Jane M. Simoni

Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials.

Summary:Adherence to highly active antiretroviral therapy (HAART) is generally suboptimal, limiting the effectiveness of HAART. This meta-analytic review examined whether behavioral interventions addressing HAART adherence are successful in increasing the likelihood of a patient attaining 95% adherence or an undetectable HIV-1 RNA viral load (VL). We searched electronic databases from January 1996 to September 2005, consulted with experts in the field, and hand searched reference sections from relevant articles. Nineteen studies (with a total of 1839 participants) met the selection criteria of describing a randomized controlled trial among adults evaluating a behavioral intervention with HAART adherence or VL as an outcome. Random-effects models indicated that across studies, participants in the intervention arm were more likely than those in the control arm to achieve 95% adherence (odds ratio [OR] = 1.50, 95% confidence interval [CI]: 1.16 to 1.94); the effect was nearly significant for undetectable VL (OR = 1.25; 95% CI: 0.99 to 1.59). The intervention effect for 95% adherence was significantly stronger in studies that used recall periods of 2 weeks or 1 month (vs. ≤7 days). No other stratification variables (ie, study, sample, measurement, methodologic quality, intervention characteristics) moderated the intervention effect, but some potentially important factors were observed. In sum, various HAART adherence intervention strategies were shown to be successful, but more research is needed to identify the most efficacious intervention components and the best methods for implementing them in real-world settings with limited resources.

HIV Disclosure Among Women of African Descent: Associations with Coping, Social Support, and Psychological Adaptation

Trained interviewers recruited and interviewed a nonprobability sample of HIV-positive women from outpatient clinics and scatter site housing in New York City. Hispanic Black (n = 37) and non-Hispanic Black (n = 106) women reported high rates of HIV disclosure to family, friends, and lovers; few ethnic differences were noted. Bivariate analyses revealed disclosure was related to greater frequency of HIV-related social support, although not directly to less depressive symptomatology (CES-D) or mood disturbance (POMS-TMD) scores. Additionally, disclosure rates were positively associated with the use of more adaptive coping strategies (i.e., spiritual resilience, constructive cognitions, and community involvement). Multiple regression analyses indicated satisfaction with social support mediated the relationship between adaptive coping and psychological distress. The discussion considers HIV disclosure within the constellation of processes leading to successful adaptation to HIV/AIDS.

Stressors and strengths among women living with HIV/AIDS in New York City

We conducted face-to-face interviews with a non-probability sample of 373 women living with HIV/AIDS in New York City. Most were indigent African-Americans and Latinas (M age = 39.61 years). Participants reported considerable stressors. For example, 59% (n = 221) had been sexually abused and 69% (n = 258) physically abused at some point in their lives. In the past 30 days, 9% reported having injected drugs. However, participants also reported considerable strengths, including high levels of spirituality, mastery and HIV-related social support. Multivariate analyses indicated these resources were generally associated with less depressive symptomatology. Findings suggest the need for thorough psychosocial evaluations of women living with HIV to facilitate psychological adaptation, including an exploration of their strengths and culturally-based competencies.

Is acculturation associated with sexual risk behaviours? An investigation of HIV-positive Latino men and women

This cross-sectional study of 226 HIV-positive Latino men and women sampled and assessed at an outpatient HIV clinic in Los Angeles examined the associations among acculturation, use of a substance before sex, and unsafe sexual behaviour. As acculturation increased, men and women were increasingly likely to have engaged in unsafe sex in the most recent sexual encounter since testing seropositive. In men, the association was partially mediated by use of a substance (primarily alcohol) in the three hours before the sexual encounter; in women, the association was not mediated by drug use. The findings underscore the need for culturally sensitive, secondary prevention programmes for HIV-positive persons.

Safer sex among HIV+ women: The role of relationships.

Among 230 HIV+ women in New York City, 105 had been heterosexually active in the last 90 days and 54% of these reported unsafe sex. Contrary to our hypotheses based on relational theory, respondents with steady partners were more likely to have unprotected sex than nonpartnered women. However, among respondents with steady partners, the degree of commitment to the relationship was positively associated with condom use. The only other correlate of unprotected sex was current drug use. Almost all steady partners were aware of the womans HIV status, and, contrary to our hypothesis, respondents were not more likely to have protected sex with HIV− than HIV+ steady partners. The discussion considers self-in-relation theory, culture, power, and contextualistic behaviorism.

Confronting heterosexism in the teaching of psychology

Psychology is not immune from the biases of its cultural context, including the devaluation of homosexuality. Historically, the profession has pathologized nonheterosexual orientations and failed to cultivate an appreciation of and sensitivity toward diversity in sexual orientation. Part of the instructors role is to challenge prevailing heterosexist assumptions and provide accurate information about the psychology of lesbians and gay men. This article presents a rationale for making the psychology curriculum more inclusive of lesbian and gay male issues. Results are presented from a survey of current psychology textbooks that indicate inadequate coverage and segregated treatment of the topic of homosexuality. Finally, suggestions are provided to instructors for expanding coverage of lesbian and gay male psychological issues and avoiding heterosexist bias.