An ultraviolet-optical flare from the tidal disruption of a helium-rich stellar core.

The flare of radiation from the tidal disruption and accretion of a star can be used as a marker for supermassive black holes that otherwise lie dormant and undetected in the centres of distant galaxies. Previous candidate flares have had declining light curves in good agreement with expectations, but with poor constraints on the time of disruption and the type of star disrupted, because the rising emission was not observed. Recently, two 'relativistic' candidate tidal disruption events were discovered, each of whose extreme X-ray luminosity and synchrotron radio emission were interpreted as the onset of emission from a relativistic jet. Here we report a luminous ultraviolet-optical flare from the nuclear region of an inactive galaxy at a redshift of 0.1696. The observed continuum is cooler than expected for a simple accreting debris disk, but the well-sampled rise and decay of the light curve follow the predicted mass accretion rate and can be modelled to determine the time of disruption to an accuracy of two days. The black hole has a mass of about two million solar masses, modulo a factor dependent on the mass and radius of the star disrupted. On the basis of the spectroscopic signature of ionized helium from the unbound debris, we determine that the disrupted star was a helium-rich stellar core.

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Factors influencing attitudes within AIDS service organizations toward the use of research-based HIV prevention interventions.

Although the efficacy of small-group, risk reduction interventions based on cognitive behavioral principles has been widely documented in HIV behavioral research literature, little is known about how AIDS service organizations (ASOs) view these research-based models. From a nationwide sample of 77 ASOs, this study assessed factors influencing attitudes of prevention program directors and frontline staff toward research-based interventions. Characteristics of individual respondents as well as organizational characteristics of the ASO itself were used to predict perceived benefits of adopting this type of intervention, perceived efficacy (confidence) in the ASO's ability to implement it, and perceived barriers to adoption. Findings revealed uniformly positive perceptions of benefits among respondents from ASOs of different sizes and organizational experiences, although directors held more favorable evaluations than frontline staff. Respondents from ASOs that were larger, had previously delivered group or workshop interventions, or had received outside technical assistance in the past expressed more confidence in the ability of their ASO to implement the intervention. On the other hand, older and more highly education individuals had less confidence in their organization's ability to implement the model. Resource constraints (money, staff, and time) were the most common barriers cited by the respondents. Overall, higher organizational role and longer tenure at an ASO were associated with the perception of more barriers to adopting science-based interventions. Respondents from ASOs with a history of receiving technical assistance reported fewer perceived barriers. The successful dissemination of HIV prevention models from the research arena to the service arena will require mechanisms to provide appropriate funding and technical assistance, particularly to smaller organizations. Mindful of the resource constraints faced by ASOs, researchers can facilitate this process by attempting to develop interventions that are less resource- and time-consuming than current models.

Differences in HIV risk characteristics between bisexual and exclusively gay men.

Research investigating HIV-risk sexual behaviors of men who have sex with men usually combines gay and bisexual men, treating them as a single, homogeneous group. However, gay and bisexual men may differ in their HIV risk behavior and in psychological characteristics indicative of risk. Exclusively gay (N = 1,180) and bisexual men (N = 136) completed anonymous surveys at gay bars. The surveys assessed demographic, psychological, and behavioral data related to sexual behavior and HIV risk. Relative to exclusively gay men, bisexual men had lower intentions to use condoms in their next intercourse occasion, reported a greater frequency of oral sex with men and more oral-sex partners, knew fewer people who were HIV positive, and perceived weaker peer norms favoring safer sex and risk avoidance. One-third of bisexual men reported engaging in unprotected anal intercourse, and 17% of bisexual men had multiple unprotected anal sex partners in the past two months. Interventions tailored to the needs of bisexual men are urgently needed and should focus on increasing intentions to use condoms, increasing HIV-risk sensitization, and fostering norms favoring safer sex and risk avoidance.

Transfer of research-based HIV prevention interventions to community service providers: fidelity and adaptation.

HIV prevention research interventions usually follow protocols with specific procedures. If a community-delivered intervention uses the same procedures with the same populations as those in the original research, the behavior change effects should be similar. However, community-based providers may not replicate an intervention exactly as it was conducted in the effectiveness study. Adaptation may be needed to better meet the needs of the clients, community, or organization. We propose that interventions can be defined in terms of core elements likely to be responsible for effectiveness. These core elements cannot be changed without fundamentally changing the intervention, whereas other characteristics may be modified without altering effectiveness. HIV prevention researchers and service providers can collaborate to develop interventions that not only are effective but can also be successfully implemented by service organizations. If researchers actively involve service providers and community members in intervention planning, technology transfer goals can be better achieved.

Psychosocial differences between recently HIV tested and non-tested gay men who reside in smaller US cities.

While a number of studies have examined behavioural and psychosocial correlates of HIV test seeking, most of this research has relied on samples of urban gay men. Less is known about HIV testing rates and factors associated with testing among gay and bisexual men who live in smaller cities. The present research administered surveys to 3969 non-exclusively partnered gay and bisexual men attending gay bars in small American cities to determine (a) rates of HIV test seeking, and (b) how tested and non-tested men differed on a battery of psychosocial indices. A total of 68% of men had been tested for antibodies to HIV--50% in the past year. Men tested for HIV in the past year, compared to men never tested for HIV, knew more people who were HIV positive or were diagnosed with AIDS, had a closer relationship with someone who had died of AIDS, were more likely to be ethnic minorities, reported more conversations with friends about safer sex, and had stronger intentions to use condoms during their next intercourse occasion. Our results indicate that HIV counselling and testing programmes comprise an important component of HIV prevention efforts assisting gay men residing in smaller USA cities.

Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS.

OBJECTIVE: This study examined the prevalence and characteristics of suicidal ideation among middle-aged and older persons who have HIV infection or AIDS. METHODS: A total of 113 subjects older than age 45 who had HIV-AIDS were recruited from AIDS service organizations in Milwaukee, Wisconsin, and New York City. Participants completed confidential questionnaires covering suicidal ideation, emotional distress, quality of life, coping, and social support. RESULTS: Twenty-seven percent of respondents reported having thought about taking their own life in the previous week. Those who had thought about suicide reported greater levels of emotional distress and poorer health-related quality of life than those who had not considered suicide. They were also significantly more likely to use escape and avoidance strategies for coping with HIV infection and less likely to use positive-reappraisal coping. Those who had thought about suicide also were more likely to have disclosed their HIV status to the people close to them, and yet they perceived receiving significantly less social support from friends and family. With the exceptions of physical functioning and coping strategies, differences between those who had contemplated suicide and those who had not remained unchanged after controlling for symptoms of depression. CONCLUSIONS: Persons who are in midlife and older and are living with HIV-AIDS experience significant emotional distress and thoughts of suicide, suggesting a need for targeted interventions to improve mental health and prevent suicide.

Reducing barriers to care and improving quality of life for rural persons with HIV.

Rural persons living with HIV disease is a patient group rapidly increasing in size and one that will present America's health-care system with daunting challenges. As the HIV epidemic increasingly affects rural America, it is clear there are many significant barriers to providing adequate care for persons with HIV and AIDS in these smaller communities. The study surveyed 57 attendees of the National Rural AIDS Conference held in early 1995, St. Cloud, MN, to assist in the identification of barriers to care and to examine strategies that may improve their quality of life. Health care professionals were more likely to believe the following circumstances made living with HIV/AIDS in a rural community difficult: long distances to medical facilities and personnel, lack of employment opportunities and unsupportive work environments, and a shortage of psychologists, social workers, and mental health counselors. Health care and nonhealth care personnel also showed high levels of agreement regarding ways to improve the quality of life among rural persons with AIDS. Quality of life strategies rated as most promising included ensuring that instrumental support and daily assistance is readily available, teaching HIV-affected persons coping and problem-solving skills, and conducting weekly face-to-face support groups for persons living with HIV/AIDS. These findings provide useful information for strategies to improve the life circumstances of persons living with HIV/AIDS in rural areas.

Psychosocial differences between urban and rural people living with HIV/AIDS.

During the past decade, many investigations have examined the life circumstances of people living with HIV disease. Most of these studies, however, have focused on HIV-infected people in large metropolitan areas. This study compares the psychosocial profiles of rural and urban people living with HIV disease. Anonymous, self-administered surveys were completed by 276 people with HIV/AIDS in a Midwestern state. The assessment instrument measured respondents' quality of life, perceptions of loneliness, social support, experiences with AIDS-related discrimination, access to services, and illness-related coping strategies. Compared with their urban counterparts, rural people with HIV reported a significantly lower satisfaction with life, lower perceptions of social support from family members and friends, reduced access to medical and mental health care, elevated levels of loneliness, more community stigma, heightened personal fear that their HIV serostatus would be learned by others, and more maladaptive coping strategies. Programs that are designed to improve the life circumstances of people with HIV disease in rural areas--particularly those that facilitate access to adequate health care, increase perceptions of social support, and improve illness-related coping--are urgently needed.

Psychosocial predictors of life satisfaction among persons living with HIV infection and AIDS.

As AIDS becomes a more chronic but manageable illness, understanding quality of life issues among persons living with this disease has become an important goal of health care researchers. However, most quality of life investigations of persons living with HIV disease have relied heavily on clinical samples (e.g., hospitalized patients, psychiatric outpatients). The present study sought to identify psychosocial predictors of general life satisfaction in a community sample of 275 persons living with HIV/AIDS in a large midwestern state. Principal components and multiple regression analyses revealed that improved physical/functional well-being, increased social support, more frequent use of active coping strategies, and fewer incidents of AIDS-related discrimination and stigma predicted higher levels of general life satisfaction (R2 = 39). Intervention strategies likely to produce higher levels of life satisfaction among persons living with HIV disease are discussed.

Late middle-aged and older men living with HIV/AIDS: race differences in coping, social support, and psychological distress.

Although AIDS mental health research has recently devoted more attention to the psychosocial needs of older adults living with human immunodeficiency virus (HIV) disease, studies of this population have typically combined older African-American and white participants into one large sample, thereby neglecting potential race differences. The current study examined race differences in stressor burden, ways of coping, social support, and psychological distress among late middle-aged and older men living with HIV/AIDS. Self-administered surveys were completed by 72 men living with HIV/AIDS in New York City and Milwaukee, WI (mean age = 53.4 years). Older African-American and white men experienced comparable levels of stress associated with AIDS-related discrimination, AIDS-related bereavement, financial dilemmas, lack of information and support, relationship difficulties, and domestic problems. However, in responses to these stressors, older African-American men more frequently engaged in adaptive coping strategies, such as greater positive reappraisal and a stronger resolve that their future would be better. Compared to their African-American counterparts, HIV-infected older white men reported elevated levels of depression, anxiety, interpersonal hostility, and somatization. African-American men also received more support from family members and were less likely to disclose their HIV serostatus to close friends. As AIDS becomes more common among older adults, mental health-interventions will increasingly be needed for this group. The development of intervention programs for this group should pay close attention to race-related differences in sociodemographic, psychosocial, and behavioral characteristics.

HIV risk differences between African-American and white men who have sex with men.

African-American men who have sex with men remain at disproportionately greater risk for contracting human immunodeficiency virus (HIV) infection. While high HIV seroincidence has been documented among homosexual African-American men, behavioral research has rarely studied the HIV risk issues confronting these men. This study assessed a sample of 253 men who have sex with men to determine if African-American (n = 79) and white (n = 174) men report different rates of HIV risk behaviors and differ in characteristics indicative of risk. African-American men who have sex with men were more likely to be HIV-seropositive, to report past treatment for gonorrhea and syphilis, and to have a recent unprotected sex partner known or believed to be HIV-seropositive. Multivariate analyses of covariance, controlling for group differences in age, education, and income, revealed that African-American men who have sex with men were less open about their sexual orientation, scored lower in HIV risk behavior knowledge, had more female sexual partners, and more frequently used cocaine in association with sex relative to white men who have sex with men. Human immunodeficiency virus prevention programs tailored to the needs and risk issues of African-American men who have sex with men are needed.

Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior.

Past research has shown that recreational drug use correlates with sexual behaviors that confer high risk for human immunodeficiency virus (HIV) infection. The present study tested the hypothesis that sensation seeking, a disposition characterized by the tendency to pursue novel, exciting, and optimal levels of arousal, accounts for a majority of the variance in associations between substance use and high-risk sexual behavior. Ninety-nine homosexually active men completed measures of sensation seeking, self-reported sexual behavior, and substance use. Path analysis and hierarchical regression analyses demonstrated that sensation seeking accounts for the observed relationship between substance use and high-risk sexual behavior. We conclude that personality characteristics, often ignored in high-risk sexual episodes, predict risk behavior over and above substance use, and may be useful in tailoring HIV prevention interventions.

HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group.

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.

Developmental stages and spiritual coping responses among economically impoverished women living with HIV disease.

Identifies environmental markers, situational appraisals, perceived ability to mediate situations and outcomes, primary coping strategies, and purposes served by religion and spirituality in 10 HIV-positive women recruited from a regional health care clinic. Findings indicated that the women experienced a disintegration of family during their early developmental years, yielding feelings of hopelessness and isolation; that their sexual development was marked by rape and incest, and their early adulthood was characterized by failed relationships, pregnancies, drugs, and alcohol. Reports that the women's religious influences were predominantly maternal and provided a model for intercessory prayer. Notes that prior to their diagnosis of HIV, participants described their coping as escapist, while after diagnosis they believed there was a divine intercession renewing their spiritual growth and connectedness with others. Reports that the women's personal spirituality was greatly influenced by prayer, television ministries, and reading the Bible. Suggests the interventions that actively recruit women into social support services, health care systems, and faith congregations are needed and that television ministries may serve as access points for connecting women with necessary services.

Patterns, predictors and gender differences in HIV risk among severely mentally ill men and women.

A number of studies have established high human immunodeficiency virus (HIV) seroprevalence among severely mentally ill men and women living in large urban areas. Much less research has characterized the patterns of risk behavior that contribute to elevated vulnerability to HIV/AIDS among the mentally ill, as well as psychological, situational, and gender-related influences on risk in this population. One-hundred thirty-four severely mentally ill men and women who reported sexual activity outside of an exclusive relationship or with high-risk partners completed an extensive measure battery concerning HIV risk. Knowledge about HIV was low and sexual risk behavior levels were high in the sample. On average, condoms were used in only 32% of intercourse occasions in the past three months, and nearly one-half of participants reported multiple sexual partners in the same period. Patterns common in the sample were sex associated with substance use; coerced sex, bartering sex for money, food, clothes, or a place to stay; and sex with injection drug user partners. Factors predictive of greater risk were being female, presently being in a relationship, perceiving oneself to be at risk, high levels of alcohol use, and weak risk reduction behavioral intentions. Mental health programs serving severely mentally ill men and women are reaching a population at elevated risk for contracting HIV infection, and can serve as a venue for targeted HIV prevention interventions.

Life optimism, substance use, and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged innercity women.

The development of more effective human immunodeficiency virus (HIV) prevention programs for disadvantaged women requires identification of factors associated with risk. In the present study, 158 women - all of whom met criteria indicative of HIV risk - were recruited in innercity primary healthcare clinics and administered measurements that assessed variables in three domains believed pertinent to HIV sexual risk behavior: (1) substance use in the past 3 months, (2) acquired immunodeficiency syndrome (AIDS)-specific cognitive and attitudinal factors, including AIDS risk knowledge, condom attitudes, perceived risk for AIDS, behavior change intentions, and perceived self-efficacy, and (3) life context variables, including self-esteem, fatalism, personal optimism toward the future, and current life satisfaction. When women were categorized into highest and lower groups based on their recent risk behavior, AIDS-specific cognitive and attitudinal factors, as expected, differentiated the groups. However, women at highest risk for HIV also most often used a variety of substances and scored lower in self-esteem, held views more characterized by personal fatalism and low optimism concerning the future, and had greater life dissatisfaction than women at lower risk. HIV prevention programs for disadvantaged women require attention not only to AIDS-specific knowledge, attitudes, and skills development but also to broader issues of life context that, if unaddressed, may limit women's ability and motivation to reduce risk for HIV/AIDS.

Coping strategies and emotional wellbeing among HIV-infected men and women experiencing AIDS-related bereavement.

AIDS influences the psychological coping not only of the person with the disease but also those close to that individual. Following a death from AIDS, family members and friends may experience atypical bereavement. Bereavement coping challenges can be especially difficult and pronounced for persons who are themselves HIV-positive. The prevalence of AIDS-related bereavement and psychosocial predictors of grief severity were examined in an ethnically diverse sample of 199 HIV-infected men and women. Eighty per cent of HIV-positive respondents had experienced the loss of someone close to AIDS, the majority of whom had sustained multiple and repetitive losses. Two-thirds of the participants who had experienced an AIDS-related loss reported grief symptoms in the past month. Hierarchical regression analyses revealed that grief was most closely associated with emotional suppression and avoiding coping strategies, with residual variance related to depression. Interventions for AIDS-related bereavement that reduce distress and maladaptive ways of coping are needed in order to meet the secondary prevention needs of bereaved people living with HIV/AIDS.

A pilot coping improvement intervention for late middle-aged and older adults living with HIV/AIDS in the USA.

As AIDS becomes more prevalent among late middle-aged and older adults, mental health support services that facilitate the coping and adjustment efforts of this group are increasingly needed. The current article: (1) outlines a coping improvement group intervention for HIV-infected older adults; and (2) examines the efficacy of the intervention utilizing a small sample (N = 16) of older adults living with HIV/AIDS in Milwaukee, Wisconsin and New York City. The intervention focused on enabling HIV-infected older adults to accurately appraise sources of stress, develop adaptive coping responses and access social support resources to facilitate coping efforts. An evaluation of this pilot intervention, conducted using a pretest-posttest, no control group design, revealed that the intervention increased participants' perceptions of social support, produced higher perceptions of social wellbeing and enabled participants to engage in more planful problem solving, confrontive coping and future optimism. Intervention participants also experienced less stressor burden associated with AIDS-related loss and health concerns. While the current intervention showed potential to facilitate the adjustment efforts of HIV-infected older adults, randomized clinical trials of this intervention with larger samples are needed before its appropriateness for this population can be determined.

Psychological symptoms among persons 50 years of age and older living with HIV disease.

Although persons 50 years of age and older account for 10% of all US AIDS cases, the mental health needs of this growing group remain largely overlooked. The current study delineated patterns and predictors of psychological symptoms amongst late middle-aged and older adults living with HIV/AIDS in two large US cities. In late 1998, 83 HIV-infected individuals 50-plus years of age (M = 55.2, Range = 50-69) completed self-report surveys eliciting data on psychological symptomatology, HIV-related life-stressor burden, social support, barriers to health care and social services, and sociodemographic characteristics. Based on the Beck Depression Inventory, 25% of participants reported 'moderate' or 'severe' levels of depression. HIV-infected older adults also evidenced an elevated number of symptoms characteristic of somatization. A hierarchical multiple regression analysis revealed that HIV-infected older adults who endorsed more psychological symptoms also reported more HIV-related life-stressor burden, less support from friends, and reduced access to health care and social services due to AIDS-related stigma. As the impact of HIV on older communities continues to increase, geropractitioners must be prepared to provide care to greater numbers of HIV-infected older adults, a substantial minority of whom will present with complex comorbid physical and mental health conditions.