Webster Luke

Stress, Social Support, and HIV-Status Disclosure to Family and Friends Among HIV-Positive Men and Women

Patterns of HIV-status disclosure and social support were examined among 331 HIV-positive men and women. Structured interviews assessed HIV-status disclosure to family and friends, perceived stress of disclosure, social support, and depression. Results showed patterns of selective disclosure, where most participants disclosed to some relationship members and not to others. Rates of disclosure were associated with social support. Friends were disclosed to most often and perceived as more supportive than family members, and mothers and sisters were disclosed to more often than fathers and brothers and perceived as more supportive than other family members. Path analyses tested a model of HIV-status disclosure showing that perceived stress of disclosing HIV was associated with disclosure, and disclosures were related to social support. Disclosure and its association to social support and depression varied for different relationships and these differences have implications for mental health and coping interventions.

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.

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.

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: Preliminary results from a community survey

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.

Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men.

Alcohol use and sensation-seeking personality characteristics are commonly associated with sexual risk behavior in populations at risk for HIV infection. However, these associations are not well understood and have not yet been examined in people living with HIV-AIDS. We used path analyses to test a model of sensation seeking, alcohol use expectancies, and sexual risk behaviors among 197 HIV seropositive men. Results showed that alcohol use outcome expectancies and alcohol used in sexual contexts were closely associated with unprotected intercourse and that sensation seeking was significantly related to alcohol use expectancies. Sensation seeking did not mediate the association between alcohol use and unprotected sexual behavior. Further analyses showed that the association between sensation seeking and alcohol use in unprotected sexual contexts was accounted for by expectancies that alcohol use improves sexual performance and enhances sexual pleasure. Analyses also indicated that men living with HIV-AIDS who used alcohol in sexual contexts were characterized by greater overall frequency and quantity of drinking. Prevention interventions may be improved by tailoring them for alcohol-using HIV-infected men, particularly by challenging beliefs and expectations that alcohol enhances sexual performance and sexual pleasure.

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.

Internet access and Internet use for health information among people living with HIV–AIDS

Widespread access to the Internet has the potential to improve the health care and quality of life of people with chronic illnesses, including people living with HIV-AIDS. However, the Internet is not equally accessible to all persons. We surveyed 96 men and 51 women living with HIV-AIDS regarding their experiences using the Internet. Results showed that persons with 12 or fewer years of education were significantly less likely to have used the Internet and were less likely to have been instructed in Internet use. A broad range of health-related Internet activities was reported including searching for health, AIDS-specific information, and using the Internet to communicate with providers. Among current Internet users, individuals who had an Internet connection in their home reported significantly more experiences using the Internet, including Internet use for interpersonal communication and search functions. A digital divide therefore exists among people living with HIV-AIDS, and the benefits of the Internet appear better achieved with home access.

HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships

As many as one in three persons living with HIV-AIDS continue to practise unprotected sexual intercourse and these practices often occur with HIV-negative or unknown HIV serostatus (serodiscordant) partners. The current study examined the rates of HIV transmission risk behaviours in non-regular (e.g. casual) and regular (e.g. steady) serodiscordant relationships. HIV positive men (n = 269) and women (n = 114) responded to measures of demographic characteristics, health and mental health status, and sexual behaviours assessed in partner-by-partner interviews. 257 (67%) participants were sexually active in the preceding three months and 182 (71%) of the sexually active persons had engaged in vaginal or anal intercourse with serodiscordant partners. Comparisons of persons with non-regular (n = 97) and regular (n = 85) serodiscordant partners showed that overall rates of unprotected and protected intercourse were greater with regular partners than non-regular partners. Disclosure of HIV status to regular and non-regular serodiscordant partners did not appear to influence the pattern of results. Mathematical modelling showed that HIV transmission estimates over a one-year horizon were significantly greater for male regular partners of HIV-positive men than non-regular partners and there was a trend toward greater HIV transmission rates from HIV-positive men to their regular serodiscordant female partners compared to non-regular partners. Results suggest an urgent need for HIV transmission risk reduction interventions for HIV serodiscordant couples, particularly for couples in established, regular relationships.

Perceptions of Health Care among Persons Living with HIV/AIDS Who Are Not Receiving Antiretroviral Medications

Antiretroviral medications are effective at improving the health and increasing the survival of people living with HIV/AIDS. However, studies have shown that a substantial number of HIV-infected people do not receive antiretroviral treatments. The current study examined the physical and mental health, substance use, and perceptions of medical care of 163 men and 78 women living with HIV/AIDS. Results of a confidential survey showed that 79 (33%) were not currently treated for HIV. These persons did not differ from those who were treated in chart-abstracted CD4 cell counts, years living with HIV infection, HIV-related symptoms, and HIV-related hospitalizations. Unlike past studies, gender was not found to be a factor in treatment status. However, untreated persons had higher chart-abstracted viral loads and were more likely to be ethnic minorities, have a lower level of education, greater level of depression, and greater pessimistic attitude. They were significantly more likely to have used alcohol, powder cocaine, and crack cocaine in the previous 3 months, were likely to know their own viral load and CD4 count, and held significantly more negative views of their health care and their health care providers. There were no differences between untreated and treated persons in their meeting the year 1999 antiretroviral treatment guidelines that were in effect at the time of data collection. These results suggest that persons who are not receiving antiretroviral medications may be in need of mental health and substance use interventions and may benefit from interventions designed to engage and retain them in medical treatment.

Initial Development of Scales to Assess Self-Efficacy for Disclosing HIV Status and Negotiating Safer Sex in HIV-Positive Persons

Two studies were conducted to develop scales for assessing self-efficacy to disclose HIV status to sex partners and negotiate safer sex practices among people living with HIV/AIDS. Elicitation research was used to derive 4 sets of scenarios with graduated situational demands that serve as stimulus materials in assessing self-efficacy. Two studies demonstrated that the self-efficacy scales for effective disclosure and negotiating safer sex practices were internally consistent, time stable over 1 month, and demonstrated evidence for validity. Self-efficacy scales also demonstrated evidence of criterion-related, convergent, and divergent validity. Reliable and valid instruments for assessing self-efficacy to make effective HIV status disclosure decisions and practice safer sex were therefore developed and these scales can be used in research to explain, predict, and enhance self-efficacy for these important behaviors.