Correlates of human immunodeficiency virus infection risk behavior in male attendees of a clinic for sexually transmitted disease.

Human immunodeficiency virus (HIV) infection risk behavior was evaluated in a cross-sectional survey of 400 male active-duty US Army personnel who presented at a sexually transmitted disease (STD) clinic with symptoms of acute urethritis. High-risk partners were common, and nearly one-quarter of the sample had previously had STDs. Logistic regression models examined correlates of HIV exposure risk, of inconsistent condom use, and of having partners with increased risk of HIV infection. Frequent partner turnover, sex "binging," negative attitudes toward condom use, and engaging in sex during military leaves were important correlates of risk. Individuals with HIV infection risk behavior generally were cognizant of their risk for HIV infection. Implications for intervention are discussed.

Reducing risk of sexually transmitted disease (STD) and human immunodeficiency virus infection in a military STD clinic: evaluation of a randomized preventive intervention trial.

Three single-session preventive interventions for reducing sexually transmitted disease (STD) and human immunodeficiency virus infection risk behaviors were evaluated with a sample of 400 men who attended a large military STD clinic. A quasi-experimental, pre-evaluation/postevaluation design was used, comparing standard clinic care alone versus standard care combined with 1 of 3 experimental interventions: health-risk appraisal, interactive video, and targeted situational behaviors. Questionnaire data were collected at baseline and during follow-up visits at 2 weeks and 2 months. Findings indicated that the health-risk appraisal and interactive video increased adherence with clinic recommendations to abstain from sex (chi(2)3199=19.67; P<.001) and increased readiness to change "risky" partner-selection behavior (chi(2)2194=6.42; P<.04). Follow-up data suggested that STD-related risk behavior was particularly resistant to change but that the single-session intervention had some impact, which could be viewed as a "priming" effect that enhances multisession interventions.

Complex coping patterns and their role in adaptation and neuroimmunomodulation. Theory, methodology, and research.

This paper describes the evolution of a model of adaptative coping, as well as an example of the converse, a maladaptive coping pattern, type C. It was hypothesized that the more closely a coping process resembles the inverted U-shaped function that characterizes homeostasis for most biological systems, the more likely it is to be adaptive, and to be associated with more positive health outcomes. Maladaptive learned coping patterns, such as type C coping, represent deviations from homeostasis in that they fail to recognize, respond appropriately to, and/or resolve stressors, thus keeping the physiological stress response chronically engaged, with subsequent long-term damage to implicated biological systems. This interpretation of how maladaptive coping patterns such as type C can influence health outcomes is consistent with findings from the author's 20-year program of research on the type C pattern, its assessment, and its association with poorer health indicators and outcomes in cancer (malignant melanoma) and HIV/AIDS.

Secondary HIV prevention.

AIDS: Primary HIV prevention, preventing HIV exposure among uninfected persons, has been the focus of much attention. However, secondary HIV prevention, preventing HIV transmission from infected people to their uninfected contacts, has not received as much interest or attention from HIV researchers, clinicians, and policymakers. The concept of secondary HIV prevention, as distinguished from primary prevention, is clarified, and the current and future strategies to further secondary HIV prevention efforts are explored. Secondary prevention strategies can be incorporated into comprehensive programs and result in shifts in attitudes and behaviors. This could reduce the size of the epidemic, while also benefiting the individual and his or her close relationships.^ieng

Stress and depressive symptoms prospectively predict immune change among HIV-seropositive men. HIV Neurobehavioral Research Center Group.

LIFE stress, mood, and other psychosocial factors may help to explain variability in HIV (human immunodeficiency virus) disease progression. Attempts to support this notion empirically have produced mixed findings; several studies report a positive relationship between psychosocial factors and various indicators of disease progression or immune function (e.g., Evans et al. 1992; Goodkin et. al. 1992), whereas others have failed to detect any association (e.g., Perry et. al. 1992).

Incentives and disincentives to participate in prophylactic HIV vaccine research.

An anonymous cross-sectional paper-and-pencil survey was used to assess incentives and disincentives to participate in a Phase I preventive human immunodeficiency virus (HIV) vaccine trial in a potential Thai target population. A total of 255 persons employed in health care service and research settings completed questionnaires after attending informational briefings regarding the proposed vaccine product and the planned trial procedures. Willingness to participate was related to self-perceived benefits from joining a preventive vaccine trial, as well as to concerns about product safety and social discrimination that might result from participation. The distinction between positive results of enzyme-linked immunosorbent assay from vaccine administration and positivity from HIV infection was unclear for many participants. Men were more willing to participate than women, and there was a trend toward greater willingness to participate in those who were less educated. Preparations for preventive vaccine trials may be more successful if they emphasize personal benefits of trial participation, clearly address safety issues, and consider ways to prevent social discrimination against participants.

Reaction time slowing in HIV-1-infected individuals: role of the preparatory interval.

Psychomotor speed and directed attention were evaluated in 83 human immunodeficiency virus-1-infected individuals (HIV+) and 50 HIV-1 seronegative (HIV-) control participants using simple and choice reaction time (RT) tasks. The simple RT task included 1- and 3-s, irregularly varied preparatory intervals (PI) between the warning and target lights. Relative to the HIV- group, simple and choice RT were significantly slowed in the HIV+ group. Further, again relative to the HIV- controls, the HIV+ group did not show expected faster RT with increased response preparation time in the simple RT task. This also occurred in some HIV+ subjects who did not have psychomotor slowing. These findings suggest that RT performance in HIV-1-infected individuals may reflect separate processes associated with psychomotor slowing and impaired ability to direct attention. Possible neural mechanisms associated with control of these processes are discussed.

Working memory in individuals with HIV infection.

The central executive component (CE) of Baddeley's working memory model (Baddeley, 1992) was evaluated in 26 asymptomatic human immunodeficiency virus-infected individuals (HIV+) and 23 HIV-control subjects using a dual-task working memory paradigm. The HIV+ and HIV- groups showed an equivalent reduction in performance on both the primary task (visual vigilance) and the secondary task (letter span) when they were performed concurrently relative to when either task was performed alone. This result suggested normal CE functioning in these HIV+ subjects. In contrast, the HIV+ subjects had significantly longer response latencies on reaction time measures relative to the HIV- control group. These findings indicated that slowed processing in early stage HIV-infected individuals is not associated with a working memory deficit.

Measuring performance decrements in aviation personnel infected with the human immunodeficiency virus.

There is controversy over whether cognitive impairment occurs in early human immunodeficiency virus (HIV) disease. When impairment is reported, findings are typically subclinical, affect only a minority, and their relationship to occupational functioning has not been established. Despite such findings, it has been recommended that HIV-seropositive pilots be disqualified from flying. This paper reviews research relevant to measuring performance decrements in HIV-infected aviators. Based upon current data, we conclude that although subtle neurobehavioral dysfunction may occur in some asymptomatic HIV-seropositive individuals, there is no research which has demonstrated associated decrements in aviation-related skills. Thus, it may be premature to recommend medical disqualification of all HIV-seropositive aviators. We propose, instead, that sensitive neurocognitive measures, incorporated into a comprehensive neurodiagnostic evaluation, could be used to evaluate asymptomatic HIV-seropositive aviators. Only those who are impaired on evaluation would be disqualified from flying. Concurrently, research investigating the relationship between abnormalities and aviation abilities would be conducted.

Identification of psychobiological stressors among HIV-positive women. HIV Neurobehavioral Research Center (HNRC) Group.

This research describes major stressors in the lives of women who have been infected with the human immunodeficiency virus (HIV). Thirty-one HIV antibody positive (HIV+) women infected primarily through heterosexual contact participated in a two hour semi-structured interview detailing the circumstances, context, and consequences of all stressful life events and difficulties experienced within the preceding six months. Qualitative methods of data analyses were utilized (Miles & Huberman, 1984). HIV-related life events and difficulties were classified into primary and secondary stressors based on the stress process model (Pearlin et al., 1981). Problems arising directly from one's seropositivity were defined as primary stressors. Stressful life events and difficulties occurring in other role areas were defined as secondary stressors. Six categories of HIV-related stressors were identified and quantified. Primary stressors were health-related, and included both gynecological problems (e.g., amenorrhea) and general symptoms of HIV infection (e.g., fatigue). Secondary stressors related to child and family (e.g., future guardianship of children), marital/partner relations (e.g., disclosure of HIV+ status), occupation (e.g., arranging time-off for medical appointments), economic problems (e.g., insurance "hassles"), and social network events (e.g., death of friends from AIDS). This research indicates that HIV-positive women are exposed to multiple stressors; some may be viewed as unique to women, whereas others may be considered common to both sexes. Identification of stressors has implications for the design of medical and psychiatric interventions for women.

Prevalence of psychiatric disorders in early stages of HIV infection.

As part of a military universal HIV screening program, 442 men were assessed for the presence of DSM-III-R defined psychiatric disorders and symptoms of anxiety and depression after notification of HIV seroconversion. Of them, 84.4% were in the earliest, asymptomatic stages of disease at the time of interview (96% did not have AIDS). The Structured Clinical Interview for DSM-III-R and Structured Interview Guide for the Hamilton Anxiety and Depression Scales were used. Relevant comparisons were made to Epidemiologic Catchment Area prevalence data. HIV seropositive men were more likely than age-matched men in the community to have current diagnoses of major depression (ages 18-44) and anxiety disorders (ages 25-44). Higher lifetime rates of major depression and alcohol use disorder, and high current prevalence of sexual dysfunction (21.7%) were noted. We conclude that men who become HIV seropositive have high rates of mood and substance use disorders prior to knowledge of seroconversion, and that early in the course of HIV infection men are at risk for developing major depression, anxiety disorders, and disorders of sexual desire.

Results of a one year longitudinal study of HIV antibody test notification from the San Francisco General Hospital cohort.

We examined the psychological impact of HIV antibody testing in 107 homosexual men in San Francisco. Seventy-eight percent of the seropositives but only 43% of the seronegatives correctly anticipated their results. Twelve months after notification (but not earlier), notified seropositives reported significantly greater increases in total distress than nonnotified controls. However, notified seronegatives demonstrated significantly lower levels of hopelessness than nonnotified controls at every follow-up assessment. Thus, knowledge of HIV antibody status appears to dispel a sense of gloom in persons who incorrectly believe themselves to be infected with HIV, but does not appear to induce significant distress in those whose expectation of a positive result is confirmed. Both groups reported lower distress than men with ARC or AIDS, suggesting that distress was related more to symptomatology than knowing antibody status. These results suggest the benefits of HIV testing for the considerable proportion of seronegative subjects believing themselves to be seropositive and should be weighted against the more limited induction of distress in seropositives who receive confirmation of their test result expectation. The benefits of testing are also supported by increasing knowledge of the usefulness of early intervention in HIV disease.

Evaluation of a hospital based substance abuse intervention and referral service for HIV affected patients.

This paper reports an outcome evaluation and needs assessment conducted by the AIDS and Substance Abuse Program (ASAP) of the San Francisco AIDS Health Project. The study was designed to: 1) evaluate effectiveness of a hospital based intervention and referral service for HIV affected substance abusers, and 2) gather information from this population regarding accessibility and barriers to drug treatment. Participants were 86 individuals consecutively referred to ASAP over an 8-month period. All received a brief needs assessment interview in addition to the standard ASAP evaluation protocol. Agency follow-up contacts were made for those individuals referred by ASAP to extended substance abuse treatment, with information limited to whether or not the client contacted the designated referral resource. Source of referral to ASAP, interest in treatment, and prior sexual risk behavior change were significant predictors of intervention outcome. Personal unreadiness and treatment program waiting lists were the most frequently reported obstacles to treatment. While most participants reported changing risk behavior in response to the AIDS epidemic, patterns of change differed according to intravenous drug use history.

Issues in psychoneuroimmunology research.

Careful design of studies is crucial for meaningful progress in this area of inquiry. Along with systematic evaluation of immunologic factors, clear understanding of antecedent factors is also important. Age, sex, and other sociodemographic factors might play a major role in how an individual reacts to a given situation when compared with another individual. Assessment of the impact of these factors on the immune system might be further complicated by immunosuppressive viruses like HIV or by the use of many common medications such as beta-blockers for hypertension (Kiecolt-Glaser & Glaser, 1988). Longitudinal studies are needed to understand the process of change and the dynamic patterning of psychosocial and immunologic relationships over time. Additionally, use of multimodal measures to assess psychological events such as stress is imperative (Baum, Grunberg, & Singer, 1982). It will not serve our understanding of psychological influences on the immune system to jump to the conclusion that an event is "stressful" because it seems as if it should be. Finally, establishing a "core" battery of widely accepted immune tests will be important in establishing comparability across studies. The standardization and acceptance of specific biochemical measures will facilitate the infusion of talented clinical and basic scientists into the area of psychoneuroimmunology.