CD4 Count and Physical Symptoms Among Urban African American Mothers with HIV: An Examination of the Role of Optimism and Depressive Symptoms

The current study examined the link between immune functioning (CD4 count) and physical symptoms, as well as the moderating role of optimism and depressive symptoms, in a sample of 99 low income, inner city African American women with HIV. Although there was no main effect of CD4 count on physical symptoms, depressive symptoms moderated the association between CD4 count and physical symptoms. More compromised immune functioning (lower CD4 count) was associated with more physical symptoms under conditions of higher levels of depressive symptoms, but not lower levels of depressive symptoms. This finding was observed using both a self-report measure and a clinician-rating of women’s depressive symptoms. There were no main or interactive effects for optimism. Clinical implications and future research directions are presented.     

Culturally Sensitive AIDS Educational Videos for African American Audiences: Effects of Source, Message, Receiver, and Context

The importance of using culturally sensitive educational materials in HIV-related interventions with racial and ethnic minority groups is widely recognized. However, little empirical research has been conducted to assess the relative effectiveness of different techniques for creating culturally sensitive AIDS educational videos. Two field experiments with three samples of African American adults (N = 174, 173, and 143) were conducted to assess how source characteristics (race of communicator), message characteristics (multicultural message vs. culturally specific message), and audience characteristics (racial distrust and AIDS-related distrust) influence proximate (perceptions of the message's credibility and attractiveness) and distal (AIDS-related attitudes, beliefs, and behavioral intentions) output variables for AIDS educational videos. In Study 1, an AIDS video with a culturally specific message was rated as more credible, more attractive, and of higher quality than was a video with a multicultural message. The multicultural message was rated less favorably when delivered by a White announcer than when the announcer was Black. In Study 2, the same pattern was replicated with a second community sample and a campus-based sample. Study 2 also indicated that a multicultural message might be more effective if delivered in a culturally specific context, namely, after audience members watch a culturally specific video. Minimal changes were observed in distal outcome variables. It is argued that influencing proximate output variables is necessary, though not sufficient, for effecting long-term change in AIDS-related attitudes, beliefs, and behaviors.     

有偿献血艾滋病患者的情绪状况及影响因素分析

考察有偿献血艾滋病患者的情绪状况 ,探讨他们面临的艾滋病压力和家庭状况、周围环境、身体状况等对情绪的影响。采用Beck抑郁量表、焦虑自评量表、艾滋病压力量表作为测查工具 ,测查了 1 85名有偿献血艾滋病患者 ,并收集了他们的人口学资料和生理学指标信息。结果发现 :( 1 )有偿献血艾滋病患者存在着严重的情绪障碍 ,他们的焦虑程度不但显著高于正常人 ,而且显著高于神经衰弱者和焦虑症者 ,且 92 %的患者有中、重度抑郁障碍 ;( 2 )身体症状和情绪 /生存压力能够显著预测焦虑的程度 ,社会压力和情绪 /生存压力能够显著预测抑郁的程度。因此 ,有偿献血艾滋病患者抑郁、焦虑情绪障碍严重 ,症状和艾滋病压力是情绪障碍的有效预测因素。     

Factors Influencing Condom Use Among African American Women: Implications for Risk Reduction Interventions

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.     

Underlying correlation structures of parental stress, general health and anxiety

A partial least square regression (PLSR) was performed on the Swedish Parenthood Stress Questionnaire (SPSQ) sum score and subscales on incompetence, role restriction, social isolation, spouse relationship and health problems, using 42 items from the General Health Questionnaire (GHQ) and 20 items from the State Anxiety Inventory (STAI-X1). The dataset contained 227 fathers and 301 mothers of children aged 1.0-6.6 years from a population-based study on parental psychological distress in the general Norwegian population, and all items correlated positively with SPSQ. Subscales on spouse relationship, incompetence, social isolation and role restriction related to items on state anxiety and depression. The SPSQ subscale on health problems related to GHQ items on somatic symptoms and social dysfunction. The STAI-X1 item "not feeling rested" had a particularly important effect on parental stress. Underlying correlation structures between parental stress and items from STAI-X1 and GHQ were explored, but only the SPSQ sum score could be acceptably predicted. PLSR as a statistical methodology was found useful for health and psychometric data.     

Partner Influences and Gender-Related Factors Associated with Noncondom Use Among Young Adult African American Women

We examined the partner influences and gender-related correlates of noncondom use among African American women. The prevalence of noncondom use was 45.3%. Women whose sexual partners were noncondom users were four times more likely to believe that asking their partner to use a condom implied he was unfaithful, three times as likely to have a partner who resisted using condoms, three times more likely to receive AFDC, twice as likely to be sexually nonassertive, three times more likely to believe that it was not difficult to find an eligible African American man, and three times as likely to have had one sexual partner. HIV prevention tailored towards African American women should address these partner influences and gender-related factors.     

Structural Ecosystems Therapy for HIV+ African‐American Women and Drug Abuse Relapse

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This report examines the effect of Structural Ecosystems Therapy (SET) for (n=143) HIV+ African‐American women on rate of relapse to substance use relative to both a person‐centered approach (PCA) to therapy and a community control (CC) group. A prior report has shown SET to decrease psychological distress and family hassles relative to these 2 comparison groups. In new analyses, SET and CC had a significant protective effect against relapse as compared with PCA. There is evidence that SET's protective effect on relapse was related to reductions in family hassles, whereas there was not a direct impact of change in psychological distress on rates of relapse. Lower retention in PCA, perhaps caused by the lack of a directive component to PCA, may have put these women at greater risk for relapse. Whereas SET did not specifically address substance abuse, SET indirectly protected at‐risk women from relapse through reductions in family hassles.     

Listening to the Voices of Children in Early Schooling in the South African Context of HIV/AIDS

This study explored how children in early schooling interpreted their social reality to construct vulnerable childhoods in an HIV/AIDS context. Ten males and ten females between the ages of eight and nine years from low-income families in KwaZulu-Natal participated in the study. In order to raise the voices of the children, a listening framework was created through participatory techniques. Focus group interviews, drawings, story telling and projection techniques were used in the study. The study found that children actively interpreted their social reality through engaging with circumstances that surrounded their lives in an HIV/AIDS context. Child activism is important to HIV/AIDS education.     

Apathy is associated with lower mental and physical quality of life in persons infected with HIV

HIV infection is associated with lower health-related quality of life (HRQoL), which is influenced by immunovirological factors, negative affect, neurocognitive impairment, and functional dependence. Although apathy is a common neuropsychiatric sequela of HIV infection, emerging findings regarding its unique role in lower HRQoL have been mixed. The present study was guided by Wilson and Cleary's (1995), model in examining the association between apathy and physical and mental HRQoL in 80 HIV+ individuals who completed a neuromedical examination, neuropsychological assessment, structured psychiatric interview, and a series of questionnaires including the SF-36. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation subscale of the Profile of Mood States. Independent of major depressive disorder, neurocognitive impairment, functional status, and current CD4 count, apathy was strongly associated with HRQoL. Specifically, apathy and CD4 count were significant predictors of physical HRQoL, whereas apathy and depression were the only predictors of mental HRQoL. All told, these findings suggest that apathy plays a unique role in HRQoL and support the importance of assessing and managing apathy in an effort to maximize health outcomes among individuals with HIV disease.     

Adherence to antiretroviral therapy for pediatric HIV infection: review of the literature and recommendations for research

This review described and compared empirical investigations of adherence to pediatric antiretroviral therapy (ART) and predictors/correlates of adherence with regard to methodology and outcome. Thirteen empirical studies of children's adherence to ART, conducted between the years 1981 and 2002 were identified. Investigations varied by age of participant, drug therapy regimen, method of adherence assessment, and by the reporting of predictors/correlates of adherence. Conclusions from the literature are limited by the lack of common sample characteristics and adherence assessment methodologies. Nevertheless, consistent with much of the pediatric adherence literature, adherence to antiretroviral medications among children and adolescents appears to be frequently suboptimal. Few investigations identified predictors/correlates of adherence, but these appear generally similar to those found in adult samples. Recommendations for future investigations are proposed.     

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.     

Social support,psychological vulnerability,and HIV risk among African American men who have sex with men

Previous research has suggested a need to understand the social-psychological factors contributing to HIV risk among African American men who have sex with men (MSM). We conducted individual in-depth interviews with 34 adult African American MSM to examine their personal experiences about: (i) sources of social support, (ii) psychological responses to the presence or absence of social support and (iii) influences of social support on sexual behaviours. The majority of participants described limited positive encouragement and lack of emotional support from family, as well as few meaningful personal relationships. Feelings of isolation and mistrust about personal relationships led many participants to avoid emotional intimacy and seek physical intimacy through sexual encounters. Findings highlight a need for multilevel interventions that enhance social support networks and address the social-psychological, emotional and interpersonal factors that contribute to HIV risk among African American MSM.     

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).     

Risk perception and victim perception: The judgment of HIV cases

There is a vast literature confirming that reactions to different risks are strongly affected by characteristics other than scientific risk estimates; most of this research has concentrated on mapping people's representations of sets of widely varying dangers (e.g. diseases, natural disasters, accidents). This study explored a potentially vital component of risk that cannot be studied by eliciting general reactions to many hazards: the extent to which who is at risk contributes to perceptions and judgments of a risk. While it may be preferable to assume that misfortunes affect the population uniformly, of course the truth is not so egalitarian. Thus, for both theoretical and policy reasons, it is worth exploring psychometrically representations of a particular risk as it affects different people. Using multidimensional scaling and hierarchical cluster analysis, we constructed models of respondents' representations of a disease assumed to be particularly affected by victim perception: Human Immunodeficiency Virus (HIV). Subjects rated the similarity of all possible pairs among 16 scenarios involving HIV infection; the scenarios contained information about both the victim and the method of contraction. A set of attribute scales as well as political/demographic information allowed us both to interpret the structures and to predict individual differences. The results confirmed that reactions to HIV infection are greatly affected by reactions to the victim. In particular, the perceived distastefulness and riskiness of the method of infection loomed larger than did either the overall likability of the victim or the general riskiness of the victim's behavior. Further, the salience of the most statistically influential dimension, ‘deservedness’, depended significantly on demographic and political characteristics of the respondents, suggesting that the relationship between personal values and risk perception is in part mediated by victim perception. Implications for risk perception work and public policy 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.     

Anxiety and performance in runners: Effects of stress and anxiety on physical performance

Abstract

The aim of this study was to investigate the effects of state and trait anxiety on physical performance under both neutral and stressful conditions. In Study I, 43 male and female track athletes answered the State-Trait Anxiety Inventory and twice underwent ergometric testing in the physiology laboratory after receiving a neutral or a stress-inducing instruction. In Study II, these 43 runners completed the state scale shortly before a test run in a practice session and once again just before the start in an official competition. Results showed a significant increase in self-reported state anxiety under the stress condition in both the laboratory and the field setting. At the same time, the mean physical performance, measured as physiological performance parameters (maximum oxygen intake, physical work capacity) or as running performance, significantly deteriorated under stress. The induced stress affected the heart rate in addition to the mere physical work load, with no sign of compensation occurring during the entire period of ergometric testing. Effects of anxiety on performance were tested by separate 2(trait) × 3(state) ANOVAs for each situation. For both laboratory situations, and for the practice situation as well, no significant relationships, neither linear nor nonlinear, were detected. In the competition situation, however, an inverted-U relationship was found in the low trait-anxious subgroup.     

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.     

Parental illness,attachment dimensions,and health beliefs: testing the cognitive-behavioural and interpersonal models of health anxiety

The cognitive-behavioral and interpersonal models of health anxiety propose that parental illness could be a contributory factor to the development of health anxiety but through different mechanisms. The cognitive-behavioral model suggests that exposure to parental illness may lead to health beliefs that could increase health anxiety. In contrast, the interpersonal model proposes that parental illness may contribute to the development of an insecure attachment pattern and consequently health anxiety. To assess the additive value of the models, 116 emerging adults (i.e. aged 18–25) who had a parent diagnosed with a serious medical illness (e.g. cancer, multiple sclerosis) completed measures of health anxiety, adult attachment dimensions, and health beliefs. Attachment anxiety, attachment avoidance, health beliefs, and death of the ill parent were statistically significant predictors of health anxiety. The results provide support for both models of health anxiety. Theoretical implications and directions for future research are discussed.     

Parents Living with HIV in China: Family Functioning and Quality of Life

In China, HIV shifts the lifestyle of not only parents living with HIV/AIDS, but also their children, partners, and extended families. We examined factors related to the quality of life of parents living with HIV and the relation between family functioning and individual quality of life. Interviews were conducted with a total of 116 parents living with HIV/AIDS. Analyses of variance, Pearson correlations, and multiple regression analyses were performed to examine the relation between family functioning and quality of life. We found a significant association between family functioning and individual quality of life for parents living with HIV. In particular, family sociability had a strong relationship with the quality of life of parents living with HIV. Parents living with HIV from families where both parents are HIV-positive reported a lower level of family sociability than those from families with only one HIV-positive parent. HIV disclosure, family sociability, and number of children per family were found to be significant predictors of overall quality of life for the population. Study findings underscore the importance of developing interventions that improve family functioning for people living with HIV/AIDS in China.