Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life.

HIV-related stigma and the effect on quality of life is an on-going public health concern despite decades of education, prevention, and intervention efforts. The main purposes of this study were to examine the mediating role of four coping styles and the moderating role of gender on the relationship between HIV-positive status disclosure concerns and eight health-related quality of life outcomes. Data were collected from 346 women and men living with HIV. Results indicated that two coping styles - acquiring social support and positive reframing - mediated the negative relationship between disclosure concerns and health-related quality of life outcomes. There was no support for a moderated mediation. Interventions aimed at helping people living with HIV should focus on identifying and acquiring coping styles that transform perceptions of HIV-related stigma to support disclosure and improve health-related quality of life.

Reasons for and against maternal HIV disclosure to children and perceived child reaction.

This study explores the decision making of 66 HIV-positive women regarding disclosing their serostatus to their children and the child's perceived immediate and long-term reactions. Data came from a larger investigation of the disclosure process of HIV-infected women. Children included 27 boys and 39 girls between the ages 5 and 18 years. Forty-one children knew of their mother's diagnosis and 32 were disclosed to by their mother. Results suggest that women are interested in taking a leading role in disclosing to their children and make the decision based on the child's ability to handle the information and not be psychologically harmed.

The impact of mental health, sexual desire and sexual importance on the sexual behaviour of women with HIV.

HIV infection is increasing among women in the US, particularly among racial minority groups. The hypothesized theoretical model considered the extent to which indicators of depression, sexual desire and sexual importance would predict whether sexual behaviour would occur for a sample of 96 women with HIV. The results of this study supported previous findings that depression significantly decreases the chances that sexual behaviour will occur, while sexual desire and sexual importance moderately increased the chance occurrence of this variable. The results of this study suggested that the mental health of women with HIV significantly affects whether they engage in sexual behaviour. HIV-prevention and intervention models need to be more inclusive of those factors that are most salient in the sexual relationships of women. Moreover, additional research is needed to examine the importance of maintaining sexual behaviour for women with HIV.

The effect of perceived and actual social support on the mental health of HIV-positive persons.

The purpose of this paper is to compare the ways in which perceived and actual social support affect the mental health of gay men, straight or bisexual men, and women living with HIV/AIDS. Participants included 125 women and 232 men with an HIV-positive or AIDS diagnosis involved in three larger investigations of HIV, disclosure and mental health. Results suggest each sub-group experienced perceived social support as significantly predictive of better mental health while the effect of actual social support was minimal.

The role of stigma in reasons for HIV disclosure and non-disclosure to children.

This study examined how stigma may impact HIV-positive women's disclosure to their children. Participants included HIV-infected women recruited from AIDS service organizations located in large midwestern cities. Using a questionnaire and guided interview, quantitative data were obtained regarding perceived HIV-related stigma and rates of maternal disclosure to children aged 5-18. According to the Kruskal-Wallis test, comparison between the disclosure groups showed non-significant differences in the total score of HIV stigma (chi(2)=0.518 with df = 2, p=0.77).

A test of two HIV disclosure theories.

The purpose of this study was to examine two theories of HIV disclosure. The first is a disease progression theory and the second is the theory of competing consequences. Participants were 138 HIV-positive gay men involved in a larger study of HIV disclosure. Structural equation modeling was used to analyze each model, with the root mean square error of approximation (RMSEA) and the nonnormed fit index (NNFI) used to evaluate goodness of fit. The RMSEA for the disease progression model was .031 and the NNFI was .932. The RMSEA for the consequences model was .018 and NNFI was .978. Both indices are considered to be a close fit; however, the parameter estimates for disease progression to disclosure in the disease model and disease progression to consequences in the consequences model were nonsignificant, suggesting that disease progression may not play a role in the decision to disclose an HIV diagnosis. Researchers may want to focus on the intentions and possible outcomes from disclosure as predictive factors.

The role of family and friend social support in reducing emotional distress among HIV-positive women.

The purpose of this study was to examine HIV-positive women regarding their perceptions of family and friend social support and mental health outcomes. Regression models were constructed for five mental health outcomes. Results indicated that while each outcome has slightly different significant predictors, perceived family support was predictive of the reduced loneliness over the past few days and past year, stress, and presence of depressive symptoms. Implications for researchers and therapists are discussed.

Helping HIV-positive persons to negotiate the disclosure process to partners, family members, and friends.

For people who have been diagnosed with a chronic illness, one inevitable issue to be addressed is whether and how to share this information with others. For persons who are HIV positive, disclosure presents an especially arduous task. The purpose of this article is to offer a strategy to assist marriage and family therapists in facilitating client disclosure of an HIV-positive status to partners, family members, and friends. In addition, suggestions for setting the stage for disclosure to occur and recommendations for client follow-up are proposed.

Training issues for supervisors of marriage and family therapists working with persons living with HIV.

The purpose of this article is to address the special issues and considerations Martial and Family Therapy (MFT) supervisors might face with the increasing HIV/AIDS epidemic. Three primary issues will be addressed in this article. First, the importance of educating therapists regarding various aspects of the disease process and its transmission will be discussed, followed by educational strategies programs might adopt. Second, we will discuss the ethical and legal considerations that may need monitoring by supervisors and trainees. Third, special therapeutic considerations will be provided to supervisors of therapists working with stigmatized populations.

Barriers to social support for persons living with HIV/AIDS.

The purpose of this study was to test a barrier theory of perceived social support to HIV-positive gay men. The proposed model was tested for friends and family separately in order to investigate the uniqueness each provided. In both models, it was hypothesized that the presence of barriers to social support (availability, intimacy and disclosure) diminished acquisition of social support. The influence of barriers on the relationship between social support and health outcome (i.e. depression, t-cell count) for both friend and family models was also investigated. In general, data from HIV-positive gay men support barrier theory premises for both family and friends. Implications for helping professionals and researchers are proposed.

The role of family and friend social support in reducing risk behaviors among HIV-positive Gay men.

Researchers have intimated a link between social support and risk-taking behaviors for HIV-positive persons, yet few have empirically examined this assumption. This study examined HIV-positive Gay men regarding their perceptions of family and friend social support, behavioral intentions, and risk-taking behaviors. Results indicated that the more family members were perceived as supportive the less likely participants intended to behave in risky ways. In addition, family availability for support was more predictive of reduced risky behaviors than the availability of friends. Implications for researchers and helping professionals are discussed.

PIP: This study examined HIV positive gay men concerning their perceptions of family and friend social support, behavioral intentions, and risk-taking behaviors. The study hypothesized that HIV positive gay men who perceived their family and friends as providing social support and who utilized social support from their family and friends would intend to behave in less risky ways and would engage in fewer risk behaviors. A total of 142 HIV positive men were interviewed from an AIDS Clinical Trial Unit associated with a large Midwestern university in the US. Results indicated that as more family members perceived to be as supportive, the less likely participants intended to behave in risky ways. In addition, family available for support was more predictive of reduced risky behaviors than the availability of friends. Such results highlight the need for support by the distinct group and the importance of families and family professionals in preventing and reducing the spread of HIV.

Twenty years and still in the dark? Content analysis of articles pertaining to gay, lesbian, and bisexual issues in marriage and family therapy journals.

To what extent do marriage and family therapy journals address gay, lesbian, and bisexual issues and how does this coverage compare to allied fields? To answer these questions, a content analysis was conducted on articles published in the marriage and family therapy literature from 1975 to 1995. Of the 13,217 articles examined in 17 journals, only 77 (.006%) focused on gay, lesbian, and/or bisexual issues or used sexual orientation as a variable. Findings support the contention that gay, lesbian, and bisexual issues are ignored by marriage and family therapy researchers and scholars.

In-law relationships when a child is homosexual.

The purpose of this study is to review related literature concerning in-law relationships and begin an empirical exploration of the relationship between parents of gay men and lesbians and their child's significant other. Three hundred forty-seven parents of lesbians and gay men were surveyed regarding their sexuality, religiosity, socioeconomic status, attitude toward homosexuality, years they have known their child was homosexual, number of other children in the family, and acceptance of their homosexual child's significant other. A model was designed and tested via analysis of covariance structures in the LISREL VII package (Joreskog & Sorbom, 1989). Results suggest that the proposed model and the model estimated for the data are not significantly different, indicating support for the model. Future research issues are offered.

Intradermal hepatitis B vaccination in a large hospital employee population.

The intradermal route of hepatitis B vaccine administration has been tested in several clinical trials and has produced various degrees of immunogenicity, but usually among small groups of participants. To assess more adequately the immunogenicity of hepatitis B vaccine using the intradermal route, the Centers for Disease Control conducted a clinical trial among 425 well health-care workers in a hospital setting. Participants were randomly assigned to one of two treatment groups: those receiving a 20 micrograms intramuscular injection, and those receiving a 2 micrograms intradermal injection. Participants received the plasma-derived hepatitis B vaccine by the standard schedule at 0, 1 and 6 months, and serum samples were collected at 3, 8, 12 and 24 months after the first dose. Antibody response rates (anti-HBs titre greater than or equal to 10 sample ratio units by radioimmunoassay) for the intradermal vaccination group were consistently lower than those for the intramuscular vaccination group at each testing interval. The differences were greatest for the 3-month test and decreased over time. Geometric mean titres for anti-HBs for the intradermal group were significantly lower than those for the intramuscular group at the 8-month test point. In addition to inoculation route, factors of gender, smoking and age were found to have significant effects on immune response. The results suggest that intradermal vaccination with hepatitis B vaccine may be appropriate under certain conditions and for certain population subgroups.