Resiliency in young children whose mothers are living with HIV/AIDS.

Resiliency was investigated among well children 6-11 years of age (N = 111) whose mothers are living with AIDS or are HIV symptomatic to determine if mother's HIV status was a risk factor that could effect child resiliency, as well as investigate other factors associated with resiliency. Assessments were conducted with mother and child dyads over four time points (baseline, 6-, 12-, and 18-month follow-ups). Maternal illness was a risk factor for resiliency: as maternal viral load increased, resiliency was found to decrease. Longitudinally, resilient children had lower levels of depressive symptoms (by both mother and child report). Resilient children also reported higher levels of satisfaction with coping self-efficacy. A majority of the children were classified as non-resilient; implications for improving resiliency among children of HIV-positive mothers are discussed.

Predictors of antiretroviral adherence.

This study was conducted in order to help determine the key factors that predict adherence to antiretroviral medications. A total of 115 HIV/AIDS patients who were having trouble adhering to their antiretroviral regimens completed face-to-face interviews in which adherence levels, medication side effects, mental health, social support, patient-provider relationship characteristics, substance use and health anxiety were assessed. Three measures of adherence were used: adherence over the past three days, adherence over the past week, and adherence over the past month. Logistic regression analyses indicated strongest prediction of three-day adherence, with mental health, social support, patient-provider relationship characteristics and side effects contributing to prediction. Past week adherence was associated with age and social support measures, and showed a marginal association with side effects. Past month adherence was less strongly predicted, with social support and alcohol use contributing to prediction. Thus, a variety of factors were found to determine adherence, and implications of the findings for adherence models and interventions are discussed.

Effects of empowerment among HIV-positive women on the patient-provider relationship.

An assessment of the effects of HIV/AIDS patients' empowered behaviours on the patient-provider relationship was undertaken. Participants were 50 HIV-positive women ranging in age from 23 to 48 years, with 60% of the sample African American, 24% Latina, 6% White and 10% mixed/other race. Descriptive and canonical correlation analyses were used to investigate the interrelationships between patients' empowered behaviours and self-reported interactions with their providers. Positive associations were noted between patients' medical decision-making involvement and patient-provider interactions. Patients reporting greater decision-making involvement, had higher levels of communication with their providers, and received more information and positive affect from their providers. Health care providers of HIV-positive women are encouraged to cultivate empowered behaviours in their patients.

Evaluation of a brief low-cost intervention to improve antiretroviral treatment decisions.

An earlier pilot study found that US DHHS guidelines for antiretroviral treatment were not being successfully implemented (Mann et al., 2000). A brief and inexpensive intervention (visual aid checklist) was developed with the assistance of HIV-expert physicians in order to aid HIV/AIDS health care providers' and their patients' decisions about antiretroviral therapy. The visual aid checklist consisted of a two-page coloured diagram and explanation of key concepts (T-cell, viral load and resistance) and a checklist of the benefits and risks of antiretroviral therapy. Twenty adult HIV-positive subjects and eight health care providers were studied. Ten subjects were observed with their providers without the intervention being used, and then ten subjects were observed with the intervention. A pre-/post-test format was used to assess the patients' antiretroviral knowledge, patient-provider discussion of the DHHS guidelines, and provider satisfaction with the intervention. No differences in baseline HIV knowledge were found between the two groups. Results showed that patients in the intervention condition had greater knowledge of the benefits and risks of antiretroviral therapy than patients in the control condition. Providers reported that the intervention was useful in aiding and encouraging communication as well as conveying knowledge.

Mothers living with HIV/AIDS: mental, physical, and family functioning.

There has been little work assessing the psychological condition of mothers living with HIV, their home life, and how these women function as caretakers with a chronic illness. In this study, interviews were conducted with 135 HIV symptomatic or AIDS diagnosed mothers of young, well children aged 6-11. White mothers were less likely to be severely ill (CD4 counts of <500) than all other race/ethnic groups. The mean level of depression was elevated among this sample, and was associated with poorer cohesion in the family, and with poorer family sociability. Depression also was associated with the mothers being less able to perform tasks that they typically do; children of more depressed mothers had increased responsibilities for household tasks.

HIV/AIDS patient involvement in antiretroviral treatment decisions.

An assessment of HIV/AIDS patients' involvement in antiretroviral treatment decisions with their health care providers was undertaken. Four focus group interviews were conducted with HIV-positive individuals (N = 39) who were receiving antiretroviral medications at the time of the study. Participants ranged in age from 33 to 54 years, 69% were male, with 44% African-American, 39% White and 12% Latino/other race. Qualitative analyses were used to uncover patterns of patient involvement with their health care providers. Transcripts revealed four primary themes regarding patients' participation with providers in antiretroviral treatment decision making: (1) joint decision making between patients and providers, (2) patients taking control of their drug treatment decisions, (3) initial passivity followed by increased involvement, and (4) patients as knowledge gatherers (revealing where patients get treatment information). HIV/AIDS patients were generally active in making treatment decisions with their providers, garnering information about antiretroviral treatments from a variety of sources including peers, family members, health professionals and the media. Patient passivity in decision-making involvement was found only after initial HIV-positive diagnosis. Implications for patients' apparent empowered position are discussed.

Assessment of anxiety and depression in young children: support for two separate constructs.

Validated the interrelatedness of depression and anxiety in young children by testing four latent factor models: dual construct, unrelated; dual construct, correlated; single construct; and second-order or higher order analysis to test that depression and anxiety are primary constructs under the higher order factor of general affective distress. Children (N = 86) were ages 6 to 11, with mothers who were HIV-symptomatic or diagnosed with AIDS. Depression and anxiety measures included the Children's Depression Inventory (Kovacs, 1992), selected items from the Dominic-R (Valla, Bergeron, Berube, Gaudet, & St-Georges, 1994), and the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985). Structural equation modeling was used to test the models. Model 2 (dual construct, correlated) fit the data better than did Models 1 and 3; results for the higher order model were identical to Model 2, suggesting the higher order model is equivalent to the dual-construct model.

Gender differences in the control of alcohol-impaired driving in California.

OBJECTIVE: An examination of gender differences in alcohol-impaired driving. METHOD: Attitudes, perceptions and behaviors concerning drinking and driving were compared for male and female California drivers in three random-digit-dialing telephone survey interviews from 1983, 1986 and 1994 (survey response rates of 58%, 52% and 49%, respectively). A moral reasoning framework was applied to account for observed gender differences. RESULTS: Gender differences were examined within aggregate data from the 1983 and 1986 surveys (n = 291), and within the 1994 survey data (n = 608). Self-reported drinking-driving violations showed a substantial decline for both men and women across the survey periods (although violations remained much higher for men), paralleling the well-documented drop in alcohol-related traffic crashes during this time span. Men and women responded equally to the threat of punishment from the legal system (threat of arrest, jail, loss of license, fine, increased insurance), but women were much more responsive to social and internal controls (perceived disapproval from friends, feelings of guilt, violation of a moral standard). CONCLUSIONS: These gender differences suggest that women may play an important role in strengthening broad social and moral constraints regarding alcohol-impaired driving. Implications of these findings to deterrence, the effects of sanctions, and social change are discussed.

HIV risk among homosexual, bisexual, and heterosexual male and female youths.

Variations in sexual risk acts and the social-cognitive mediators of sexual acts were examined among young homosexual, bisexual, and heterosexual males and females (N = 478; 13-21 years of age) from four community-based agencies in New York City, San Francisco, and Los Angeles (29% African American, 36% Latino, 36% White/other). The prevalence and frequency of sexual risk acts varied be gender but were similar across youth of different sexual orientations, ethnicities, and ages. Condom use and the social-cognitive mediators of risk varied by sexual orientation and gender. Homosexual youths reported a gap between their positive attitudes toward HIV prevention and their skills to implement safer sex acts, particularly under social pressure. Bisexual youths appeared at greatest risk; their reports of sexual risk were the highest, yet their perceived risk for HIV was relatively low and skills and knowledge were moderate (relative to their peers). Heterosexual youths appear at high risk for HIV based on reports of low rates of condom use and HIV-related beliefs and attitudes. However, heterosexual youths demonstrated the highest level of condom skills. The number of sexual partners was not associated with any HIV-related social cognitive mediator, suggesting that alternative theoretical models must be proposed for partner selection. Longitudinal research with similar subgroups of youths is needed.

Legal and social control of alcohol-impaired driving in California: 1983-1994.

OBJECTIVE: This research was designed to provide information on the legal and social forces that influence change in control of alcohol-impaired driving. METHOD: Attitudes, perceptions and behaviors concerning drinking and driving for California drivers in 1994 (n = 608) were compared to similar information collected from California drivers in 1983 and 1986 (n = 291) through random-digit-dialing telephone interviews. RESULTS: Self-reported drinking-driving violations showed a substantial decline, paralleling the well-documented drop in alcohol-related traffic crashes during this time span. A large reduction in drinking before driving was reported for all age groups, men and women, and for both heavy drinkers and light drinkers. There was evidence of an increase in the levels of both general deterrence and general prevention. Increased external control was reflected in greater knowledge of drinking-driving laws and trends toward an increased expectation that violations would be followed by unpleasant consequences. Strong gains in creating a social norm for control of alcohol-impaired driving were indicated by perceptions that friends and relatives were more likely to disapprove of driving after drinking, observations of more control of drinking by drivers at occasions where alcohol is served and an increase in the view that it is morally wrong to drive after heavy drinking. CONCLUSIONS: California has made substantial progress in efforts to control alcohol-impaired driving, through increases in both general deterrence (fear of punishment) and general prevention (moral inhibitions and socialization of preventive habits), especially the latter.

Links between race/ethnicity and cultural values as mediated by racial/ethnic identity and moderated by gender.

Two studies examined whether individualism (orientation toward one's own welfare), collectivism (orientation toward the welfare of one's larger community), and familism (orientation toward the welfare of one's immediate and extended family) are distinct cultural values predicted by race/ ethnicity. The 3 constructs proved to be separate dimensions, although collectivism and familism were positively correlated. In Study 1, persons of color scored higher on collectivism and familism than did Anglos. No differences emerged for individualism. Also, persons of color scored higher than Anglos on racial/ethnic identity, which in turn was a positive predictor of all 3 cultural values. In Study 2, we replicated the group differences on collectivism and familism for men but not for women.

HIV-1 seroprevalence among women attending sexually transmitted disease clinics in California. California Family of Surveys and Sentinel Surveillance Consortia.

To evaluate the distribution of the human immunodeficiency virus type 1 (HIV-1) epidemic among California women, we analyzed HIV-1 seroprevalence and risk factors among women attending sexually transmitted disease (STD) clinics in 21 local health jurisdictions. Using standardized protocols developed by the Centers for Disease Control, we tested unlinked serum specimens from women attending participating STD clinics in 1989. We analyzed demographic characteristics, HIV risk exposure groups, and results of HIV-1 antibody testing on 17,210 specimens with an overall HIV-1 seroprevalence of 0.57%. Seroprevalence rates were highest for African-American women, women 25 to 29 years of age, injection drug users, and women attending STD clinics in San Francisco. After multiple logistic regression analysis, HIV-1 seropositivity remained highest for these four groups. The rate of HIV-1 infection among women attending STD clinics in California underscores the continued need to make HIV counseling and testing an integral component of routine services for women being evaluated for, or presenting with, sexually transmitted diseases.

Distribution of HIV type 1 infection in childbearing women in California.

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.