Professor - Med Center Line, Psychiatry and Behavioral Sciences
Associate Chair, Department of Psychiatry and Behavioral Sciences (2011 - Present)
Associate Dean, Academic Affairs, Stanford University School of Medicine (2014 - Present)
Honors & Awards
Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Fellow, Institute for Women's Health and Leadership® at Drexel University College of Medicine (2011 -2012)
Fellowship: Stanford University Psychology Postdoctoral Fellowship (1999) CA
PhD Training: Stanford University Registrar (1997) CA
Internship: VA Palo Alto Health Care Psychology Training (1996) CA
Ph.D., Stanford University, Counseling & Health Psychology (1997)
Ed.M., Boston University, Counseling Psychology (1989)
B.A., UCLA, Psychology (1986)
Current Research and Scholarly Interests
My clinical focus is the treatment of anxiety disorders, including post traumatic stress disorder. My research focuses on developing effective psychotherapy interventions to reduce chronic stress as well as enhance positive health behaviors to reduce morbidity and mortality among patients coping with chronic, medical illnesses which are often life threatening.
Efficacy of Group Intervention to Reduce Stress Symptoms
This research study will examine the usefulness of groups in reducing stress and helping individuals with HIV to stay healthy and avoid problems associated with sexually transmitted diseases. We hope to discover whether being in a group is effective in reducing stress-related symptoms and promoting healthy behaviors.
Stanford is currently not accepting patients for this trial. For more information, please contact Susanne Lee, MPH, 650-724-7025.
Marital Functioning Among Combat Veterans
The purpose of this research study is to examine marital dynamics related to husband-wife reunification following the veteran's return
Stanford is currently not accepting patients for this trial. For more information, please contact Susanne Lee, MPH, 650-724-7025.
Graduate and Fellowship Programs
Modern Warfare: Video Game Playing and Posttraumatic Symptoms in Veterans
JOURNAL OF TRAUMATIC STRESS
2017; 30 (2): 182-185
Many of the current generation of veterans grew up with video games, including military first-person shooter (MFPS) video games. In MFPS games, players take the role of soldiers engaged in combat in environments modeled on real-life warzones. Exposure to trauma-congruent game content may either serve to exacerbate or to ameliorate posttraumatic symptoms. The current study examined the relationship between MFPS and other shooter video game playing and posttraumatic stress disorder (PTSD) symptoms among current and former members of the military (N = 111). Results indicated that video game play was very common, and 41.4% of participants reported playing MFPS or other shooter games (shooter players group). The shooter players group reported higher levels of PTSD symptoms than participants who did not play any video or shooter games (nonshooter/nonplayers group; d = 0.44); however, playing shooter games was not predictive of PTSD symptoms after accounting for personality, combat exposure, and social support variables. This may indicate that the same psychosocial factors predict both PTSD and shooter video game play. Although veterans may benefit from the development and use of clinical applications of video games in PTSD treatment, clinical attention should continue to focus on established psychosocial predictors of PTSD symptoms.
View details for DOI 10.1002/jts.22172
View details for Web of Science ID 000400339000011
View details for PubMedID 28370328
The Impact of Stigma and Social Support on Development of Post-traumatic Growth Among Persons Living with HIV
JOURNAL OF CLINICAL PSYCHOLOGY IN MEDICAL SETTINGS
2016; 23 (2): 126-134
Given high rates of trauma in people living with HIV (PLH) and the health benefits of posttraumatic growth (PTG), understanding how to foster PTG in PLH exposed to trauma could be of interest to clinical psychologists working with this population. The current study examined factors theoretically related to development of PTG in PLH, namely HIV-related stigma, disclosure of HIV status, and emotional support. A sample of 334 HIV-positive adults answered a battery of self-report questionnaires. HIV-related stigma, disclosure to sexual partners, and emotional support were significant predictors of PTG: stigma was associated with lower PTG, whereas disclosure and emotional support were associated with higher PTG. Disclosure and emotional support remained significantly associated with PTG in the model including demographic factors and stigma. These findings highlight the need for development of interventions that can aid PLH in disclosing their HIV status to sexual partners and increasing available social support.
View details for DOI 10.1007/s10880-015-9447-2
View details for PubMedID 26611361
HIV-related stigma: implications for symptoms of anxiety and depression among Malawian women.
African journal of AIDS research : AJAR
2015; 14 (1): 67-73
An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health. However, little is known about how HIV/ AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17-46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being.
View details for DOI 10.2989/16085906.2015.1016987
View details for PubMedID 25920985
View details for PubMedCentralID PMC4416225
The Relationship Between Sexual Trauma, Peritraumatic Dissociation, Posttraumatic Stress Disorder, and HIV-Related Health in HIV-Positive Men
JOURNAL OF TRAUMA & DISSOCIATION
2014; 15 (4): 420-435
This study tested a novel extension of P. P. Schnurr and B. L. Green's (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD-health relationship in HIV-positive individuals.
View details for DOI 10.1080/15299732.2013.873376
View details for Web of Science ID 000338990700004
View details for PubMedID 24354509
View details for PubMedCentralID PMC4119469
General self-efficacy in relation to unprotected sexual encounters among persons living with HIV.
Journal of health psychology
2013; 18 (5): 658-666
This study examined general self-efficacy in relation to sexual risk behavior among persons living with HIV and evaluated psychometric properties of the Positive Self Questionnaire, a novel measure of general self-efficacy. The Positive Self Questionnaire showed high internal consistency, a factor analysis supported by a single factor structure, and convergent validity supported by significant correlations in predicted directions with indicators of mental health. The Positive Self Questionnaire was related to unprotected sexual encounters, even after controlling for other factors. Results suggest that general self-efficacy is important to examine when assessing sexual risk behavior; an internally consistent measure is available for such endeavors.
View details for DOI 10.1177/1359105312454039
View details for PubMedID 22933575
The impact of childhood bullying among HIV-positive men: Psychosocial correlates and risk factors
CHILD ABUSE & NEGLECT
2013; 37 (4): 273-281
While some studies have examined the deleterious effects of childhood bullying on adults, no studies to date have focused on the effects of bullying on Persons Living with HIV (PLH), a particularly at-risk population. PLH experience higher rates of childhood and adulthood physical and sexual abuse than the population at large, and experience of childhood abuse appears to be predictive of sexual and other risk behaviors in this population. Thus it remains critical to examine rates of childhood bullying and correlates of bullying in adult PLH.A sample of 171 HIV-positive men over 18 years of age were recruited from the San Francisco Bay Area. All participants reported experiencing symptoms of traumatic stress. The participants were recruited as part of a larger study assessing a group intervention for individuals with HIV and symptoms of trauma. Self-report questionnaires were administered to assess participants' exposure to bullying in childhood and trauma symptoms in adulthood.Bullying was commonly reported by men in the current sample, with 91% of the sample endorsing having experienced some level of bullying before age 18. Having been bullied in childhood was significantly (p<.05) associated with methamphetamine use in adulthood, difficulties with mood, and with symptoms of trauma. Results of a hierarchical regression equation found that report of bullying in childhood predicted additional, unique variance in trauma symptoms in adulthood above and beyond the effect of exposure to other forms of trauma, resulting in a better-fitting model.The current study highlights the association between rate of childhood bullying and symptoms of trauma in adulthood, accounting for the effect of exposure to other forms of trauma. Given the impact of trauma symptoms on disease progression in PLH, exposure to bullying must be considered in any intervention aiming to reduce trauma symptoms or improve mental or physical health among HIV-positive populations.
View details for DOI 10.1016/j.chiabu.2012.09.016
View details for Web of Science ID 000317548200008
View details for PubMedID 23294606
View details for PubMedCentralID PMC3622771
Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS
JOURNAL OF BEHAVIORAL MEDICINE
2013; 36 (1): 51-60
Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.
View details for DOI 10.1007/s10865-012-9400-x
View details for Web of Science ID 000313366300006
View details for PubMedID 22311104
Sexual Risk Behaviors by Relationship Type and Trauma History Among HIV-Positive Men Who Have Sex with Men
ARCHIVES OF SEXUAL BEHAVIOR
2013; 42 (2): 257-265
The association of trauma exposure and coping style to sexual risk behavior has yet to be fully examined in the context of primary and casual sexual partnerships. The current study assessed a high risk sexual behavior-unprotected anal intercourse (UAI)-in a high risk population of HIV-positive men who have sex with men (MSM) with a history of trauma. Using audio computer-assisted self-interview technology, 132 HIV-positive MSM completed measures of trauma exposure, trauma symptoms, coping strategies, and sexual risk behavior. Hierarchical logistic regression analyses indicated that completing more years of education and having experienced sexual abuse were positively associated with UAI with casual partners. Additionally, use of active coping was negatively associated with UAI with casual partners and the final model significantly predicted variance in UAI with casual partners. However, no variables were significantly associated with UAI with primary partners, suggesting that sexual risk behavior with primary partners may be associated with factors not commonly assessed in risk prediction or prevention research. We discuss the results in the context of developing new or modifying existing interventions to address rates of sexual risk in the relationships of HIV-positive MSM.
View details for DOI 10.1007/s10508-011-9870-x
View details for PubMedID 22127728
Socio-Contextual Factors: Moving Beyond Individual Determinants of Sexual Risk Behavior among Gay and Bisexual Adolescent Males.
Journal of LGBT youth
2013; 10 (3)
This study investigated factors associated with sexual behavior that confers the greatest risk for HIV transmission (i.e., unprotected anal intercourse; UAI) among 52 sexually active gay and bisexual adolescent males in a Midwestern city ages 15-19. A logistic regression model found that ethnicity other than African American, more sexual partners in the past year, greater stigma towards homosexuality, and greater perceived peer sexual norms for risky behavior were significantly associated with UAI (x(2) =27.96, df=5, p<.001; Nagelkerke R(2) = 0.56). Implications for prevention interventions are discussed.
View details for DOI 10.1080/19361653.2013.799000
View details for PubMedID 24187600
View details for PubMedCentralID PMC3810983
The impact of denial on health-related quality of life in patients with HIV
QUALITY OF LIFE RESEARCH
2012; 21 (8): 1327-1336
The purpose of this study was to examine the influence of denial coping on quality of life (QOL) over time among individuals living with HIV, as denial has been understudied as a coping strategy within the literature on HIV/AIDS.In a sample of 65 adult men and women, we used multilevel linear modeling to test trajectories of change in physical and mental health-related QOL across baseline, 3, 6, and 12 months, including denial as a predictor and gender as a moderator.The use of denial coping was associated with lower physical and mental health-related QOL at baseline. Denial coping predicted an increase in QOL over time, though QOL remained low in those who practiced denial coping. Men's baseline mental health-related QOL was more negatively affected by denial coping than women's. Women tended to increase in QOL more slowly over time compared to men.Reliance on denial as a coping strategy is associated with poorer physical and mental health-related QOL in an HIV-positive population, though participants who engaged in denial also displayed more rapid improvement in their QOL over time. Men and women displayed different rates of improvement in QOL, indicating a need for gender-based treatment approaches. Future research should examine the complex role of denial on change in QOL.
View details for DOI 10.1007/s11136-011-0045-y
View details for PubMedID 22038393
THE IMPACT OF TRAUMA AND EMOTION DYSREGULATION ON SEXUAL RISK BEHAVIOR DIFFERS BY SEX AMONG ADULTS LIVING WITH HIV
SPRINGER. 2012: S102
View details for Web of Science ID 000302092400394
Sexual minority status and trauma symptom severity in men living with HIV/AIDS
JOURNAL OF BEHAVIORAL MEDICINE
2012; 35 (1): 38-46
Traumatic experiences are common among populations living with HIV; furthermore, the minority stress model indicates that sexual minority group members, such as men who have sex with men (MSM), are more likely to experience negative psychological outcomes after exposure to trauma, given the stress of minority stigma. The current study examined the prevalence of traumatic events and the impact of these events on trauma symptoms in a sample of 113 MSM and 51 men who have sex with women (MSW) who are living with HIV/AIDS. Rates of experiencing trauma were similar for both MSM and MSW. However, MSM, as sexual minority group members, were more likely to report symptoms of trauma and dissociation than MSW. The current study indicates that MSM may experience additional negative psychological outcomes after exposure to trauma. Findings are discussed in the context of implications for HIV prevention with sexual minority group members.
View details for DOI 10.1007/s10865-011-9329-5
View details for PubMedID 21344319
Relationships Among Childhood Trauma, Posttraumatic Stress Disorder, and Dissociation in Men Living with HIV/AIDS
JOURNAL OF TRAUMA & DISSOCIATION
2012; 13 (1): 102-114
This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r = .20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r = .69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.
View details for DOI 10.1080/15299732.2011.608629
View details for PubMedID 22211444
- "Liquor before beer, you're in the clear": binge drinking and other risk behaviours among fraternity/sorority members and their non-Greek peers JOURNAL OF SUBSTANCE USE 2012; 17 (4): 323-339
HIV disclosure patterns, predictors, and psychosocial correlates among HIV positive women in Zimbabwe
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
2012; 24 (3): 358-368
Disclosure of positive HIV status in Sub-Saharan Africa has been associated with safer sexual practices and better antiretroviral therapy (ART) adherence, but associations with psychosocial function are unclear. We examined patterns and psychosocial correlates of disclosure in a Zimbabwean community. Two hundred HIV positive women at different stages of initiating ART participated in a cross-sectional study examining actual disclosures, disclosure beliefs, perceived stigma, self-esteem, depression, and quality of life. Ninety-seven percent of the women disclosed to at least one person, 78% disclosed to their current husband/partner, with an average disclosure of four persons per woman. The majority (85-98%) of disclosures occurred in a positive manner and 72-95% of the individuals reacted positively. Factors significantly correlated with HIV disclosure to partners included being married, later age at menses, longer duration of HIV since diagnosis, being on ART, being more symptomatic at baseline, ever having used condoms, and greater number of partners in the last year. In multivariate analysis, being married and age at menses predicted disclosure to partners. Positive disclosure beliefs, but not the total number of disclosures, significantly correlated with lower perceived stigma (ρ = 0.44 for personalized subscale and ρ = 0.51 for public subscale, both p<0.0001), higher self-esteem (ρ = 0.15, p=0.04), and fewer depressive symptoms (ρ = -0.14, p=0.05). In conclusion, disclosure of positive HIV status among Zimbabwean women is common and is frequently met with positive reactions. Moreover, positive disclosure beliefs correlate significantly with psychosocial measures, including lower perceived stigma, higher self-esteem, and lower depression.
View details for DOI 10.1080/09540121.2011.608786
View details for Web of Science ID 000301532700011
View details for PubMedID 21902570
View details for PubMedCentralID PMC3243809
Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS
JOURNAL OF PSYCHIATRIC RESEARCH
2011; 45 (7): 942-948
There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship.Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis.Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05).This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence.
View details for DOI 10.1016/j.jpsychires.2011.05.003
View details for Web of Science ID 000292667900012
View details for PubMedID 21636097
View details for PubMedCentralID PMC3118254
CRACK USE AMONG HIV-POSITIVE ADULTS IS ASSOCIATED WITH SYMPTOMS OF PAIN AND FATIGUE
SPRINGER. 2011: S122
View details for Web of Science ID 000289297700481
RELATIONSHIP TYPE, TRAUMA EXPOSURE, AND SEXUAL RISK BEHAVIORS IN HIV-POSITIVE MEN WHO HAVE SEX WITH MEN
SPRINGER. 2011: S18
View details for Web of Science ID 000289297700068
METHAMPHETAMINE USE AMONG HIV-POSITIVE MEN WITH HISTORIES OF TRAUMA
SPRINGER. 2011: S46
View details for Web of Science ID 000289297700180
A Review of Efficacious Technology-Based Weight-Loss Interventions: Five Key Components
TELEMEDICINE JOURNAL AND E-HEALTH
2010; 16 (9): 931-938
Obesity is highly prevalent among American adults and has negative health and psychosocial consequences. The purpose of this article was to qualitatively review studies that used technology-based interventions for weight loss and to identify specific components of these interventions that are effective in facilitating weight loss.We conducted a narrow, qualitative review, focusing on articles published in the last 10 years that used an experimental or pre/posttest design and used a technology-based intervention for weight loss.Among the 21 studies reviewed, we identified the following five components that we consider to be crucial in technology-based weight-loss interventions that are successful in facilitating weight loss: self monitoring, counselor feedback and communication, social support, use of a structured program, and use of an individually tailored program.Short-term results of technologically driven weight-loss interventions using these components have been promising, but long-term results have been mixed. Although more longitudinal studies are needed for interventions implementing these five components, the interface of technology and behavior change is an effective foundation of a successful, short-term weight-loss program and may prove to be the basis of long-term weight loss.
View details for DOI 10.1089/tmj.2010.0065
View details for Web of Science ID 000284576000004
View details for PubMedID 21091286
View details for PubMedCentralID PMC3000900
TEST OF A SOCIAL-COGNITIVE MODEL OF REGULAR HIV-TESTING AMONG HETEROSEXUAL MEN
SPRINGER. 2010: 140
View details for Web of Science ID 000275841700541
EMOTION REGULATION AND COPING PREDICT SEXUAL RISK BEHAVIORS IN HIV-POSITIVE MEN
SPRINGER. 2010: 204
View details for Web of Science ID 000275841700795
A pilot study investigating the effects of trauma, experiential avoidance, and disease management in HIV-positive MSM using methamphetamine.
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
2010; 9 (2): 78-81
With high rates of trauma among HIV-positive men who have sex with men (MSM) who use methamphetamine, this preliminary pilot study examined the associations between experiential avoidance, trauma symptoms, and management of a chronic illness. Among a small sample of HIV-positive, methamphetamine-using MSM in a California Bay Area County, greater reported experiential avoidance was significantly related to greater reported trauma and symptoms of traumatic stress. Furthermore, greater reported experiential avoidance was significantly related to reduced self-efficacy of illness management and more frequent methamphetamine use. Although further research is needed, these data suggest that addressing issues of experiential avoidance and trauma could affect behavioral choices and treatment outcomes in this high-risk population.
View details for DOI 10.1177/1545109709360065
View details for PubMedID 20142604
Reactions of Heterosexual African American Men to Women's Condom Negotiation Strategies
JOURNAL OF SEX RESEARCH
2010; 47 (6): 539-551
This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.
View details for DOI 10.1080/00224490903216763
View details for Web of Science ID 000283880100003
View details for PubMedID 19760529
View details for PubMedCentralID PMC2888974
Personal Values and Meaning in the Use of Methamphetamine Among HIV-Positive Men Who Have Sex With Men
QUALITATIVE HEALTH RESEARCH
2009; 19 (4): 504-518
Our aim with this qualitative study was to understand the role of personal values, meaning, and impact of drug use among HIV-positive men who have sex with men (MSM) who struggle with methamphetamine use. Participants were 22 MSM recruited from an ethnically diverse county in the San Francisco Bay area of California. Grounded theory was used to analyze the data collected in individual interviews. Emergent constructs of context, meaning, and perceived impact were identified and are described in a theoretical narrative format. The importance of broadening our understanding of HIV and methamphetamine addiction and their interaction is highlighted. This study contributes to the understanding of the complexity of methamphetamine use within the specific population of MSM living with HIV/ AIDS, and suggests possible directions for addressing important maintaining factors like adaptive use and enhancing factors that could contribute to an individual's ability to make better choices based on meaning and personal values.
View details for DOI 10.1177/1049732309333018
View details for Web of Science ID 000264405400008
View details for PubMedID 19299756
Relationship Power, Acculturation, and Sexual Risk Behavior Among Low-Income Latinas of Mexican or Puerto Rican Ethnicity
SEXUALITY RESEARCH AND SOCIAL POLICY
2009; 6 (1): 56-69
View details for Web of Science ID 000207936100005
Influenced Coping, Social Support, and Depression on Subjective Health Status Among HIV-Positive Adults With Different Sexual Identities
2009; 34 (4): 133-144
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
View details for Web of Science ID 000261652700002
View details for PubMedID 19064372
View details for PubMedCentralID PMC2653049
Alcohol Use and Sexual Risk Behavior among College Students: Understanding Gender and Ethnic Differences
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE
2009; 35 (2): 80-84
The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior.Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey.Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men.Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.
View details for DOI 10.1080/00952990802585422
View details for Web of Science ID 000264554500006
View details for PubMedID 19253158
Quality of life, psychosocial health, and antiretroviral therapy among HIV-positive women in Zimbabwe
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
2009; 21 (12): 1517-1527
Little is known about the psychosocial impact of antiretroviral therapy (ART) among women in sub-Saharan Africa. Therefore, we conducted a cross-sectional study in Zimbabwe to assess the impact of ART on HIV-positive women's health-related quality of life, using the Medical Outcomes Study-HIV Quality of Life (QOL) questionnaire. Additionally, we assessed socio-demographics, reproductive and sexual health, HIV-related history, disclosure, social stigma, self-esteem, and depression. Structured interviews were conducted with 200 HIV-positive women and categorized into three groups by treatment: (1) Group 1 (n=31) did not meet clinical or laboratory criteria to begin treatment; (2) Group 2 (n=73) was eligible to begin treatment but awaiting initiation of treatment; and (3) Group 3 (n=96) was on ART for a median of 13 months. The women had similar socio-demographic characteristics but varied significantly in clinical characteristics. Women on ART reported fewer AIDS-related symptoms in the last week and year and had higher current and lower baseline CD4 counts compared to women not on ART. On most QOL domains women on ART reported higher mean scores as compared to women not on ART (p<0.01). Additionally, women on ART reported less depression compared to women not on ART (p<0.001). Between the two groups of women not on ART, unexpectedly, there were no significant differences in their scores for QOL or depression. Thus, Zimbabwean women living with HIV experience better overall QOL and lower depression on ART. Altogether, our findings suggest that ART delivery in resource-poor communities can enhance overall QOL as well as psychosocial functioning, which has wide-ranging public health implications.
View details for DOI 10.1080/09540120902923055
View details for Web of Science ID 000273008700005
View details for PubMedID 20024731
Spiritual Striving, Acceptance Coping, and Depressive Symptoms among Adults Living with HIV/AIDS
JOURNAL OF HEALTH PSYCHOLOGY
2009; 14 (1): 88-97
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.
View details for DOI 10.1177/1359105308097949
View details for Web of Science ID 000262287200011
View details for PubMedID 19129341
Behavioral mediation of the relationship between psychosocial factors and HIV disease progression
2008; 70 (5): 569-574
The psychological and physical demands of coping with medication side effects and comorbid illnesses can be overwhelming and may influence behaviors, such as medication adherence, substance use, sexual risk behavior, and exercise that, in turn, affect health outcomes. Cross-sectional and prospective studies among diverse populations of persons living with HIV suggest that these behavioral mechanisms may be associated with HIV disease progression. The motivation to change behavior is often highest in the immediate aftermath of a stressor. However, over time the motivation to continue a particular behavior change is often challenged by habits, environmental influences, and psychosocial factors. Furthermore, a number of studies suggest that behavioral mechanisms may mediate the relationship between psychosocial variables (e.g., stress, depression, coping, and social support) and disease progression in HIV. Thus, developing clinical interventions that address these psychosocial factors and enhance protective health behaviors and reduce behaviors that convey risk to health are likely to lessen overall morbidity and mortality among patients living with HIV/AIDS.
View details for DOI 10.1097/PSY.0b013e318177353e
View details for Web of Science ID 000257307100008
View details for PubMedID 18519885
Condom use negotiation in heterosexual African American adults: Responses to types of social power-based strategies
JOURNAL OF SEX RESEARCH
2008; 45 (2): 150-163
This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually active African American adults attending an inner-city community center. Participants completed a semistructured qualitative interview in which they were presented with six negotiation strategies based on Raven's 1992 Power/Interaction Model of Interpersonal Influence. Results showed that female participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Male participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of participants indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention efforts are discussed.
View details for DOI 10.1080/00224490801987440
View details for Web of Science ID 000256887200088
View details for PubMedID 18569536
View details for PubMedCentralID PMC2753393
Lessons learned from more than two decades of HIV/AIDS prevention efforts: Implications for people who are deaf or hard of hearing
AMERICAN ANNALS OF THE DEAF
2008; 153 (1): 48-54
In contrast with the nearly 30 years of HIV/AIDS research with the hearing community, data on HIV infection among persons who are deaf and hard of hearing is primarily anecdotal. Although the few available estimates suggest that deaf and hard of hearing persons are disproportionately affected by HIV infection, no surveillance systems are in place to identify either frequency or mode of HIV infection within this population. Moreover, to date, all empirically validated HIV prevention interventions have relied on communication strategies developed for persons who hear. Therefore, understanding and developing effective prevention methods is crucial for persons who are deaf or hard of hearing. The authors explore (a) factors among this population that may contribute to HIV-related behaviors, (b) four key concepts consistently included in successful interventions, and (c) practical ways in which to use this information to tailor effective intervention strategies for this population.
View details for Web of Science ID 000256818600005
View details for PubMedID 18619068
View details for PubMedCentralID PMC2728086
Medication adherence and sexual risk behavior among HIV-Infected adults: Implications for transmission of resistant virus
AIDS AND BEHAVIOR
2007; 11 (5): 663-675
As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.5% of the sample reported both non-adherence and sexual risk. Individuals were 46% more likely to report one of these risk outcomes when the other one was present and the presence of both outcomes was associated with an increased likelihood of having a detectable viral load. A simultaneous polytomous regression analysis revealed complex relationships among a range of psychosocial variables and the two primary behavioral risk outcomes. There is a need for targeted interventions and integration of mental health and substance use services into primary HIV care settings.
View details for DOI 10.1007/s10461-006-9201-8
View details for Web of Science ID 000249008000003
View details for PubMedID 17243012
Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence
JOURNAL OF INTERPERSONAL VIOLENCE
2007; 22 (4): 438-455
This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.
View details for DOI 10.1177/0886260506297028
View details for Web of Science ID 000244936300005
View details for PubMedID 17369446
Depressive symptomatology among HIV-positive women in the era of HAART: A stress and coping model
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2006; 38 (3-4): 275-285
An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace.HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors.Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology.Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.
View details for DOI 10.1007/s10464-006-9083-y
View details for Web of Science ID 000242602400014
View details for PubMedID 16967343
Effects of quality of life and coping on depression among adults living with HIV/AIDS (vol 11, pg 711, 2006)
JOURNAL OF HEALTH PSYCHOLOGY
2006; 11 (6): CP2
View details for Web of Science ID 000242342000001
Effects of quality of life and coping on depression among adults living with HIV/AIDS
JOURNAL OF HEALTH PSYCHOLOGY
2006; 11 (5): 711-729
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.
View details for DOI 10.1177/1359105306066626
View details for Web of Science ID 000240771400006
View details for PubMedID 16908468
- Childhood sexual abuse and HIV risk among men who have sex with men: Initial test of a conceptual model JOURNAL OF FAMILY VIOLENCE 2006; 21 (4): 263-270
Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: A mediation model
AIDS PATIENT CARE AND STDS
2006; 20 (4): 258-268
Adherence to antiretroviral (ARV) therapy for HIV infection is critical for maximum benefit from treatment and for the prevention of HIV-related complications. There is evidence that many factors determine medication adherence, including adherence self-efficacy (confidence in one's ability to adhere) and relations with health care providers. However, there are no studies that examine how these two factors relate to each other and their subsequent influence on HIV medication adherence. The goal of the current analysis was to explore a model of medication adherence in which the relationship between positive provider interactions and adherence is mediated by adherence self-efficacy. Computerized self-administered and interviewer-administered self reported measures of medication adherence, demographic and treatment variables, provider interactions, and adherence self-efficacy were administered to 2765 HIV-infected adults on ARV. Criteria for mediation were met, supporting a model in which adherence self-efficacy is the mechanism for the relationship between positive provider interactions and adherence. The finding was consistent when the sample was stratified by gender, race, injection drug use history, and whether the participant reported receipt of HIV specialty care. Positive provider interactions may foster greater adherence self-efficacy, which is associated with better adherence to medications. Results suggest implications for improving provider interactions in clinical care, and future directions for clarifying interrelationships among provider interactions, adherence self-efficacy, and medication adherence are supported.
View details for Web of Science ID 000237073900005
View details for PubMedID 16623624
Perceived partner serostatus, attribution of responsibility for prevention of HIV transmission, and sexual risk behavior with "main" partner among adults living with HIV
AIDS EDUCATION AND PREVENTION
2006; 18 (2): 150-162
Persons living with HIV (PLH) often attribute HIV status to sexual partners based on observable partner characteristics. The present study investigated the relationship of sexual behavior with most recent "main" partner to that partner's perceived serostatus among 1,232 PLH interviewed in clinics and community agencies in Los Angeles, California. PLH who believed their most recent main partner to be HIV-negative more often identified partner appearance as a basis for their perceptions than those who believed their most recent main partner to be HIV-positive. PLH who perceived their most recent main partner as HIV-negative were more likely to assume responsibility for partner protection and always to use condoms, and less likely to report recent unprotected vaginal or anal sex with that partner. Unprotected receptive anal intercourse with their most recent main partner was less common among African American, Latino, and White participants who believed that partner to be HIV-negative. Although PLH appear protective toward HIV-negative main partners, interventions to encourage valid methods of identifying partner serostatus are needed.
View details for Web of Science ID 000237119200005
View details for PubMedID 16649960
Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments
2005; 19 (14): 1509-1516
Youth are increasingly at risk for contracting HIV infection, and community-level interventions are needed to reduce behavioral risk.A randomized, controlled, multi-site community-level intervention trial was undertaken with adolescents living in 15 low-income housing developments in five US cities.Baseline (n = 1172), short-term follow-up (n = 865), and long-term follow-up (n = 763) risk assessments were conducted among adolescents, ages 12-17, in all 15 housing developments. The developments were randomly assigned in equal numbers to each of three conditions: experimental community-level intervention (five developments); "state-of-the-science" skills training workshops (five developments); and, education-only delayed control intervention (five developments).At long-term follow-up, adolescents living in the housing developments receiving the community-level intervention were more likely to delay onset of first intercourse (85%) than those in the control developments (76%), while those in the workshop developments (78%) did not differ from control condition adolescents. Adolescents in both the community-level intervention (77%) and workshop (76%) developments were more likely to use a condom at last intercourse than those in control (62%) developments.Community-level interventions that include skills training and engage adolescents in neighborhood-based HIV prevention activities can produce and maintain reductions in sexual risk behavior, including delaying sexual debut and increasing condom use.
View details for Web of Science ID 000232314400010
View details for PubMedID 16135905
Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS
AIDS PATIENT CARE AND STDS
2005; 19 (9): 587-598
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.
View details for Web of Science ID 000232058300006
View details for PubMedID 16164385
Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus
2005; 43 (4): 401-410
Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort.Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization.Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis.A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.
View details for Web of Science ID 000227914000011
View details for PubMedID 15778643
Demographic characteristics, treatment history, drug risk behaviors, and condom use attitudes for US and Russian injection drug users: The need for targeted sexual risk behavior interventions
AIDS AND BEHAVIOR
2005; 9 (1): 111-120
Two separate databases, one on Russian (n = 444) injection drug users (IDUs), and the other on U.S. IDUs (n = 241), were merged, and responses were compared. Results indicated that Russian IDUs perceived themselves to be at greater risk for HIV/AIDS based upon behaviors over the past 90 days. U.S. IDUs were more likely to be tested for HIV, report a negative HIV result, and know more people with HIV. U.S. IDUs consumed greater amounts of alcohol and marijuana, and made more alcohol/drug treatment attempts than Russian IDUs. Russian IDUs injected more frequently, although were more likely to recently use clean needles. Russian and U.S. IDUs responded significantly differently to eight AIDS knowledge questions. Eight condom attitude questions were asked of each group, and each revealed significantly different responses. Gender differences for Russian IDUs were also observed. There is a clear need to create culturally targeted sexual risk reduction interventions.
View details for DOI 10.1007/s10461-005-1686-z
View details for Web of Science ID 000228178800010
View details for PubMedID 15812618
Predictors of substance use frequency and reductions in seriousness of use among persons living with HIV
DRUG AND ALCOHOL DEPENDENCE
2005; 77 (2): 129-138
To examine predictors of the current level of substance use and reductions in seriousness of substance use among adults living with HIV.Cross-sectional survey. Setting: Four major metropolitan areas of the United States.Three thousand eight hundred six adults living with HIV.Self-reported substance use, depression, and quality of life from audio computer assisted self-interviewing and computer assisted personal interviewing structured assessments.Recent substance use of persons living with HIV was classified as frequent (40%), occasional (32%), or abstinent (28%). Participants using drugs at a frequent level identified as heterosexual, had public insurance, and had higher levels of depression. Participants who reduced from a lifetime high seriousness in substance use were female, older, and knew their HIV status for a longer period of time.Screening and identification of substance use should be included in all treatment settings and community-based organizations serving adults living with HIV.
View details for DOI 10.1016/j.drugalcdep.2004.07.009
View details for Web of Science ID 000227092300003
View details for PubMedID 15664714
Perceived adverse effects of antiretroviral therapy
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
2005; 29 (2): 193-205
Adverse effects from antiretroviral therapy (ARV) for HIV are associated with medication nonadherence. The purposes of this study were to explore group differences in the reporting of adverse effects, identify individual adverse effects that are linked to nonadherence, and to explore the role of coping in the relationship between adverse effects and adherence. Cross-sectional interviews of 2,765 HIV-positive adults on ARV therapies in four U.S. cities were performed using a computerized assessment of self-reported adverse effects, coping self-efficacy, and adherence. There were no gender differences in the rate or severity of adverse effects reported. Latino respondents reported more adverse effects than either White or African Americans. Those taking a protease inhibitor (PI) reported a higher rate and greater severity of adverse effects. Older participants reported fewer adverse effects despite being more likely to be on a regimen containing a PI. Respondents with less than 90% adherence reported greater numbers and severity of adverse effects overall. In multivariate analyses, nausea, skin problems, vomiting, and memory adverse effects were independently related to less than 90% adherence over the prior three days. Coping moderated the relationship between nausea and adherence such that individuals who reported lower coping self-efficacy and experienced nausea were at increased risk for nonadherence, regardless of the length of time on the current ARV regimen. Women and men are similar in their overall reports of adverse effects, and Latinos report more adverse effects to ARVs than White or African American patients. Specific adverse effects (skin problems, memory problems, vomiting, and nausea) are more likely than others to be associated with missing ARV medications. Increasing adaptive coping self-efficacy among patients experiencing nausea may be a particularly effective strategy in increasing medication adherence.
View details for DOI 10.1016/j.jpainsymman.2004.05.005
View details for Web of Science ID 000227736200014
View details for PubMedID 15793937
The Healthy Living Project: An individually tailored, multidimensional intervention for HIV-infected persons
AIDS EDUCATION AND PREVENTION
2005; 17 (1): 21-39
The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals. Sessions are tailored to individuals within a structure that uses role-plays, problem solving, and goal setting techniques. A 'Life Project'--or overarching goal related to personal striving-provides continuity throughout sessions. Because this is an ongoing project with efficacy yet to be established, we do not report intervention outcomes. However, the intervention was designed to be useful for prevention case management, settings where repeated one-on-one contact is possible, and where a structured but highly individualized intervention approach is desired.
View details for Web of Science ID 000227328200003
View details for PubMedID 15843115
Sleep disturbances among HIV-positive adults - The role of pain, stress, and social support
JOURNAL OF PSYCHOSOMATIC RESEARCH
2004; 57 (5): 459-463
Investigate the relationships between pain, stress, social support, and sleep disturbance among a diverse sample of HIV-positive adults.Participants (N = 146) completed self-report measures on pain, stress, social support, and sleep disturbance. CD4 T-cell count was obtained from medical records.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.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.
View details for DOI 10.1016/j.jpsychores.2004.03.003
View details for Web of Science ID 000225987500008
View details for PubMedID 15581649
The changing age of HIV: sexual risk among older African American women living in rural communities
2004; 39 (4): 809-814
African American women aged 50 and older are disproportionately affected by the HIV/AIDS epidemic. Despite African Americans making up 11% of all older women in the United States, in 2001, they accounted for more than 50% of AIDS cases among older women and more than 65% of HIV cases among older women. Using the AIDS Risk Reduction Model as a conceptual framework, this study investigated HIV risk behavior among older rural African American women (mean age = 58 years).A cross-sectional survey was conducted (n = 181) in three rural counties in South Carolina.Most (67%) of the women had at least one sex partner in the past five years, and of these, more than half (59.5%) reported at least one sexual risk behavior. High-risk behavior was associated with less education, lower condom use self-efficacy, more peers who discussed HIV-related risk behavior, and less comfort communicating with partners about sex.A significant proportion of older African American women living in rural counties are at increased risk for HIV infection, suggesting an urgent need for HIV prevention efforts to target this population.
View details for DOI 10.1016/j.ypmed.2004.03.005
View details for Web of Science ID 000224053500023
View details for PubMedID 15351550
Characteristics and hiv risk behaviors among injection drug users in St. Petersburg, Russia: A comparison of needle exchange program attenders and nonattenders
JOURNAL OF DRUG ISSUES
2004; 34 (4): 787-803
View details for Web of Science ID 000226232300004
Distance communication transfer of HIV prevention interventions to service providers
2004; 305 (5692): 1953-1955
Most acquired immunodeficiency syndrome (AIDS) service providers are in countries with little access to scientific developments relevant to their programs. It is critical to transfer advances from the scientific arena to service providers on a global scale. Human immunodeficiency virus (HIV) prevention organizations in 78 countries were randomized to receive either a control condition or a technology transfer condition with an interactive distance learning computer training curriculum and individualized distance consultation. Of 42 nongovernmental organizations in the technology transfer condition, 29 adopted the science-based program in their communities or trained other agencies to also use it. Advanced communication technologies can create a cost-effective infrastructure to disseminate new intervention models to service providers worldwide.
View details for Web of Science ID 000224136000045
View details for PubMedID 15448268
HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
2004; 36 (5): 1057-1066
Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.
View details for Web of Science ID 000222974300009
View details for PubMedID 15247559
HIV risk behavior among ethnically diverse adolescents living in low-income housing developments
JOURNAL OF ADOLESCENT HEALTH
2004; 35 (2): 141-150
To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents.Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification.Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use.HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.
View details for DOI 10.1016/j.jadohealth.2003.09.008
View details for Web of Science ID 000222880400010
View details for PubMedID 15261643
Drug use and sexual risk behaviours among female Russian IDUs who exchange sex for money or drugs
INTERNATIONAL JOURNAL OF STD & AIDS
2004; 15 (5): 343-347
Countries of the former Soviet Union are experiencing the steepest increases in annual HIV incidence in the world. Over 80% of registered HIV cases in Russia have occurred among intravenous drug users (IDUs), but current conditions set the stage for a heterosexually-transmitted epidemic. IDUs who also trade sex for money or drugs may serve as a conduit, or 'bridge' group, through which HIV could make inroads into the general Russian population. The present study examined the prevalence of sex trading among female Russian IDUs, and further examined drug use, sexual behaviour, and perceived vulnerability in this group. Female IDUs (n=100) in St Petersburg, Russia participated; 37% reported a history of sex trading. This group reported a mean of 49.5 male sexual partners in the previous month and an average of 15.4 unprotected vaginal intercourse acts in the previous 30 days. A significant minority (44%) also reported sharing injection equipment with others. Mathematical models to calculate risk estimates for HIV seroconversion indicated that participants were at significant risk of contracting HIV and infecting sexual partners. Despite significant rates of risk behaviours, most participants perceived themselves to be at little risk of contracting HIV. Effective HIV prevention programmes targeted at this group are urgently needed and are likely to be a cost-effective step in curtailing the spread of HIV in the region.
View details for Web of Science ID 000221585900014
View details for PubMedID 15117506
Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men.
Journal of child sexual abuse
2004; 13 (1): 1-15
Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.
View details for PubMedID 15353374
Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: Findings from the healthy living project
AIDS PATIENT CARE AND STDS
2003; 17 (12): 645-656
Adherence to antiretroviral therapy (ART) remains a challenge in efforts to maximize HIV treatment benefits. Previous studies of antiretroviral adherence are limited by low statistical power, homogeneous samples, and biased assessment methods. Based on Social Action Theory and using a large, diverse sample of men and women living with HIV, the objectives of the current study are to clarify correlates of nonadherence to ART and to provide theory-guided, empirically supported direction for intervening on ART nonadherence.Cross-sectional interview study utilizing a computerized interview.Recruited from clinics, agencies, and via media ads in four U.S. cities from June 2000 to January 2002.Two thousand seven hundred and sixty-five HIV-positive adults taking ART.Computer-assessed self-reported antiretroviral adherence.Thirty-two percent reported less than 90% adherence to ART in the prior 3 days. A number of factors were related to nonadherence in univariate analysis. Multivariate analyses identified that being African American, being in a primary relationship, and a history of injection drug use or homelessness in the past year were associated with greater likelihood of nonadherence. Furthermore, adherence self-efficacy, and being able to manage side effects and fit medications into daily routines were protective against nonadherence. Being tired of taking medications was associated with poorer adherence whereas a belief that nonadherence can make the virus stronger was associated with better adherence.Results support the need for multifocused interventions to improve medication adherence that address logistical barriers, substance use, attitudes and expectancies, as well as skills building and self-efficacy enhancement. Further exploration of issues related to adherence for African Americans and men in primary relationships is warranted.
View details for Web of Science ID 000187840000005
View details for PubMedID 14746658
Correlates of sexually transmitted disease infection among adults living with HIV
INTERNATIONAL JOURNAL OF STD & AIDS
2003; 14 (8): 539-546
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.
View details for Web of Science ID 000184475400011
View details for PubMedID 12935384
Alternative therapies: a common practice among men and women living with HIV.
journal of the Association of Nurses in AIDS Care : JANAC
2003; 14 (3): 17-27
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.
View details for PubMedID 12800809
Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDS
2003; 44 (1): 51-58
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.
View details for Web of Science ID 000180171100007
View details for PubMedID 12515838
The influence of gender on factors associated with HIV transmission risk among young Russian injection drug users
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE
2003; 29 (4): 881-894
HIV infection rates are dramatically increasing in the Russian Federation. Epidemiological studies indicate that the greatest rise of HIV incidence has been among injection drug users (IDU). Young adults (N = 188) who reported injecting drug use completed surveys and interviews that assessed injection drug use behavior, sexual behavior, and HIV-related knowledge. The average age of participants was 21.3 years. Multiple linear regression analysis found male gender and younger age at sexual debut was positively and significantly associated with having multiple sexual partners. Gender moderated the effects of sexual debut and number of times injected drugs were used in the past month. Males who initiate sex at a younger age were more likely to report multiple sex partners and females who reported higher frequency of drug use were more likely to report multiple sex partners. Gender is an important factor, as well as moderator of risk behavior among Russian injection drug users. Delaying sexual debut, particularly for males, may be an effective strategy to reduce subsequent risk behavior. Prevention efforts among IDUs need to address sexual risk behavior in conjunction with injection risk behavior.
View details for DOI 10.1081/ADA-120026267
View details for Web of Science ID 000187385900011
View details for PubMedID 14713145
- Recent stressful life events, sexual revictimization, and their relationship with traumatic stress symptoms among women sexually abused in childhood JOURNAL OF INTERPERSONAL VIOLENCE 2002; 17 (12): 1274-1290
The influence of social support, coping with mood on sexual risk behavior among HIV-positive men and women
JOURNAL OF HEALTH PSYCHOLOGY
2002; 7 (6): 713-722
The purpose of this study was to examine the relationships between social support, coping, mood and sexual risk behavior. Participants were 122 HIV-positive adults (60 women and 62 men). All participants were assessed on sexual risk behavior, perceived partner social support, coping with HIV/AIDS and mood. The results showed that sexual risk behavior was associated with male gender, education, perceived support of their partners and the use of emotion-focused coping style to deal with living with HIV and AIDS. Intervening with partners and developing effective coping strategies may decrease risk among HIV-positive men and women. Indeed, effective HIV prevention interventions must consider the social, psychological and cultural context in which sexual risk behavior occurs and develop strategies that intervene on these psychosocial factors.
View details for Web of Science ID 000179174100007
View details for PubMedID 22113412
Coping, social support, and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS
JOURNAL OF BEHAVIORAL MEDICINE
2002; 25 (4): 337-353
The purpose of this study was to examine psychosocial correlates of adjustment to HIV/AIDS in a sample of 137 HIV-positive persons (78 men and 59 women). Multiple regression analysis was used to examine relationships between perceived quality of general social support, three attachment styles, and three coping styles with total score on Positive States of Mind Scale (PSOMS), our measure of adjustment. The influence of demographic and medical status variables was also accounted for. PSOMS total score was significantly associated with greater satisfaction with social support related to HIV/AIDS, more secure attachment style, and less use of behavioral disengagement in coping with HIV/AIDS. These results indicate that for people with HIV or AIDS, those individuals who are more satisfied with their relationships, securely engaged with others, and more directly engaged with their illness are more likely to experience positive adjustment. Implications for physical health outcome and opportunities for intervention are discussed.
View details for Web of Science ID 000176226700002
View details for PubMedID 12136496
Characteristics and predictors of HIV risk behaviors among injection-drug-using men and women in St. Petersburg, Russia
AIDS EDUCATION AND PREVENTION
2002; 14 (4): 295-305
The purpose of this study was to establish the prevalence of high-risk sexual behaviors and drug-using behaviors in a large community sample of male and female injection drug users (IDUs) in St. Petersburg, Russia. This investigation used a data collection plan that systematically recruited a drug user sample from venues where IDUs were known to congregate and could be accessed. Surveys were completed by 239 IDUs (males = 139, females = 100), aged 13-25. Participants averaged 44 injections (range = 0-240) in the past 30 days, with heroin (70%) and heroin plus other drugs (20%) the most frequently used. Participants' mean age of first drug injecting was 17.6 years, 41% of participants regularly shared needles, most had multiple sexual partners (mean = 9.3 partners in the past 3 months), and 70% reported engaging in vaginal intercourse without condoms. Stepwise logistic regression showed that high-risk sexual behavior was predicted by being female, young, using heroin several times a month, and less negative attitudes toward using condoms. Effective HIV prevention efforts for IDUs in Russia must be tailored to their age, gender, drug use, and condom attitudes. These programs will also have to address the dual risk factors, unique to IDUs, of risky sexual behaviors and needle sharing. Without a rapid intervention response, Russia's HIV/AIDS crisis will soon turn catastrophic.
View details for Web of Science ID 000177658900003
View details for PubMedID 12212716
Psychological distress among minority and low-income women living with HIV
2002; 28 (2): 53-60
The growing incidence of HIV infection among low-income and minority women makes it important to investigate how these women adjust to living with HIV and AIDS. Psychological distress associated with HIV infection may compound the adjustment difficulties and increase the barriers to care associated with living in poverty. The authors surveyed 100 women who were receiving HIV care at a public hospital in the southeastern United States on measures of depression, anxiety, life stress, social support, and coping; they also assessed demographic and medical characteristics of the sample. Participants' annual incomes were low (87% < $10,000), and most participants were minorities (84% African American). Their levels of depression, stress, and anxiety symptoms were elevated relative to community norms. Greater anxiety and depression symptoms were associated with women who reported higher stress, using fewer active coping strategies, and perceiving less social support (ps < .001).
View details for Web of Science ID 000180870600002
View details for PubMedID 12613286
HIV: effectiveness of complementary and alternative medicine
2002; 29 (2): 361-?
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 . 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 . 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.
View details for Web of Science ID 000176753700008
View details for PubMedID 12391716
An example of maximizing survey return rates - Methodological issues for health professionals
EVALUATION & THE HEALTH PROFESSIONS
2002; 25 (2): 152-168
Obtaining a high response rate in survey research can bolster statistical power, reduce sampling error, and enhance the generalizability of the results to the population surveyed. We describe a mail survey designed to achieve a high return rate of completed questionnaires from members of the American Psychological Association who were engaged in clinical practice. We adapted the Total Design Method for survey research and were able to achieve a high response rate (68%) among health professionals. This was not an experiment in which we assessed the best method to increase survey response rates, hence we cannot empirically evaluate how each of the steps influenced our overall response rate. Future research is needed to identify the relative effectiveness of each of these principles in enhancing survey response rates. Research is also needed to distinguish general principles that apply across populations from those that must be tailored to specific subpopulations.
View details for Web of Science ID 000177001300002
View details for PubMedID 12026750
Acute stress reactions to recent life events among women and men living with HIV/AIDs
INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE
2002; 32 (4): 361-378
This study examined the prevalence of acute stress reactions to recent life events among persons living with HIV/AIDS. A second aim was to investigate the relationship of acute stress reactions among HIV-infected men and women to posttraumatic stress disorder (PTSD) symptoms to previous traumatic life events.Participants included 64 HIV-seropositive persons (33 men and 31 women) drawn from a larger study examining the effects of group therapy on quality of life and health behavior. These individuals were assessed at baseline on demographic and medical status characteristics and (PTSD) symptoms andthen randomly assigned to either receive group therapy plus education or education alone. Three months later they were assessed for acute stress reactions to recent life events.Nearly a third (31.3 percent) of the participants reported levels of acute stress reactions to recent life events that met all symptom criteria for the diagnosis of acute stress disorder. However, only 9.4 percent of the respondents described a recent stressful life event that was threatening to the life or physical integrity of themselves or others. Acute stress reactions to recent life events were significantly and positively related to experiencing PTSD symptoms to prior traumatic life events. Acute stress did not differ significantly by gender, AIDS status, or whether or not participants had received 12 weeks of group therapy.A subset of individuals with HIV/AIDS experience high levels of acute stress reactivity to life events considered non-traumatic. HIV-infected individuals who react strongly to ongoing life stressors are more likely to have developed PTSD symptoms in response to previous traumatic life events.
View details for Web of Science ID 000183005200005
View details for PubMedID 12779186
Psychiatric functioning and substance use: Factors associated with HIV risk among incarcerated adolescents
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2002; 33 (2): 91-106
This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.
View details for Web of Science ID 000179379700001
View details for PubMedID 12462349
Sociodemographic characteristics associated with medical appointment adherence among HIV-seropositive patients seeking treatment in a county outpatient facility
2001; 33 (5): 470-475
Adherence is a major problem facing HIV-seropositive patients. Low adherence has been associated with faster disease progression as well as development of drug-resistant strains of HIV. Thus it is critical to understand factors associated with treatment compliance. This study examined the independent contributions of disease severity, age, gender, household income, homelessness, ethnicity, and sexual orientation on appointment adherence.Participants (n = 671) scheduled for appointments in an outpatient county treatment facility for HIV-related medical care completed demographic questionnaires and clinic staff collected appointment attendance data.Multiple regression analyses indicated that patients diagnosed with AIDS, older in age, and receiving a higher income were more likely to keep medical appointments. Additionally, African American ethnicity and identifying as heterosexual were associated with missing scheduled medical appointments.These data suggest that cultural and sociodemographic characteristics influence patients' adherence to outpatient services. Implications for interventions aimed at increasing medical adherence are discussed.
View details for Web of Science ID 000172078500017
View details for PubMedID 11676589
HIV disease, violence, and post-traumatic stress.
Focus (San Francisco, Calif.)
2001; 16 (6): 5-6
View details for PubMedID 11547387
Unwanted sexual experiences and sexual risks in gay and bisexual men: Associations among revictimization, substance use, and psychiatric symptoms
JOURNAL OF SEX RESEARCH
2001; 38 (1): 1-9
View details for Web of Science ID 000169177700001
Acute stress reactions to everyday stressful life events among sexual abuse survivors with PTSD.
Journal of child sexual abuse
2001; 10 (2): 83-99
This study examined symptoms of Acute Stress Disorder (ASD), which is often thought of as a precursor to PTSD, among 54 women who already had PTSD for childhood sexual abuse for which they were seeking treatment. We examined the prevalence of ASD symptoms as well as their relationships to trauma symptoms measured by the Trauma Symptom Checklist-40. The ASD diagnosis requires the occurrence of a traumatic life event as well as meeting specific symptoms criteria. We found that fourty-four percent of participants met all symptom criteria for ASD, but only three of these 24 participants described a traumatic life event. Moreover, ASD symptoms were significantly related to trauma symptom scores. These findings suggest that a significant proportion of women with PTSD for childhood sexual abuse may be highly symptomatic for everyday stressful events that would not be experienced as traumatizing to others. Thus, these individuals need assistance in coping with everyday life stressors that do not involve a serious threat or injury in addition to needing help to alleviate their trauma symptoms.
View details for PubMedID 15149937
Relationships of sexual, physical, and emotional abuse to emotional and behavioral problems among incarcerated adolescents.
Journal of child sexual abuse
2001; 10 (1): 73-88
This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.
View details for PubMedID 16221621
Relationships of perceived stress to coping, attachment and social support among HIV-positive persons
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
2000; 12 (5): 663-672
The purpose of this study was to examine the relationships of coping, attachment style and perceived social support to perceived stress within a sample of HIV-positive persons. Participants were 147 HIV-positive persons (80 men and 67 women). Multiple regression analysis was used to examine the relationships of the demographic variables, AIDS status, three coping styles, three attachment styles and perceived quality of general social support with total score on the Perceived Stress Scale (PSS). PSS score was significantly associated with less income, greater use of behavioural and emotional disengagement in coping with HIV/AIDS, and less secure and more anxious attachment styles. These results indicate that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.
View details for Web of Science ID 000089953400013
View details for PubMedID 11218551
- Psychologists' beliefs and clinical characteristics: Judging the veracity of childhood sexual abuse memories PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2000; 31 (4): 372-377
The relationship between pain and coping styles among HIV-positive men and women
PSYCHOLOGY & HEALTH
2000; 15 (6): 869-879
View details for Web of Science ID 000165761600011
Improving the quality and quantity of life among patients with cancer: A review of the effectiveness of group psychotherapy
EUROPEAN JOURNAL OF CANCER
1999; 35 (11): 1581-1586
Cancer patients suffer from a number of psychosocial problems related to the progression of their disease as well as standard medical interventions. Fortunately, there is empirical evidence suggesting that group psychotherapy is effective at ameliorating psychological distress and in some cases improving survival. For this literature review we examined the psychological morbidity, particularly anxiety and depression, among cancer patients. Further, we conducted a critical examination of the current evidence regarding the effectiveness of group psychotherapy for improving the quality as well as the quantity of life in cancer patients. Finally, we explored the specific components of effective group psychotherapy, which has been associated with enhanced survival. We conclude that there is compelling evidence indicating that group psychotherapy improves the quality of life of cancer patients. Furthermore, there is a growing body of evidence suggesting that group psychotherapy improves survival of cancer patients.
View details for Web of Science ID 000083402300006
View details for PubMedID 10673965
A review of acute stress reactions among victims of violence: Implications for early intervention
AGGRESSION AND VIOLENT BEHAVIOR
1999; 4 (3): 293-306
View details for Web of Science ID 000078977800004
Psychologists' beliefs about the prevalence of childhood sexual abuse: The influence of sexual abuse history, gender, and theoretical orientation
CHILD ABUSE & NEGLECT
1999; 23 (8): 803-811
This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists.A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics.Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs.These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed.
View details for Web of Science ID 000081643300008
View details for PubMedID 10477240