David Rompa

Effectiveness of an Intervention to Reduce HIV Transmission Risks in HIV-Positive People

BACKGROUND As many as one in three HIV-positive people continue unprotected sexual practices after learning that they are HIV infected. This article reports the outcomes of a theory-based intervention to reduce risk of HIV transmission for people living with HIV infection. METHODS Men (n=233) and women (n=99) living with HIV-AIDS were randomly assigned to receive either (1) a five-session group intervention focused on strategies for practicing safer sexual behavior, or (2) a five-session, contact-matched, health-maintenance support group (standard-of-care comparison). Participants were followed for 6 months post-intervention. RESULTS The intervention to reduce risk of HIV transmission resulted in significantly less unprotected intercourse and greater condom use at follow-up. Transmission-risk behaviors with non-HIV-positive sexual partners and estimated HIV transmission rates over a 1-year horizon were also significantly lower for the behavioral risk-reduction intervention group. CONCLUSIONS This study is among the first to demonstrate successful HIV-transmission risk reduction resulting from a behavioral intervention tailored for HIV-positive men and women.

Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS.

Background: Poor health literacy is a prevalent barrier to medical care and people with lower health literacy experience greater illness severity than people with higher health literacy. Health literacy may therefore be an important factor in the health and treatment of people living with HIV‐AIDS. Methods: A community‐recruited sample of 339 HIV‐infected men and women completed surveys and interviews that assessed functional health literacy, health status, AIDS‐related disease and treatment knowledge, and health care perceptions and experiences. Medical records were available for chart abstraction of health status for a subsample of participants. Results: About 1 of 4 people living with HIV‐AIDS demonstrated difficulty comprehending simple medical instructions and therefore lower health literacy. HIVinfected people with lower health literacy had lower CD4 cell counts, higher viral loads, were less likely to be taking antiretroviral medications, reported a greater number of hospitalizations, and reported poorer health than those with higher health literacy. In addition, after adjusting for years of formal education, lower health literacy was associated with poorer knowledge of ones HIV‐related health status, poorer AIDS‐related disease and treatment knowledge, and more negative health care perceptions and experiences. Conclusions: Health literacy is a significant factor in the health and treatment of persons living with HIV‐AIDS. Interventions are needed to improve medical care and the health status of people with lower health literacy that are living with HIV‐AIDS.

Health literacy and health-related knowledge among persons living with HIV/AIDS

BACKGROUND Functional health literacy is associated with illness-related knowledge, understanding, and treatment perceptions for several chronic illnesses. This study examined health literacy in relation to knowledge and understanding of HIV/AIDS. METHODS Persons living with HIV/AIDS recruited from AIDS service organizations and HIV clinics completed the Test of Functional Health Literacy for Adults (TOFHLA) reading comprehension scale and measures of health status, knowledge and understanding of health status, perceptions of primary care givers, and perceptions of anti-HIV treatments. RESULTS Eighteen percent of the sample scored below the cutoff for marginal functional health literacy on the TOFHLA. Controlling for years of education, persons of lower health literacy were significantly less likely to have an undetectable HIV viral load, somewhat less likely to know their CD4 cell count and viral load, and lower health-literacy persons who knew their CD4 count and viral load were less likely to understand their meaning. Lower health literacy was also related to misperceptions that anti-HIV treatments reduce risks for sexually transmitting HIV and beliefs that anti-HIV treatments can relax safer-sex practices. CONCLUSIONS Poor health literacy creates barriers to fully understanding ones health, illness, and treatments. Misperceptions of treatment in the case of HIV infection creates danger for potentially transmitting treatment-resistant strains of HIV. These results have implications for patient education and treatment programming for people who have poor health-literacy skills and are living with HIV/AIDS.

Distinguishing between overlapping somatic symptoms of Depression and HIV disease in people living with HIV-AIDS

HIV-AIDS is a prevalent medical diagnosis in U.S. cities, and symptoms of depression are common in persons with HIV infection. This study examined the effects of overlapping symptoms of HIV disease and somatic depression that can inflate scores on the Beck Depression Inventory (BDI) and the Centers for Epidemiological Studies Depression Scale (CESD). Results from 357 HIV positive men and women identified discrete subsets of depression symptoms that correspond with symptoms of HIV infection. Removing somatic subsets of depression symptoms improved the clinical utility of the BDI and CESD. Clearer symptom separation occurred with the BDI than the CESD, but the CESD may be more sensitive than the BDI to depression associated with progression of HIV disease. Findings suggest that depression scales that include somatic symptoms will inflate depression scores in people living with HIV infection, and available methods for distinguishing overlapping symptoms should be employed when assessing people living with HIV infection.

The Sexual Compulsivity Scale : Further development and use with HIV-positive persons

We examined the reliability and validity of the Sexual Compulsivity Scale for use in assessing HIV-positive men and women. Measures collected from 287 men and women recruited from the community, the majority of whom were African American and over the age of 30, showed that the Sexual Compulsivity Scale was reliable for men (Α = .89) and women (Α = .92). Correlations with measures of sexual behaviors and numbers of sex partners supported the concurrent validity of the Sexual Compulsivity Scale for men and women. Results of discriminant function analyses that included participant age, use of nonalcohol drugs, the Sexual Compulsivity Scale, and scores on measures of trait anxiety, obsessive-compulsiveness, future pessimism, cognitive depression, and borderline personality characteristics showed that sexual compulsivity clearly discriminated between persons with 1 or no sex partners and persons with multiple partners in the past 3 months, for both men and women, suggesting evidence for criterion-related validity. Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women. We conclude that the Sexual Compulsivity Scale is reliable and valid in assessing men and women infected with HIV, although sexual compulsivity may present differently between genders in relation to other forms of psychopathology.

Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex.

Background:Advances in the treatment of HIV disease with protease inhibitor combination therapies have been widely documented in the media. Objectives:To investigate perceptions concerning the severity of HIV/AIDS and the need to maintain safer sex practices in the light of recent HIV treatment advances. Methods:A survey eliciting demographic characteristics, HIV serostatus and treatment information, and HIV/AIDS severity and safer sex perceptions was administered to a community sample of 379 homo-/bisexual men who reported awareness of combination therapy regimens. Results:Ten per cent of all respondents agreed or strongly agreed with the statement that ‘AIDS is now very nearly cured’ and 13% felt that the threat of AIDS is less serious than in the past. HIV-positive men were more likely to perceive AIDS as a less serious threat or as very nearly cured. Overall, 8% of men in the sample indicated that they practice safer sex less often since new AIDS treatments came along; 18% of HIV-positive men on combination therapy regimens said they practice safer sex less frequently since treatments have advanced. Regardless of serostatus, nearly 20% of men indicated they would stop practicing safer sex if an AIDS cure was announced. Conclusion:It is essential to integrate behavior change counseling into HIV treatment programs and to temper optimism concerning treatment advances with recognition that the threat of HIV/AIDS remains great.

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.

Unwanted sexual experiences and sexual risks in gay and bisexual men: Associations among revictimization, substance use, and psychiatric symptoms

Unwanted sexual experiences are associated with high‐risk sexual practices for HIV infection. The current study examined histories of unwanted sexual contact in childhood and adulthood in relation to HIV risk behavior in men who have sex with men. Men attending a large gay pride event in Atlanta, Georgia (N = 595) completed anonymous surveys measuring sexual history, substance use, sexual risk behavior, and symptoms of dissociation, trauma‐related anxiety, and borderline personality. Results showed that men who had been sexually coerced into unwanted sexual activity as adults were more likely to report being treated for substance abuse as well as use of crack cocaine and nitrite inhalants in the past 6 months. Sexually coerced men were also more likely to report high‐risk sexual behaviors and symptoms of dissociation, trauma‐related anxiety, and borderline personality. History of sexual victimization in childhood and revictimization in adulthood was not, however, associated with increased risk behavior over and above that seen in relation to adult unwanted sexual experiences. We conclude that sexual coercion is a significant problem among men who have sex with men, including increasing risk for HIV infection.

Trauma Symptoms, Sexual Behaviors, and Substance Abuse: Correlates of Childhood Sexual Abuse and HIV Risks among Men Who Have Sex with Men.

ABSTRACT 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.

HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior.

Close and consistent adherence to anti-HIV medication regimens is necessary to achieve the maximum benefit of these potentially effective treatments. The authors examined cognitive and behavioral factors associated with HIV treatment adherence in a convenience sample of 112 women, 72 of whom were currently taking HIV treatments at the time of the study. Women completed confidential surveys and interviews to assess HIV-related health status, treatment regimens, and cognitive behavioral characteristics derived from the Information-Motivation-Behavioral Skills model of health promotion behaviors. Results showed that women who had missed at least one dose of their HIV medications in the past week reported lower intentions (motivation) to remain adherent and lower adherence self-efficacy (skills). Structural equation modeling showed that motivational and skills-building factors significantly predicted the number of medication doses missed. However, treatment-related information did not predict treatment adherence. In addition, women who had missed a dose of medication in the past week were more likely to have ever used devices and strategies to remind them of doses, but were no more likely to currently use such strategies. Interventions that enhance treatment adherence motivation and build adherence skills may help improve HIV treatment adherence in women receiving anti-HIV therapies.