Macro-level implicit HIV prejudice and the health of community residents with HIV.

OBJECTIVES: This study examined how community levels of implicit HIV prejudice are associated with the psychological and physical well-being of people with HIV living in those same communities. It also examined whether community motivation to control prejudice and/or explicit HIV prejudice moderates the relationship of implicit prejudice and well-being. METHOD: Participants were 206 people with HIV living in 42 different communities in New England who completed measures that assessed psychological distress, thriving, and physical well-being. Telephone surveys of 347 residents of these same communities (selected via random digit dialing) were used to assess community explicit HIV prejudice and motivation to control HIV prejudice. These community residents then completed an online measure of implicit prejudice toward people with HIV, the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998). RESULTS: Multilevel analyses showed that higher community implicit HIV prejudice was associated with greater psychological distress among residents with HIV living in that community. The physical well-being of participants with HIV was negatively related to community implicit HIV prejudice in communities in which residents were unmotivated to control HIV prejudice or had high levels of explicit HIV prejudice. CONCLUSIONS: These findings indicate that implicit prejudice of residents of real-world communities may create an environment that may impair the well-being of stigmatized people. Implicit prejudice can therefore be considered an element of macro-level or structural stigma. The discussion considered the possible role of implicit HIV prejudice on a community's social capital as a pathway by which it compromises the well-being of residents with HIV. (PsycINFO Database Record

Neurocognitive outcomes in neurofibromatosis clinical trials: Recommendations for the domain of attention.

Neurofibromatosis type 1 (NF1) is associated with neurocognitive deficits that can impact everyday functioning of children, adolescents, and adults with this disease. However, there is little agreement regarding measures to use as cognitive endpoints in clinical trials. This article describes the work of the Neurocognitive Committee of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration. The goal of this committee is to identify standardized and specific cognitive assessment tools for use in NF clinical trials. The committee first identified cognitive domains relevant to NF1 and prioritized attention as the first domain of focus given prior and current trends in NF1 cognitive clinical trials. Performance measures and behavioral rating questionnaires of attention were reviewed by the group using established criteria to assess patient characteristics, psychometric properties, and feasibility. The highest rated tests underwent side-by-side comparison. The Digit Span subtest from the Wechsler scales was given the highest ratings of the performance measures due to its good psychometrics, feasibility, utility across a wide age range, and extensive use in previous research. The Conners scales achieved the highest ratings of the behavioral questionnaires for similar reasons. Future articles will focus on other cognitive domains, with the ultimate goal of achieving agreement for cognitive endpoints that can be used across NF clinical trials.

Patient-reported outcomes of pain and physical functioning in neurofibromatosis clinical trials.

OBJECTIVE: Tumors and other disease complications of neurofibromatosis (NF) can cause pain and negatively affect physical functioning. To document the clinical benefit of treatment in NF trials targeting these manifestations, patient-reported outcomes (PROs) assessing pain and physical functioning should be included as study endpoints. Currently, there is no consensus on the selection and use of such measures in the NF population. This article presents the recommendations of the PRO group of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration for assessing the domains of pain and physical functioning for NF clinical trials. METHODS: The REiNS PRO group reviewed and rated existing PRO measures assessing pain intensity, pain interference, and physical functioning using their systematic method. Final recommendations are based primarily on 4 main criteria: patient characteristics, item content, psychometric properties, and feasibility for clinical trials. RESULTS: The REiNS PRO group chose the Numeric Rating Scale-11 (≥8 years) to assess pain intensity, the Pain Interference Index (6-24 years) and the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference Scale (≥18 years) to evaluate pain interference, and the PROMIS Physical Functioning Scale to measure upper extremity function and mobility (≥5 years) for NF clinical trials. CONCLUSIONS: The REiNS Collaboration currently recommends these PRO measures to assess the domains of pain and physical functioning for NF clinical trials; however, further research is needed to evaluate their use in individuals with NF. A final consensus recommendation for the pain interference measure will be disseminated in a future publication based on findings from additional published research.

A transactional approach to relationships over time between perceived HIV stigma and the psychological and physical well-being of people with HIV.

RATIONALE: Cross-sectional studies demonstrate that perceived discrimination is related to the psychological and physical well-being of stigmatized people. The theoretical and empirical foci of most of this research in on how racial discrimination undermines well-being. The present study takes a transactional approach to examine people with HIV, a potentially concealable stigma. HYPOTHESIS: The transactional approach posits that even as discrimination adversely affects the psychological well-being of people with HIV, psychological distress also makes them more sensitive to perceiving that they may be or have been stigmatized, and may increase the chances that other people actually do stigmatize them. METHODS: This hypothesis was tested in a longitudinal study in which 216 New England residents with HIV were recruited to complete measures of perceived HIV stigma and well-being across three time points, approximately 90 days apart. This study also expanded on past research by assessing anticipated and internalized stigma as well as perceived discrimination. RESULTS: Results indicated that all of these aspects of HIV stigma prospectively predicted psychological distress, thriving, and physical well-being. Equally important, psychological distress and thriving also prospectively predicted all three aspects of HIV stigma, but physical well-being did not. CONCLUSION: These findings suggest that people with HIV are ensnared in a cycle in which experiences of stigma and reduced psychological well-being mutually reinforce each other.

Psychological symptoms are associated with both abstinence and risky sex among men with HIV.

Sexual abstinence is often deemed the "safest behavior" in HIV prevention, but is sometimes associated with psychological symptoms (e.g., depression) just as sexually risky behavior is. This study explored whether sexual abstinence and risky sexual behavior among men with HIV were associated with similar constellations of psychological symptoms. Prior research has not addressed this issue because abstinent people often are not included in the sample or, when data are analyzed, researchers combine abstinent people with sexually active people who practice safer sex. Past research also neglects the co-morbidity of psychological symptoms. A latent class analysis of the psychological symptoms (assessed with the Symptom Check List 90-R; Derogatis, 1994) of 140 men with HIV, mostly from rural New England, revealed three latent classes: men who were asymptomatic on all symptom domains (28.8 %), men who were symptomatic on all domains (34.1 %), and men who were symptomatic on internalizing domains (37.1 %), but were asymptomatic on the externalizing symptoms of hostility and paranoid ideation. Logistic regression showed that sexual behavior during the past 90 days of men in the all symptom class and the internalizing symptoms class was similar, with abstinence and risky sex predominating, and safer sex being relatively uncommon for both classes. The sexual behavior of men in the asymptomatic class differed, with safer sex being relatively more likely to occur compared to the symptomatic classes. These findings suggest that the psychological symptom profile of sexually abstinent people places them at risk for inconsistent condom use should they engage in sexual behavior.

Perceptions of Behavioral Norms Related to HIV Transmission by People with HIV and by Residents of Their Communities.

We examined how people with HIV are both part of and apart from the communities in which they live. We compared perceptions of behavioral norms of 203 people with HIV living in 33 different communities with community-level normative perceptions assessed by surveys of 2,444 randomly selected residents of these communities. Participants with HIV perceived behavior that risks the transmission of HIV as injunctively and descriptively more normative than did other community residents. Participants with HIV living in communities in which community residents perceived relatively widespread approval of condom use to prevent HIV and other sexually transmitted diseases also perceived these behaviors as injunctively normative, and they perceived relatively low levels of HIV stigmatization. Discussion focuses on how perceptions about "deviant" behaviors may affect the experiences of people whose stigmatized status is assumed to be the result of such behavior.

Sexual behavior as a function of stigma and coping with stigma among people with HIV/AIDS in rural New England.

The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed.

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS.

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.

Community norms about suppression of AIDS-related prejudice and perceptions of stigma by people with HIV or AIDS.

We investigated the relationship between community motivations to control AIDS-related prejudice and the experience of stigma by community members with HIV or AIDS, using self-reports from 203 New England residents with HIV or AIDS and 2,444 randomly selected residents of the same New England communities. Multilevel regression analyses revealed that the disclosure concerns of participants with HIV or AIDS were lower in communities where residents were motivated by personal values to control AIDS-related prejudice, and were higher in communities where residents were motivated by social pressure to control AIDS-related prejudice. Reported experiences with discrimination and exclusion were unrelated to community motivations. The results of our study suggest that external and internal pressures to control prejudice shape the experience of stigmatization.

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma.

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.

Exploration of the relevance of anxiety sensitivity among adults living with HIV/AIDS for understanding anxiety vulnerability.

This investigation explored facets of anxiety sensitivity (AS-social, physical and mental concerns) in regard to somatization, anxiety and depression symptoms among people with HIV/AIDS. Significant relations were found for AS-physical concerns and somatization symptoms (beta = .52, p = .007) and AS-mental concerns and anxiety symptoms (beta = .29, p < .05), controlling for negative affectivity, gender and shared variance with other AS subscales. Together, AS subscales were significantly related to depression symptoms (DeltaR(2) = .11; p = .006), but no one subscale was independently related. Findings are discussed in terms of examining AS in better understanding the HIV/AIDS-anxiety relation.

The interaction of mindful-based attention and awareness and disengagement coping with HIV/AIDS-related stigma in regard to concurrent anxiety and depressive symptoms among adults with HIV/AIDS.

This investigation examined the interaction of disengagement coping with HIV/AIDS-related stigma and mindful-based attention and awareness in regard to anxiety and depressive symptoms among people with HIV/AIDS. There was a significant interaction in regard to anxiety symptoms. Higher levels of disengagement coping paired with lower levels of mindful-based attention and awareness was related to the greatest degrees of anxiety symptoms, while lower levels of disengagement coping paired with higher levels of mindful-based attention and awareness was related to the lowest levels of anxiety symptoms. Although the interaction for depressive symptoms was not significant, a similar pattern of results was observed.

Size matters: community size, HIV stigma, & gender differences.

Conclusions regarding HIV stigma in rural areas are hampered by lack of agreement about rural classification. This investigation examined perceptions of HIV stigma among males and females with HIV/AIDS in metropolitan, micropolitan, and rural areas. Two-hundred people with HIV/AIDS completed a measure of perceived HIV stigma. Their county or town of residence was used to classify community size. Results indicated that community size was related to one aspect of perceived stigma, disclosure concerns, differently for men and women. Rural women reported more disclosure concerns than did metropolitan and micropolitan women. They also reported more disclosure concerns than rural men. Men in micropolitan communities reported more disclosure concerns than men in rural areas and tended to report more disclosure concerns than men in metropolitan areas. Understanding the relationship of community size to HIV stigmatization requires acknowledging that many communities are neither urban nor rural, and it requires considering gender differences.

Urban-rural differences in motivation to control prejudice toward people with HIV/AIDS: the impact of perceived identifiability in the community.

CONTEXT: HIV/AIDS is occurring with increasing frequency in rural areas of the United States, and people living with HIV/AIDS in rural communities report higher levels of perceived stigma than their more urban counterparts. The extent to which stigmatized individuals perceive stigma could be influenced, in part, by prevailing community attitudes. Differences between rural and more metropolitan community members' attitudes toward people with HIV/AIDS, however, have rarely been examined. PURPOSE: This study investigated motivation to control prejudice toward people with HIV/AIDS among non-infected residents of metropolitan, micropolitan, and rural areas of rural New England. METHODS: A total of 2,444 individuals were identified through a random digit dialing sampling scheme, and completed a telephone interview to determine attitudes and concerns about a variety of health issues. Internal or external motivation to control prejudice was examined using a general linear mixed model approach, with independent variables including age, gender, community size, and perceived indentifiability within one's community. FINDINGS: Results showed that community size, by itself, was not related to motivation to control prejudice. However, there was a significant interaction between community size and community residents' perceptions about the extent to which people in their communities know who they are. CONCLUSION: Our results indicate that residents of rural areas, in general, may not show a higher level of bias toward people with HIV/AIDS. The interaction between community size and perceived identifiability, however, suggests that motivation to control prejudice, and potentially the subsequent expression of that prejudice, is more complex than originally thought.

Cardiophobia: a critical analysis.

Cardiophobia, a clinical syndrome that affects hundreds of thousands of individuals in the USA, is characterized by abrupt, recurrent sensations and pain in the chest in the absence of physical pathology. This conceptual article seeks to address the significance of cardiophobia in western culture and to distinguish it from related disorders. In addition, a model of cardiophobia that highlights the role of heart-focused anxiety and interoceptive conditioning in the generation of limited-symptom panic attacks and acute chest pain is presented and vulnerability factors for cardiophobia are discussed. Future research directions relevant to the assessment and treatment of this clinically significant phenomenon are reviewed.

Three-year follow-up of same-sex couples who had civil unions in Vermont, same-sex couples not in civil unions, and heterosexual married couples.

This study was a 3-year follow-up of 65 male and 138 female same-sex couples who had civil unions in Vermont during the 1st year of that legislation. These couples were compared with 23 male and 61 female same-sex couples in their friendship circles who did not have civil unions and with 55 heterosexual married couples (1 member of each was a sibling to a member of a civil union couple). Despite the legalized nature of their relationships, civil union couples did not differ on any measure from same-sex couples who were not in civil unions. However, same-sex couples not in civil unions were more likely to have ended their relationships than same-sex civil union or heterosexual married couples. Compared with heterosexual married participants, both types of same-sex couples reported greater relationship quality, compatibility, and intimacy and lower levels of conflict. Longitudinal predictors of relationship quality at Time 2 included less conflict, greater level of outness, and a shorter relationship length for men in same-sex relationships and included less conflict and more frequent sex for women in same-sex relationships at Time 1.

Measurement of stigma in people with HIV: a reexamination of the HIV Stigma Scale.

Stigma associated with HIV infection can unfavorably impact the lives and behavior of people living with HIV/AIDS. The HIV Stigma Scale was designed to measure the perception of stigma by those who are HIV infected. Reanalysis of the psychometric properties of this scale was conducted in a new sample of 157 individuals living with HIV/AIDS in rural New England. This resulted in revision of the scale: shortening it from 40 to 32 items and retaining the original four factors but renaming one: Enacted Stigma (formerly Personalized Stigma), Disclosure Concerns, Negative Self-image, and Concern With Public Attitudes. These four subscales have been refined such that each consists of unique items. Cronbach's alphas for the subscales ranged from .90 to .97, and .95 for the overall scale, indicating internal consistency. Correlations with other scales confirmed the validity of the HIV Stigma Scale in another sample of people living with HIV/AIDS.

Emotional-vulnerability and mindfulness: a preliminary test of associations among negative affectivity, anxiety sensitivity, and mindfulness skills.

This study evaluated associations between general (negative affectivity) and specific (anxiety sensitivity) factors that may relate to the mindfulness skill domains assessed by the Kentucky Inventory of Mindfulness Skills. Participants were 154 young adults (88 females; M(age) = 22.4 years, SD = 7.9) recruited from the community. Partially consistent with predictions, higher levels of negative affectivity were significantly associated with lower levels of Awareness, Acceptance, and Describe mindfulness skills, and higher levels of anxiety sensitivity were significantly associated with lower levels of Awareness and Acceptance mindfulness skills. Additionally, negative affectivity and anxiety sensitivity each demonstrated unique relations to participants' ability to experience the present state without evaluating or judging its content (Accept factor), after accounting for their shared variance, but only anxiety sensitivity demonstrated a unique association to the Act with Awareness factor independent of variance explained by negative affectivity. Findings are discussed in relation to theory and research on mindfulness processes.

Incremental validity of mindfulness-based attention in relation to the concurrent prediction of anxiety and depressive symptomatology and perceptions of health.

This investigation evaluated the role of mindfulness-based attention in concurrently predicting anxiety and depressive symptomatology and perceived health functioning in a community sample of 170 young adults (95 females; mean age (Mage) = 22.2 years, SD = 7.6). Partially consistent with prediction, results indicated that, relative to negative and positive affectivity and emotional expression and processing associated with approach-oriented coping, mindfulness-based attention incrementally predicted anhedonic depressive, but not anxious arousal, symptoms. Additionally, consistent with prediction, mindfulness-based attention demonstrated incremental validity in relation to perceived health, and the degree of impairment of health in terms of physical and mental functioning. Results are discussed in relation to the construct development of mindfulness-based attention, and specifically, the role(s) of this factor in emotional and physical health processes.

Pioneers in partnership: lesbian and gay male couples in civil unions compared with those not in civil unions and married heterosexual siblings.

This study compared 212 lesbians and 123 gay men who had civil unions in Vermont (during the first year legislation made this available) with 166 lesbians and 72 gay men in their friendship network who had not had civil unions, and also with 219 heterosexual married women and 193 heterosexual married men consisting of civil union couples' siblings and their spouses. Married heterosexual couples had been together longer and had more traditional division of labor and child care than did lesbians and gay men in both types of couples. Lesbians in civil unions were more open about their sexual orientation than those not in civil unions, and gay men in civil unions were closer to their family of origin than gay men not in civil unions. This is the first study on same-sex couples with civil unions, and the first to compare lesbians and gay men with their married siblings. At a time of legal changes for same-sex couples, these results indicate that legalized same-sex relationships are related to visibility of same-sex couples to their family and the general public.