Nina A. Cooperman

Suicidal ideation and attempted suicide among women living with HIV/AIDS

The prevalence, timing, and predictors of suicidal ideation and attempted suicide were evaluated in a sample of 207 HIV-positive women in New York City. Twenty-six percent of the women reported attempting suicide since their HIV diagnosis. Of those who made an attempt, 42% acted within the first month after diagnosis and 27% acted within the first week. AIDS diagnosis, psychiatric symptoms, and physical or sexual abuse were significant positive predictors of both suicidal ideation and attempts. Contrary to expectations, having children and being employed were also significant positive predictors. Spirituality was significantly negatively associated with suicidal ideation only. These results suggest that suicide prevention measures should be implemented for HIV-positive women immediately after diagnosis. Specifically, interventions should target those with an AIDS diagnosis, psychiatric symptoms, an abuse history, children, or employment. The encouragement of spiritual connection seems to be a deterrent to suicidal thoughts and is a possible avenue for intervention.

Review: The Need for Smoking Cessation Among HIV-Positive Smokers

Most HIV-positive persons in the U.S. smoke cigarettes. Despite substantial clinical advances in HIV care in the era of highly active antiretroviral therapy (HAART), HIV-positive persons are at high risk of tobacco-related disease and death. HIV-positive persons have complex social, economic, psychiatric, and medical needs that may impact smoking behavior and response to smoking cessation interventions, but there is a dearth of research on smoking cessation interventions tailored to HIV-positive persons. HIV care providers should treat tobacco use with the array of evidence-based smoking cessation treatments available, updating their clinical practice as new data emerge. This article reviews the literature on the health consequences of tobacco use in HIV-positive persons, the treatment of tobacco dependence, and the research to date on smoking cessation interventions in HIV-positive persons, and it presents recommendations for future research and intervention.

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.

Smokers With Behavioral Health Comorbidity Should Be Designated a Tobacco Use Disparity Group

Smokers with co-occurring mental illness or substance use disorders are not designated a disparity group or priority population by most national public health and tobacco control groups. These smokers fulfill the criteria commonly used to identify groups that merit special attention: targeted marketing by the tobacco industry, high smoking prevalence rates, heavy economic and health burdens from tobacco, limited access to treatment, and longer durations of smoking with less cessation. A national effort to increase surveillance, research, and treatment is needed. Designating smokers with behavioral health comorbidity a priority group will bring much-needed attention and resources. The disparity in smoking rates among persons with behavioral health issues relative to the general population will worsen over time if their needs remain unaddressed.

Strategies to Improve Access to and Utilization of Health Care Services and Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users

We review five innovative strategies to improve access, utilization, and adherence for HIV-infected drug users and suggest areas that need further attention. In addition, we highlight two innovative programs. The first increases access and utilization through integrated HIV and opioid addiction treatment with buprenorphine in a community health center, and the second incorporates adherence counseling for antiretroviral therapy in methadone programs. Preliminary evaluations demonstrated that these strategies may improve both HIV and opioid addiction outcomes and may be appropriate for wider dissemination. Further refinement and expansion of strategies to improve outcomes of HIV-infected drug users is warranted.

Abuse, Social Support, and Depression Among HIV-Positive Heterosexual, Bisexual, and Lesbian Women

SUMMARY A nonprobability sample of HIV-positive mostly African American and Puerto Rican women in New York City were surveyed regarding abusive experiences, social support, and depressive symptoms. Seventy-five percent reported experiencing physical or sexual abuse at some point in their lives. Multiple regression analyses controlling for relevant sociodemographic variables indicated that child physical and sexual abuse and adult sexual abuse were significantly associated with depressive symptomatology (i.e., CES-D scores). HIV-related social support had a significant negative correlation with CES-D scores but did not have a moderating impact on the effects of physical or sexual abuse. Lesbian/bisexual women reported higher rates of lifetime sexual and physical abuse than heterosexual women. However, there were no differences between the groups in total CES-D scores. Lesbian/bisexual women had significantly greater support from friends and groups/organizations than the heterosexual women. The implications of the findings for future research and the provision of services for HIV-positive women are considered.

Self-efficacy and depression as mediators of the relationship between pain and antiretroviral adherence

Abstract The goals of this study were to examine the association between pain and antiretroviral adherence and to estimate the mediating effect of adherence self-efficacy and depression symptom severity. Surveys using audio computer-assisted self-interview were conducted among 70 HIV-infected current and former drug users enrolled in a methadone program. We assessed antiretroviral adherence and adherence self-efficacy using questions from the Adult Clinical Trials Group survey. We considered participants adherent if they reported taking at least 95% of prescribed antiretrovirals over the past seven days. We assessed depression symptom severity using the depression subscale of the Brief Symptom Inventory. Participants reported pain of any duration in response to a question from the Brief Pain Inventory. Participants reporting pain were 87% less likely to be classified as adherent compared to those without pain (Unadjusted OR = 0.13, 95%CI: 0.03–0.52). When we examined adherence self-efficacy as a mediator of the relationship between pain and adherence, criteria for partial mediation were met. Adjusting for self-efficacy, the beta coefficient for pain decreased by 23% but the independent relationship between pain and antiretroviral adherence was maintained. Mediation criteria were not met when we examined the mediating effect of depression symptom severity on the relationship between pain and adherence. Adjusting for depression symptom severity, the beta coefficient for pain decreased by 9% and the relationship between pain and antiretroviral adherence remained significant. Our results indicate that neither adherence self-efficacy nor depression symptom severity fully mediated the relationship between pain and adherence. HIV providers should recognize the potential impact of pain on antiretroviral adherence among current and former drug users.

The Development and Feasibility of an Intervention to Improve HAART Adherence Among HIV-Positive Patients Receiving Primary Care in Methadone Clinics

Abstract We developed an adherence counseling program to help HIV-positive, opioid dependent patients, receiving primary care in methadone clinics, to improve adherence to highly active antiretroviral therapy (HAART). The intervention is conducted by paraprofessional adherence counselors and consists of six, semi-structured counseling sessions that focus on motivational interviewing and cognitive-behavioral skills training. To date, we have enrolled 119 patients into adherence counseling, suggesting that patients are interested and receptive to the program. Clinic staff has welcomed the additional support provided by the program, and are working collaboratively with the adherence counselors to provide integrated and comprehensive care. The successful implementation of the adherence counseling program indicates that paraprofessionals can effectively be trained to provide semi-structured adherence counseling and that adherence interventions can be incorporated into existing substance abuse and HIV-related treatment programs.

Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone Treatment.

Background: Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. Objective: To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. Methods: Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Results: Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. Conclusions: Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.

Impact of adherence counseling dose on antiretroviral adherence and HIV viral load among HIV-infected methadone maintained drug users

Abstract Adherence counseling can improve antiretroviral adherence and related health outcomes in HIV-infected individuals. However, little is known about how much counseling is necessary to achieve clinically significant effects. We investigated antiretroviral adherence and HIV viral load relative to the number of hours of adherence counseling received by 60 HIV-infected drug users participating in a trial of directly observed antiretroviral therapy delivered in methadone clinics. Our adherence counseling intervention combined motivational interviewing and cognitive-behavioral counseling, was designed to include six 30 minute individual counseling sessions with unlimited “booster” sessions, and was offered to all participants in the parent trial. We found that, among those who participated in adherence counseling, dose of counseling had a significant positive relationship with antiretroviral adherence measured after the conclusion of counseling. Specifically, a liner mixed-effects model revealed that each additional hour of counseling was significantly associated with a 20% increase in post-counseling adherence. However, the number of cumulative adherence counseling hours was not significantly associated with HIV viral load, also measured after the conclusion of counseling. Our findings suggest that more intensive adherence counseling interventions may have a greater impact on antiretroviral adherence than less intensive interventions; however, it remains unknown how much counseling is required to impact HIV viral load.