies using a randomized, controlled design with larger samples of individuals with HIV are needed to determine the efficacy of a spiritual intervention when compared to a secular one.     

Intentions to Care for Children Orphaned by HIV/AIDS: A Test of the Theory of Planned Behavior

HIV/AIDS has added an unparalleled number of children to South Africa's orphan population. The theory of planned behavior (TPB) was used to investigate the decision-making processes of potential substitute caregivers of children orphaned by AIDS. Existing foster and adoptive parents ( n  = 175) completed a self-report postal survey. Of the sample, 76.0% reported willingness to care for an HIV-negative child and 62.2% an HIV-positive child. Analyses of the theory's components reveal contradictory and disappointing results. While the theory is most useful in conceptualizing the factors that bear on fostering and adoption, the current study suggests that the TPB is limited in its ability to address the complexity of decisions that attend fostering and adoption of children orphaned by HIV/AIDS.     

Neuropsychological impairment in veterans who are HIV-positive

The purpose of this study was to compare the neuropsychological functioning of 12 veterans who were HIV-positive to 21 age-matched veterans who were HIV-negative. Consistent with expectations, the HIV-positive group was found to perform more poorly in areas related to attention and concentration, immediate and delayed verbal recall, immediate and delayed visual recall, visual learning, and tasks requiring psychomotor speed, while a number of language tasks were left intact. This was similar to dysfunction often seen in HIV-related dementia cases. However, this group was also significantly more impaired in confrontation naming, planning, mental calculations, and abstract thought when compared to the HIV-negative group. Comorbid substance abuse found in the majority of our HIV-positive subjects was thought to contribute to the HIV-related dysfunction.     

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.     

Insert Discourse: Rectal Douching Among Young HIV-Positive and HIV-Negative Men Who Have Sex with Men in Vancouver,Canada

Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching, understandings of rectal douching (RD) for MSM are limited. In the epidemiological and medical literature, RD is presented as a behaviour that removes beneficial bacteria and the surface epithelium layer of the colon, which can, potentially, increase the risk of HIV transmission in MSM. The paucity of research on male douching practices is curious given the primacy of anal sex in HIV prevention initiatives and the widespread nature of rectal douching among this population. This paper provides preliminary data on RD and is intended to engender a dialogue about male douching and the need for additional research into the cultural construction of the body among MSM, namely with respect to the anus. Findings were derived from qualitative interviews with 12 young HIV-positive men who had recently become HIV-infected and 12 HIV-negative age-matched counterparts who were participating in a prospective cohort study. Beliefs about RD differed according to HIV serostatus; HIV-positive men discussed the practice much more openly than their counterparts did. Pre-coital RD is an embedded behaviour about which very little is known. However, it is a critical issue to include in the development of effective HIV prevention strategies and warrants an acknowledgement of importance of the anus in the lives, sexual practices, and identities among MSM.     

Brief Report: Power and Attitudes in Relationships (PAIR) Among a Sample of Low-Income,African-American Women: Implications for HIV/AIDS Prevention

This study describes a scale that was designed to measure low-income urban, heterosexual women's perception of Power and Attitudes in Relationships (PAIR). Although frequently mentioned in the literature as an important aspect of women's risk for HIV, there are few described scales which measure such attitudes among this population. PAIR was based in part on Connell's (1987) Theory of gender and power. PAIR was found to be reliable (alpha = 0.79) among a Baltimore cross-sectional sample of inner-city women (n = 417), half of whom were HIV-negative and half were HIV-positive. Our findings suggest that PAIR is reliable among both HIV-infected and HIV-uninfected inner-city women. The scale can be a useful tool in understanding the interpersonal context of women's risk of HIV.     

Infant birth weight among women with or at high risk for HIV infection: the impact of clinical, behavioral, psychosocial, and demographic factors.

The purpose of these analyses was to provide a prospective examination of the impact of HIV on birth weight using clinical, behavioral, psychosocial, and demographic correlates. HIV-positive (n = 319) and HIV-negative (n = 220) pregnant women matched for HIV risk factors (i.e., drug use and sexual risk behaviors) were interviewed during the 3rd trimester of pregnancy and 6 weeks postpartum. Medical chart reviews were also conducted for the HIV-seropositive pregnant women to verify pregnancy-related and birth outcome data. In a logistic regression analysis, model chi2(9, N = 518) = 124.8, p < .001, controlling for parity and gestational age, women who were HIV seropositive were 2.6 times more likely to have an infant with low birth weight. In addition, Black women and those who did not live with their partners were more than 2 times as likely to have infants with low birth weight, and those who smoked were 3.2 times more likely to have infants with low birth weight. Knowing that women with HIV, those who are Black, and those not living with a partner are at highest risk for adverse birth outcomes can help those in prenatal clinics and HIV specialty clinics to target resources and develop prevention interventions. This is particularly important for women with HIV because birth weight is associated with risk of HIV transmission from mother to child.