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HIV disclosure to sexual partners facilitates joint decision-making and risk reduction strategies for safer sex behaviors, but disclosure may be impacted by depression symptoms. Disclosure is also associated with disclosure self-efficacy, which in turn may also be influenced by depressive symptoms. This study examined the relationship between depression and HIV disclosure to partners following diagnosis among men who have sex with men (MSM), mediated by disclosure self-efficacy. Newly HIV-diagnosed MSM (n = 92) who reported sexual activity after diagnosis completed an assessment soon after diagnosis which measured depressive symptoms, and another assessment within 3 months of diagnosis that measured disclosure self-efficacy and disclosure. Over one-third of the sample reported elevated depressive symptoms soon after diagnosis and equal proportions (one-third each) disclosed to none, some, or all partners in the 3 months after diagnosis. Depressive symptoms were negatively associated with disclosure self-efficacy and disclosure to partners, while disclosure self-efficacy was positively associated with disclosure. Disclosure self-efficacy partially mediated the relationship between depression and disclosure, accounting for 33% of the total effect. These findings highlight the importance of addressing depression that follows diagnosis to enhance subsequent disclosure to sexual partners.

Men who have sex with men (MSM) represent more than half of all new HIV infections in the United States. Utilizing a collaborative, community based approach, a brief risk reduction intervention was developed and pilot tested among newly HIV-diagnosed MSM receiving HIV care in a primary care setting. Sixty-five men, within 3 months of diagnosis, were randomly assigned to the experimental condition or control condition and assessed at baseline, 3-month, and 6-month follow-up. Effect sizes were calculated to explore differences between conditions and over time. Results demonstrated the potential effectiveness of the intervention in reducing risk behavior, improving mental health, and increasing use of ancillary services. Process evaluation data demonstrated the acceptability of the intervention to patients, clinic staff, and administration. The results provide evidence that a brief intervention can be successfully integrated into HIV care services for newly diagnosed MSM and should be evaluated for efficacy.

Highly Active Antiretroviral Therapy (HAART) has transformed HIV from a terminal illness to a chronic condition. While disagreement remains regarding the level of medication adherence required to achieve and maintain viral suppression, the highest possible rate is preferable. This article discusses the case study of "Bob," a 54 year-old man living with HIV for 25 years. At baseline, Bob evinced fluctuating patterns of medication over- and under-adherence and reported numerous negative side effects. Bob participated in eight videophone-administered adherence intervention sessions. His adherence improved to a high of 97.9% at one-month follow-up; his negative treatment side effects subsided considerably. This case study demonstrates that videophone technology is a potential medium by which to assess and intervene upon HIV medication adherence.

Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.

Aims Few interventions exist to reduce alcohol and non-injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV-positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use. Design Participants were assigned randomly to the experimental coping group or a time-matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90-minute sessions. Setting and Participants A diverse sample of 247 HIV-positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City. Measurements Substance use was assessed pre- and post-intervention and every 4 months during a 12-month follow-up period. Using an intent-to-treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations. Findings At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ2(4) = 10.77, P = 0.029) and any cocaine use (Wald χ2(4) = 9.81, P = 0.044) overtime. Conclusions Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12-month follow-up. Integrating mental health treatment into HIV prevention may improve outcomes.

The CDC estimates that by 2015, half of all persons living with HIV/AIDS in the USA will be over the age of 50. Despite increasing HIV seroprevalence rates in older adults, most research examining adherence to antiretroviral therapy (ART) has focused on young HIV-infected persons and, in general, has been atheoretical in nature. This study examined two ART adherence conceptual frameworks to determine whether these models generalize to HIV-seropositive older adults. Two hundred and forty-four HIV-positive adults 50-plus years of age were recruited through AIDS service organizations in Ohio and New York. Participants completed a neuropsychological battery and an audio computer-assisted self-interview. FIML SEM analyses revealed that neuropsychological functioning was not associated with adherence. Fit indices supported a stress and coping model, with negative affect mediating the effects of social support and maladaptive coping on ART adherence. Results were consistent with stress and coping models and suggest that interventions intending to increase adherence to ART in HIV-infected older adults may be more effective if they address negative affect and enhance adaptive coping and social support.

This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed.

Objectives: To examine the effect of a 15-session coping group intervention compared with a 15-session therapeutic support group intervention among HIV-positive men and women with a history of childhood sexual abuse (CSA) on sexual transmission risk behavior. Design: A randomized controlled behavioral intervention trial with 12-month follow-up. Methods: A diverse sample of 247 HIV-positive men and women with histories of CSA was randomized to 1 of 2 time-matched group intervention conditions. Sexual behavior was assessed at baseline; immediately after the intervention; and at 4-, 8-, and 12-month follow-up periods (5 assessments). Changes in frequency of unprotected anal and vaginal intercourse by intervention condition were examined using generalized linear mixed models for all partners, and specifically for HIV-negative or serostatus unknown partners. Results: Participants in the HIV and trauma coping intervention condition decreased their frequency of unprotected sexual intercourse more than participants in the support intervention condition for all partners (P < 0.001; d = 0.38, 0.32, and 0.38 at the 4-, 8-, and 12-month follow-up periods, respectively) and for HIV-negative and serostatus unknown partners (P < 0.001; d = 0.48, 0.39, and 0.04 at the 4-, 8-, and 12-month follow-up periods, respectively). Conclusion: A group intervention to address coping with HIV and CSA can be effective in reducing transmission risk behavior among HIV-positive men and women with histories of sexual trauma.

Group interventions have been proposed as perhaps the most promising psychosocial treatment modality for persons receiving care in clinical and community-based health care settings (Simonton & Sherman, 2000), and interest in and practice of group interventions is growing among researchers and practitioners (Sherman et al., 2004). For the purposes of this study, group interventions refer to the broad range of behavioral and mental health interventions that are delivered within the group environment. Types of groups that fall under the umbrella of a “group intervention” include psychotherapeutic groups, educational groups, support groups, skills-building groups, and any combination of the four. Using this perspective, group interventions may take place as a part of a research study examining the effectiveness of an intervention (e.g., a randomized controlled clinical trial), or they can exist as a part of services provided to clients in public or private health service organizations or community-based organizations. Likewise, intervention groups refer to groups that are unstructured and conducted for indefinite periods of time, as well as those that are structured and delivered for a predetermined number of sessions to a fixed number of participants. There are many advantages of using the group environment to deliver an intervention. These advantages include: (a) the development of a sense of universality, cohesion, and social support among group members; (b) the opportunity for modeling and social learning from other group members, and (c) the positive experience of sharing with and helping others (Burlingame, MacKenzie, & Strauss, 2003; Hyde, Appleby, Weiss, Bailey & Morgan, 2005; Yalom, 1985). Additionally, research suggests that participants often view group interventions as less stigmatizing than individual interventions (Sherman et al., 2004). Furthermore, group interventions have been shown to be effective (Burlingame, Fuhriman, & Mosier, 2003), are more cost-effective than individual-level interventions (Holtgrave & Pinkerton, 1998) and allow for fewer personnel and reduced implementation-related costs. These features may make group interventions more desirable and practical for clinical and community-based prevention and treatment programs. While research has made clear the import of the group intervention as an integral part of behavioral and mental health interventions (Burlingame, MacKenzie, & Strauss, 2003; Hyde et al., 2005; Sherman et al., 2004), the social environment of the group, as well as relationships among group members and leaders (i.e., facilitators, therapists, or other personnel in charge of running and organizing the group) remain relatively undocumented in intervention research. Nonetheless, the perceived social environment of a group can exert a considerable influence on an intervention’s efficacy in reaching its designated goals and may help explain variation in behavioral and mental health outcomes among individual members of groups. Seminal research by Barker (1968, 1978) extensively documented the role that social settings play in influencing behavior and psychological well-being. Barker theorized that established standing patterns of behavior guide and shape interactions between persons within a setting, as well as learning and other psychological processes. Extending his theory to group interventions, one could posit that the group environment plays an important role in shaping the outcomes that interventions seek to change. Yalom (1985) echoed this idea in his work examining group psychotherapy. He noted that group cohesiveness, broadly defined as the participant’s relationship to the group leader, the other group members, and the group as a whole, is a strong determinant of positive therapeutic outcomes. Several studies have demonstrated that features of group environments have an impact on the effectiveness of interventions. In one study, examining members’ appraisals of self-help groups (i.e., Multiple Sclerosis, Compassionate Friends, and Overeaters Anonymous groups), members who perceived that their group was well organized and had a proficient leader reported greater satisfaction with the group, higher levels of selfγesteem, and lower levels of depression (Maton, 1988). Similar findings have been obtained in other studies, which have shown that primary group outcomes are related to several features of group environments, including perceived levels of group cohesion (Budman, Soldz, Demby, Feldstein, Springer & Davis, 1989; Meredith, 1987), disruptive group dynamics (Faris & Brown, 2003), group leadership and implementation (Kulic, Horne, & Dagley, 2004), and perceived group climate (Choi, Price, & Vinokur, 2003; MacKenzie, Dies, Coche, Rutan, & Stone, 1987).

AIDS-related grief was examined and its association with coping among HIV-positive men and women explored. AIDS-related grief, psychological distress and coping were examined among a sample of 268 HIV-infected individuals, diverse with respect to gender, ethnicity, and sexual orientation. Participants exhibited elevated scores on measures of grief reaction and psychological distress including depressive symptoms, anxiety, and traumatic stress related to their losses. Hierarchical regression analyses revealed that severity of grief reaction was associated with escape-avoidance and self-controlling coping strategies, type of loss, depressive symptoms, and history of injection drug use. Interventions are needed to enhance coping and reduce psychological distress associated with the unique bereavement experienced by people living with HIV- and AIDS-related grief.

By 2015, one-half of all HIV-positive persons in the U.S. will be 50-plus years of age, and as many as 30 % of older adults living with HIV/AIDS continue to engage in unprotected sexual intercourse. Contemporary positive prevention models often include mental health treatment as a key component of HIV prevention interventions. This secondary data analysis characterized longitudinal patterns of sexual behavior in HIV-positive older adults enrolled in a randomized controlled trial of group mental health interventions and assessed the efficacy of psychosocial treatments that targeted depression to reduce sexual risk behavior. Participants were 295 HIV-positive adults ≥50 years of age experiencing mild to severe depressive symptoms, randomized to one of three study conditions: a 12-session coping improvement group intervention, a 12-session interpersonal support group intervention, or individual therapy upon request. Approximately one-fifth of participants reported one or more occasions of unprotected anal or vaginal intercourse with HIV-negative sexual partners or persons of unknown HIV serostatus over the study period. Changes in sexual behavior did not vary by intervention condition, indicating that standalone treatments that target and reduce depression may be insufficient to reduce sexual risk behavior in depressed HIV-positive older adults.

Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagnosed men who have sex with men (MSM), was evaluated for preliminary efficacy. Participants were enrolled if they reported unprotected anal intercourse (UAI) in the three months prior to HIV diagnosis (n = 102). Three months after diagnosis, participants completed baseline assessments and were randomly assigned to receive the 3-session PC intervention or the comprehensive standard of care (C-SoC) at a community health center. Participants completed assessments at 3- (post intervention), 6-, and 9- months after baseline. Compared to C-SoC participants, PC participants significantly reduced the frequency of UAI with HIV serodiscordant (HIV negative or status unknown) partners over the 9-month follow-up period. No differences by condition were found in the frequency of UAI with all partners. The findings from this trial suggest that brief risk reduction approaches for newly-diagnosed MSM integrated into HIV care can benefit secondary HIV prevention efforts.

This study examined the prevalence and characteristics of suicidal ideation among middle-aged and older persons who have HIV infection or AIDS.A total of 113 subjects older than age 45 who had HIV-AIDS were recruited from AIDS service organizations in Milwaukee, Wisconsin, and New York City. Participants completed confidential questionnaires covering suicidal ideation, emotional distress, quality of life, coping, and social support.Twenty-seven percent of respondents reported having thought about taking their own life in the previous week. Those who had thought about suicide reported greater levels of emotional distress and poorer health-related quality of life than those who had not considered suicide. They were also significantly more likely to use escape and avoidance strategies for coping with HIV infection and less likely to use positive-reappraisal coping. Those who had thought about suicide also were more likely to have disclosed their HIV status to the people close to them, and yet they perceived receiving significantly less social support from friends and family. With the exceptions of physical functioning and coping strategies, differences between those who had contemplated suicide and those who had not remained unchanged after controlling for symptoms of depression.Persons who are in midlife and older and are living with HIV-AIDS experience significant emotional distress and thoughts of suicide, suggesting a need for targeted interventions to improve mental health and prevent suicide.

Childhood sexual abuse (CSA) is among the most common traumatic experiences encountered in the United States, with as many as one in three women and one in six men having a history of CSA (Briere & Elliott, 2003; Finkelhor, Hotaling, Lewis, & Smith, 1990). The negative impacts of CSA are well documented and include mental disorders, substance abuse, sexual dysfunction, physical health problems and relationship difficulties (Briere & Elliott, 2003; Irish, Kobayashi, & Delahanty, 2010; Jumper, 1995; Neumann, Houskamp, Pollock, & Briere, 1996; Wyatt et al., 2002). CSA has also been associated with HIV risk behaviors, such as unprotected sex and multiple partners (Arriola, Louden, Doldren, & Fortenberry, 2005; Mimiaga et al., 2009). The psychological difficulties that often arise from CSA, such as helplessness, low self-esteem, dissociation, denial, avoidance, and self-destructiveness, have been linked to HIV risk behavior, and likely mediate the relationship between CSA and HIV infection (Becker, Rankin, & Rickel, 1998; Briere, 2004; Mimiaga et al., 2009; Rotheram-Borus, Mahler, Koopman, & Langabeer, 1996). Further, CSA survivors are less responsive to HIV risk reduction interventions (Belcher et al., 1998; Kalichman, Carey, & Johnson, 1996; Mimiaga et al., 2009). Given these psychological and behavioral sequelae of CSA, it is perhaps not surprising that the reported rates of CSA among HIV-infected persons are between 33% and 53% (Henny, Kidder, Stall, & Wolitski, 2007; Kalichman, Sikkema, DiFonzo, Luke, & Austin, 2002; Markowitz et al., 2011; Welles et al., 2009; Whetten et al., 2006). CSA among HIV-infected individuals is a public health concern because it is associated with engagement in unprotected intercourse and substance abuse (Holmes, 1997; Kalichman et al., 2002; Markowitz et al., 2011; O’Leary, Purcell, Remien, & Gomez, 2003; Welles et al., 2009). Despite the growing recognition of the need for HIV prevention and mental health interventions to take into account the experience of CSA (Chin, Wyatt, Carmona, Loeb, & Myers, 2004; Greenberg, 2001; Parillo, Freeman, Collier, & Young, 2001; Sikkema et al., 2004), few interventions have been developed specifically for HIV-infected persons with CSA (Sikkema et al., 2007; Sikkema et al., 2004; Williams et al., 2008; Wyatt et al., 2004)

Shame has been shown to predict sexual HIV transmission risk behavior, medication non-adherence, symptomatic HIV or AIDS, and symptoms of depression and PTSD. However, there remains a dearth of tools to measure the specific constructs of HIV-related and sexual abuse-related shame. To ameliorate this gap, we present a 31-item measure that assesses HIV and sexual abuse-related shame, and the impact of shame on HIV-related health behaviors. A diverse sample of 271 HIV-positive men and women who were sexually abused as children completed the HIV and Abuse Related Shame Inventory (HARSI) among other measures. An exploratory factor analysis supported the retention of three-factors, explaining 56.7% of the sample variance. These internally consistent factors showed good test–retest reliability, and sound convergent and divergent validity using eight well-established HIV specific and general psychosocial criterion measures. Unlike stigma or discrimination, shame is potentially alterable through individually-focused interventions, making the measurement of shame clinically meaningful.

Michael J Skrajner1, Cameron J Camp1,Jessica L Haberman1, TimothyG Heckman2, Arlene Kochman3, Cristina Frentiu11Hearthstone Alzheimer Care, Willoughby, OH, USA; 2Ohio University College of Osteopathic Medicine, Northfield, OH, USA; 3Callen-Lorde Community Health Center, New York, NY, USAAbstract: Adherence to highly active antiretroviral therapy (HAART) medication regimens is vital to maintaining suppression of human immunodeficiency virus (HIV), but persons with HIV face many challenges to adhering consistently to HIV medication regimens. This is particularly true for persons who live in geographically-isolated areas or who have significant levels of cognitive compromise. A videophone-based version of Reynolds’ HAART CARE (HC) telephone intervention for medication adherence was pilot-tested with 23 persons living with HIV residing in both urban and non-urban communities. The purpose of the pilot study was to evaluate the feasibility and acceptance of an adherence improvement intervention administered via videophones. Furthermore, the feasibility and acceptability of conducting HIV pill counts through videophones were assessed. The videophone version of HC produced significant increases in self-reported rates of medication adherence and was generally well-received by interventionists and participants. Pill counts conducted via videophone were also well-accepted by participants. Self-reported adherence levels were higher than videophone-based pill count adherence levels. Challenges to the use of videophones included the requirement that only analog landlines be used, poor quality of video and audio transmissions, and high cost for equipment. Methods to overcome these challenges are discussed.Keywords: videophone, HIV, HAART, adherence

Few interventions exist to reduce alcohol and non-injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV-positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use.Participants were assigned randomly to the experimental coping group or a time-matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90-minute sessions.A diverse sample of 247 HIV-positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City.Substance use was assessed pre- and post-intervention and every 4 months during a 12-month follow-up period. Using an intent-to-treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations.At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ²(₄)=10.77, P = 0.029) and any cocaine use (Wald χ²(₄) = 9.81, P = 0.044) overtime.Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12-month follow-up. Integrating mental health treatment into HIV prevention may improve outcomes.

This research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms.

HIV is a chronic, life-threatening illness that necessitates regular and consistent medical care. Childhood sexual abuse (CSA) is a common experience among HIV-positive adults and may interfere with treatment utilization. This study examined rates and correlates of treatment utilization among HIV-positive adults with CSA enrolled in a coping intervention trial in New York City. The baseline assessment included measures of treatment utilization, mental health, substance abuse, and other psychosocial factors. In 2002-2004, participants (50% female, 69% African-American, M = 42.3 +/- 6.8 years old) were recruited. Nearly all (99%) received HIV medical care. However, 20% had no outpatient visits and 24% sought emergency services in the past 4 months. Among 184 participants receiving antiretroviral therapy (ART), 22% were less than 90% adherent in the past week. In a multivariable logistic regression model, no outpatient treatment was associated with African American race (AOR = 3.46 [1.42-8.40]), poor social support (AOR = 1.59 [1.03-2.45]), and abstinence from illicit drug use (AOR = 0.37 [0.16-0.85]). Emergency service utilization was associated with HIV symptoms (AOR = 2.30 [1.22-4.35]), binge drinking (AOR=2.92 (1.18-7.24)), and illicit drug use (AOR = 1.98 [1.02-3.85]). Poor medication adherence was associated with trauma symptoms (AOR = 2.64 [1.07-6.75]) and poor social support (AOR = 1.82 [1.09-2.97]). In sum, while participants had access to HIV medical care, a sizable minority did not adhere to recommended guidelines and thus may not be benefiting optimally from treatment. Interventions targeting HIV-positive adults with CSA histories may need to address trauma symptoms, substance abuse, and poor social support that interfere with medical treatment utilization and adherence.

The purpose of this study was to examine the mechanisms responsible for the beneficial psychological effects of a coping-focused group intervention for HIV-positive individuals who had lost loved ones to AIDS. Data from 235 HIV-positive men and women enrolled in a randomized controlled clinical trial testing a coping-focused group intervention were analyzed using a multiple-indicator-multiple-cause (MIMIC) structural equation model. Results revealed that the effects of the intervention on decreases in depression and grief were mediated by decreases in avoidant coping. Specifically, participants in the intervention condition decreased their use of avoidant coping. Decreases in avoidant coping, in turn, were related to decreased depression and grief. The results of this study help to validate the use of coping-focused interventions for HIV-positive bereaved individuals.

Few studies have examined the relation between race, social support, and coping, particularly among HIV-infected individuals. We examined the relation of race and social support to coping with HIV infection in a sample of 121 gay and bisexual men (64 African American, 57 White). Compared to White participants, African Americans reported higher use of multiple coping strategies. High levels of perceived social support were related to greater use of positive coping and seeking support; lower levels of social support were related to greater use of self-destructive coping. There were no race-related differences in social support, and no race by social support interactions. Possible explanations for observed cultural differences and coping challenges of African American gay and bisexual men with HIV are discussed.

Childhood sexual abuse (CSA) is associated with HIV sexual risk behavior. Although many psychosocial correlates of sexual risk among HIV-positive persons have been identified, studies predicting continued risk among HIV-positive adults with histories of CSA are limited. This cross-sectional study identified variables predictive of sexual transmission risk behavior among an ethnically diverse sample of 256 HIV-positive adults (women and men who have sex with men; MSM) with CSA histories. Participants were assessed for trauma symptoms, shame related to HIV and sexual trauma, substance use, coping style, and sexual risk behavior. Logistic regression analyses were conducted to identify variables predictive of unprotected sexual behavior in the past 4 months. Unprotected sex was significantly associated with substance use and trauma-related behavioral difficulties among women and men, and less spiritual coping among men. Unprotected sex with HIV negative or serostatus unknown partners was significantly associated with greater trauma-related behavioral difficulties, more HIV-related shame, and fewer active coping strategies. Thus, trauma symptoms, shame, coping style, and substance use were significantly associated with sexual risk behavior among HIV-positive adults with histories of CSA, with models of prediction differing by gender and partner serostatus. HIV prevention intervention for persons with HIV and CSA histories should address trauma-related behavioral difficulties and enhance coping skills to reduce sexual transmission risk behavior.

Background: AIDS-related bereavement is a severe life stressor that may be particularly distressing to persons themselves infected with HIV. Increasing evidence suggests that psychological health is associated with disease progression, HIV-related symptoms, and mortality. Purpose: This study assessed change in health-related quality of life among HIV+ persons following a group intervention for coping with AIDS-related loss. Methods: The sample included 235 HIV+ men and women of diverse ethnicities and sexual orientations who had experienced an AIDS-related loss within the previous 2 years. Participants were randomly assigned to a 12-week cognitive-behavioral bereavement coping group intervention or offered individual psychotherapy upon request. Quality of life was assessed at baseline and 2 weeks after the intervention. Results: Participants in the group intervention demonstrated improvements in general health-related and HIV-specific quality of life, while those in the comparison remained the same or deteriorated. Effect sizes indicated that the majority of change occurred in women. Conclusion: This bereavement group aimed at improving coping with grief also had a positive impact on health-related quality of life among HIV+ men and women, and suggests that cognitive-behavioral interventions may have a broad impact on both emotional and physical health.