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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).

This study demonstrates the utility of classification and regression trees (CR depressive symptoms and active coping strategies predicted outcome for the coping group condition, and shame about sexual abuse and dissociative symptoms predicted outcome for the support group condition. Methodological issues and implications for clinical decision making are discussed.

This study examined the longitudinal effects of coping on outcome one year following completion of a randomized, controlled trial of a group coping intervention for AIDS-related bereavement. Bereaved HIV-positive participants (N = 267) were administered measures of grief, psychiatric distress, quality of life, and coping at baseline, post-intervention, and at 4-, 8-, and 12-month follow-ups. Coping strategies directly impacted all outcome variables for both study conditions. Additionally, the coping intervention moderated the relationship between avoidant coping and the longitudinal course of grief and psychiatric distress, resulting in greater reductions in grief and distress for intervention participants after accounting for avoidant coping strategies.

Childhood sexual abuse is common among HIV-infected persons, though few empirically supported treatments addressing sexual abuse are available for men and women with HIV/AIDS. This study reports the outcome from a randomized controlled trial of a group intervention for coping with HIV and sexual abuse. A diverse sample of 202 HIV-positive men and women who were sexually abused as children was randomly assigned to one of three conditions: a 15-session HIV and trauma coping group intervention, a 15-session support group comparison condition, or a waitlist control (later randomly assigned to an intervention condition). Traumatic stress symptoms were assessed at baseline and post-intervention, with analysis conducted for the three-condition comparison followed by analysis of the two-condition comparison between the coping and support group interventions. Participants in the coping group intervention exhibited reductions in intrusive traumatic stress symptoms compared to the waitlist condition and in avoidant traumatic stress symptoms compared to the support group condition. No differences were found between the support group intervention and waitlist conditions. Tests of clinical significance documented the meaningfulness of change in symptoms.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses.

We examined the influence of gender and ethnicity on coping strategies of 252 bereaved, HIV-positive individuals (65.1% male; 71% ethnic minorities [African-American and Hispanic]). Factor analyses of the Ways of Coping Questionnaire and Coping with Illness Scale yielded five coping subscales: Active, Avoidant, Social Support, Self-destructive, and Spiritual. Multivariate analyses of covariance revealed significant gender and ethnic group effects on spiritual coping, after controlling for social support, education, and sexual orientation. Of all subscales, only spiritual coping was not influenced by perceived social support. Women and ethnic minorities reported greater use of spiritual coping while White men reported the least use of spiritual coping. White women reported significantly greater use of avoidant coping than White men. Further, the relationship between spiritual coping and grief varied across gender and ethnicity. These results highlight the influence of gender and ethnicity in the use of spi...

A qualitative study was conducted with 28 women who are human immunodeficiency virus (HIV)–positive and have experienced childhood sexual abuse (CSA) in order to examine (1) the challenges generated by the experience of sexual abuse and related coping strategies, (2) the impact of the HIV diagnosis on their coping strategies, and (3) the links perceived by the women between their CSA and HIV infection. The interviews revealed that CSA raised challenges in four areas: disclosure of the abuse, sexual problems, relationship difficulties, and psychological distress. The women used two strategies to cope with their CSA: illicit substances to numb their emotional distress and sexual activity, and alienation to gain control in relationships. When diagnosed with HIV, the women initially coped with their illness by using these two strategies. The women reported that, over time, they were able to accept their HIV illness, seek social support, find alternative sources of significance, and use spirituality to sustain their growth. However, they continued to suffer psychological distress related to their sexual trauma. Further, most of the women did not perceive any connection between the two traumas. Implications of these findings for secondary prevention interventions with women who have HIV and experience of CSA are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 655–672, 2005.

The purpose of this study was to examine the impact of a group coping intervention for HIV-positive men and women who have lost a loved one(s) to AIDS in the past 2 years. Two hundred thirty-five participants, diverse with respect to race/ethnicity and sexual orientation, were randomly assigned to a 12-week cognitive-behavioral group intervention or to an individual therapy on request comparison condition. Measures assessing grief and psychiatric distress were administered at baseline and 2 weeks post-intervention period. Although a strong gender effect was observed in outcome, both men and women participating in the group intervention demonstrated significantly more reduction in psychiatric distress than controls. Further, women in the group intervention demonstrated significant reductions in grief and depressive symptoms over men in both conditions and women in the comparison condition. Brief cognitive-behavioral group interventions for coping with grief have a positive impact on the psychiatric functioning of HIV-positive participants. This appears to be especially true for HIV-positive women; a group not previously focused on in clinical research related to AIDS bereavement.

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.

Although persons 50 years of age and older account for 10% of all US AIDS cases, the mental health needs of this growing group remain largely overlooked. The current study delineated patterns and predictors of psychological symptoms amongst late middle-aged and older adults living with HIV/AIDS in two large US cities. In late 1998, 83 HIV-infected individuals 50-plus years of age (M = 55.2, Range = 50-69) completed self-report surveys eliciting data on psychological symptomatology, HIV-related life-stressor burden, social support, barriers to health care and social services, and sociodemographic characteristics. Based on the Beck Depression Inventory, 25% of participants reported 'moderate' or 'severe' levels of depression. HIV-infected older adults also evidenced an elevated number of symptoms characteristic of somatization. A hierarchical multiple regression analysis revealed that HIV-infected older adults who endorsed more psychological symptoms also reported more HIV-related life-stressor burden, less support from friends, and reduced access to health care and social services due to AIDS-related stigma. As the impact of HIV on older communities continues to increase, geropractitioners must be prepared to provide care to greater numbers of HIV-infected older adults, a substantial minority of whom will present with complex comorbid physical and mental health conditions.

HIV is recognized as a highly stigmatized disease; however, there has been a lack of research on the internalization of this stigma by seropositive people. This study examined internalized stigma among HIV-positive men and women (N = 268) in Milwaukee and Madison, Wisconsin, and New York City. The majority of the sample experienced internalized stigma related to their HIV status. Individuals who experienced high internalized HIV stigma (IHS) had been diagnosed with HIV more recently, their families were less accepting of their illness, they were less likely to ever have attended an HIV support group, and they knew fewer people with HIV. Individuals with high IHS also worried more about spreading their infection to others. Heterosexuals and participants from Wisconsin experienced higher levels of IHS. Hierarchical regression analyses showed that IHS contributed significantly to levels of depression, anxiety, and hopelessness after controlling for the effects of key behavioral and psychosocial variables.

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.

This paper lays out an historical overview of the way in which homosexuality has been viewed by psychiatry and the helping professions. It suggests that it is time to look at gay and lesbian older adults with a different perspective and presents a case example to illustrate the ways in which older gay adults can be helped by social workers.

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.

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.

This study examined how resiliency (represented by optimism, social support, religiosity, and finding growth and meaning), within the context of perceived impact of sexual trauma and HIV-related stress, was linked to perspectives on addressing trauma among individuals (N=266) with HIV and childhood sexual abuse (CSA). Structural equation modeling analyses indicated that lower resiliency and greater HIV-related stress were related to negative feelings about addressing trauma, whereas greater resiliency and higher perceived impact of sexual trauma were associated with positive feelings about addressing trauma. Findings suggest that multiple factors influence perspectives on addressing trauma among individuals with HIV and CSA, and that resiliency might influence these attitudes. Language: en

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.

The association between sexual abuse and HIV risk is well documented, yet little empirical data exists on treatment approaches integrating the psychological impact of sexual abuse and HIV disease. This study examined the clinical significance of change on sexual-trauma-related stress following a coping group intervention study among 28 women and men with HIV-AIDS and a history of childhood sexual abuse. More than 75% of participants showed improvement on 1 or more subscales of the Trauma Symptom Inventory, with the majority of improvements within domains related to trauma symptoms and behavioral difficulties. Most observed gains were modest, but are considered meaningful in the context of stressors encountered by this disenfranchised sample, which was diverse with respect to race, sexual orientation, and psychiatric comorbidity. These preliminary findings support the need for the conduct of research trials to identify mental health and secondary prevention intervention models that can assist those with HIV–AIDS who have experienced childhood sexual abuse.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N = 329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease.

This study characterized rates and predictors of suicidal thoughts among HIV-infected persons living in rural communities of eight U.S. states. Self-administered surveys were completed by 201 HIV-infected persons living in communities of 50,000 or fewer that were located at least 20 miles from a city of 100,000 or more. All participants were clients of rural AIDS service organizations and had recently enrolled into a randomized clinical trial of a telephone-delivered, coping improvement-group intervention designed specifically for HIV-infected rural persons. At baseline, participants reported on thoughts of suicide, psychological symptomatology, life-stressor burden, ways of coping, coping self-efficacy, social support, and barriers to health care and social services. Thirty-eight percent of HIV-infected rural persons had engaged in thoughts of suicide during the past week. A logistic regression analysis revealed that participants who endorsed thoughts of suicide also reported more depressive symptoms (odds ratio [OR] = 2.19; 95% confidence interval [CI] = 1.32-3.63, p < .002), less coping self-efficacy (OR = 0.70; 95% CI = 0.56-0.88, p < .002), more frequently worried about transmitting their HIV infection to others (OR = 1.66, 95% CI = 1.14-2.40, p < .008), and experienced more stress associated with AIDS-related stigma (OR = 1.58, 95% CI = 1.07-2.35, p < .03). As AIDS prevalence rates increase in rural areas, interventions that successfully identify and treat geographically isolated HIV-infected persons who experience more frequent or serious thoughts of suicide are urgently needed.

The procedures are described for a research project's assistance to four service organizations in successfully replicating a model program found effective in the laboratory. The goals, methods, and problems are reported, and some general recommendations are offered.