Jonelle M. Taylor

A validity and reliability study of the coping self‐efficacy scale

OBJECTIVES Investigate the psychometric characteristics of the coping self-efficacy (CSE) scale, a 26-item measure of ones confidence in performing coping behaviors when faced with life challenges. DESIGN Data came from two randomized clinical trials (N1=149, N2=199) evaluating a theory-based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. METHODS The 348 participants were HIV-seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre- and post-intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well-being. RESULTS Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13-item reduced form of the CSE scale with three factors: Use problem-focused coping (6 items, alpha=.91), stop unpleasant emotions and thoughts (4 items, alpha=.91), and get support from friends and family (3 items, alpha=.80). Internal consistency and test-retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self-efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem- and emotion-focused coping skills were predictive of reduced psychological distress and increased psychological well-being over time. CONCLUSIONS The CSE scale provides a measure of a persons perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.

Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention.

Objective This randomized clinical trial was designed to compare the effects of a theory-based coping effectiveness training (CET) intervention with an active informational control (HIV-Info) condition and a waiting-list control (WLC) condition on psychological distress and positive mood in HIV-seropositive gay men. Materials and Methods The authors recruited 149 self-identified gay or bisexual men who were 21 to 60 years of age, reported depressed mood, and had CD4 levels of 200 to 700 cells/mm3. CET and HIV-Info participants attended 10 90-minute group sessions during the 3-month intervention phase and six maintenance sessions over the remainder of the year. Participants were assessed at baseline and at 3, 6, and 12 months. Data were collected 1992 to 1994, before the introduction of HAART. Analyses were based on the 128 participants who completed the 3-month assessment. Results After the 3-month intervention phase, when compared with HIV-Info, CET participants showed significantly greater decreases in perceived stress and burnout, and regression analyses indicated that significant increases in coping self-efficacy mediated the improvements in perceived stress and burnout. Compared with WLC, CET participants also showed significantly greater decreases in anxiety, and regression analyses indicated that significant increases in positive states of mind mediated the improvements in anxiety. Significant treatment group differences for positive morale were maintained at 6 and 12 months. In addition, optimism continued to increase in the CET and HIV-Info treatment groups during the maintenance phase. Conclusions CET can be an effective strategy for managing psychological distress and improving positive psychological states in patients confronting chronic illness.

Social support, distress, and well-being in older men living with HIV infection

Summary: Older men with HIV infection/AIDS, having often lived with the condition longer, are more likely to confront the stress of managing more advanced HIV disease than their younger counterparts. Meanwhile, they also are more likely to have less social support and experience more distress than younger persons with HIV infection. The moderating effect of social support on health functioning and distress is unknown for persons with HIV infection, particularly those who are older. Study objectives were to assess whether the association between perceived health functioning and psychological distress and well‐being is moderated (or influenced) by social support and age and if the impact of social support on distress and well‐being is more pronounced for older than for younger men living with HIV infection/AIDS. In this cross‐sectional study of HIV‐positive adult men (n = 199) who have sex with men, participants completed self‐report assessments of perceived health functioning, social support, and psychological distress and well‐being. Measures of health functioning and overall social support were significantly associated with outcome measures of distress and positive affect (all p < .05). However, the main effect for social support was qualified by a significant age‐by‐social support interaction for both outcomes (&bgr; = ‐.190, p < .01 for distress; &bgr; = .172, p < .05 for positive affect), indicating that the impact of social support on decreasing distress and increasing well‐being was more pronounced in older men. The relationships between perceived health functioning and distress and well‐being were not moderated by social support or age. The influence of social support on negative and positive moods in this population of HIV‐infected men who have sex with men was significantly greater among older than among younger participants. With an increasing number of older people with HIV infection/AIDS, special efforts to create effective and sustainable social support interventions may be particularly beneficial to older persons living with HIV infection.

Primary Relationships, HIV Treatment Adherence, and Virologic Control

To identify factors associated with antiretroviral therapy (ART) adherence and virologic control among HIV-positive men on ART in primary relationships, data were collected from 210 male couples (420 men). Dyadic actor–partner analyses investigated associations with three levels of adherence-related dependent variables: self-efficacy (ASE), self-reported adherence, and virologic control. Results indicated that higher patient ASE was related to his own positive beliefs about medications, higher relationship autonomy and intimacy, and fewer depressive symptoms. Fewer depressive symptoms and less relationship satisfaction in the partner were linked to higher ASE in the patient. Better self-reported adherence was related to the patient’s positive appraisal of the relationship and the partner’s positive treatment efficacy beliefs. Greater medication concerns of both patient and partner were associated with less adherence. The partner’s higher relationship commitment was associated with lower viral load in the patient. Findings suggest that depressive symptoms, treatment beliefs, and relationship quality factors of both partners may influence adherence-related outcomes.

Partner reports of HIV viral suppression predict sexual behavior in serodiscordant male couples.

To the Editors: Biomedical prevention strategies, specifically the achievement of an undetectable viral load, can prevent transmission of HIV among men who have sex with men (MSM). Moreover, among MSM, viral load information is used in the negotiation of condomless anal intercourse (CAI), and studies find that MSM are more likely to engage in CAI if they believe their partners are virally suppressed. To date, research on the association between viral load and CAI has focused exclusively on a single partner (ie, the HIV-negative or HIV-positive partner) without attending to the dyadic nature of sexual relationships and potentially contributing to pseudounilaterality—a bias that results from continually studying only 1 side of a 2-way interaction. The probability of HIV transmission is low when a partner is virally suppressed and clear of genital tract inflammation. Yet viral-sorting practices (ie, considering a partner’s viral load when making decisions about sexual behaviors) rely on subjective beliefs about viral suppression, and recent data show that MSM are likely to overestimate that their primary partner is virally suppressed. Thus, a better understanding of partner perceptions of viral suppression and sexual risk behavior has important implications for HIV prevention and clinical practice. In this study, we fill a key gap in the literature by examining the relative importance of both partners’ self-reports of viral suppression—and confirmatory viral load blood test results—on intradyadic (ie, within-couple) sexual risk behavior.

A longitudinal study of persistent smoking among HIV-positive gay and bisexual men in primary relationships

INTRODUCTION We examined the stability of smoking behaviors, and factors associated with persistent smoking in a longitudinal study of HIV-positive gay and bisexual men in primary relationships. METHODS A sample of 377 HIV-positive men on antiretroviral therapy and their same-sex partners completed five assessments over two years. Participants completed semi-structured interviews which assessed smoking status, sociodemographic factors, relationship dynamics, and HIV-related disease characteristics. Latent transition analysis estimated the amount of transition in smoking over time. Latent class analysis examined factors associated with smoking status across the study period. RESULTS At baseline, 28.1% (n=106) of participants reported current smoking. Over 90% of the HIV-positive men remained in the same smoking category over time (68.4% persistent non-smokers; 24.1% persistent smokers). Men whose partners smoked and men with lower income had higher odds of being persistent smokers, whereas older men and men who identified as Latino race/ethnicity had lower odds of being persistent smokers compared to non-smokers. CONCLUSIONS Despite efforts to reduce smoking among people living with HIV (PLWH), a substantial subset of men continued to smoke during their two years in the study. Findings suggest that primary partners who also smoke and low income were the strongest predictors of sustained smoking behaviors among HIV-positive men. Additional research is needed to better understand how to increase motivation and support for smoking cessation among PLWH and their primary partners, while attending to how socioeconomic status may inhibit access to and the sustained impact of existing smoking cessation programs.