Effects of a Decision-Making Intervention to Help Decide Whether to Disclose HIV-Positive Status to Family Members on Well-Being and Sexual Behavior.

An HIV diagnosis is often followed by uncertainty, questions over next steps, and concerns over how to share the diagnosis with others. The goal of the current study was to investigate the effects of an intervention designed to help people living with HIV decide whether or not they want to disclose their status to family members (i.e., decision-making process rather than actual disclosure) and the subsequent decision on their well-being and sexual behavior. Additionally, differences in outcomes among men who have sex with men (MSM), heterosexual men (HSM), and women were examined. A total of 346 women and men living in the Southeastern part of the United States. Participated in the study, which consisted of a baseline assessment, followed by randomization into either the disclosure intervention or attention control case management group. Both treatments consisted of seven sessions over a 12-month period. Results from repeated measures ANOVA indicated that although there was no significant intervention effect, participants in both groups reported some improvements in well-being and decreases in risky sexual behavior. However, no consistent differences in outcomes emerged among MSM, HSM, and women. Assisting with the disclosure decision-making process and reducing HIV transmission risk should continue to be an essential focus in future research endeavors and for frontline professionals dedicated to HIV-related care and prevention.

Ways of coping and perceived HIV-related stigma among people living with HIV: moderation by sex and sexual orientation.

Perceived HIV-related stigma continues to persist among people living with HIV and coping strategies are crucial to overall health. Coping may be associated with perceived HIV-related stigma. However, research examining differences by sex and sexual orientation is lacking. Therefore, the aims of the study were to assess the association between ways of coping and perceived HIV-related stigma, and to examine the relationship by sex and sexual orientation. Data were obtained from 346 individuals (191 men and 155 women) living with HIV. Multiple linear regression models showed that overall, distancing, and attack/escape avoidance coping were positively associated with perceived HIV-related stigma among the overall population, among men who have sex with men (MSM), and among women overall and heterosexual women. Among men overall, distancing and attack/escape avoidance coping were positively associated with perceived HIV-related stigma. Among women who have sex with women (WSW), attack/escape avoidance coping was positively associated with perceived HIV-related stigma. Effect sizes indicated small effects for overall coping and medium to large effects for distancing and attack/escape avoidance coping. Interventions focused on reducing perceived HIV-related stigma among populations living with HIV should address distancing and attack/escape avoidance strategies especially among women, regardless of sexual orientation, and MSM.

Decision Readiness to Disclose Human Immunodeficiency Virus-positive Status to Family Members.

BACKGROUND: People living with human immunodeficiency virus (HIV) (PLWH) are faced with the often difficult decision of whether, when, and how to disclose their seropositive status. This study draws on the transtheoretical model of change to examine men and women's decision readiness to disclose their HIV-positive status to family members and to assess predictors (decisional balance and decision self-efficacy) of their decision readiness. METHODS: Cross-sectional data were collected from 346 PLWH-191 males and 155 females. Participants self-reported on their disclosure decision readiness, decisional balance, and decision self-efficacy. Data were analyzed using χ tests, general linear models, and multinomial logistic regression models. RESULTS: Two thirds of PLWH were in the 3 lower stages of decision readiness, with the majority starting to think about disclosure. One third of PLWH were in the 3 higher stages of decision readiness (close to deciding or have made the decision to disclose). Decisional balance and decision self-efficacy predicted decision readiness. Overall, few gender differences emerged. CONCLUSIONS: These findings can help researchers, clinicians, and health care providers to better understand and support PLWH as they move through the decision making process.

Mediating Effects of Depressive Symptoms on Perceived Social Support and HIV Disclosure: Assessing Moderation by Sex.

People living with HIV may decide to disclose their HIV-positive status after considering the benefits and costs. Studies have shown associations between perceived social support, depressive symptoms and HIV disclosure among men and women; however, research assessing the mediating pathway among these variables and the associated disparities by sex are lacking. Therefore, the aims of this study were to determine the association between perceived social support from family and friends and HIV disclosure to sexual partners; assess the mediating effects of depressive symptoms; and examine the disparities by sex. Participants included 147 men and 115 women living with HIV who took part in a disclosure intervention study. Mediation analyses were conducted to determine the direct and indirect associations between perceived social support from family and friends, depressive symptoms, and disclosure behavior. Depressive symptoms mediated the association between perceived social support (from family: ß = 0.103, p = 0.019; and from friends: ß = 0.111, p = 0.009) and HIV disclosure to sexual partners, specifically among women. However, these pathways were not statistically significant among men. Women living with HIV may benefit from two types of interventions: (1) Disclosure to sexual partners interventions, which aim to accentuate perceived social support from family and friends through attenuating depressive symptoms; and (2) Social support interventions, which may increase disclosure to sexual partners via reducing depressive symptoms.

Ways of coping and HIV disclosure among people living with HIV: mediation of decision self-efficacy and moderation by sex.

Individuals living with HIV/AIDS face several stressors and use varying strategies to cope. Disclosure (or nondisclosure) of HIV serostatus is an important consideration among individuals living with HIV. However, studies examining the association between coping and HIV disclosure are lacking, and more research examining potential mediators and moderators is needed. The transactional model of stress and coping and the theory of planned behavior may help in understanding the mediating relationship between coping, decision self-efficacy, and HIV disclosure. Therefore, the aims of this study were to examine the association between coping and HIV disclosure to sexual partners, assess the mediating role of decision self-efficacy, and examine moderation by sex. Baseline data from 262 individuals living with HIV who participated in a disclosure intervention were used for analysis. Descriptive statistics were used to assess sociodemographic characteristics. Principal component analysis was used to operationalize coping. Path analysis was then used to determine the mediating role of decision self-efficacy in the association between overall, adaptive, distancing, and attack/escape avoidance coping and HIV disclosure to sexual partners. After adjusting for age and time since diagnosis, direct associations between coping and decision self-efficacy, and decision self-efficacy and disclosure behavior varied by sex. Among the overall study population, decision self-efficacy mediated the associations between adaptive coping (ß = 0.064, p = 0.003), attack/escape avoidance coping (ß = -0.052, p = 0.009) and disclosure behavior. Disclosure intervention programs geared towards populations living with HIV should include decision self-efficacy and adaptive coping, and attenuate attack/escape avoidance coping.

Perceived intentional transmission of HIV infection, sustained viral suppression and psychosocial outcomes among men who have sex with men living with HIV: a cross-sectional assessment.

OBJECTIVE: HIV continues to be a global and national public health challenge, and men who have sex with men (MSM) are disproportionately affected in the USA. Transmission of HIV is intentional if the person living with HIV knows about his/her serostatus, acts with the intention to and actually transmits HIV. Research on intentional transmission of HIV infections is lacking, and the relationships between perceived intentional transmission, viral suppression and psychosocial outcomes have not been assessed. The objective of this study was to investigate the association between perceived intentional transmission of HIV, sustained viral suppression and psychosocial outcomes. METHODS: Data were obtained from 338 MSM living with HIV who participated in a disclosure intervention study. Logistic and linear regression models were used to assess the associations between perceived intentional transmission and viral suppression, condomless anal intercourse in the past 30 days, being at risk for clinical depression, substance use, self-efficacies for condom use, HIV disclosure and negotiation of safer sex practices, and sexual compulsivity. RESULTS: 44% of the study population reported perceiving intentional HIV transmission. After adjusting for sociodemographic characteristics, men who thought that they were infected intentionally had 69% higher odds (adjusted OR: 1.69; 95% CI 1.01 to 2.83) of being at risk for clinical depression, and on average, scored approximately 3 points and 4 points higher on depressive symptoms and sexual compulsivity, respectively (adjusted ß: 3.29; 95% CI 0.42 to 6.15; adjusted ß: 3.74; 95% CI 1.32 to 6.17) compared with men who did not think that they were intentionally infected. After adjusting for confounders, there was no statistically significant association between perceived intentional transmission and viral suppression. CONCLUSIONS: Intervention programmes for MSM living with HIV who thought they were infected intentionally are warranted and should aim to attenuate depressive symptoms and sexual compulsivity.

Vengeance, sexual compulsivity and self-efficacy among men who have sex with men living with HIV.

Vengeance is defined as a continuum of thoughts and/or actions ranging from harmless thoughts to destruction or death, due to feelings of hurt or anger, as a result of a perceived personal attack. Studies assessing the association between vengeance and HIV risk behavior are extremely lacking. The primary aims of this study were to examine the associations between vengeance and sexual compulsivity (SC), and self-efficacies (SEs) for condom use, HIV disclosure, and negotiation of safer sex practices. Data were obtained from 266 men who have sex with men (MSM) living with HIV. Simple and multiple linear regression were used to explore the associations between vengeance, SC and SE. After adjusting for sociodemographic and HIV-related factors, there was a negative association between vengeance and SE for HIV disclosure: (most vengeful: ß = -1.49; 95% CI: -2.40, -0.58; more vengeful: ß = -1.17; 95% CI: -2.12, -0.22; vengeance (continuous: ß = -0.03; 95% CI: -0.05, -0.01). Intervention programs geared towards improving SE for HIV disclosure among MSM living with HIV should endeavor to reduce vengeful feelings.

Evaluation of HIV Disclosure Behavior Following a Randomized Controlled Disclosure Intervention for Men Who Have Sex with Men Living with HIV.

Preventing the transmission of HIV, especially among high-risk populations, is a U.S. public health priority. Interventions aimed at easing the burden of HIV disclosure to casual sexual partners among men who have sex with men (MSM) living with HIV are essential in this endeavor. This randomized controlled study evaluated differences in disclosure behavior between a disclosure intervention (DI) and attention control case management (ACCM) group for MSM living with HIV (N = 315) and determinants (self-efficacy, outcome expectancy) of disclosure. Mixed-effects models results showed no significant differences in disclosure behavior between the DI and ACCM groups. Further, disclosure behavior changed in a curvilinear manner over 12 months and benefited from a booster session. Both disclosure self-efficacy and outcome expectancy predicted disclosure behavior. Interventions targeting HIV disclosure among MSM living with HIV should focus on improving perceptions of disclosure self-efficacy and outcome expectancy and include a booster session to facilitate HIV disclosure.

Longitudinal Findings on Changes in and the Link Between HIV-Related Communication, Risky Sexual Behavior, and Relationship Status in Men Who Have Sex With Men Living With HIV.

BACKGROUND: Reducing the risk of HIV transmission among men who have sex with men (MSM) is a national health priority. This study longitudinally examined changes in and the link between HIV-related communication, unprotected anal intercourse (UAI), and relationship status among MSM. METHODS: Data were obtained from 337 MSM living with HIV who participated in a randomized controlled study. Approximately equal percentages of men were randomized to either the disclosure intervention group or the attention control case management group. Repeated measures were collected at 5 time points for 12 months and included health-protective sexual communication (HPSC), HIV disclosure, insertive and receptive UAI, and relationship status. Data were analyzed using mixed-effects models. RESULTS: Independent of the treatment condition, HPSC and HIV disclosure increased over time; insertive UAI showed a curvilinear pattern but no significant decrease over time. Relationship status was related to HIV-related communication and UAI. Greater HPSC was related to less insertive and receptive UAI; disclosure was positively related to insertive UAI. CONCLUSIONS: Based on the findings, prevention programs should continue to focus on improving HIV-related communication among MSM and consider relationship status in prevention messages. Intervention studies are needed to continue to identify and test factors that help reduce risky sexual behaviors.

Vengeance, Condomless Sex and HIV Disclosure Among Men Who Have Sex with Men Living with HIV.

Vengeance has been shown to be a risk factor for HIV nondisclosure. Research examining the associations between vengeance, condomless sex, and HIV nondisclosure is lacking. The aim of the current study was to explore the association between vengeance, condomless sex and disclosure (behavior, attitude and intention) among men who have sex with men (MSM) living with HIV. Participants included 266 MSM who were a part of a disclosure intervention study. Men were recruited from local and state AIDS service organizations (ASOs), HIV-related venues and forums, and at local eating and drinking establishments in Tampa, Florida, and Columbus and Dayton, Ohio metropolitan statistical areas (MSAs). Advertisements were also placed in local daily newspapers. Vengeance was operationalized into three groups based on percentiles (least, more, and most vengeful) and as a continuous variable. Crude and multivariable logistic regression models were used to examine the association between vengeance and condomless sex in the past 30 days. Simple and multiple linear regression models were used to determine the association between vengeance and HIV disclosure. After adjusting for demographic and geographic characteristics, participants who were "most vengeful" had, on average, an approximate six-point decrease (ß: -5.46; 95% CI -9.55, -1.36) in disclosure intention compared to MSM who were "least vengeful." Prevention and intervention programs geared towards improving disclosure among MSM should address vengeance.

Psychometric Evaluation of the HIV Disclosure Belief Scale: A Rasch Model Approach.

This study provides psychometric assessment of an HIV disclosure belief scale (DBS) among men who have sex with men (MSM). This study used baseline data from a clinical trial evaluating the effectiveness of an HIV serostatus disclosure intervention of 338 HIV-positive MSM. The Rasch model was used after unidimensionality and local independence assumptions were tested for application of the model. Results suggest that there was only one item that did not fit the model well. After removing the item, the DBS showed good model-data fit and high item and person reliabilities. This instrument showed measurement invariance across two different age groups, but some items showed differential item functioning between Caucasian and other minority groups. The findings suggest that the DBS is suitable for measuring the HIV disclosure beliefs, but it should be cautioned when the DBS is used to compare the disclosure beliefs between different racial/ethnic groups.

Depressive Symptoms, Substance Use and Partner Violence Victimization Associated with HIV Disclosure Among Men Who have Sex with Men.

HIV continues to disproportionately affect men who have sex with men (MSM). Depression and substance use have been shown to be risk factors of partner violence among male same-sex couples. However, research exploring the risk factors for partner violence victimization after HIV disclosure among MSM is limited. The aim of this study was to determine the association between depressive symptoms, substance use, and disclosure-associated verbal and/or physical violence from a partner among MSM. Data were obtained from 340 HIV-positive MSM. Multivariable logistic regression was used to determine the associations between Center for Epidemiologic Studies-Depression and substance use scores, and disclosure-associated partner violence. After adjusting for age and income, every one-unit increase in substance use scores resulted in a 9 % (OR 1.09; 95 % CI 1.01-1.16) increase in the odds of disclosure-associated partner violence. HIV disclosure interventions for MSM populations should address substance use and potential violence from partners after disclosure.

Outcome Expectancy and Sexual Compulsivity Among Men Who Have Sex with Men Living with HIV.

Sexual compulsivity is operationalized by engaging in repetitive sexual acts, having multiple sexual partners and/or the excessive use of pornography. Outcome expectancy refers to the beliefs about the consequences of engaging in a given behavior. Research examining the relationship between outcome expectancy and sexual compulsivity is limited. The aim of this study was to assess the association between outcome expectancy and sexual compulsivity among men who have sex with men (MSM) living with HIV. Data were obtained from 338 MSM. Simple and multiple linear regression models were used to assess the association between outcome expectancy and sexual compulsivity. After adjusting for age, race/ethnicity, income, education, and employment status, for every one point increase in outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices, there was, on average, an approximate one point decrease in sexual compulsivity score. Prevention and intervention programs geared towards reducing sexual compulsivity among MSM should focus on increasing outcome expectancies for condom use, HIV disclosure and negotiation of safer sex practices.

Psychological reactance and HIV-related stigma among women living with HIV.

Psychological reactance is defined as the drive to re-establish autonomy after it has been threatened or constrained. People living with HIV may have high levels of psychological reactance due to the restrictions that they may perceive as a result of living with HIV. People living with HIV may also exhibit levels of HIV-related stigma. The relationship between psychological reactance and HIV-related stigma is complex yet understudied. Therefore, the main aim of this study was to examine the association between psychological reactance and HIV-related stigma among women living with HIV. Data were obtained from one time-point (a cross-sectional assessment) of a longitudinal HIV disclosure study. Psychological reactance was measured using the 18-item Questionnaire for the Measurement of Psychological Reactance. HIV-related stigma was measured using the HIV Stigma Scale, which has four domains: personalized, disclosure concerns, negative self-image, and concerns with public attitudes. Principal component analysis was used to derive components of psychological reactance. Linear regression models were used to determine the association between overall psychological reactance and its components, and stigma and its four domains, and depressive and anxiety symptoms. The associations between stigma and mental health were also examined. Three components of psychological reactance were derived: Opposition, Irritability, and Independence. Overall psychological reactance and irritability were associated with all forms of stigma. Opposition was linked to overall and negative self-image stigma. Overall psychological reactance, opposition, and irritability were positively associated with anxiety symptoms while opposition was also associated with Centers for Epidemiologic Studies-Depression depressive symptoms. There were also positive associations between all forms of stigma, and depressive and anxiety symptoms. Health-care providers and counselors for women living with HIV addressing feelings of irritability and opposition toward others may reduce HIV-related stigma. Future research should examine the link between psychological reactance, mental health, and HIV-related stigma among other populations living with HIV.

Researcher Views of Barriers to Clinical and Translational Research in a Statewide Program.

The Tracking and Evaluation Core of Rhode Island Advance-CTR conducted an online needs assessment survey at the program's inception in 2016 and again in 2021. Now dealing with well-established support systems provided by the grant, we were particularly interested in how the perceived needs of the research community in Rhode Island might have changed over five years. Specifically, what barriers have been reduced or eliminated and which have persisted or increased? How do those barriers vary by demographic status and what implications do those differences have for the CTR? An online survey was completed by 199 researchers, who reported the extent to which they perceived the lack of access to a range of research supports as a barrier to conducting research at their institution. Overall, researchers indicated statistically significant changes from 2016 to 2021 such that a lack of pilot project funding and proposal development support had decreased as barriers, while space for research, and advice on commercial development, had increased. Statistically significant differences in the salience of particular barriers by some demographic variables were also noted and the results of this study suggest Centers for Clinical and Translational Research can have salutary effects on the research paradigm within their partnering institutions in a relatively short time.

Going to the Source: Discussions With Early and Mid-Career Faculty From Groups Underrepresented in Biomedical Research to Develop and Enhance CFAR Services.

BACKGROUND: To include, sustain, and retain HIV-focused early career faculty from groups historically excluded from biomedical research, the Providence/Boston Center for AIDS Research (CFAR) conducted focus groups and individual interviews with early and mid-career faculty to discern their needs. METHODS: We conducted focus groups and interviews with 15 faculty at institutions affiliated with Providence/Boston CFAR from groups underrepresented in biomedical research. The discussion was guided using the domains of an Asset Bundle Model encompassing scientific human capital, social capital, and financial capital. RESULT: Participants' identities, including their race, ethnicity, gender, sexual orientation, and being a parent affected their vision of themselves as scientists. Participants reported confusion or limited training on or access to resources for professional development, hiring staff, meeting NIH reporting requirements, international research, support for working parents, sabbaticals, and addressing workplace conflict or unsupportive work environments. Some described feeling like they were a burden on their mentors who seemed overextended. They identified attributes of effective mentors, such as believing in and investing in the mentee; having the requisite content area expertise and self-confidence; being able to identify mentees needs and meet them where they are; and being consistent, communicative, respectful, and kind. They described a need for additional education and support preresearch and postresearch grant award management. CONCLUSIONS: To learn how to equitably serve all interested in HIV research, CFARs should engage and include perspectives from scientists who have historically been excluded from biomedical research. Our future work will test, implement, and disseminate the ideas generated by these focus group discussions.

Impact of a Multi-Institutional Initiative to Engage Students and Early-Stage Scholars From Underrepresented Racial and Ethnic Minority Groups in HIV Research: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative.

BACKGROUND: The Centers for AIDS Research Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) aims to establish programs to develop pathways for successful careers in HIV science among scholars from underrepresented racial and ethnic populations. This article describes cross-site evaluation outcomes during the first 18 months (July 2021-December 2022) across 15 programs. METHODS: The aims of the evaluation were to characterize participants, describe feasibility, challenges, and successes of the programs and provide a basis for the generalizability of best practices to Diversity, Equity, and Inclusion (DEI) programs in the United States. Two primary data collection methods were used: a quarterly programmatic monitoring process and a centrally managed, individual-level, participant quantitative and qualitative survey. RESULTS: During the first year of evaluation data collection, 1085 racially and ethnically diverse scholars ranging from the high school to postdoctoral levels applied for CDEIPI programs throughout the United States. Of these, 257 (23.7%) were selected to participate based on program capacity and applicant qualifications. Participants were trained by 149 mentors, teachers, and staff. Of the N = 95 participants responding to the individual-level survey, 95.7% agreed or strongly agreed with statements of satisfaction with the program, 96.8% planned to pursue further education, and 73.7% attributed increased interest in a variety of HIV science topics to the program. Qualitative findings suggest strong associations between mentorship, exposure to scientific content, and positive outcomes. CONCLUSIONS: These data provide evidence to support the feasibility and impact of novel DEI programs in HIV research to engage and encourage racially and ethnically diverse scholars to pursue careers in HIV science.

Evaluating systemic changes to support clinical and translational health research.

In evaluation research, "programs" are often conceptualized as clearly bounded, narrow in scope, focused on specific outcomes, using a well-defined linear causal model, and hence, suitable for standard evaluation methods. The evaluation work reported here was carried out in a more challenging context, where large, complex, interwoven systems were targets for change as a means to influence a diffuse array of outcomes. Our evaluation of an NIH-funded program to improve statewide infrastructure for clinical and translational health research ("Advance-CTR") used qualitative data provided by investigators who used the program's services, were funded awardees, or were members of an internal advisory committee (leadership representatives from partnering institutions). We examined perceived barriers to systemic changes to enhance research, as well as how systems have changed due to the Rhode Island Advance-CTR program's efforts, to what degree, and with what effects. Using the causal logic of our program to connect these more distal systemic outcomes to the services and components of Advance-CTR, we discuss the effects this program has had on researchers and their environments, contributing to the development of sustainable programs of research that ultimately improve the health and well-being of our state's residents.

Improving the quality and quantity of clinical and translational research statewide: An application of group concept mapping.

INTRODUCTION: Advance Clinical and Translational Research (Advance-CTR) serves as a central hub to support and educate clinical and translational researchers in Rhode Island. Understanding barriers to clinical research in the state is the key to setting project aims and priorities. METHODS: We implemented a Group Concept Mapping exercise to characterize the views of researchers and administrators regarding how to increase the quality and quantity of clinical and translational research in their settings. Participants generated ideas in response to this prompt and rated each unique idea in terms of how important it was and feasible it seemed to them. RESULTS: Participants generated 78 unique ideas, from which 9 key themes emerged (e.g., Building connections between researchers). Items rated highest in perceived importance and feasibility included providing seed grants for pilot projects, connecting researchers with common interests and networking opportunities. Implications of results are discussed. CONCLUSIONS: The Group Concept Mapping exercise enabled our project leadership to better understand stakeholder-perceived priorities and to act on ideas and aims most relevant to researchers in the state. This method is well suited to translational research enterprises beyond Rhode Island when a participatory evaluation stance is desired.

Disparities by age in depressive symptoms and substance use among men who have sex with men living with HIV.

The aim of this study was to assess the association between age, depressive symptoms, and substance use among men who have sex with men (MSM) living with HIV. Baseline data were obtained from 337 MSM living with HIV. Linear and logistic regression models were used to determine the association between age and depressive symptoms and substance use. MSM aged 35-49 had higher depressive symptoms than MSM 50 and older (B = 3.53; 95% CI: 0.33, 6.72); MSM aged 25-34 and MSM 35-49 had higher substance use than MSM 50 and older (B = 2.66; 95% CI: 0.77, 4.54; and B = 1.68; 95% CI: 0.22, 3.14, respectively). MSM aged 35-49 were more likely to be at risk for clinical depression than MSM 50 and older (OR = 1.84; 95% CI: 1.06, 3.22); MSM aged 18-24 and MSM 35-49 were less likely and more likely to have substance abuse than MSM 50 and older (OR = 0.29; 95% CI: 0.09, 0.91; and OR = 1.83; 95% CI: 1.02, 3.29, respectively). Interventions addressing depressive symptoms and substance use tailored to individuals in different age groups should account for varying needs at different stages of life.