Behavioral and psychosocial predictors of self-efficacy for managing chronic disease among people living with HIV: forgiveness, life perspective, and social support.

HIV medication can help people living with HIV (PLWH) live longer, but many PLWH still report difficulty managing their disease and report engaging in harmful behaviors to themselves and others, which have adverse downstream consequences. Self-efficacy is predictive of positive health behaviors and outcomes, and it is modifiable through interventions. While existing studies overwhelmingly examine self-efficacy among PLWH, much fewer studies focus on self-efficacy for managing HIV, including self-efficacy for managing physical and psychological health problems caused by HIV-common problems that PLWH experience. Additionally, only limited literature on other-forgiveness and life perspective among PLWH exists. Thus, we further examine predictors of self-efficacy for managing HIV. We hypothesize that other-forgiveness, positive life perspective, and social support significantly predict self-efficacy for managing HIV after controlling for demographic variables. The results show that the overall multiple linear regression model significantly accounted for 38% of the variance in self-efficacy for managing HIV. Additionally, other-forgiveness was as powerful at predicting self-efficacy as social support; moreover, positive life perspective was a significant and the most powerful predictor of self-efficacy. These findings indicate that other-forgiveness and positive life regard may be as important, if not more so, than social support to chronic disease management.

Correlates and Racial/Ethnic Differences in Bareback Sex Among Men Who Have Sex with Men with Unknown or Negative HIV Serostatus.

Men who have sex with men (MSM), particularly racial/ethnic minority MSM, are disproportionately affected by HIV in the United States and Texas. Bareback sex or condomless anal intercourse (CAI) can be a high HIV risk behavior. Despite this, a majority of MSM continues to engage in barebacking. Research suggests racial/ethnic differences in barebacking exist; however, these conclusions remain unclear due to insufficient sample sizes to compare racial/ethnic groups. Our cross-sectional correlational design explores barebacking correlates (substance use during sex, safe sex fatigue, and optimistic HIV treatment beliefs) within and between racial/ethnic groups among 366 MSM. Regression models are significant for Latino and African-American MSM alone and for all MSM combined, though not significant for European-American and Other Race/Ethnicity MSM alone. Our findings suggest motivations and behaviors underlying barebacking among MSM vary by racial/ethnic membership with clinical implications for informing culturally sensitive HIV interventions and prevention programs for target racial/ethnic groups.

Attachment, forgiveness, and physical health quality of life in HIV + adults.

Research aims to help HIV + individuals improve and maintain a healthy quality of life, while managing a chronic illness. Using Lazarus and Folkman's model of stress and coping, we examined the main and interactive effects of attachment style and forgiveness on physical health quality of life of HIV + adults. Participants (n=288, 49% women) were recruited in Dallas/Fort Worth and self-identified as African-American (52%), European-American (32%), Latino(a) (12%), and other (4%), with an average age of 41.7 (SD=8.6). The average number of years participants reported being HIV + was 7.6 (SD=5.4). Participants completed medical and demographic information, measures assessing attachment anxiety and avoidance, forgiveness of self and others, and five quality of life scales (physical functioning, pain, role functioning, social functioning, and health perceptions). Significant correlations revealed that attachment anxiety was inversely related to physical health quality of life, while forgiveness of self was associated with greater quality of life. Hierarchical multiple regression analyses revealed that attachment anxiety and avoidance, forgiveness of self and others, as well as interactions between attachment style and forgiveness, were related to the physical health quality of life of HIV + adults. Interpretation of the interactions identified that for individuals who endorsed greater attachment anxiety, forgiveness of others was associated with greater pain, while forgiveness of self was associated with a greater perception of health. Research has indicated that forgiveness interventions lead to positive health outcomes for most individuals; however, in HIV + adults, whether an outcome is health promoting may be dependent on attachment style.

Gender differences in HIV-related coping and depression.

Our study examined differences in HIV-related coping in relation to depression in men and women. Ethnically diverse participants (n = 247, 46% women) were recruited in Dallas/Fort Worth and completed medical and demographic information, the Coping with HIV Scale (CHIV), and the Center for Epidemiological Studies-Depression scale (CES-D). Multiple regression analyses revealed that in men, depression was associated with symptoms, higher use of distraction, blame, expression and lower use of positive growth. In women, depression was associated with symptoms and higher use of blame. These results shed light on the ways in which each gender copes with HIV and may help researchers develop interventions tailored to the needs of the HIV-positive population.

Spiritual striving, acceptance coping, and depressive symptoms among adults living with HIV/AIDS.

We prospectively examined the effects of spiritual striving, social support, and acceptance coping on changes in depressive symptoms among adults living with HIV/AIDS. Participants were 180 culturally diverse adults with HIV/AIDS. Participants completed measures of spiritual striving, social support, coping styles, and depressive symptoms at baseline, three-month follow-up, and six-month follow-up. A path model showed that spiritual striving had direct and indirect inverse effects on changes in depressive symptoms. The relationship between spiritual striving and depressive symptoms was partially mediated by acceptance coping, but not by social support. Results suggest that people living with HIV/AIDS who strive for spiritual growth in the context of their illness experience less negative affect.

Pessimism, trauma, risky sex: covariates of depression in college students.

OBJECTIVE: To explain variance in depression in students (N = 648) using a model incorporating sexual trauma, pessimism, and risky sex. METHOD: Survey data collected from undergraduate students receiving credit for participation. RESULTS: Controlling for demographics, a hierarchical linear regression analysis [Adjusted R(2) = .34, F(5,642) = 67.38, P<.001] suggests that higher pessimism (t = 16.05, P < .001), more sexual trauma (t = 3.76, P<.001), and more risky sex (t = 3.40, P<.001) were associated with increased depression. Not being in a relationship (t = 3.54, P<.001) and being unemployed (t = 3.10, P<.01) also predicted more depression in students. CONCLUSIONS: Results identify key access points for the treatment of depression in students.

Attachment style, stigma and psychological distress among HIV+ adults.

This study explored the role of adult attachment style in reported experiences of HIV-related stigma, stress and depression in a diverse sample of HIV+ adults. Participants (N = 288) recruited from AIDS service organizations were administered the Experiences in Close Relationships Scale, Perceived Stress Scale, CES-D, HIV Stigma Scale and a health information questionnaire. Adult romantic attachment style was significantly associated with perceived stress, depression and HIV-related stigma. Results of regression analyses supported contentions that in addition to HIV symptomatology, other psychosocial risk factors such as attachment style and stigma contribute to perceived stress and depression among HIV+ men and women.

Effects of quality of life and coping on depression among adults living with HIV/AIDS.

This prospective study examined the effect of maladaptive coping strategies and psychological quality of life (QOL) on depression at two time points in a diverse sample of persons living with HIV/AIDS (N = 85). The use of maladaptive coping strategies to deal with the stress of living with HIV/AIDS, particularly engaging in various kinds of avoidant behaviors, was significantly associated with greater depression at baseline and increased depression at three months. QOL was the single most important predictor of depression. In an effort to develop effective clinical methods aimed at decreasing depression among adults living with HIV, future studies need to focus on improving quality of life and increasing adaptive coping strategies associated with the stress of living with HIV/AIDS.

Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS.

This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.

Sleep disturbances among HIV-positive adults: the role of pain, stress, and social support.

OBJECTIVE: Investigate the relationships between pain, stress, social support, and sleep disturbance among a diverse sample of HIV-positive adults. METHOD: Participants (N = 146) completed self-report measures on pain, stress, social support, and sleep disturbance. CD4 T-cell count was obtained from medical records. RESULTS: Greater pain and stress were associated with greater sleep disturbance. Greater assistance from friends was associated with greater sleep disturbance, whereas greater understanding from friends regarding participants' HIV-related stress was associated with less sleep disturbance. CONCLUSION: As expected, pain was significantly associated with sleep disturbance. Additionally, psychosocial variables were strongly associated with sleep. The type of support from friends differentiated whether the support was positively or negatively associated with sleep problems. Social support, depending on the type, may not always be helpful for adults living with HIV/AIDS. Future studies need to examine factors that may mediate the relationship between psychosocial constructs and healthy sleep.

Correlates of sexually transmitted disease infection among adults living with HIV.

This study examined the prevalence of sexually transmitted diseases (STDs) as well as the relationships between STDs and coping strategies used to deal with the stress of living with HIV among adults. The sample comprised 179 men and women, 58% were Caucasian, 54% were male, more than half (61%) were diagnosed with AIDS, 43% were heterosexual, and 39% reported an STD post-HIV diagnosis. Logistic regression analysis indicated that individuals reporting longer time elapsed since HIV diagnosis and greater use of emotion-focused coping were more likely to report STDs. There was an interaction effect between time and coping such that the less time that elapsed since HIV diagnosis and the more an individual used emotion-focused coping, the more likely they were to report an STD. Tailoring interventions to address specific stressors associated with length of time living with HIV, may be a particularly effective prevention strategy.

Alternative therapies: a common practice among men and women living with HIV.

This study examined the prevalence and factors associated with alternative therapy use in an ethnically diverse, gender-balanced sample of persons living with HIV/AIDS. More than two thirds (67%) of the participants who were taking HIV-related medications were also taking an alternative supplement. Half of the sample (50%) reported that they took one or more multivitamins, 17% reported using mineral supplements, 12% reported using Chinese herbs, and 12% reported using botanicals. Substantial proportions of the sample also reported using acupuncture (31%), massage (23%), and meditation (28%) to specifically treat HIV-related symptoms. Women were four times more likely to use alternative therapies than men. Also, Caucasians were nearly four times more likely to use alternative treatments compared to other ethnic groups. The results of this study indicate a strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients.

Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDS.

The authors examined factors associated with four dimensions of functional quality of life (physical functioning, energy/fatigue, social functioning, and role functioning) in 142 men and women living with HIV/AIDS. Participants completed the Brief COPE inventory and the Medical Outcomes Study Health Survey, with HIV-relevant items added. Greater use of maladaptive coping strategies was associated with lower levels of energy and social functioning. Pain severe enough to interfere with daily living tasks was associated with a lower level of functional quality of life on all four quality of life dimensions. Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.

HIV: effectiveness of complementary and alternative medicine.

Outcome studies examining the efficacy of CAM among people living with HIV-AIDS are often conducted among small sample sizes with very little follow-up data or time points. Generalizability of many of the study findings is further limited by participant attrition. It is difficult to conduct clinical studies on chronically ill patients without participants dropping out, typically because the study demands coupled with their illness become too burdensome. Several studies have been conducted that include control groups, double-blind designs, and randomization. These scientifically sound studies have demonstrated promising results that strongly indicate a need for further research with larger samples in a prospective research design so that safety and efficacy can be determined over time. Many of the studies with small sample sizes reported trends, but did not find statistical significance. Increasing sample sizes in future studies is necessary to evaluate the scientific merit of these trends. Moreover, researchers need to evaluate the clinical and statistical significance in CAM use. The psychologic benefits of taking CAM should not be underestimated. For the purposes of this article, the authors did not include psychologic outcomes; however, there is evidence suggesting that decreasing depression can decrease HIV-related somatic complaints [69]. Studies need also to examine the effectiveness of CAM on psychologic outcomes and physical outcomes. This article and the authors' own research (Gore-Felton C et al, unpublished data) have revealed a high prevalence of alternative supplement use in conjunction with HIV medication, indicating an urgent need to understand the health benefits and the health risks of alternative supplements among patients with HIV and AIDS. Patients and physicians need more empirically based research to examine the toxicities, interactions, and health benefits of CAM. Many patients do not report the use of CAM to their physicians and very few physicians record treatments in the clinical record [70]. This will likely change as CAM becomes more widely recognized as a legitimate medical intervention; however, controlled outcome studies among large, diverse samples of people living with HIV-AIDS are needed. Health care providers need to assess the use of herbal and alternative therapy practices by their patients. Some patients may not be aware that they are taking a supplement or plant-based herb. Furthermore, some patients may believe that they are using something innocuous and even healthy simply because it came from a health food store. Understanding the contraindications of alternative therapies is necessary to prevent deleterious outcomes and to facilitate the safe and efficacious use of CAM in the management of HIV disease and related symptoms. As the epidemic in the United States continues to rise among women and minority populations, clinical research trials must include ethnically diverse patient populations that are gender balanced. Current available studies indicate that many CAM interventions may improve the quality of life of people living with HIV-AIDS; however, further studies using longitudinal, controlled designs are needed to accurately assess the safety of such interventions.