Programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean.

This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention.

Drug use and sexual risk behaviours among female Russian IDUs who exchange sex for money or drugs.

Countries of the former Soviet Union are experiencing the steepest increases in annual HIV incidence in the world. Over 80% of registered HIV cases in Russia have occurred among intravenous drug users (IDUs), but current conditions set the stage for a heterosexually-transmitted epidemic. IDUs who also trade sex for money or drugs may serve as a conduit, or 'bridge' group, through which HIV could make inroads into the general Russian population. The present study examined the prevalence of sex trading among female Russian IDUs, and further examined drug use, sexual behaviour, and perceived vulnerability in this group. Female IDUs (n=100) in St Petersburg, Russia participated; 37% reported a history of sex trading. This group reported a mean of 49.5 male sexual partners in the previous month and an average of 15.4 unprotected vaginal intercourse acts in the previous 30 days. A significant minority (44%) also reported sharing injection equipment with others. Mathematical models to calculate risk estimates for HIV seroconversion indicated that participants were at significant risk of contracting HIV and infecting sexual partners. Despite significant rates of risk behaviours, most participants perceived themselves to be at little risk of contracting HIV. Effective HIV prevention programmes targeted at this group are urgently needed and are likely to be a cost-effective step in curtailing the spread of HIV in the region.

HIV prevention nongovernmental organizations in Central and Eastern Europe: programs, resources and challenges.

HIV incidence is rising more rapidly in some areas of Central and Eastern Europe than anywhere else in the world. Carrying out effective HIV prevention programs requires the presence of "bridges" that can reach community populations most vulnerable to the disease. Nongovernmental organizations (NGOs) are in a natural role to conduct HIV prevention programs. The Directors of 29 HIV prevention NGOs representing almost all countries in Central and Eastern Europe participated in in-depth interviews by telephone. The broad topics of these interviews included descriptions of the three largest programs conducted by each NGO during the past six months, at-risk target populations served, major barriers faced, and funding sources that sponsored HIV prevention activities. NGO programs most often targeted injection drug users (IDUs); other stigmatized groups were less frequently served by NGOs in the sample. The most common types of prevention activities were needle exchange, HIV prevention peer education, and delivering AIDS presentations and distributing educational materials. Among the major barriers that hampered effective conduct of HIV prevention programs were a shortage of available financial resources, governmental indifference or opposition, and AIDS-related stigma. National governments rarely provided substantial funds for NGO programs, and most funding came from United Nations agencies or private foundations. The information sources reported to be most helpful in assisting NGOs in program development were sharing ideas with other NGOs, participating in conferences, and accessing information from the Internet. A number of programs reported by the NGO Directors were innovative, outstanding, and comprehensive. Five such exemplary programs are described in this article. HIV epidemics in the region are still potentially controllable. NGOs need immediate support so that they can carry out their community-based activities on a larger scale.

Anticipated psychological impact of receiving medical feedback about HIV treatment outcomes.

Two hundred and seven persons taking antiretroviral HIV medications rated anticipated affective responses to two vignettes depicting different medical feedback situations. Participants were randomly assigned to a medical feedback vignette which varied between participants by (a) the direction of HIV viral load change (increase, decrease, no change) and (b) whether or not a medication change was recommended by the physician. The first experimental vignette was always followed by a second vignette depicting a viral load decrease (indicating treatment success in suppressing the virus). A mixed 3 (viral load change) x 2 (medication change) x 2 (within-subjects factor) factorial design was used. Significant differences in anticipated affective responses to treatment outcome situations were found, suggesting feedback about success or failure of treatment regimens impacts psychosocial adjustment of persons living with HIV.

Factors influencing physicians' judgments of adherence and treatment decisions for patients with HIV disease.

New medications for HIV reduce mortality and morbidity but require strict adherence. Thus, physicians treating HIV-positive patients must weigh both disease severity and likelihood of adherence when deciding whether to start patients on treatment. A national sample of 495 physicians surveyed via mail responded to clinical scenarios depicting HIV-positive patients and indicated whether they would start patients on medication (response rate = 53%). Scenarios varied on the patient characteristics of gender, disease severity, ethnicity, and risk group. Physicians predicted that patients with less severe disease, former injection drug users, and African American men would be less likely to adhere. Perceived adherence and disease severity influenced treatment decisions. Results are discussed in the context of attitudes about minority groups and injection drug users, which may influence adherence judgments in practice settings. Psychological research to identify better methods of predicting medication adherence may serve to inform medical decision making.

Rapid anxiety assessment in medical patients: evidence for the validity of verbal anxiety ratings.

Rapid assessment of patient anxiety is necessary to insure quality care. A number of self-report measures provide valid and reliable measures of anxiety. These measures can be time-consuming to complete, however, and may be burdensome to medical patients who are in pain or acute anxiety states. Many medical procedures are performed in conditions in which written measures are cumbersome (e.g. patient in supine position), and scoring and interpretation of written measures in a busy clinical setting may be difficult for medical personnel. The present study provides validity data for a verbally administered (0-10) anxiety rating. One hundred and ninety-eight adult interventional radiology patients completed standard measures assessing state anxiety, trait Negative and Positive Affect, and the dimensions of the five-factor model of personality. Verbal anxiety rating was highly correlated with Spielberger's State Anxiety Inventory, showed moderate correlations to the related constructs of neuroticism and trait Negative Affect, and was largely unrelated to theoretically distinct constructs. Verbal anxiety ratings made prior to the invasive procedure also predicted pain and anxiety during the procedure. The verbal anxiety rating also demonstrated sensitivity to changes in anxiety that occurred as a result of changes in situation. Findings support the convergent and discriminant validity of verbal anxiety ratings.

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.

BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease.

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed.

Imagery content during nonpharmacologic analgesia in the procedure suite: where your patients would rather be.

RATIONALE AND OBJECTIVES: Imagery as a hypnotic technique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable individuals. This study assessed (a) whether patients not selected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-efficient technique for imagery. MATERIALS AND METHODS: Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test. RESULTS: Patients as a group had average distribution of hypnotizability. The induction script was started in all patients and completed in 53. All patients developed an imagery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented. CONCLUSION: Average patients who present for interventional radiologic procedures and are not preselected for hypnotizability can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or provider-directed imagery unlikely to be equally successful.

Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: prevalence and predictors of high-risk behaviors.

Most persons aware of their HIV-positive serostatus refrain from sexual behavior that could transmit HIV infection to others. However, a minority of men who test HIV-seropositive continue to engage in transmission risk behavior. One factor that may play a role in high-risk sexual activity involves sexual behavior self-management. The present study investigated the role of sexual compulsivity as a contributing factor to high-risk sexual behavior in HIV seropositive men who have sex with men (N = 112). Participants also completed measures of factors known to be related to risky sexual behavior including: personal substance use, sexual partner substance use, pleasure associated with high-risk activities, beliefs about transmission risks, intentions to avoid future instances of risky behavior, and self-esteem. Men scoring high on sexual compulsivity reported engaging in more frequent unprotected sexual acts with more partners, reported greater use of cocaine in conjunction with sexual activity, rated high-risk sexual acts as more pleasurable, and reported lower self-esteem. Mediational analyses indicated that the relationship between sexual compulsivity and high-risk sexual behavior was partially mediated by both personal cocaine use and partner cocaine use in conjunction with sexual activity. The results suggest a need to integrate HIV risk-reduction services and substance use treatment for those persons living with HIV who have difficulty avoiding transmission risk behavior.

Hostility, social support, and ambulatory cardiovascular activity.

The present study compared ambulatory blood pressure in male and female subjects preselected for high and low hostility levels and investigated interpersonal daily stress as a possible mediational mechanism. Ambulatory blood pressure and heart rate were measured in 48 male and female students previously classified as high or low on the Cook-Medley Hostility (Ho) Scale. Subjects wore an ambulatory monitor for a working day and also completed measures of perceived social support, daily interpersonal stress, and health behavior information. Results indicated that subjects scoring high on the Ho scale had higher mean levels of ambulatory systolic blood pressure than low Ho subjects, even when controlling for traditional risk factors, such as cigarette smoking. High Ho subjects also reported greater daily interpersonal stress and less social support than low Ho subjects. Perceived interpersonal stress partially accounted for the relationship between hostility and blood pressure. Subjects high in hostility showed greater mean ambulatory systolic blood pressure levels. Consistent with the transactional model of hostility and health, the relationship between hostility and blood pressure appears to be partially accounted for by the daily experience of interpersonal stress.

Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility.

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individual's level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.

Coping with treatment-related stress: effects on patient adherence in hemodialysis.

With a modified version of the Ways of Coping Checklist, the relation of coping to adherence among 57 hemodialysis patients was examined. The association of a particular type of coping to adherence was predicted to depend on the specific type of stressful encounter being considered. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts involving emotional self-control were associated with more favorable adherence. The seeking of informational support in response to an uncontrollable encounter was associated with poorer fluid-intake adherence. Confrontive coping was associated with poorer adherence for both high- and low-control situations.