Personality, appraisal, and adaptational outcomes in HIV seropositive men and women

Perceived discrimination, social support, and perceived stress among people living with HIV/AIDS in China

Perceived stress among people living with HIV/AIDS (PLWH) was associated with severe mental health problems and risk behaviors. Discrimination toward PLWH in China is prevalent. Both perceived discrimination and social supports are determinants of the stress level among PLWH. Psychological support services for PLWH in China are scarce. It is unknown whether social support is a buffer between the perceived discrimination and perceived stress. With written consent, this study surveyed 258 PLWH recruited from multiple sources in two cities in China. Instruments were validated in previous or the present study, including the perceived stress scale for PLWH (PSSHIV), the perceived social support scale (PSSS), and the perceived discrimination scale for PLWH (PDSHIV). Pearson correlations and multiple regression models were fit. PDSHIV was associated with the Overall Scale and all subscales of PSSHIV, whilst lower socioeconomic status in general and lower scores of PSSS were associated with various subscales of PSSHIV. The interaction item (PSSS×PSDHIV) was nonsignificant in modeling PSSHIV, hence no significant moderating effect was detected. Whilst perceived discrimination is a major source of stress and social support can reduce stress among PLWH in China, improved social support cannot buffer the stressful consequences due to perceived discrimination. The results highlight the importance to reduce discrimination toward PLWH and the difficulty to alleviate its negative consequences. It is warranted to improve mental health among PLWH in China and it is still important to foster social support among PLWH as it has direct effects on perceived stress.

Stress and coping in HIV-positive former plasma/blood donors in China: a test of cognitive appraisal theory

Throughout the 1990s, many villagers in rural China were infected with HIV through commercial plasma/blood donation. These former plasma/blood donors (FPDs) experienced many HIV-related stressors. This study tested a cognitive appraisal model of stress and coping in a sample of HIV-positive adult FPDs. Participants (N = 207) from multiple villages completed a battery of questionnaires assessing HIV-related stress, HIV symptoms, cognitive appraisal, coping behaviors, and psychological distress. Participants reported high levels of HIV-related stress, depression, and anxiety. In a structural equation model, greater HIV-related stress, HIV symptoms, and threat appraisal were directly associated with psychological distress. HIV-related stress was also indirectly associated with psychological distress through threat appraisal. In a second model, coping was found to mediate the relationship between challenge appraisal and psychological distress. Results support the utility of cognitive appraisal theory. Stress management interventions targeting HIV-positive FPDs in China are indicated.

Bearing witness to suffering in AIDS: the testing of a substantive theory

AIDS volunteerism, as a response by those affected by loss associated with HIV/AIDS, has been described as an act of bearing witness. The theory "bearing witness to suffering in HIV/AIDS," proposes that AIDS volunteerism assists individuals affected by loss to increase their levels of hope, self-esteem, social support, and develop a sense of purpose in life (PIL). The purpose of this descriptive research was to determine if AIDS volunteerism, hope, self-esteem, and social support were predictive of PIL among individuals affected by loss from HIV/AIDS. Path analysis was used to analyze data. Hope, social support, and self-esteem were found to have significant positive effects on PIL and accounted for 66% of the total variance. The results from this study will be used to further develop the theory of bearing witness; this theory may be useful to develop and test interventions to relieve the suffering experienced by individuals affected by HIV/AIDS.

Enhancing the perceived health of HIV seropositive men

The purpose of this study was to examine the relationships between hope, social support, uncertainty in illness, and spirituality and their effect on the perceived health of HIV seropositive men. A prospective design was used to test a causal model on a sample of 125 HIV seropositive men recruited from urban HIV/AIDS outpatient clinics. A goodness of fit index of .90 and a comparative fit index of .79 indicated minimal fit of the theorized model with the data. Findings revealed significant, positive paths from hope to perceived health and from spirituality to hope. Significant negative paths were found between social support and uncertainty in illness and uncertainty in illness and hope. The level of hope may play an important role in enhancing health of HIV seropositive men.

Mastery over stress among women with HIV/AIDS

To better understand how women with HIV infection deal with the stress of their disease, the authors explored the relationships between stressors, resources for managing stress, and mastery over stress in 80 HIV-positive women. Nurses and other professionals recruited participants in a variety of settings in 10 states. Participants completed a packet of research instruments that measured the stressors of perceived stress intensity, interpersonal conflict, and severity of illness; the resources of social support, support networks, and spiritual perspective; and the outcome of mastery over stress. Participants reported high levels of social support, spiritual perspective, interpersonal conflict, and perceived stress intensity. Twenty-nine women (36%) had achieved mastery over stress. Mastery over stress was significantly and positively correlated with social support, spiritual perspective, and physical functioning, a measure of severity of illness. Mastery over stress was significantly and negatively correlated with interpersonal conflict. An exploratory stepwise multiple regression analysis yielded two predictors of mastery over stress: social support and spiritual perspective. Although a comparison of these results with those reported in the literature for men suggests that men and women differ in how they respond to stressors, further research will be needed to enhance our understanding of these gender differences. Stress management training, especially related to interpersonal conflict, may be an effective intervention to facilitate mastery. Other potential interventions include assessing social support and spiritual perspective, discussing the potential benefit of these resources, and making referrals for psychosocial services as needed.

A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men

BACKGROUND

People who are HIV-positive now live longer when they have contracted AIDS, and nursing interventions can help improve their quality of life.

OBJECTIVES

To test the effects of an intervention based on developing cognitive coping skills as compared to one focused on facilitating the expression of emotions. Both interventions were intended to help regulate emotional response to an exacerbation of HIV-related symptoms.

METHOD

In a randomized, controlled trial, 90 hospitalized HIV-positive men were randomly assigned to one of three groups: cognitive, expression, or control. The intervention was administered on three consecutive days in 20-30 minute sessions. Preintervention and postintervention data were gathered on mood, distress, and anxiety.

RESULTS

Both interventions produced a beneficial effect on negative affect (cognitive group p =.002, expression group p =.011), and immediately following the first daily session (p =.001). No change in positive affect was produced by either intervention. Paired t tests indicated a decrease in distress (p =.039), specifically, of intrusive ideation (p =.03), for the cognitive group, which also experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, the expression group experienced an increase in anxiety (p =.018).

DISCUSSION

The cognitive coping skills nursing intervention was effective in helping to regulate HIV-positive persons' emotional responses to advanced disease. This nursing intervention is feasible for use by skilled practitioners providing daily care.

The use of life review to enhance quality of life of people living with AIDS: a feasibility study

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.

Social interactions, perceived support, and level of distress in HIV-positive women

Although powerful pharmacological therapies are helping women with HIV infection live longer, women continue to experience the stressors of chronic illness. This study used a person-environment systems framework to describe social interactions, perceived social support, and psychological distress in HIV-positive women. A convenience sample of 104 HIV-positive women living in the San Francisco Bay Area completed a questionnaire on social interactions, perceived social support, and distress. Women reported limited social interactions with family and friends and a low level of perceived social support. Social support and level of distress did not differ by ethnicity. Limited perceived social support was a significant predictor of distress in this sample of women. Supportive interactions from health care providers can be useful in mediating the relationship between the stressor of HIV disease and distress in HIV-positive women. Community-based nurses can enhance HIV-positive women's support network by providing positive and supportive interactions as they intervene with women in symptom management, case management, and other health care services.

The role of illness, resources, appraisal, and coping strategies in adjustment to HIV/AIDS: the direct and buffering effects

This study examined the utility of a stress and coping model of adjustment to HIV/AIDS. A total of 114 HIV-infected gay or bisexual men were interviewed and they completed self-administered scales. Predictors included illness variables (disease stage and number of symptoms), coping resources (optimism and social support), appraisal (threat, challenge, and controllability), and coping strategies (problem- and emotion-focused). Adjustment outcomes were depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that better adjustment was related to an asymptomatic illness stage, fewer HIV-related symptoms, greater social support, challenge and controllability appraisals, problem-focused coping, and lower threat appraisals and reliance on emotion-focused coping. There was limited support for the stress-buffering effects of optimism. Findings support the utility of a stress and coping model of adjustment to HIV/AIDS.

Women with HIV infection: the three waves of scientific inquiry

Initial efforts to curtail the spread of HIV infection to women failed. Consequently, women are the fastest growing population newly infected with HIV. This article presents a historical look at the waves of scientific inquiry that directed research on HIV infection among women. The author proposes three distinct waves. Each has been shaped by movement within the scientific community away from traditional biomedical and public health approaches toward feminist strategies that embrace the social, political, and cultural forces that influence women's health. These waves provide both valuable insights for nurses new to the field of HIV and a framework to guide future research on women with HIV infection.

The Transtheoretical Model and stress management practices in women at risk for, or infected with, HIV

Although scientific inquiry using the Transtheoretical Model of Behavior (TTM) supports various behavior changes in multiple samples, no research was found that examined this model with women already infected with HIV. This article provides a brief overview of the related literature and describes a pilot study that evaluated TTM concepts in women at risk for, or infected with, HIV. The pilot study examined preliminary psychometrics of the research measures in women at risk for (n = 9), or infected with, HIV (n = 10), and examined predicted differences in situational confidence and stress management practices by HIV serostatus (positive vs. negative) and stage of change (precontemplation and contemplation vs. preparation, action, and maintenance) implied by the TTM. This pilot study supports use of the TTM to examine readiness to use stress management behavior in women regardless of their HIV serostatus. Further TTM stress management inquiry is encouraged to extend the knowledge base needed in caring for this vulnerable population.