Behaviorally and perinatally HIV-infected young women: targets for preconception counseling.

This study aimed to describe demographic and psychological characteristics among HIV-infected young women, and to identify knowledge, attitudes, and behaviors associated with conception, with the goal of informing interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV. Behaviorally and perinatally HIV-infected young women (n = 34) were conveniently sampled in Miami, Florida. Participants were asked to complete measures of reproductive knowledge, attitudes toward conception, and risk behaviors, as well as measures of depression and cognitive functioning. Perinatally and behaviorally HIV-infected young women were very similar in important areas of health preconception practices such as conception-related health literacy and conception-related communication with providers. Behaviorally infected women, however, were somewhat more likely to have been pregnant in the past, and had greater knowledge of healthy contraception practices and family planning. Despite the difference among groups, both the perinatally and behaviorally acquired women demonstrated having adequate overall knowledge. Depression was higher and consistent with moderate depression among the behaviorally HIV-infected women in comparison to perinatally infected women. This study found that that despite adequate reproductive knowledge, most young HIV-infected women were not using contraception. Given the consequences of presentation of advanced HIV during pregnancy, the need for both treatment adherence and preconception counseling is essential. Results suggest that interventions or programmatic decisions regarding preconception counseling methods for young women living with HIV are necessary and potentially transferrable between populations.

Review of recent behavioral interventions targeting older adults living with HIV/AIDS.

Increasing attention has been paid to older adults living with HIV over the past few years given the increasing prevalence of HIV in this age group. Yet, despite numerous studies documenting psychosocial and behavioral differences between older and younger HIV-infected adults, few evidence-based behavioral interventions have been developed for this population. This review found only 12 manuscripts describing behavioral intervention studies in older HIV-positive adults published between 2011 and 2014, and they reported on a total of six interventions. Despite promising findings, there is a clear need for large-scale clinical trials to replicate these initial results and further develop additional interventions to address important clinical issues such as depression, sexual risk behaviors, cognition, and other significant issues affecting this cohort. This represents an exciting opportunity for behavioral scientists and HIV specialists to develop interventions that combine the psychological and behavioral with medical aspects of the disease.

Impact of a secondary prevention intervention among HIV-positive older women.

Despite the fact that older women represent a growing risk group for HIV, they have been rarely targeted by public health campaigns designed to prevent HIV/AIDS and are often excluded from many prevention studies. This unique cohort may be often overlooked due to beliefs that older women are not sexually active and do not engage in high risk sexual activity. Data suggest a need for increased attention to this unique cohort. Risk reduction interventions tailored to the special needs of people living with HIV/AIDS have begun to demonstrate promising results. In this manuscript, we report the 6 month outcomes for female participants in Project ROADMAP, a secondary prevention intervention designed to reduce high risk sexual behavior in older adults living with HIV/AIDS. Our results indicate that female participants in the intervention group were more likely to report a reduction in high risk sexual behavior than women in the control condition. Our findings also suggest that the intervention succeeded in increasing the HIV-related knowledge of the participants and decreasing their stigma vis-à-vis the HIV condition. The study findings suggest that Project ROADMAP is an effective secondary prevention intervention for sexually active older HIV positive women.

Sexual risk behaviors in late middle age and older HIV seropositive adults.

Little is known about the sexual behaviors of older adults, although the prevalence of HIV/AIDS is rapidly increasing in this population. As part of a larger multi-site study examining secondary HIV prevention, we recruited from an HIV primary care clinic 210 sexually active HIV positive individuals aged 45 and over (125 men, 85 women) who had engaged in vaginal or anal sex within the past six months. Twenty percent of the participants reported inconsistent use of condoms and 33% had multiple sexual partners during the previous six months. Negative mood and perceived HIV stigma were associated with inconsistent condom use. In addition, multiple sex partners and higher level of education were related to inconsistent condom use during sex with partners of negative or unknown serostatus. These findings indicate that contrary to current beliefs, sexually active older adults, similar to younger ones, may be engaging in high risk transmission behaviors.

HIV is always with me: men living with perinatally acquired HIV and planning their families.

Once expected to not survive childhood, youth with perinatally-acquired HIV have now reached young adulthood are of reproductive age and sexually active. Given the health impact of pregnancy among YPHIV, understanding reproductive decision making may inform preconception counseling strategies. Most literature regarding reproductive health among YPHIV focuses on women, overlooking one of the most important factors influencing the reproductive decision making process, male sexual partners. This manuscript examined attitudes, perceptions and experiences of young men with perinatally-acquired HIV (YMPHIV) regarding family planning and relationships, safer sex, disclosure, stigma and psychological health. Participants (n = 21) were YMPHIV aged 18-24 recruited in Miami, Florida. Focus groups (n = 4) were conducted; qualitative data were analyzed using grounded theory. HIV disclosure, stigma, fertility intentions, safer preconception knowledge, attitudes and practices, family planning communication with medical providers and family, and mental health emerged as themes. Results suggest that despite accurate knowledge regarding healthy preconception practices, psychopathology, substance use, and stigma, impact the uptake of HIV healthcare interventions. Effective interventions on preconception counseling may require more tailored approaches than knowledge-based psychoeducation alone, such as inclusion of psychological treatment, which could be offered in HIV healthcare settings to optimize health outcomes.

Adolescent girls and young women living with HIV: preconception counseling strategies.

BACKGROUND: Rates of pregnancy among women living with HIV are similar to those in the general population. Unintended pregnancies are also common, and among adolescents and young women perinatally infected (PHIV+) or behaviorally infected (BHIV+) with HIV, planning for both conception and contraception is an important element of HIV care that may be neglected. This pilot study examined the influence of intervention strategies targeting fertility planning, safer conception practices and patient-provider communication. It was hypothesized that preconception counseling interventions would enhance reproductive knowledge, planning and practices, as well as stimulate discussion with providers regarding conception. METHODS: Adolescent girls and young women (N=34) perinatally (n=21) or behaviorally (n=13) infected with HIV, aged 16-29 years, were recruited from urban South Florida, and completed measures of reproductive knowledge, sexual practices and fertility intentions. Participants were randomized to condition, ie, video presentation plus Motivational Interviewing (MI), MI only, control. RESULTS: The average age of women was 22 years (SD =3.27), and the majority of them were African American. Levels of depression were higher among BHIV+ compared to PHIV+ at baseline and 6 months. Pregnancy knowledge (pregnancy, safe conception and pregnancy planning) and the proportion of those engaging in birth control planning (condom use, long-term birth control, patient-provider discussions on preventing pregnancy and fertility desires) were similar between conditions at post-intervention and 6 months. Bayes factors indicated that the data were insensitive with regard to differences between conditions, limiting support for both the null and alternative hypotheses. CONCLUSION: The impact of interventions used in this study to stimulate pregnancy planning was inconclusive. Results suggest that pregnancy planning interventions may require greater intensity to influence sexual behavior in this population. Despite adequate reproductive knowledge, HIV-infected adolescent girls and young women may fail to engage in planning behavior.

Prenatal and mental health care among trauma-exposed, HIV-infected, pregnant women in the United States.

Comprehensive prenatal care for HIV-infected women in the United States involves addressing mental health needs. Retrospective quantitative data are presented from HIV-infected pregnant women (n = 45) who reported childhood sexual or physical abuse (66%), abuse in adulthood by a sexual partner (25%), and abuse during pregnancy (10%). Depression and anxiety were the most commonly reported psychological symptoms; more than half of the sample reported symptoms of posttraumatic stress disorder (PTSD), including HIV-related PTSD (PTSD-HIV). There was a strong association between depression and PTSD as well as between anxiety and PTSD-HIV. The majority of infants received zidovudine at birth and continued the recommended regimen. All but one infant were determined to be noninfected. Women improved their CD4(+) T cell counts and HIV RNA viral loads while in prenatal care. Results support the need for targeted prenatal programs to address depression, anxiety, substance use, and trauma in HIV-infected women.

Abuse and mental health concerns among HIV-infected Haitian women living in the United States.

This study describes the prevalence of abuse and mental health issues among a cohort of HIV-infected Haitian women living in the United States. We present data on 96 women, ages 19-73 years (M = 47.6, SD = 11.1), who were screened for mental health concerns between 2009 and 2012. Results demonstrated that 12.5% of the women reported a history of abuse. However, posttraumatic stress disorder (PTSD) secondary to HIV was reported by approximately 34% of women. Depression and anxiety were also highly reported, with rates of 49% and 43%, respectively. Women who reported a history of abuse were more likely to report anxiety, PTSD, and PTSD related to HIV symptoms than those without. Our findings suggest that Haitian HIV-infected women may underreport abuse and experience significant depression and anxiety. These preliminary results could be used to develop future studies and to design and implement culturally sensitive interventions for this underserved population.

Project ROADMAP: Reeducating Older Adults in Maintaining AIDS Prevention: a secondary intervention for older HIV-positive adults.

The number of older adults living with HIV/AIDS is larger than ever. Little is known about their sexual behaviors, although contrary to stereotypes, older adults desire and engage in sexual activity. Despite increased recognition of the need for prevention interventions targeting HIV-positive individuals, no secondary HIV prevention interventions have specifically targeted the older HIV-positive adult. Efforts to target high-risk sexual behaviors may be even more critical in the older population because of sociocultural, biological, and behavioral vulnerabilities. In response, Project ROADMAP (Reeducating Older Adult in Maintaining AIDS Prevention) intervention was developed to reduce high-risk sexual behaviors among older HIV-positive patients in primary care clinics. The purpose of this article is to report the 6-month outcomes of a behavioral intervention designed to reduce sexual risk behaviors in older HIV-positive adults.