[Are there predictors for sexual risk behavior in HIV-infected patients?]. / Gibt es Prädiktoren für sexuelles Risikoverhalten bei HIV-Infizierten?

The influence of four coping strategies ("rumination," "search for affiliation," "threat minimization," and "search for information"), four social network dimensions ("affectively positive," "affectively negative," "accepting confidants," and "liking confidants") and sociodemographics on the sexual risk behavior of HIV-infected persons were analyzed in sexual encounters with steady and casual partners. The analysis examines bi- and multivariately the predictors for sexual risk behavior. The study population consisted of 103 asymptomatic HIV-infected persons (80 men, 23 women, mean age 34 years, range 21-69 years) who participated in our prospective study and reported their sexual contacts during the previous 6 months. In sexual encounters with steady partners, the risk of unprotected behavior increased with the frequency of sexual contact. In these encounters, coping strategies and social network had no influence on sexual risk behavior. In sexual contacts with casual partners, the number of contacts with these partners was also of importance. The coping strategy "rumination" correlates significantly with enhanced risk behavior. In sexual contacts with casual partners, there was no correlation between sexual risk behavior and the three other coping strategies or social network. In multivariate analysis, the number of sexual contacts was the only significant predictor for sexual risk behavior with steady partners as well as casual ones. As sexual activity with HIV-infected persons is not absolutely safe, further prevention campaigns have to focus more on the motivation for safe sex, its situational aspects, and partners' responsibility.

Predictors of unprotected sexual contacts in HIV-infected persons in Switzerland.

Predictors of sexual risk behavior with regular and casual partners among HIV-infected heterosexual and gay persons were addressed. Sociodemographic data as well as self- and interviewer-reported data on sexual behavior were obtained from 117 asymptomatic HIV-infected persons enrolled in the Zurich part of the Swiss HIV Cohort Study (SHCS). Participants who reported sexual intercourse at least once (vaginal and/or anal) without condom use in the 6 months prior to interview were considered to have risk behavior. Sexual risk behavior was analyzed separately in contacts with regular and casual partners. In the 6-month preinterview period, 92% (108 of 117) of the HIV-infected study population reported sexual contacts, and 30/117 (26%) had at least one unprotected vaginal and/or anal contact. Among 93 persons using condoms, 25% of the heterosexual and 10% of the homosexual participants reported breakage of the condom. The main predictor for unprotected sexual behavior with regular partners was an elevated number of contacts. Predictors for sexual risk behavior with casual partners were the combination of alcohol and sexual encounters and the change of sexual behavior since the epidemic of AIDS. These findings did not differ between persons with hetero- and homosexual behavior. Considering that these contacts may have passed the virus on to the seronegative population, that the probability of unsafe sex increased with the growing number of contacts, and that the number of condom breakages was remarkable, it is imperative that this group be educated and motivated to take the active role in insisting on safer sex practices in each encounter.

Are immunological markers, social and personal resources, or a complaint-free state predictors of progression among HIV-infected patients?

Predictors of disease progression were studied in 89 asymptomatic HIV-infected patients who were prospectively evaluated for psychosocial variables and the development of clinical symptoms over a period of 2 years. The subjects were assessed for symptoms, laboratory measures, demographic variables, social and personal resources, mental status, alcohol, nicotine and drug use, sexual activity and risk behaviour, and sexually transmitted diseases. After 1 year, 17% of the patients had developed HIV-associated symptoms (symptomatic disease or AIDS), and after 2 years, 32% had developed symptoms or had died. In the multivariate analyses, the baseline CD4 count was the only significant predictor of disease progression during both observation periods. Psychosocial measures did not predict the progression of HIV infection.

[Is there a correlation between alcohol drinking and sexual risk taking? A discussion of conceptional aspects exemplified by HIV infected men with homosexual behavior]. / Besteht ein Zusammnenhang von Alkoholkonsum und sexuellem Risikoverhalten? Eine Diskussion konzeptioneller Aspekte am Beispiel HIV-infizierter Männer mit homosexuellem Verhalten.

Does sexual risk behavior and alcohol consumption correlate or is sexual risk behavior due to alcohol consumption? These questions are controversially discussed in the literature. We investigated whether the two different methodological concepts (global association, e.g. not specific to the critical incident and situational association) cause these discrepancies in a sample of 64 HIV-infected gay men. There was no significant global association between alcohol consumption and sexual risk behavior. Using the situational approach, drinking was not related to sexual risk behavior. The combination of these two concepts may help to identify persons at risk.

[Are there factors which maintain a subjective symptom-free psychological state? A study exemplified with HIV-infected subjects]. / Gibt es Einflussfaktoren, welche die subjektive psychische Symptomfreiheit aufrechterhalten? Eine Untersuchung am Beispiel HIV-infizierter Personen.

AIMS: In the absence of curative treatment, the diagnosis of HIV infection imposes a heavy burden. Infected persons are therefore confronted with psychological, social and physical problems and cope with them via different strategies and social resources. We investigated the question of what factors help to maintain a psychologically symptom-free state. METHODS: A sample of 117 asymptomatic HIV-infected persons was recruited out of the Swiss HIV Cohort Study (Part A) in 1989 and 1990. The psychological symptoms were assessed with a self-rating questionnaire (SCL-90-R). The structured interview focused on social network, social support (SONET), and coping strategies (FEKB). RESULTS: 79% of the asymptomatic persons did not report psychological symptoms. In multivariate analyses, "rumination" (= preoccupational thinking), female gender, and affectively negative relationships correlated with more, but affectively positive relationships and the strategy "defence against threat" with fewer, psychological symptoms. Additionally, there was no significant correlation between the immunological markers (CD4-, CD8-cell count, p24 antigen) and psychological complaints. CONCLUSIONS: The low number of asymptomatic HIV-infected persons with psychological symptoms (21%) is in accordance with other studies. Psychological symptoms and rumination correlate significantly in our sample. As rumination is difficult to recognize, HIV-infected patients should be directly questioned about rumination and their defence against threat should be supported in order to prevent the development of psychological symptoms.

[Economic status of the elderly and claims for financial support]. / Wirtschaftliche Lage Betagter und Inanspruchnahme finanzieller Unterstützung.

The health-related and social needs of aged people and their fulfillment are studied. Only a very weak relation is found between the financial situation and the claims for possible financial resources. On the other side education is found to have a key position for the drawing of supplementing pensions. The problems resulting for the assignment of financial support to aged people are discussed.