Safer sex decision-making among men with haemophilia and HIV and their female partners.

An exploratory qualitative study of adult heterosexual men with haemophilia and HIV and women who were their sexual partners was conducted as formative research to better understand cognitive factors involved in behavioural intentions and practices which comprise HIV risk-reduction for sexual transmission. The study sought to generate hypotheses, uncover themes, and develop a broad perspective on possible determinants of behaviours related to HIV transmission risk reduction. Qualitative analysis of these data served as a basis for developing a subsequent quantitative, hypothesis-testing survey and an intervention. Face-to-face interviews were conducted with 23 single men and 28 married men with haemophilia and HIV infection, and 28 married women partners selected through stratified, purposeful sampling. The interviews identified beliefs, attitudes, and values underlying decisions regarding target behaviours related to preventing sexual transmission of HIV, including (1) using condoms consistently during vaginal intercourse and (2) talking to partners about risk reduction. The interviews elicited information about perceived advantages and disadvantages of performing each of the targeted behaviours, and factors that facilitate or prevent performing them. Qualitative analysis of coded responses yielded important themes regarding how choices are made about sexual activity and safer sex. Most notably, communication between partners (1) plays a direct, key role in facilitating condom use and (2) forms the basis for maintaining emotional intimacy in these relationships. The link between condom use and communicating about safer sex was viewed as pivotal in achieving HIV prevention for individuals in serodiscordant couples. Recommendations for risk reduction intervention development are discussed.

Maintenance of safer sexual behaviours: evaluation of a theory-based intervention for HIV seropositive men with haemophilia and their female partners.

A theory-based HIV risk-reduction intervention was developed for HIV-positive men with haemophilia and their HIV-negative female romantic partners. The intervention was based on Prochaska and DiClemente's Transtheoretical Model which describes behaviour change as an incremental, stage-based process. The intervention targeted both communication about safer sex and safer sex behaviours (consistent condom use or abstinence from vaginal intercourse). A total of 255 males and 158 females from six funded haemophilia treatment centres or patient organizations (and 27 associated subsites) participated in the study. Baseline and follow-up (15 months after baseline) measures were administered to assess safer sexual behaviours, communication about safer sex and condom self-efficacy. A quasi-experimental, repeated measures design was utilized to compare two naturally occurring groups; those who received the full intervention package and those who received incomplete or no intervention components. Significant intervention effects for safer sex behaviours, communication about safer sex and condom self-efficacy were identified for the male participants, with those receiving the full intervention package demonstrating better outcomes at follow-up. Women who received the full intervention package were more likely to report the use of a condom by their male partner during the last act of vaginal intercourse.

Secular trends in the prevalence of HIV infection among a population of males with hemophilia, 1988-1997: the Oklahoma Hemophilia Surveillance System.

Tracking the natural history of HIV/AIDS in the hemophilia community is useful for planning future health care needs and for adjusting estimates of the prevalence of hemophilia as the impact of HIV/AIDS wanes over time. The present study was designed to determine the annual prevalence of HIV infection from 1988 through 1997 in a population of males with hemophilia A or B. Data were obtained from the Oklahoma Hemophilia Surveillance System and were limited to individuals who were seen at the Oklahoma Hemophilia Treatment Center. In 1988, the prevalence rate of HIV infection was 34 percent. Rates have declined in each subsequent year through 1997. The highest rates of HIV infection were observed in persons with severe hemophilia and hemophilia A. The overall prevalence rates of HIV infection in this treatment center population are lower than those reported in other populations. No new cases of HIV infection were observed in persons with hemophilia born after 1985.

Determinants of Safer Sexual Behavior in a Long-term HIV-seropositive Population: The Multisite Hemophilia Behavior Intervention Evaluation Project (HBIEP.

Determinants of safer sexual behaviors among HIV-infected adult men with hemophilia were examined. A model was proposed that personal adjustment, communication skills, self-efficacy, and perceived advantages of condom use would influence safer sex practices. The model was tested with 181 men with hemophilia and HIV infection from 27 hemophilia treatment centers across the United States. The hypothesized model was tested using LISREL and explained 35 percent of the variance in safer sexual behaviors. Personal adjustment was significantly associated with general communication skills. General communication was linked with communication about safer sex which, in turn, influenced self-efficacy and perceived advantages of condom use. Communication about safer sex, efficacy and perceived advantages of condom use were all directly related to safer sexual behaviors.

Risk and resistance factors in the adaptation of mothers of children with cystic fibrosis.

Examined 35 mothers of children with cystic fibrosis (CF) to assess the relationship of risk and resistance factors to level of psychological adjustment. Dimensions of maternal adaptation, disease severity, family adaptability and cohesion, family life stress, and intrapersonal coping style were assessed. As a group, mothers evidenced significant levels of general psychological distress, and appear to constitute an at-risk population. Multiple regression analyses indicated higher levels of maternal distress were associated with increased levels of stressful family life events and an escape-avoidance coping style. Disease severity, family financial resources, and family adaptability and cohesion did not significantly contribute to the regression model.

Acquired immunodeficiency syndrome educational program: effects on adolescents' knowledge and attitudes.

Although many schools are presenting acquired immunodeficiency syndrome (AIDS) education programs for adolescents, few have evaluated the effects of the programs. The effects of two different types of program presentation, a lecture or a film, were compared to a no-program condition. Students who received the lecture demonstrated significantly greater knowledge gains than either of the other two groups. The lecture group's greater gain was maintained at the 1-month follow-up, although all three groups showed a decline in knowledge scores from posttest to follow-up. Both educational programs significantly increased students' positive attitudes toward patients with AIDS; there were no differences between the two groups. Positive attitudes decreased equally for both groups from posttest to follow-up, although these scores remained significantly more positive than the pretest scores. Students in both treatment groups showed a slight increase in positive attitudes toward practicing preventive behaviors following the programs, but those attitude scores returned to baseline levels at follow-up. Although educational programs increase knowledge and positive attitudes toward patients with AIDS, they do not appear to have a positive effect on attitudes toward practicing preventive behaviors. More intensive programs may be necessary to encourage behavioral changes.

AIDS and hemophilia: implications for interventions with families.

Informational needs of hemophiliacs must first be assessed to develop effective educational and prevention programs. A survey of 132 hemophilia patients and family members was conducted to determine the information needs, the preferred source of information and the patients' knowledge of AIDS. Results indicated that the major source of information for the patients was the media; the preferred source was the hemophilia treatment center. Most patients wanted more information about the treatment of AIDS and how to cope with the stresses of AIDS. Although patients indicated that they had received sufficient information about the sexual transmission of AIDS, answers to knowledge questions indicated important misconceptions. Results are discussed with respect to the development of educational and prevention programs for hemophiliacs and their families.

Pediatric AIDS/HIV infection: an emerging challenge to pediatric psychology.

The number of pediatric AIDS cases are increasing. This disease, with its social and political ramifications, as well as its biological consequences, presents a number of unique issues for psychologists. Some of the areas that present opportunities and problems for psychologists are briefly identified. These areas include prevention, clinical issues, public education, research, neuropsychological effects, psychoneuroimmunological issues, and ethical concerns. Current epidemiological projections and future directions for research are also discussed.