AIDS information needs: conceptual and content analyses of questions asked of AIDS information hotlines

Dissemination of accurate information about HIV is an essential element of national AIDS prevention strategies and AIDS telephone hotlines serve a vital function in providing such information. In this study, questions asked of two AIDS information hotlines were collected and examined to determine the AIDS information needs of the general public. Questions asked of local AIDS lines in Houston and Milwaukee (N = 1611) were independently classified into 30 content areas, with two independent raters achieving 94% agreement. The content areas were organized for analysis into 11 broader information domains. Questions about HIV antibody testing were the most frequently asked (27%), followed by questions about sexual transmission of HIV (16%), HIV-related symptoms (16%) and situations that do not confer risk for HIV infection (14%). Content analyses suggested that individuals were motivated to call hotlines by fears of contracting HIV from actual risk behaviors or to dismiss concerns about contracting HIV through casual modes. Many individuals had information needs related to their own personal experiences that could not be addressed through media campaigns or other means of mass public health education. Results suggest that HIV information dissemination to the public through hotlines and other means of direct health education serves both preventive and destigmatizing functions.

Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women

This research evaluated a motivation-based HIV risk reduction intervention for economically disadvantaged urban women. Participants completed a survey that assessed HIV-related knowledge, risk perceptions, behavioral intentions, sexual communication, substance use, and risk behavior. A total of 102 at-risk women (76% African American) were randomly assigned to either the risk reduction intervention or to a waiting list. Women were reassessed at 3 and 12 weeks. Results indicated that treated women increased their knowledge and risk awareness, strengthened their intentions to adopt safer sexual practices, communicated their intentions with partners, reduced substance use proximal to sexual activities, and engaged in fewer acts of unprotected vaginal intercourse. These effects were observed immediately, and most were maintained at follow-up.

HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention

A minority of people who test HIV seropositive continue to engage in sexual behaviour that places their partners at high risk for HIV infection. However, little is known about factors that contribute to sexual risk behaviour among. HIV-seropositive men. In this study, HIV-seropositive men participating in substance abuse support groups and HIV prevention programmes (n = 223) completed measures of demographic characteristics, sexual behaviour history, sensation-seeking (the propensity to seek optimal stimulation), and sexual compulsivity (persistent sexual preoccupations). Twenty-six per cent of the sample reported having recent multiple unprotected sexual intercourse partners. Across support group and prevention programme participants, men with multiple unprotected partners reported greater sexual compulsivity than men with one or no unprotected partners, but groups did not differ in terms of sensation-seeking. Results suggest that intensive therapeutic interventions are needed for a relatively small number of people who may contribute significantly to the HIV epidemic.

Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men

This study surveyed 430 men at an urban gay pride celebration to assess fatalism, current life satisfaction, and perceived expected years of life among men who have sex with men. Analyses showed that men who engaged in unprotected anal intercourse outside of exclusive relationships reported a greater fatalistic outlook, were more dissatisfied with life, and perceived a shorter life for themselves than men who practiced only safer sex and men who were in exclusive relationships. Gay men in exclusive relationships scored higher than nonexclusively partnered gay men on the measure of current life satisfaction. These results suggest that efforts to prevent HIV infection among gay men should include building personal self-worth, support of long-term relationships, and future goal orientations.

Lack of positive outcomes from a cognitive-behavioral HIV and AIDS prevention intervention for inner-city men: lessons from a controlled pilot study

African American men are at increasingly high risk for HIV infection, but there have been few studies of HIV risk reduction interventions for heterosexual ethnic minority men. The present study randomly assigned 81 African American men to one of two HIV prevention interventions: a four-session cognitive-behavioral skills training HIV risk reduction intervention that has been successful with other populations or a four-session HIV risk education and sensitization control condition. Men were assessed at baseline, at immediate postintervention, and at a 3-month follow-up. Forty-five percent of participants dropped out of the intervention; dropouts were younger, more likely to have used condoms, and less likely to have been tested for HIV antibodies than men who completed the study. Outcome analyses showed that both interventions significantly increased AIDS-related knowledge, initial intentions to change HIV risk behaviors, and reduced unprotected vaginal intercourse. However, there were no significant differences between groups on any of the measures at postintervention or follow-up assessments. Recognizing the limitations of our small sample size, the results of this initial study caution against generalizing skills training HIV prevention interventions that have been successful with other populations to African American heterosexual men.

Continued high-risk sex among HIV seropositive gay and bisexual men seeking HIV prevention services

The authors examined HIV risk-related sexual behaviors in an ethnically diverse sample of HIV seropositive gay and bisexual men (N = 86). Measures of sexual behavior, substance use, condom attitudes, behavior change intentions, and engagement in risk-reducing practices were completed. Thirty-nine percent of the men reported engaging in unprotected anal intercourse in the past 3 months. Unprotected anal intercourse was associated with using nitrite inhalants, sex partners who used substances before sex, and low intentions to change risk behavior. These results highlight the difficulties that people living with HIV infection face in maintaining a lifetime of safer sex and the necessity of integrating clinical and prevention interventions for these persons.

It's like a regular part of gay life: repeat HIV antibody testing among gay and bisexual men

HIV antibody testing is a critical facet of national AIDS prevention strategies and increasing numbers of persons are tested each year. Research has shown that a significant number of men who have sex with men are repeatedly tested for HIV antibodies, and many are tested regularly every 6 months. This study investigated the prevalence of repeat testing (having been tested three or more time) and regular testing (having been tested three or more times and getting tested every 6 months), and their association to testing attitudes and sexual behaviors. We found that 66% of 253 HIV seronegative gay and bisexual men surveyed at a large gay pride festival had been repeatedly tested, and 47% were tested regularly. Repeat testing was associated with knowing people with HIV or AIDS, whereas regular testing was associated with younger age and not being in an exclusive sexual relationship. Both repeat and regular testers held more positive health-related attitudes about testing than nonrepeat and nonregularly tested men, respectively. Contrary to previous research, repeat testing was not associated with unprotected anal intercourse or unprotected oral sex. However, both repeat and regular testing were positively related to condom use during anal intercourse as well as having multiple protected anal intercourse partners. We therefore conclude that both repeat testing and higher rates of condom use reflect positive health attitudes and that repeat testing may function to meet the needs of some men who have sex with men.

Psychological and social factors associated with histories of risk for human immunodeficiency virus infection among African-American inner-city women

Minority women constitute the fastest-growing segment of the American epidemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The present study examined the psychological and social factors related to HIV risk among 153 African-American inner-city women who completed measures of HIV risk history, sexual and substance use behaviors, perceived risk for HIV infection, self-efficacy to reduce risk (belief that one can effectively perform specific behaviors), and perceived social norms supporting risk reduction. Fifty-five percent of the women (n = 84) reported at least one factor that had placed them at known risk for HIV infection. Results of a stepwise regression analysis showed that HIV risk history was associated with self-perceived risk for HIV infection and self-efficacy to perform risk-reducing actions. Social norms for safer sex did not contribute significantly to the explained variance. Women at risk were more likely to have been forced or coerced into unwanted sex and were less likely to have been familiar with their most recent sex partner. These result suggest that HIV risk-reduction interventions targeting inner-city women should focus on skills training approaches to build self-efficacy and empower women to adopt risk-reducing practices.

Women living with HIV/AIDS: the dual challenge of being a patient and caregiver

More than 60,000 women in the United States have been diagnosed with AIDS, and millions of women worldwide are infected with HIV. Most of these women will die at an early age, leaving their children motherless. During their HIV illness, women confront the challenge of being both patient and family caregiver. Little research has explored this dual challenge. The authors conducted semistructured one-hour interviews with HIV-positive women that focused on the impact of the HIV diagnosis on the women's lives. Significant factors emerging from the interviews included the impact of stigma associated with HIV/AIDS, disbelief of the diagnosis, the lack of a guardian for their children, the paucity of women's support groups, and barriers associated with seeking services. All women exhibited evidence of clinical depression. A model for multidisciplinary intervention is proposed that focuses on women's needs within their family systems.

Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses

Individuals diagnosed with a severe mental illness are at significantly enhanced risk for infection with the human immunodeficiency virus (HIV). To better understand elevated seroprevalence in this population, we review the research literature that has investigated HIV-related risk behavior among adults who have a severe and persistent mental illness. This review indicates that 54%-74% of adults report that they have been sexually active in the last year with approximately one third reporting two or more partners. Among those who were sexually active, condom use was inconsistent. A significant minority (4%-35%) of adults also reported a history of injection drug use. Overall, the data indicate that the severely mentally ill engage regularly in practices known to involve increased risk for HIV transmission. We introduce and modify Fisher and Fisher's (1992) theoretical model to organize the possible determinants of HIV-related risk taking among severely mentally ill adults, and encourage use of this model in the design of behavioral epidemiological and risk reduction studies. We also identify several methodological challenges to HIV-related research, including problems associated with the use of self-report measures; diagnostic imprecision; and participant recruitment and retention.

Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women

A component analysis of a behavioral HIV risk reduction intervention was conducted among 87 women recruited from an inner-city community. Women were randomly assigned to an intervention consisting of (a) sexual communication skills training, (b) self-management skills training, (c) a combination of sexual communication and self-management skills, or (d) HIV education and risk sensitization. Results showed that all 4 intervention conditions increased AIDS knowledge and intentions to reduce risk behaviors. Communication skills training resulted in higher rates of risk reduction conversations and risk refusals. However, the combined skills training condition showed the lowest rates of unprotected sexual intercourse at the 3-month follow-up. This study is the first to experimentally control HIV risk reduction elements in an analysis of a skills-based HIV prevention intervention.

People living with HIV infection who attend and do not attend support groups: a pilot study of needs, characteristics and experiences

People living with Human Immunodeficiency Virus (HIV) confront a myriad of stressors over the course of their infection. Social support groups offer a means of addressing the support needs of people living with HIV. In the present study, 34 persons who had attended HIV support groups and 29 who had not attended groups completed measures of distress, coping, and social connectedness, and participated in open-ended interviews concerning their support group experiences. Results showed that those who attended support groups knew they were HIV-seropositive for a longer time, reported less emotional distress, and had more social contact than did non-attenders. However, non-attenders endorsed avoidant coping strategies to a greater extent. Analyses showed that time since testing positive accounted for differences between groups in social connectedness but not differences in anxiety, depression, or avoidance coping. Thus, HIV-seropositive persons become socially reconnected with time, but individuals with avoidant coping styles experience greater emotional distress and are unlikely to seek support groups. A sizeable proportion of people with HIV may therefore need supportive interventions, particularly nearer to the time that they test HIV-seropositive.

Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women

A component analysis of a behavioral HIV risk reduction intervention was conducted among 87 women recruited from an inner-city community. Women were randomly assigned to an intervention consisting of (a) sexual communication skills training, (b) self-management skills training, (c) a combination of sexual communication and self-management skills, or (d) HIV education and risk sensitization. Results showed that all 4 intervention conditions increased AIDS knowledge and intentions to reduce risk behaviors. Communication skills training resulted in higher rates of risk reduction conversations and risk refusals. However, the combined skills training condition showed the lowest rates of unprotected sexual intercourse at the 3-month follow-up. This study is the first to experimentally control HIV risk reduction elements in an analysis of a skills-based HIV prevention intervention.

Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior

Past research has shown that recreational drug use correlates with sexual behaviors that confer high risk for human immunodeficiency virus (HIV) infection. The present study tested the hypothesis that sensation seeking, a disposition characterized by the tendency to pursue novel, exciting, and optimal levels of arousal, accounts for a majority of the variance in associations between substance use and high-risk sexual behavior. Ninety-nine homosexually active men completed measures of sensation seeking, self-reported sexual behavior, and substance use. Path analysis and hierarchical regression analyses demonstrated that sensation seeking accounts for the observed relationship between substance use and high-risk sexual behavior. We conclude that personality characteristics, often ignored in high-risk sexual episodes, predict risk behavior over and above substance use, and may be useful in tailoring HIV prevention interventions.

Sexual sensation seeking and Sexual Compulsivity Scales: reliability, validity, and predicting HIV risk behavior

Two studies are presented that evaluate newly developed scales of sensation seeking and sexual compulsivity. Results showed that the scales were reliable and correlated with convergent and divergent measures in expected directions in samples of both gay men (N = 296) and inner city low-income men and women (N = 158). Consistent with theories of sensation seeking, the scales corresponded to an attraction toward a range of sexual practices, including increased frequencies of unprotected intercourse and a greater number of sexual partners. As expected, sexual compulsivity was not related to variety and novelty in sexual practices, but was associated with lower levels of self-esteem and resistance to adopting sexual risk-reducing strategies. However important differences were observed between the gay men and heterosexual samples; scales correlated with substance use only among gay men, and sexual compulsivity was related to a range of sexual practices only among heterosexuals. The sensation seeking and Sexual Compulsivity Scales were therefore reliable, appeared valid, and useful in predicting sexual risk behaviors.

Increased attention to human sexuality can improve HIV-AIDS prevention efforts: key research issues and directions

Curtailing the human immunodeficiency virus (HIV) epidemic requires the development of effective strategies for helping people reduce high-risk sexual behavior patterns. Because the objective of HIV prevention involves changing how people behave sexually, research findings in human sexuality are extremely pertinent to efforts to promote AIDS risk reduction. Unfortunately, most public health HIV prevention programs rarely reflect findings of human sexuality research. In this article, research is reviewed in the areas of the relationship contexts of sexuality, including variations in monogamy, condom use in affectionate versus casual relationships, sexual communication, and coercion; the modification of sexual behavior repertoires; substance use in relation to sexual intercourse; and sexual schema and scripts relevant to HIV risk. Policy and training issues related to human sexuality may have hindered efforts to incorporate sexuality research findings in HIV prevention programs. Advances and refinements in the success of HIV prevention efforts are likely if research on human sexuality is better integrated in AIDS prevention programs.

HIV antibody testing of gay men in smaller US cities

The incidence of new AIDS diagnoses among gay males indicates that risk reduction in smaller communities may be lagging behind that reported in larger cities. Contradictory evidence exists, largely from urban areas, concerning the utility of HIV testing as a means of promoting behavioural change. This study examined the relationship between HIV antibody testing and subsequent high-risk sexual behaviours among gay men in cities of 180,000 or fewer inhabitants. In February and March of 1992, male gay bar patrons in sixteen small US cities were administered an anonymous questionnaire concerning recent sexual behaviour and HIV testing history. Of the 1820 respondents, 28.1% had recently engaged in unprotected anal intercourse and 60.7% had been tested for HIV antibodies. Those who had been tested were more sexually active and reported more protected and safer sexual activities. Analyses at the individual and city levels converged to demonstrate that communities as well as individuals evidence increased self-protection in association with HIV antibody testing.

Group intervention to improve coping with AIDS-related bereavement: model development and an illustrative clinical example

Despite the widespread losses from AIDS, there have been no published evaluations of mental health interventions for people experiencing AIDS-related bereavement. We describe a cognitive behavioural coping model for support group interventions with people who experience an AIDS-related loss. The support group model consists of six primary components to address grief-related responses and the unique features of AIDS bereavement: social support and group cohesion; identification and expression of emotion; identification of AIDS loss specific coping challenges; recognition of current coping; goal setting; and, implementation of adaptive coping to reduce psychological distress. The model integrates theories of cognitive behavioural coping within a social support group context. Results of a pilot study with four men and four women showed that the intervention model cast into eight group sessions significantly reduced depression, intrusive experiences, grief reactions, demoralization, and overall psychological distress immediately following the intervention and at a 3-month follow-up assessment. The intervention appeared to facilitate the adjustment of these bereaved persons and warrants further study.

Context framing to enhance HIV-antibody-testing messages targeted to African American women

African American women (N = 100) recruited from an urban clinic were randomly assigned to view 1 of 3 experimental videotapes promoting HIV testing: (a) an ethnicity-matched information control videotape; (b) the same ethnicity-matched videotape presented by an African American woman (gender-ethnicity-matched control condition); or (c) an experimental videotape with a culturally relevant context that embedded HIV-testing information within a frame of reference emphasizing personal loss. Consistent with D. Kahneman and A. Tversky's (1979) prospect theory, women who viewed the context-framing videotape were most likely to have been tested during a 2-week follow-up interval. Among women who expressed intentions to get tested after viewing the videotapes, 63% of those in the message-framing condition were tested for HIV during a 2-week period compared with 23% in the gender-ethnicity-matched condition, and none in the ethnicity-matched condition.

The perceived social context of AIDS: study of inner-city sexually transmitted disease clinic patients

The present study investigated perceptions of AIDS as a social problem relative to 10 other problems in a sample of 194 inner-city sexually transmitted disease (STD) clinic patients. Within-subjects analyses showed that AIDS was viewed as a more serious problem than housing, alcoholism, and child care, while AIDS was less of a problem than employment, drug abuse, crime, discrimination, and teen pregnancy, and no different from transportation and health care. Factor analysis was used to identify the interrelationships among social problems as perceived by STD patients. For men, factor analysis showed that AIDS was most closely related to crime, drug abuse, teen pregnancy, and discrimination, with these problems constituting the first factor and accounting for most of the variance in the analysis. Men also placed AIDS with alcoholism and child care on the third factor accounting for little variance. For women, however, AIDS clustered most closely with alcoholism and child care, accounting for a minimal amount of variance in the analysis. Results further showed that perceptions of social problems among women correlated with HIV-risk-related behaviors. The structural context of social problems, within which AIDS is embedded, is discussed with reference to HIV-AIDS-prevention interventions.

Context framing to enhance HIV-antibody-testing messages targeted to African American women

African American women (N = 100) recruited from an urban clinic were randomly assigned to view 1 of 3 experimental videotapes promoting HIV testing: (a) an ethnicity-matched information control videotape; (b) the same ethnicity-matched videotape presented by an African American woman (gender-ethnicity-matched control condition); or (c) an experimental videotape with a culturally relevant context that embedded HIV-testing information within a frame of reference emphasizing personal loss. Consistent with D. Kahneman and A. Tversky's (1979) prospect theory, women who viewed the context-framing videotape were most likely to have been tested during a 2-week follow-up interval. Among women who expressed intentions to get tested after viewing the videotapes, 63% of those in the message-framing condition were tested for HIV during a 2-week period compared with 23% in the gender-ethnicity-matched condition, and none in the ethnicity-matched condition.

Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults

OBJECTIVE

Research shows that many chronic psychiatric patients are at risk for infection by the human immunodeficiency virus (HIV). This study investigated the effects of a behavioral skills training program designed to prevent HIV infection among chronic mentally ill adults living in an inner-city area.

METHODS

Twenty-seven men and 25 women were randomly assigned either to a four-session AIDS prevention program emphasizing risk education, sexual assertiveness, condom use, risk-related behavioral self-management, and problem-solving skills or to a waiting-list group, who later received the same intervention.

RESULTS

Compared with the waiting-list control group, participants in the prevention program demonstrated significant gains in AIDS-related knowledge and intentions to change risk behaviors. The prevention program also significantly reduced rates of unprotected sexual intercourse and increased the use of condoms over a one-month follow-up period. A subset of participants who provided two-month follow-up data maintained some behavior changes.

CONCLUSIONS

A relatively brief, skills-focused AIDS prevention program for chronic psychiatric patients produced reductions in HIV risk behaviors. Such HIV risk reduction intervention programs may be of use in inpatient, outpatient, and community-based settings.

Assessing persons with human immunodeficiency virus (HIV) infection using the Beck Depression Inventory: disease processes and other potential confounds

Symptoms of Human Immunodeficiency Virus (HIV) infection and somatic symptoms of depression overlap, confounding clinical assessments of persons with HIV infection. This research examined the extent of this confounding. In Study 1, 71 persons with HIV infection demonstrated high rates of depression on the Beck Depression Inventory (BDI). However, depression scores correlated with symptoms of HIV infection. In Study 2, 63 persons with HIV infection also demonstrated high rates of depression on the BDI, and depression was again related to symptoms of HIV disease; specifically, persistent fatigue, diarrhea, night sweats, and muscle aches. Principal component factor analyses demonstrated that somatic symptoms of depression were closely associated with number of Acquired Immunodeficiency Syndrome diagnoses, number of HIV-related symptoms, and inversely related to number of T-helper cells. In contrast, cognitive-affective depression was most closely related to anxiety, hypochondriasis, and number of months since tested HIV positive. Results support the conclusion that depression scores require differential interpretations at different stages of HIV disease and that persons who have experienced HIV-related symptoms only be assessed for depression using instruments void of somatic symptoms.

Magic Johnson and public attitudes toward AIDS: a review of empirical findings

The public announcement of HIV seropositivity and early professional retirement of basketball star Earvin "Magic" Johnson acted as a naturalistic experimental manipulation of media representations of persons living with HIV infection. This article reviews empirical studies of psychological and behavioral changes that occurred following the announcement. Several studies reported substantial increases in public interest in HIV/AIDS-related information and public awareness of AIDS, as well as changes in high-risk behaviors. Increases in calls to AIDS hotlines and increased rates of HIV antibody testing were also observed. However, most effects were short-lived, subsiding within three weeks of the announcement, and few changes in AIDS-related knowledge or personal risk perceptions were reported. Patterns of results indicated different levels of impact among high- and low-risk groups and among ethnic groups. Findings across studies are consistent with previous research on media effects on public attitudes and theories of risk perception.

High risk sexual behavior and alcohol consumption among bar-going gay men

OBJECTIVES

To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men.

METHODS

Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States.

RESULTS

Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption.

CONCLUSIONS

This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

Personality characteristics of young adult offspring of substance abusers: a study highlighting methodological issues

Our study sought to demonstrate the importance of attending to methodological issues in the study of personality characteristics of offspring of substance abusers (OSAs). A 4 x 2 factorial design, Parental Mental Health (no known psychological problems, substance abuse, other psychological problems, or dual diagnosis) x Exposure to Abuse/Neglect (present or absent), was used to examine depression proneness, neuroticism, alexithymia, self-esteem, self-concept, and locus of control in young adults. Results of this study demonstrated that in order to determine whether characteristics of OSAs are uniquely related to parental substance abuse, a psychiatric control group is needed. Also, the importance of separating the influences of other family environment variables (e.g., exposure to abuse/neglect) was demonstrated. None of the differences between groups in this study could be attributed to parental substance abuse per se; rather, the concomitants of substance abuse (i.e., exposure to abuse/neglect) were found to be more strongly related to poorer adjustment in OSAs. Finally, it was shown that the proportion of treatment-seeking subjects included in the sample affected the level of pathology observed. These results are discussed in relation to previous findings, and recommendations regarding methodology are made for future studies.

Sexual sensation seeking: scale development and predicting AIDS-risk behavior among homosexually active men

Sensation seeking, the propensity to prefer exciting, optimal, and novel stimulation or arousal, is a potential mediating factor in sexual risk for human immunodeficiency virus infection (HIV), the cause of acquired immunodeficiency syndrome (AIDS). However, the most widely used measure of sensation seeking, the Sensation Seeking Scale (Zuckerman, Kolin, Price, & Zoob, 1964), contains numerous culturally outdated items and items that do not pertain to sexual behavior. In this study, 106 homosexually active men completed newly developed measures of sensation seeking related to sexual and nonsexual experiences, as well as a measure of sexual compulsivity. Results show that the new scales were internally consistent and time-stable. Additional analyses demonstrated convergent, divergent, and discriminant validity for these scales, showing them to be of use as mediating variables in models of high-risk sexual behavior. Implications for HIV prevention and behavior change are discussed.

Factors associated with risk for HIV infection among chronic mentally ill adults

OBJECTIVE

Chronic mentally ill adults have been found to be at risk for HIV infection. The authors investigated the prevalence of HIV risk behaviors among psychiatric outpatients. Correlates of HIV risk factors and characteristics of patient relationships in which risk occurred were investigated.

METHOD

Structured interviews were conducted with 95 chronic mentally ill adults from urban community support service programs. The interviews focused on sexual and substance use behavior, history of HIV risk behaviors, and relationship characteristics related to risk.

RESULTS

The study showed that 27% of all patients had had two or more sex partners in the previous year and 18% had received money or drugs for sex. High rates of illicit drug use were also found, with frequent use of drugs or alcohol in association with sexual activity. Multiple regression analyses showed that use of illicit drugs, meeting sex partners in psychiatric clinics, and meeting partners in bars accounted for a substantial proportion of the variance in HIV risk behavior.

CONCLUSIONS

These results suggest an urgent need for HIV prevention programs targeted at urban chronic mentally ill adults. Risk-producing characteristics of patient relationships and social networks should be addressed in the development of prevention interventions.

Earvin "Magic" Johnson's HIV serostatus disclosure: effects on men's perceptions of AIDS

The effects of celebrity self-disclosure of human immunodeficiency virus (HIV) seropositivity on perceptions of HIV and Acquired Immunodeficiency Syndrome (AIDS) were investigated. AIDS-related interest and knowledge measures were collected from 468 men before and after basketball star Earvin "Magic" Johnson's self-disclosure of HIV seropositivity. Increased interest in AIDS paralleled media coverage of the announcement, with the most substantial effects occurring within 2 weeks. Perceived impact of the disclosure was greatest among African-American men and men who had not previously known someone with HIV-AIDS. Celebrity self-disclosure appears to affect perceptions through mechanisms similar to those involved in personally knowing someone infected with HIV.

Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons

OBJECTIVE

Although many studies have documented patterns of emotional distress in persons with HIV disease, there have been few controlled evaluations of therapy outcomes with these individuals. This research evaluated the effects of brief cognitive-behavioral or social support group therapy with this population.

METHOD

Sixty-eight depressed men with HIV infection were randomly assigned to one of three conditions: eight-session cognitive-behavioral groups, eight-session social support groups, or a comparison condition. Before and after intervention and at 3-month follow-up, all participants were individually assessed by using measures of symptoms of distress as well as substance use and sexual practices.

RESULTS

Relative to the comparison group, both the cognitive-behavioral and social support group therapies produced reductions in depression, hostility, and somatization. The social support intervention also produced reductions in overall psychiatric symptoms and tended to reduce maladaptive interpersonal sensitivity, anxiety, and frequency of unprotected receptive anal intercourse, while the cognitive-behavioral intervention resulted in less frequent illicit drug use during the follow-up period. Tests for clinical significance of change particularly underscored benefits of the social support group intervention both at postintervention and at long-term follow-up.

CONCLUSIONS

Brief group therapy for depressed persons with HIV infection produced reductions in symptoms of distress. The two forms of therapy resulted in shared and unique improvements in functioning, although social support groups focused on emotional coping presented greater evidence of clinically significant change. As more persons contract HIV infection and live longer with HIV disease, further research is needed to evaluate outcomes of mental health services with these individuals.

Psychological interventions to prevent HIV infection are urgently needed. New priorities for behavioral research in the second decade of AIDS

Behavior change remains the only means for primary prevention of HIV disease. Psychology should take a leading role in efforts to curtail the epidemic, but has not contributed to HIV prevention at a level proportionate to the urgency of the crisis. The authors propose an updated agenda for behavioral research on AIDS-HIV prevention implementing accelerated community trials of promising behavior change models, conducting trials of community-level interventions on a large scale and focused on populations most vulnerable to HIV infections, establishing partnerships between HIV research and community service organizations, integrating efforts from across psychology disciplines to advance and refine HIV prevention interventions, and mobilizing interdisciplinary HIV prevention resources and communication mechanisms to rapidly translate research findings to community and public policy arenas.

Earvin "Magic" Johnson's HIV serostatus disclosure: effects on men's perceptions of AIDS

The effects of celebrity self-disclosure of human immunodeficiency virus (HIV) seropositivity on perceptions of HIV and Acquired Immunodeficiency Syndrome (AIDS) were investigated. AIDS-related interest and knowledge measures were collected from 468 men before and after basketball star Earvin "Magic" Johnson's self-disclosure of HIV seropositivity. Increased interest in AIDS paralleled media coverage of the announcement, with the most substantial effects occurring within 2 weeks. Perceived impact of the disclosure was greatest among African-American men and men who had not previously known someone with HIV-AIDS. Celebrity self-disclosure appears to affect perceptions through mechanisms similar to those involved in personally knowing someone infected with HIV.

Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection

Whereas some people appear to cope after learning that they have human immunodeficiency virus (HIV) infection, others experience depression and suicidal ideation. In this study, 142 persons with HIV infection were administered the Center for Epidemiological Studies Depression Scale (CES-D). High levels of depression were predicted by lower perceived social support, attributions that health was influenced more by chance, high-risk sexual behavior practices, and greater number of HIV illness symptoms and greater duration of time knowing of one's own positive serostatus. Ongoing high-risk sexual behavior practices were predicted by higher levels of recreational drug use and of depression. These findings highlight the need for improved mental health services for persons with HIV conditions.

Sexual aggression and love styles: an exploratory study

The relationship between sexual aggression and theoretical love styles was studied. Based on self-reported sexual history, 63 college men were grouped as having either consensual sexual experience only (n = 33) or having verbally coercive sexual experience (n = 30). Analyses were conducted using six love style scales, likelihood to rape, likelihood to use sexual force, masculinity, and sociopathy to predict sexual coercive group membership. Logistic regression indicated that the Ludus love style, a manipulative, game-playing orientation towards intimate relationships, was the best predictor of sexual coercion among the six love styles. Additionally, logistic regression indicated that the Ludus love style was as effective in classifying men as coercive or noncoercive as other dispositions related to sexual aggression. These results suggest that the Ludus love style may serve as a unifying construct for dispositions related to sexual aggression. This study constitutes an initial attempt to link sexually coercive behaviors to a theoretical model of intimate relationships. Results are discussed in the context of a situational model of sexual coercion.