Jean L. Richardson

Domestic Violence and Childhood Sexual Abuse in HIV-Infected Women and Women at Risk for HIV

OBJECTIVES The purpose of this study was to determine the prevalence and effect of domestic violence and childhood sexual abuse in women with HIV or at risk for HIV infection. METHODS Participants with HIV or at risk for HIV infection enrolled in the Womens Interagency HIV Study. Childhood sexual abuse; all physical, sexual, and coercive violence by a partner; HIV serostatus; demographic data; and substance use and sexual habits were assessed. RESULTS The lifetime prevalence of domestic violence was 66% and 67%, respectively, in 1288 women with HIV and 357 uninfected women. One quarter of the women reported recent abuse, and 31% of the HIV-seropositive women and 27% of the HIV-seronegative women reported childhood sexual abuse. Childhood sexual abuse was strongly associated with a lifetime history of domestic violence and high-risk behaviors, including using drugs, having more than 10 male sexual partners and having male partners at risk for HIV infection, and exchanging sex for drugs, money, or shelter. CONCLUSIONS Our data support the hypothesis of a continuum of risk, with early childhood abuse leading to later domestic violence, which may increase the risk of behaviors leading to HIV infection.

Depressive Symptoms and AIDS-Related Mortality Among a Multisite Cohort of HIV-Positive Women

OBJECTIVES We examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, mental health treatment, medication adherence, substance abuse, clinical indicators, and demographic factors. METHODS One thousand seven hundred sixteen HIV-seropositive women completed semiannual visits from 1994 through 2001 to clinics at 6 sites. Multivariate Cox and logistic regression analyses estimated time to AIDS-related death and depressive symptom severity. RESULTS After we controlled for all other factors, AIDS-related deaths were more likely among women with chronic depressive symptoms, and symptoms were more severe among women in the terminal phase of their illness. Mental health service use was associated with reduced mortality. CONCLUSIONS Treatment for depression is a critically important component of comprehensive care for HIV-seropositive women, especially those with end-stage disease.

The effect of compliance with treatment on survival among patients with hematologic malignancies.

Ninety-four newly diagnosed patients with hematologic malignancies were monitored for compliance with oral medication and scheduled clinic appointments over a 6-month treatment period. They were assigned at entry either to a control condition or an intervention condition designed to improve compliance. Compliance with medication was assessed objectively with serial serum drug and metabolite levels, as well as with self-report indices obtained on a monthly basis. Medical records were abstracted to obtain data on the number of appointments kept, treatment given, disease characteristics, and survival. On univariate analyses using the log-rank test, five variables were found to be significantly related to survival. These included compliance with allopurinol (probably acting as a surrogate for self-medication with other chemotherapeutic agents) (P = .007), control versus educational program cohort (P less than .001), disease severity (P = .009), Karnofsky at diagnosis (P = .011), sex (P = .084), and clinic appointments kept (P = .043). In hierarchical proportional hazards models, the following variables were associated with decreased risk of death: disease severity (P less than .025), keeping over 60% of appointments (P less than .05), allopurinol/oxipurinol compliance (P less than .01), and educational program cohort (P less than .05). After controlling for all other variables, three variables were associated with increased survival: high disease severity (relative risk [RR] = 2.48), high compliance with allopurinol (RR = .45), and educational program cohort (RR = .39). We conclude that compliance with oral medication has a significant effect on patient survival. In addition, the use of special educational and supportive programs designed to improve patient compliance are associated with significant prolongation of patient survival due to, as well as independent of their effects on compliance.

Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment.

Objective: To test the efficacy of brief, safer-sex counseling by medical providers of HIV-positive patients during medical visits. Setting: Six HIV clinics in California. Design: Clinics were randomized to intervention arms evaluated with cohorts of randomly selected patients measured before and after the intervention. Participants: Five-hundred and eighty-five HIV-positive persons, sexually active prior to enrollment. Interventions: Prevention counseling from medical providers supplemented with written information. Two clinics used a gain-framed approach (positive consequences of safer-sex), two used a loss-frame approach (negative consequences of unsafe sex), and two were attention-control clinics (medication adherence). Interventions were given to all patients who attended the clinics. Outcome measure: Self-reported unprotected anal or vaginal intercourse (UAV). Results: Among participants who had two or more sex partners at baseline, UAV was reduced 38% (P < 0.001) among those who received the loss-frame intervention. UAV at follow-up was significantly lower in the loss-frame arm [odds ratio (OR), 0.42; 95% confidence interval (CI), 0.19–0.91; P = 0.03] compared with the control arm. Using generalized estimating equations (GEE) to adjust for clustering did not change the conclusions (OR, 0.34; 95% CI, 0.24–0.49; P = 0.0001). Similar results were obtained in participants with casual partners at baseline. No effects were seen in participants with only one partner or only a main partner at baseline. No significant changes were seen in the gain-frame arm. Conclusions: Brief provider counseling emphasizing the negative consequences of unsafe sex can reduce HIV transmission behaviors in HIV-positive patients presenting with risky behavioral profiles.

Parenting style and adolescent depressive symptoms, smoking, and academic achievement: Ethnic, gender, and SES differences

This paper examines whether the relationship between parenting style and adolescent depressive symptoms, smoking, and academic grades varies according to ethnicity, gender, and socioeconomic status. Four parenting styles are distinguished, based on patterns of parent-adolescent decision making: autocratic (parents decide), authoritative (joint process but parents decide), permissive (joint process but adolescent decides), and unengaged (adolescent decides). The sample included 3993 15-year-old White, Hispanic, African-American, and Asian adolescents. Results are generally consistent with previous findings: adolescents with authoritative parents had the best outcomes and those with unengaged parents were least well adjusted, while the permissive and the autocratic styles produced intermediate results. For the most part, this pattern held across ethnic and sociodemographic subgroups. There was one exception, suggesting that the relationship between parenting styles, especially the unengaged style, and depressive symptoms may vary according to gender and ethnicity. More research is needed to replicate and explain this pattern in terms of ecological factors, cultural norms, and socialization goals and practices.

Cultural diversity in the predictors of adolescent cigarette smoking: The relative influence of peers

A culturally diverse sample of 4375 adolescents completed a self-report inventory assessing their current amount of smoking, and several psychosocial predictors of smoking (e.g., depression, anger, stress, smoking among peers, etc). Results revealed that Whites smoke more than Blacks, Asians, and less acculturated Latinos but not more than highly acculturated Latinos. Stepwise regression analyses of the predictors of smoking found significant ethnic and acculturation differences in the relative predictive power of 18 well-known risk factors. Smoking among peers was the best predictor of smoking for White adolescents (accounting for 23.5% of the variance) but accounted for only 15% of the variance for Latino youth, 9.6% of the variance for Asian youth, and none of the variance for Black youth. Results are discussed in terms of their implications for smoking prevention programs that focus on resisting peer influences.

Quality of Life Survey of Urinary Diversion Patients: Comparison of Ileal Conduits versus Continent Kock Ileal Reservoirs

There has been a recent marked increase in interest in continent urinary diversions. While considerable time has been spent on the technical aspects of these diversions the psychological impact has not yet been fully explored. We describe an extensive survey that was conducted among 100 consecutive adults (87 respondents) who had undergone urinary diversion via an ileal conduit and 100 consecutive adults (85 respondents) in whom a continent Kock ileal reservoir was created during the last 3 to 5 years at our university by the same surgeons. The Kock pouch patients were stratified further into 63 with primary diversion and 22 who underwent conversion from previous conduit diversions. The survey consisted of a questionnaire that included a social and sexual survey, the Beck Depressive Inventory, the Profile of Mood States and a physical impact study. The results revealed that all patients surveyed generally were satisfied with the diversions and they had adapted reasonably socially, physically and psychologically. The key to adaptation seemed to be a detailed, realistic preoperative education about the type of diversion used. Patients with ileal conduit diversions had the lowest expectations of the form of diversion as defined by the preoperative awareness of the need to wear an external ostomy appliance with its associated inconveniences and change in the external body image. Postoperatively, ileal conduit patients also had the poorest self images as defined by a decrease in sexual desire and in all forms of physical contact (sexual and nonsexual). The subset of patients who underwent conversion from conduit diversions to Kock pouches, however, were statistically the most satisfied, and they were the most physically and sexually active. We conclude that the Kock continent urostomy offers an important alternative to noncontinent forms of diversion.

Women's Self-Disclosure of HIV Infection: Rates, Reasons, and Reactions

A survey of 65 ethnically diverse women at 2 outpatient HIV clinics revealed relatively low rates of disclosure of HIV-positive serostatus to extended family members, somewhat higher rates for immediate family members, and highest rates for lovers and friends. Spanish-speaking Latinas were less likely to disclose their serostatus or to discuss HIV-related worries with others than English-speaking Latinas, African Americans, and Anglo Americans. Reasons for disclosure and nondisclosure varied by target. In general, targets reacted positively to disclosure. Implications for clinicians treating women with HIV infection are discussed.

Culturally Sanctioned Secrets? Latino Men's Nondisclosure of HIV Infection to Family, Friends, and Lovers

Spanish-speaking Latino men (n = 107) were more likely than English-speaking Latinos (n = 85) and Whites (n = 206) to withhold their HIV-positive serostatus and their gay or bisexual orientation from significant others, especially family members. Similar effects were observed when Latinos were divided by birthplace and when analyses controlled for sociodemographic and medical factors. Reasons for revealing or concealing an HIV diagnosis varied across targets. Although both Latinos and Whites were more likely to withhold their diagnosis from their parents to prevent worrying them than to avoid personal rejection, this tendency was somewhat stronger among Latinos. Our findings suggest that some traditional values may deter Latinos from seeking HIV-related social support in times of need.

The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy.

To provide a systematic analysis of how adverse symptoms of disease and side effects of cancer therapy relate to patient noncompliance with treatment, we interviewed 107 patients with hematologic malignancies at the initiation of therapy and 6 months later to collect information on the type, frequency, and difficulty of unpleasant physical effects experienced. Level of compliance was monitored (biochemically and with self-report) on a monthly basis for oral self administration of allopurinol and prednisone. Appointment-keeping to receive infused chemotherapy was also monitored. Nausea was the most frequent side effect experienced. Nausea, fever, and pain were the most difficult physical effects to tolerate when they occurred. Complex treatment regimens and severe diseases related to reports of more physical effects. Younger patients had a more difficult time dealing with these effects than did older patients. Neither the occurrence, frequency, or difficulty dealing with any of the effects related to noncompliance with either of the two self-administered medications. Difficulty with particular effects did relate to noncompliance with clinic appointments to receive infused chemotherapy.