Showing papers in "Aids and Behavior in 1999"
TL;DR: In this article, the authors examined two aspects of sexual communication between adolescents and both parents, as well as the relationship between parent-adolescent sexual communication and adolescent sexual risk-taking behavior.
Abstract: This study examined two aspects of sexual communication—process and content—between adolescents and both parents, as well as the relationship between parent–adolescent sexual communication and adolescent sexual risk-taking behavior. The participants were 332 adolescents whose biological parents were married and living together. Adolescents were between 14 and 16 years of age and self-identified as either Black or Hispanic. Correlational analyses indicate that the process and the content of sexual communication are significantly and positively correlated. In addition, both process and content of sexual communication are positively associated across parents. Hierarchical regression analyses indicate that only mothers' sexual communication, both process and content, is related to adolescent risk-taking behavior for both male and female adolescents.
206 citations
TL;DR: Deficits identified in NP assessment and captured in an observed performance test of medication management are related to HIV medication adherence.
Abstract: Neuropsychological assessment may identify mild deficits in HIV-infected persons, but it is sometimes unclear if such deficits compromise functional competencies, such as the ability to adhere to complex medication regimens. We examined the relationship between neuropsychological status (NP), observed performance on a medication management test (MMT), and antiviral medication adherence as elicited in a 3-day recall measure. Two samples of HIV+ subjects (n = 20, n = 41) were used to develop and validate the MMT. An additional 57 HIV+ patients taking antivirals were assessed to examine NP, MMT, and adherence outcomes. NP performance was scored according to age- and education-based norms. Adherence was assessed by comparing reported medication use to medication insert information. Poorer performance on the MMT was associated with scores 1 adherence error, as reported in the recall measure. Number of errors was related to both NP and MMT performance. Deficits identified in NP assessment and captured in an observed performance test of medication management are related to HIV medication adherence.
128 citations
TL;DR: In this paper, the authors applied the information-motivation-behavioral skills (IMB) model to examine psychological determinants of AIDS risk behavior in a sample of sexually active, primarily minority, urban adolescents (N = 148) drawn from an area of high adolescent HIV seroprevalence.
Abstract: The current research applied the information-motivation-behavioral skills (IMB) model to examine psychological determinants of AIDS risk behavior in a sample of sexually active, primarily minority, urban adolescents (N = 148) drawn from an area of high adolescent HIV seroprevalence. Structural equation modeling demonstrated that the IMB model fit the data and that the constructs of the model accounted for 46–75% of the variance in AIDS risk behavior among sexually active urban male and female adolescents. Structural equation modeling also examined the fit of a restricted special case of the IMB model, focusing on motivation and behavioral skills as determinants of AIDS risk behavior, and showed that this model fit the data as well. Discussion focuses on the generality of the IMB model of AIDS risk behavior across diverse populations at risk, on the comparative value of the full IMB model and the restricted special case of this model, and on the implications of these findings for interventions to reduce AIDS risk behavior among sexually active urban adolescents.
116 citations
TL;DR: Only disclosure to partner was significantly related to women's psychological functioning: Fewer symptoms of depression were evident in women who had disclosed their HIV status to their partners compared to those who had not disclosed.
Abstract: Unlike the prevalence rate of AIDS diagnoses for men, the prevalence rate for women has not reached a plateau. Moreover, the rate of AIDS diagnosis for African-American women is 17 times higher than for White women. In the context of considerable stress, these women must grapple with the question of to whom they can disclose their HIV diagnosis with minimal risk of negative consequences. This study examines patterns of disclosure to significant others, predictors of disclosure, and the relationship between disclosure and psychological functioning. Analyses indicated that women disclosed at varying rates to six different categories of others. Disclosure to mothers (66%) was most common, followed by disclosure to partners (56%). Rates of disclosure to children (28%) and fathers (25%) were lowest. Women's illness status predicted disclosure to father and friends. Only disclosure to partner was significantly related to women's psychological functioning: Fewer symptoms of depression were evident in women who had disclosed their HIV status to their partners compared to those who had not disclosed.
92 citations
TL;DR: In this paper, a review of HIV sexual risk reduction programs targeted at adult heterosexual men is presented, which includes a methodologic critique, identifies research gaps, and provides recommendations for future research efforts with heterosexually active men.
Abstract: This paper reviews published evaluations (through fall 1998) of HIV sexual risk reduction programs conducted in the United States that have targeted adult heterosexual men. The review was limited to studies that provided a male-specific analysis of intervention effects on sexual risk behavior. Fifteen of 20 peer-reviewed studies meeting inclusion criteria demonstrated that HIV sexual risk reduction programs can be effective in reducing men's heterosexual risk behavior, although effect sizes were usually modest. Outcomes varied and included biological markers and self-reported behavior. No clear pattern distinguished effective from ineffective interventions. All intervention types (information-only; condom skills/distribution; behavioral skills–focused; HIV counseling and testing; individual risk counseling; street outreach) showed some efficacy, and there were no discernable differences by targeted population. Both group and individual delivery formats were effective. The review includes a methodologic critique, identifies research gaps, and provides recommendations for future research efforts with heterosexually active men.
81 citations
TL;DR: Other-sensitive motivations fall into several categories: altruistic concern for sex partners, personal ethical/moral values, expressed desire for communal/collective survival, concerns about self-definition, and elaborate concerns over the effects of potential HIV infection on family and friends.
Abstract: Self-interest is not the only motivator to sexual safety among sexually active gay men. Indeed, limits to a self-interest prevention paradigm are significant, and growing. Semi-structured qualitative interviews in two cities with an ethnically diverse cohort of mixed-status, sexually active gay men reveal a wide range of other-sensitive motivators beyond self-interest whose roles in men's HIV safety decisions have not been recognized. Other-sensitive motivations fall into several categories: altruistic concern for sex partners, personal ethical/moral values, expressed desire for communal/collective survival, concerns about self-definition, and elaborate concerns over the effects of potential HIV infection on family and friends. Other-focused concerns seem to operate as key motivators among these men, lowering risk. Implications of other-sensitive concerns for a new generation of prevention strategies are discussed.
52 citations
TL;DR: In this paper, a motivationally-based HIV risk reduction intervention is presented, and three clinical trials that have evaluated HIV-preventive motivational interventions have been conducted to evaluate the effectiveness of these interventions.
Abstract: This article advances the view that motivational strategies can augment the effectiveness of skills-based HIV risk reduction interventions. We articulate the empirical and theoretical rationale for a motivational approach and describe how we developed a motivationally based HIV risk reduction intervention. We also describe the strategic exercises and the therapeutic style that constitutes this approach, and then present detailed reviews of three clinical trials that have evaluated HIV-preventive motivational interventions. Results of these trials provide promising evidence for the integration of motivational approaches with traditional skills-based approaches. We recognize the limitations of existing research and provide suggestions for future investigations.
51 citations
TL;DR: The results showed that condom use habit was a consistent and strong predictor of future condom use, whereas intention was a weak and inconsistent predictor.
Abstract: This three-wave study explored the prospective effects of habit (previous condom use), intentions to use condoms, past and proximal (before sex) drug use (alcohol, marijuana, cigarette, and hard drug use), and interactions among these variables on condom use among 211 men and women intravenous drug users. Several theoretical alternatives were evaluated. In one alternative, habit is thought to have preeminence over intentions and other variables in the prediction of behavior. In another alternative, drug use is thought to interact in its effects on condom use, by making individuals susceptible to not adhering to their previous intentions regarding safe sex practices. The results showed that condom use habit was a consistent and strong predictor of future condom use, whereas intention was a weak and inconsistent predictor. Neither past (long-term) nor proximal (before sex) drug use moderated (interacted with) the effects of either intention or habit on later condom use. The preeminence of habit in the prediction of condom use is similar to findings from other areas of health behavior, underscoring the need for more focused research on the underpinnings of health habit effects.
50 citations
TL;DR: The results suggest that many drug users may not require intensive counseling to reduce or eliminate high-risk practices, and the potential preventive effectiveness of a widely practiced form of health promotion known as the health risk assessment.
Abstract: We evaluated the behavioral effects of brief counseling designed to assist injecting drug users in problem-solving situations in which they engage, or are tempted to engage, in practices that place them at risk of infection with HIV. Two hundred ninety-five (295) heroin detoxification clients were randomly assigned to receive either 50 min of the experimental preventive counseling or a packet of educational brochures. Follow-up interviews were conducted 3 and 12 months after randomization to assess the effects of counseling versus brochures. In a follow-up study with 109 clients, the experimental counseling was modified to be conducted in the context of notifying drug users of their HIV test results. In the follow-up study, we conducted standard pretest counseling before randomizing subjects to receive or not to receive the 50 min of experimental counseling. Follow-up interviews conducted 6 and 12 months after randomization assessed the impact of the experimental counseling versus standard pretest counseling. Substantial decreases in injection-related and sexual risk behavior were observed among subjects in both conditions in both studies. The decreases were for the most part sustained to 12-month follow-up interviews. The results suggest that many drug users may not require intensive counseling to reduce or eliminate high-risk practices. We determined that the reductions in risk behavior for both groups and both studies were probably not the result of secular historical trends, contamination of the experimental by the comparison group, volunteer bias, or regression or maturation effects, but very likely were in part a consequence of participating in research. Implications include the potential preventive effectiveness of a widely practiced form of health promotion known as the health risk assessment.
47 citations
TL;DR: Results of the Receiver Operating Characteristic (ROC) analyses suggest that the HADS-D is a highly effective screening tool for clinical depression in HIV-seropositive patients and health care providers are encouraged to use it to screen depression in their HIV-infected patients.
Abstract: The aim of this study was to verify the capacity of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), a self-report scale, to screen clinical depression in HIV-seropositive patients. Sixty-nine HIV-infected patients participated in this study, of whom 22 met diagnostic criteria for a depressive disorder or an adjustment disorder with depressed mood, while the remaining 47 did not. Results of the Receiver Operating Characteristic (ROC) analyses suggest that the HADS-D is a highly effective screening tool for clinical depression in this population. The Beck Depression Inventory (BDI) was also found to be effective, but it takes much longer to complete than the HADS-D (21 vs. 7 items) and is therefore less likely to be routinely implemented in HIV care settings. Moreover, the BDI contains somatic items that can be confused with HIV manifestations. For these reasons, health care providers are encouraged to use the HADS to screen depression in their HIV-infected patients.
37 citations
TL;DR: This article examined the extent of childhood sexual abuse and its relationship to risky sexual and drug-using behaviors, condom use, and lifetime sexually transmitted diseases in women volunteering for the WINGS intervention in New York City, Baltimore, and Seattle.
Abstract: This study examines the extent of childhood sexual abuse and its relationship to risky sexual and drug-using behaviors, condom use, and lifetime sexually transmitted diseases (STDs) in women volunteering for the WINGS intervention in New York City, Baltimore, and Seattle. Responses to structured interviews from 825 eligible women recruited from the community, clinics, and drug programs in 1995 and 1996 were analyzed. Thirty-eight percent to 66% of women across sites reported childhood sexual abuse before age 18. Q statistics and t tests measured the bivariate relationships between sexual abuse and outcomes. Then regression analysis was used to control for ethnicity and race, age, age at first intercourse, and site in predicting the adjusted effects of sexual abuse. Compared to nonabused women, abused women reported more lifetime partners, more episodes of different STDs, lower odds of using condoms at most recent sexual intercourse with main partners, and increased odds of using drugs or alcohol before sex. Researchers need to develop and test STD and HIV interventions tailored for victims of early sexual abuse and compare them with more general interventions for at-risk women.
TL;DR: A parental diagnosis of AIDS does not appear to be associated with high rates of emotional distress among their adolescent children.
Abstract: This study examined the level and the relationship between emotional distress reported by parents living with AIDS (PLAs) and the emotional distress of their adolescent children. Levels of depression and anxiety were assessed among 268 PLAs and 403 of their adolescent children. Compared to normative clinical samples, emotional distress was significantly higher among PLAs; fathers' reports were in the clinical range. In contrast to their parents, adolescents' reports of emotional distress were similar to those of normative same-age peers. The levels of depression and anxiety reported by female adolescents were significantly higher than those of the male adolescents. The level of adolescents' depression and anxiety was significantly related to their parents' depression. In conclusion, a parental diagnosis of AIDS does not appear to be associated with high rates of emotional distress among their adolescent children.
TL;DR: Gaps in Thailand's condom campaign are suggested and the need to better address HIV risk associated with having multiple partners is better addressed.
Abstract: Correlates of behavior associated with HIV exposure risk were evaluated in cross-sectional data from 3,839 Royal Thai Army (RTA) recruits whose birthplaces and residences were located away from Thailand's main HIV epicenter. Participants were generally 21 years old, unmarried, educated at the primary school level, and previously had been engaged in agriculture or unskilled labor. HIV prevalence in the sample was 1.8%. Condom use with commercial sex workers (CSW) was less than universal, and a small subset of men emerged who had multiple categories of partners. Nonetheless, CSW patronage appeared lower than in early studies in the Thai epicenter of the Upper North, and the venues patronized generally were not low-cost, high-turnover brothels. Sexual experience with girlfriends was more frequent than CSW experience, and the rate of condom use with girlfriends was relatively low. Lifetime injection drug use (IDU) was reported by 4.1% of the total sample and was associated with recent urban residence, CSW patronage, and sexual precocity. Findings suggest gaps in Thailand's condom campaign and the need to better address HIV risk associated with having multiple partners.
TL;DR: In this paper, the authors examined the rates of unsafe sex among HIV+ gay/bisexual men and their correlates, comparing them to HIV− men recruited simultaneously to the Chicago MACS/C&CS and AIM studies.
Abstract: With the advent of highly effective antiretroviral therapies, the prospects for persons living with HIV infection (HIV+) undoubtedly include many years of continued sexual activity. Reports of unsafe sexual behavior among a subset of HIV+ men has alarmed some prevention researchers and stimulated rethinking of HIV prevention interventions for gay/bisexual men. This paper examines the rates of unsafe sex among HIV+ gay/bisexual men and their correlates, comparing them to HIV− men recruited simultaneously to the Chicago MACS/C&CS and AIM studies. Aside from initial differences in the rates of unprotected anal sex (UAS) among men prior to learning their HIV serostatus, there were no differences in actual rates of UAS or their correlates in the two samples. Further, the importance of attitudinal measures—i.e., sexual sensation seeking, preference for UAS, and belief in the efficacy of the new therapies—in predicting risky sex among gay/bisexual men regardless of serostatus argues for an emphasis on modifying these attitudes in any HIV prevention interventions for gay and bisexual men and the importance of combining primary and secondary HIV prevention strategies whenever possible.
TL;DR: In this article, the authors examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM and found that young men were more likely than older men to have engaged in unprotected anal intercourse and receptive intercourse in the past 2 months.
Abstract: Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS.
TL;DR: STD-related behaviors among STD clinic clients in this rural county were at least as frequent as reported for urban populations and the relative absence of anonymity in a small community may play a role in several of the behaviors.
Abstract: We studied sexual disease transmission behaviors among patients of a county sexually transmitted disease (STD) clinic in rural North Carolina. Six hundred-sixty patients responded to a 147-item questionnaire. Among those with symptoms (N = 358), 50% of the men and 66% of the women came to the clinic a week or more after experiencing symptoms of a curable infection. Sixty-eight percent of the men and 39% of the women reported having multiple sex partners in the last 3 months. Fifty-nine percent of men and women reported never using a condom during vaginal sex with their main partner. Condom non-use was twice as likely with main partners than with casual ones. Factors independently associated with condom non-use (older age, cohabitation, non–African-American race, and social norms for risky sex) did not vary by partner type after the correlational nature of these data was taken into account. STD-related behaviors among STD clinic clients in this rural county were at least as frequent as reported for urban populations. The relative absence of anonymity in a small community may play a role in several of the behaviors.
TL;DR: Although many youth living with HIV disclose their serostatus to their partners, condom use is not increased, and interventions are needed to increase condom use among YLH, as well as to encourage disclosure to partners by the 30% ofYLH who do not disclose.
Abstract: Disclosure of serostatus and predictors of disclosure were examined among youth living with HIV (YLH). Disclosure patterns, sociodemographic characteristics, sexual and substance-use risk history, and current health status were examined among 350 youth living with HIV aged 13–23 years (27% African-American, 38% Latino; 72% male) who had AIDS (n = 35), were symptomatic (n = 108), or asymptomatic (n = 201). Most youth disclosed their serostatus to family (87%); unexpectedly, young men (93%) were more likely to disclose to friends than were young women (79%). Being younger at diagnosis was significantly associated with disclosure to family; young men disclosed more often to friends. Most youth disclosed to all their sexual partners (69%); higher rates of disclosure to sexual partners were associated with having fewer partners and being African-American. Condom use was significantly associated with disclosure for young women, and tended to be related for young men. Although many YLH disclose their serostatus to their partners, condom use is not increased. Interventions are needed to increase condom use among YLH, as well as to encourage disclosure to partners by the 30% of YLH who do not disclose.
TL;DR: Interview data revealed the presence of many perceived barriers to safer injection and sexual behaviors, including withdrawal-related concerns, and concerns about negative social consequences of engaging in safer behaviors.
Abstract: Forty-six HIV-positive individuals with a history of injection drug use participated in a questionnaire and interview study assessing their HIV risk behaviors, and their HIV risk and prevention information, motivation, and behavioral skills related to injection drug use and sexual behavior. High levels of past and current risky injection drug use and sexual behavior were reported. HIV risk reduction information was generally high, and many participants reported proprevention attitudes and supportive perceived norms toward HIV risk reduction behaviors. However, many did not intend to engage in these preventive behaviors, and some reported deficits in prevention behavioral skills. Interview data revealed the presence of many perceived barriers to safer injection and sexual behaviors. These included withdrawal-related concerns, and concerns about negative social consequences of engaging in safer behaviors. Possible ways of incorporating these findings into interventions for reducing risk behaviors in seropositive injection drug users are discussed.
TL;DR: In this article, the authors collected data from 362 men who had sex with men at cruising areas in the Netherlands, and measured characteristics of respondents, sexual risk behavior, and risk perceptions.
Abstract: This study collected data from 362 men who had sex with men at cruising areas in the Netherlands, and measured characteristics of respondents, sexual risk behavior, and risk perceptions. Furthermore, the study assessed whether outreach activities at cruising areas promote safe sex behavior. Almost one in five respondents reported having sex with both men and women, and 18.5% of respondents reported sexual risk behavior at cruising areas. Men who had a conversation about safe sex with a volunteer used condoms more consistently than men who had not spoken with a volunteer. Finally, it was found that behaviorally bisexual men used condoms less frequently at cruising areas. The relatively high levels of risk-taking sex stress the importance of HIV prevention at cruising areas. Furthermore, special attention could be given to cruising area visitors who have sex with both men and women, because they report higher levels of risk behavior and have less access to safer sex information regarding homosexual behavior.
TL;DR: This article examined the relationship between self-reported exercise participation both at the time of the study and prior to HIV diagnosis on neuropsychological performance of 139 asymptomatic HIV-positive men.
Abstract: The present study examined the relationship between self-reported exercise participation both at the time of the study and prior to HIV diagnosis on neuropsychological performance of 139 asymptomatic HIV-positive men. History of exercise participation prior to diagnosis was significantly associated with performance on several neuropsychological tests and with overall impairment. After the effects of education were removed from this analysis, the groups differed only in their performance on the Grooved Pegboard Test. When stratified by current exercise participation, the groups differed only on one trial of the Paced Auditory Serial Addition Test. These results suggest that exercise, while it may have other benefits for this population, is not associated with improved cognitive functioning.
TL;DR: Higher baseline CD4 counts and injection drug use history were predictive of poor appointment adherence, but other demographic and psychosocial indices were not.
Abstract: Medical care for HIV disease may be most effective when medical surveillance and services are initiated early and consistently maintained over time. To benefit from continually improving HIV care regimens, persons living with HIV/AIDS must first adhere to their outpatient medical appointments. The purpose of this study was to examine psychosocial, illness, and demographic factors associated with appointment adherence problems early in HIV treatment. Results indicated that nonadherence to outpatient medical appointments was a significant problem. One hundred forty-four patients were followed for 6 months after their initial appointment at a public HIV clinic. One in five dropped out of treatment before completing their intake assessment (separate nurse and physician appointments). Men and individuals with lower levels of social support were most likely to drop out before seeing a physician. Emotional distress was not associated with early dropout, but elevated levels of anxiety and depression were found across the sample. Those still attending the clinic (n = 114) were then followed for 12 months after clinic enrollment. Overall, 35% of scheduled medical appointments were missed during this period. Higher baseline CD4 counts and injection drug use history were predictive of poor appointment adherence, but other demographic and psychosocial indices were not. These findings suggest increased research and early intervention efforts are needed to improve appointment adherence among persons living with HIV/AIDS.
TL;DR: The authors suggest that use of a tape recorder, earphones, and an anonymous answer sheet contributed to the very high acceptance rate for this sexual behavior survey and enhanced the validity of the responses.
Abstract: A survey of sexual behavior was conducted among rural residents of Anhui, China, in 1997 to determine if using a tape recorder with earphones to administer sensitive questions increased the acceptance and accuracy of the survey. Validity of the responses was evaluated by determining the internal consistency of responses to related questions, comparing reported sexual activities and frequencies reported by husband and wife within a couple, and by resurveying a cluster. Among the 1,269 individuals selected, 185 were not home. Most (62%) had migrated to cities. Among the 1,084 at home, 1,057 (97.5%) participated in the survey, compared to 70–80% in similar surveys in China. The percentage inconsistency among related questions was < 1%. The discordance within couples was 5% for premarital sex, 3% for oral–genital and/or anal–genital sexual intercourse, and 19% for coital frequency within the past 4 weeks. A repeat survey gave similar results. The authors suggest that use of a tape recorder, earphones, and an anonymous answer sheet contributed to the very high acceptance rate for this sexual behavior survey and enhanced the validity of the responses. This strategy may enhance the response rate for similar surveys in other countries.
TL;DR: In this article, a purposive sample of 146 New York City, African-American, Puerto Rican, and White non-Hispanic women using the self-report version (PAIS-SR) was examined.
Abstract: Psychosocial adjustment to living with HIV/AIDS was examined in a purposive sample of 146 New York City, African-American, Puerto Rican, and White non-Hispanic women using the Psychosocial Adjustment to Illness Scale, self-report version (PAIS-SR). Puerto Rican participants reported significantly more problems than African-Americans on the Summary Scale and the Domestic Environment and Psychological Distress domain subscales and significantly more problems than either Whites or African-Americans on the Social Environment domain subscale. Problematic sexual relationships were found to be significantly associated with race/ethnicity, although scores did not differ significantly between any two groups. On average, women in all three racial/ethnic groups reported high levels of psychosocial adjustment problems to their illness relative to normative data for cancer patients. These findings suggest that, while all HIV-infected women may be at risk for problematic psychosocial adjustment to living with HIV/AIDS, Puerto Rican women may be especially vulnerable.
TL;DR: The authors found that the amount of detachment versus involvement-oriented coping strategies used to deal with stressors was unrelated to the level of reported depressed mood and AIDS-specific distress, except among the most severely depressed men (upper 15%), for whom greater reliance on involvement coping strategies was associated with decreased depression.
Abstract: The emotional well-being of persons living with HIV/AIDS is thought to be affected by a number of factors, including stage of disease progression and presence of physical symptoms, social support, stressors (both general and AIDS-specific), appraisals of control over stressful situations, and coping behaviors. The literature has been unclear regarding the role that coping mechanisms play in mediating or buffering the effects of stressors, and continued efforts to clarify the role of coping are important in order to inform clinical interventions. The current study was based on the responses of 297 White and African-American gay men with and without HIV/AIDS participating in the Chicago Multicenter AIDS Cohort Study (MACS) and Coping & Change Study (C&CS) from 1992 to 1994. We found that the amount of detachment- versus involvement-oriented coping strategies used to deal with stressors was unrelated to the level of reported depressed mood and AIDS-specific distress, except among the most severely depressed men (upper 15%), for whom greater reliance on involvement coping strategies was associated with decreased depression. Implications of these findings and suggestions for future research are discussed.
TL;DR: In this paper, the authors focus on predictors of condom use at last sex by drug injectors with "activated motivation", that is, by those who already are trying to use condoms to reduce HIV risk.
Abstract: Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with “activated motivation,” that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes.
TL;DR: A framework for assessing the economic value of condoms is proposed and estimates of the potential societal savings, in the form of decreased HIV-related medical care and lost productivity costs, that accrue from use of condoms are provided.
Abstract: In this study, we propose a framework for assessing the economic value of condoms and provide estimates of the potential societal savings, in the form of decreased HIV-related medical care and lost productivity costs, that accrue from use of condoms. A probabilistic model of HIV transmission was used to estimate reductions in HIV risk attributable to condom use. This estimate was combined with an estimate of the cost to society of a single case of HIV infection to determine a lower bound for the potential societal savings associated with condom use. Several condom use scenarios were considered (including multiple uses with a single partner and multiple uses with multiple partners) for each of three populations: low-risk heterosexuals, high-risk heterosexuals, and men who have sex with men. The savings exceeded the estimated cost of producing and distributing condoms in all but one of the scenarios considered. For multiple condom uses, the per-condom savings ranged from about 50¢ for low-risk heterosexuals to over $500 for multi-partnered men who have sex with men.
TL;DR: The work in this article examines from a psychodynamic theoretical perspective the role of the therapist in the treatment of men, women, and children affected by the HIV/AIDS epidemic, with a common theme of exploring the nature of the therapeutic alliance.
Abstract: This text examines from a psychodynamic theoretical perspective the role of the therapist in the treatment of men, women, and children affected by the HIV/AIDS epidemic. The chapters span a wide range of HIV issues from antibody testing to dementia, with a common theme of exploring the nature of the therapeutic alliance. In this selection of essays, the editor chose not to advocate for psychodynamic therapy over other treatment orientations, but rather to use psychodynamic theory as an explanatory conceptual framework for HIV-related distress. The book is comprised of two parts. Part I includes four chapters describing a variety of HIVrelated issues and special populations. Part II is a collection of eight in-depth case studies chosen to illustrate psychodynamic approaches to therapy. In Part I, the first and most comprehensive chapter summarizes a wide variety of presenting complaints and therapeutic issues including HIV testing, unsafe sex practices, anxiety, stages of illness, loneliness and despair, and suicidal ideation. Following a description of each topic using short, illustrative cases, unconscious conflicts and forces are postulated to underlie many of these issues. For example, the grief reaction of individuals experiencing multiple losses to AIDS is conceptualized through mental representations of those who have died, or \"psychic afterlifes,\" that can be explored in therapy to resolve guilt and conflict. Regarding suicidal ideation, the editor suggests that these feelings among late-stage AIDS patient can be used to \"give the patient the freedom to fantasize having complete control of his bodily state and his destiny.\" The treatment of each topic is brief (1-2 pages), and each is interspersed with sufficient case examples to improve readability and set the groundwork for the more detailed case presentations included in Part II. The second chapter focuses more on stylistic and methodological considerations, for example, listening skills, therapist prejudice, methods for relieving shame, and use of touch to reduce stigmatization. The last two chapters of Part I address HIV/AIDS issues among families and among those with histories of substance abuse. A creative highlight of Part I is an essay by Susan Bodnar entitled, \"Gidget Goes to Sing-Sing.\" In this chapter, the personal and professional challenges of forming therapeutic alliances with the socially disenfranchised persons attending a New York City outpatient psychotherapy program are aptly and sensitively described. What is impressive about this chapter is the often dramatic contrast between the socialization experiences of the therapist (\"Gidget\") and her clients (\"some were drug dealers, some were drag queens, and some were priests\"). Using a psychodynamic perspective, she includes in her interpretation of these cases the importance of childhood trauma, early attachments, and societal rejection. Part II is a collection of eight in-depth (10page) case studies designed to illustrate the use of these approaches to effect therapeutic change. Each provides sufficient information about development history, symptoms, clinical course, and outcome to elicit a variety of possible interpretations and therapeutic methodologies. Most notable are two of the case studies, one of a 43-year-old man with a long course of AIDS dementia (Chapter 6, \"Psychotherapy of an AIDS Patient with Dementia\" by Karen Marisek), and a second case of a 27-yearold, sexually compulsive, HIV-positive gay man (Chapter 7, \"Playing with Fire,\" by Jean Petrucelli). In the former, the writer addresses the challenges of insight-based therapy for a patient who is \"not very spontaneous, did not elaborate much and was not interested in deep exploration.\" Although early intervention was designed to be \"practical, supportive, exploratory,\" the therapeutic process for this client was not without personal insights, a keen recognition of emotional distress associated with cognitive decline, and an enduring therapeutic alliance. In the second case, Jean Petrucelli provides an excellent summary of a particularly adventuresome and oppositional patient who is struggling with sexual compulsitivity and dissociative experiences in the wake of an HIV-positive diagnosis.
TL;DR: In this paper, the authors developed a multidimensional measure of AIDS-related fears, including infection fear, becoming infected through partner betrayal, economic consequences of infection, society's response to the AIDS crisis, testing concerns, worries about becoming infected, casual contact, safety of medical procedures, and safer sex communication anxiety.
Abstract: Two studies were conducted to develop a multidimensional measure of AIDS-related fears. A Fear of AIDS Instrument (FAI) was administered to 608 clients undergoing HIV testing at an anonymous test site. Factor analyses identified eight foci of fear: Infection Fear, becoming infected through Partner Betrayal, the Economic Consequences of infection, Society's Response to the AIDS crisis, Testing Concerns, worries about becoming infected through Casual Contact, the safety of Medical Procedures, and Safer Sex Communication Apprehension. All scales exhibited acceptable reliabilities and several sex differences were identified. In a second study, the FAI was revised and then administered to 669 undergraduates, along with other AIDS-related constructs. These eight dimensions of fear were again identified and preliminary evidence of construct validity was obtained. Implications for AIDS prevention message design are discussed.
TL;DR: Results indicate the importance of qualitative research in understanding how and why people are motivated to participate in epidemiological studies and how these perceptions might relate to their responses in survey research.
Abstract: An exploratory study was conducted with 15 current or former injecting drug users to gain an understanding of the motivations for and reactions to participating in ALIVE (AIDS Link to Intravenous Experiences), a longitudinal natural history study of HIV among urban drug users in Baltimore, Maryland. Semistructured qualitative interviews explored participants' perceptions of ALIVE and of its benefits and the factors that might influence accuracy of self-report. Participants described benefiting from the study in many tangible and intangible ways. ALIVE was the sole source of health care for many, as only a third of the participants had health insurance. Participants' biggest challenge in the ALIVE survey were questions related to sexuality, which were perceived as too personal or elicited shame. Results indicate the importance of qualitative research in understanding how and why people are motivated to participate in epidemiological studies and how these perceptions might relate to their responses in survey research.
TL;DR: Trial participants differed significantly on sociodemographic dimensions and in beliefs and attitudes toward medical therapies and may limit the generalizability of trial results and, consequently, the effectiveness of HIV therapeutics.
Abstract: The primary objective of this study was to identify the social, psychological, and behavioral factors that influenced recruitment in AIDS clinical trials. The study compared HIV-infected individuals participating in a trial (n = 113) and a group of HIV-infected patients not currently participating in a trial (n = 103). Trial participants were more likely to be White (61.5% vs. 38.8%, p < .004), MSM (40.7% vs. 20.4%, p < .0001), with no IDU history (74.0% vs. 38.8%, p < .0001). Among trial nonparticipants, 42.2% indicated willingness to participate in a trial. Gender, race, and IDU history was not related to willingness to participate in a trial. Trial nonparticipants rated almost all aspects of the trial regimen as significantly more difficult compared to trial participants. Trial participants differed significantly on sociodemographic dimensions and in beliefs and attitudes toward medical therapies. These differences may limit the generalizability of trial results and, consequently, the effectiveness of HIV therapeutics.