Syndemic conditions and medication adherence in older men living with HIV who have sex with men.

For people living with HIV, lack of adherence to antiretroviral therapy (ART) is a serious problem and frequently results in HIV disease progression. Reasons for non-adherence include concomitant psychosocial health conditions - also known as syndemic conditions - such symptoms of depression or posttraumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. The aim of this study was to investigate the association between syndemic conditions and medication adherence. The sample included 281 older men living with HIV who have sex with men (MSM). The study period was December 2012-July 2016. We observed the following syndemic conditions significantly decreased medication adherence: symptoms of depression (p = .008), PTSD (p = .002), and stimulant use (p < .0001). Past physical or sexual abuse, IPV, and binge drinking were not significantly associated with decreased medication adherence. The findings suggest that syndemic conditions may impact medication adherence in older MSM living with HIV.

Smoking, internalized heterosexism, and HIV disease management among male couples.

High rates of cigarette smoking have been observed among HIV-positive individuals. Smoking has been linked to HIV-related medical complications and non-AIDS defining cancers and negatively impacts on immune function and virologic control. Although internalized heterosexism has been related to smoking behaviors, little is known about associations between partners' reports of smoking, internalized heterosexism, and HIV medication management in male couples with HIV. A sample of 266 male couples completed baseline assessments for a cohort study examining relationship factors and HIV treatment. A computer-based survey assessed self-reported smoking behaviors, alcohol use, internalized heterosexism, and antiretroviral therapy (ART) adherence. HIV-positive men also provided blood samples to assess viral load. Approximately 30% of the sample reported that they are currently smoking cigarettes. After adjusting for demographic characteristics, men in a primary relationship with a partner who reported currently smoking had more than five-fold greater odds of reporting smoking. Higher levels of internalized heterosexism and financial hardship were each independently associated with greater odds of reporting smoking. Among HIV-positive men on ART (n = 371), having a partner who reported smoking was associated with almost three-fold greater odds of having a detectable viral load. Our findings add new support to the evidence of romantic partners influencing each other's health behaviors, and demonstrate an association between smoking and disease management within male couples. Future research should explore the interpersonal and social contexts of smoking in order to develop interventions that meet the unique needs of male couples.

Personal or relational? Examining sexual health in the context of HIV serodiscordant same-sex male couples.

Couples' ability to adopt a "we" orientation has been associated with optimal health outcomes. This study examined how personal and relational motivations are uniquely associated with unprotected anal intercourse (UAI), protected anal intercourse (PAI), and the absence of sexual activity within HIV-serodiscordant same-sex male couples. HIV-positive men and their HIV-negative partners (N = 116 couples, 232 men) completed questionnaires and HIV-positive men had blood drawn for viral load. Results of a multinomial logistic regression illustrated that sexual satisfaction was positively associated with PAI among HIV-negative partners and negatively associated with PAI among HIV-positive partners. Endorsing a "we" orientation was positively associated with PAI among HIV-positive partners. Findings suggest that HIV-positive partners who espouse a "we" orientation may be willing to forgo their personal interests to protect their HIV-negative partners from HIV transmission. Couples-based interventions are warranted to help strengthen relationship dynamics to enhance the sexual health of serodiscordant couples.

Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV.

The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

A multinational study of self-compassion and human immunodeficiency virus-related anxiety.

AIM: This study represents an initial effort at examining the association between the construct of self-compassion and human immunodeficiency virus (HIV)-related anxiety in a multinational population with HIV disease. BACKGROUND: Previous studies have found that self-compassion is a powerful predictor of mental health, demonstrating positive and consistent linkages with various measures of affect, psychopathology and well-being, including anxiety. METHODS: Cross-sectional data from a multinational study conducted by the members of the International Nursing Network for HIV Research (n = 1986) were used. The diverse sample included participants from Canada, China, Namibia, the United States of America and the territory of Puerto Rico. Study measures included the anxiety subscale of the Symptom Checklist-90 instrument, the Brief Version Self-Compassion Inventory and a single item on anxiety from the Revised Sign and Symptom Checklist. FINDINGS: Study findings show that anxiety was significantly and inversely related to self-compassion across participants in all countries. We examined gender differences in self-compassion and anxiety, controlling for country. Levels of anxiety remained significantly and inversely related to self-compassion for both males (P = 0.000) and females (P = 0.000). Levels of self-compassion and anxiety varied across countries. CONCLUSIONS: Self-compassion is a robust construct with cross-cultural relevance. A culturally based brief treatment approach aimed at increasing self-compassion may lend itself to the development of a cost effective adjunct treatment in HIV disease, including the management of anxiety symptoms.

Mediators of antiretroviral adherence: a multisite international study.

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

It's not just what you say: relationships of HIV dislosure and risk reduction among MSM in the post-HAART era.

In the post-HAART era, critical questions arise as to what factors affect disclosure decisions and how these decisions are associated with factors such as high-risk behaviors and partner variables. We interviewed 1,828 HIV-positive men who have sex with men (MSM), of whom 46% disclosed to all partners. Among men with casual partners, 41.8% disclosed to all of these partners and 21.5% to none. Disclosure was associated with relationship type, perceived partner HIV status and sexual behaviors. Overall, 36.5% of respondents had unprotected anal sex (UAS) with partners of negative/unknown HIV status. Of those with only casual partners, 80.4% had >1 act of UAS and 58% of these did not disclose to all partners. This 58% were more likely to self-identify as gay (versus bisexual), be aware of their status for <5 years and have more partners. Being on HAART, viral load and number of symptoms were not associated with disclosure. This study - the largest conducted to date of disclosure among MSM and one of the few conducted post-HAART - indicates that almost 1/5th reported UAS with casual partners without disclosure, highlighting a public health challenge. Disclosure needs to be addressed in the context of relationship type, partner status and broader risk-reduction strategies.

Changing HIV treatment expectancies: a pilot study.

Beliefs about HIV treatment efficacy, adherence self-efficacy, and side effects management are related cross-sectionally to adherence to antiretroviral therapy (ART). However, the role of such expectancies held prior to the initiation of ART is unknown. The purpose of this study was to explore feasibility, satisfaction, and preliminary effects of an intervention to address HIV treatment expectancies. ART naïve participants (N = 26) who were contemplating ART initiation were randomized to a single session group intervention or standard care control condition. The session included an exploration of expectancies; an education about ART efficacy, adherence, and side effects; and guided problem solving around adherence and side effects management. The pilot intervention was feasible and was rated highly satisfactory. Follow-up assessments demonstrated that intervention participants increased adherence self-efficacy and positive side effects expectancies relative to those in the control group (ps<.05). Findings have implications for nursing practice and further research in the area of HIV treatment expectancies and treatment readiness.

Intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study.

This study aimed to understand whether and how highly active antiretroviral treatment (HAART) affects views and patterns of disclosure and how disclosure interacts with treatment decisions. One hundred and fifty-two HIV-positive adults (52 MSM, 56 women and 44 IDU men) from four US cities participated in two to three-hour, semi-structured interviews in 1998-99. Results indicate that HAART interacts with and shapes HIV disclosure issues in several ways. Medications may 'out' people living with HIV. Thus, in different settings (e.g. work, prisons, drug rehabs and public situations), some try to hide medications or modify dosing schedules, which can contribute to non-adherence, and affect sexual behaviours. Disclosure of HIV and/or HAART may also result in antagonism from others who hold negative attitudes and beliefs about HAART, potentially impeding adherence. Observable side effects of medications can also 'out' individuals. Conversely, medications may improve appearance, delaying or impeding disclosure. Some wait until they are on HAART and look 'well' before disclosing; some who look healthy as a result of medication deny being HIV-positive. Alternatively, HIV disclosure can lead to support that facilitates initiation of, and adherence to, treatment. HIV disclosure and adherence can shape one another in critical ways. Yet these interactions have been under-studied and need to be further examined. Interventions and studies concerning each of these domains have generally been separate, but need to be integrated, and the importance of relationships between these two areas needs to be recognized.

Meeting health care needs of a vulnerable population: perceived barriers.

This study utilized the qualitative methodology of focus groups to explore health care needs and perceived barriers to obtaining health care for urban and rural women and children in areas served by nurse practitioner (NP) and certified nurse midwife (CNM) clinics. The clinics operate in a southeastern county with a rural health professional shortage area designation, and an urban ZIP code area with high rates of infant mortality and serious pediatric conditions. The aim of the study was to delineate barriers to health care in order to develop appropriate services at the clinics and to improve access. Four focus groups with a total of 31 women from the communities were convened. Content analysis shows that access to the clinics is hampered by the community women's limited knowledge of CNMs and NPs and their specific roles in providing health care services. The women suggested that clinics counter their low profile by a more vigorous outreach promotion.

Mother-child interaction in the presence of maternal HIV infection.

This comparative study evaluated mother-child interaction in southeastern U.S. mother-child dyads where the mother was HIV positive and determined if the presence of maternal HIV infection was associated with differences in the quality of the mother-child interaction. A comparison was made between two groups of mother-child dyads, one where the mother was HIV positive (N = 25) and one where the mother was not HIV positive (N = 25). The Barnard model of mother-infant interaction guided this study. The quality of interaction within the dyads was assessed using the Nursing Child Assessment Teaching Scales (NCATS). Associated maternal, child, and environmental factors were described using an interview form, Centers for Epidemiologic Studies Depression Scale, and the Bayley Infant Neurodevelopmental Screener. The quality of mother-child interaction in the two groups was compared using chi square and paired t tests. Findings from this research showed no statistically significant difference in mother-child interaction (measured by NCATS) between the HIV-positive and HIV-negative groups. Although maternal symptoms of depression were noted in more of the HIV-positive mothers, covariant analysis failed to show this factor had any significant influence on mother-child interaction scores between the groups. It was noted that total sample (N = 50) group mean scores on NCATS maternal subscale and total interaction were significantly lower than published population norms. As the mother-child interaction has critical implications for the child, strategies to improve reciprocity need to be developed in this population, and attention must be paid to mental health needs of HIV-positive women.

Self-appraised social problem solving abilities, emotional reactions and actual problem solving performance.

Self-report measures of social problem solving abilities have yet to be associated with objective problem solving performance in any consistent manner. In the present study, we investigated the relation of social problem solving abilities--as measured by the Social Problem Solving Skills Inventory--Revised (SPSI-R [Maydeu-Olivares, A. & D'Zurilla, T. J. (1996). A factor analytic study of the Social Problem Solving Inventory: an integration of theory and data. Cognitive Therapy and Research, 20, 115-133])--to performance on a structured problem solving task. Unlike previous studies, we examined the relation of problem solving skills to performance curves observed in repeated trials, while controlling for affective reactions to each trial. Using hierarchical modeling techniques, a negative problem orientation was significantly predictive of performance and this effect was not mediated by negative affectivity. Results are discussed as they pertain to contemporary models of social problem solving.

Belief of vaccine receipt in HIV vaccine trials: further cautions.

The purpose of this cross-sectional study was to examine relationships between belief in vaccine receipt, motivations for trial participation, and side effects in phase 1 vaccine trials. Anonymous questionnaires were completed by 125 active vaccine volunteers at two vaccine evaluation sites. Participants believing they had received the vaccine reported more side effects (p < .01), were less likely to report knowing someone with HIV/AIDS as a motivation for trial participation (p < .01), and endorsed greater concern about becoming HIV-infected as motivation for participation (p < .05). Results indicate that inferences made by trial participants in vaccine trials should be identified and addressed, and that greater efforts for maintaining the blinded nature of vaccine trials and educating trial participants about the meaning of side effects are warranted.

Television violence and its effect on children.

Television (TV) has become a large part of children's activities. Much discussion exists as to the level of violence on TV programs and its effect on children's behavior. This article reviews the literature, discusses social issues, and presents some interventions available to nursing professionals to assist children and families in coping with the impact of TV on children's lives.

Case study of the home health management of a child with congenital anomalies associated with prenatal cocaine abuse.

The presence of a history of poor parental upbringing, poverty, and substance abuse within a family stresses its capacity to cope with the needs of a child with congenital anomalies. Nursing has a key role to play in providing specific information, practical assistance, and support in these circumstances. A case study of a child in such a family is presented in this article, and the multiple nursing interventions provided to facilitate the family's coping skills are discussed.

Temperament and allergic symptoms.

Two independent studies of the first and second degree relatives of extremely shy versus sociable children revealed greater prevalence of hayfever and social anxiety among the relatives of the former group of children. These data, which are in accord with other research, imply a genetically mediated relation between social anxiety and selected atopic allergies.

Childhood derivatives of inhibition and lack of inhibition to the unfamiliar.

Behavioral and physiological assessments of 41 7 1/2-year-old children who had been selected to be inhibited or uninhibited at 21 months and observed again at 4 and 5 1/2 years revealed that each of the 2 original behavioral profiles predicted theoretically reasonable derivatives. A majority of the formerly shy, timid children became quiet and socially avoidant in unfamiliar social situations, while a majority of the formerly sociable children became talkative and interactive with peers and adults. Absolute heart-rate and cortisol level at 7 1/2 years were not as discriminating of the 2 behavioral groups as they had been 2 years earlier.