Psychology, immunology, and HIV.

The interdisciplinary field of psychoneuroimmunology (PNI), which aims to clarify the relationship between psychological factors and immunity, can also play a role in our understanding of individual susceptibility to, progression of immunologically mediated disease. Mechanisms proposed to account for the profoundly damaging effects of human immunodeficiency virus (HIV) on immune function do only partially explain the variability in individual rates of progression, suggesting, therefore, that other immunomodulatory factors are also involved. Studies have examined the proposal that the effects of stress and HIV may interact in some complex way, and psychological, physiological and virological evidence for the role of stress in HIV progression is discussed in detail. A critical review of HIV-specific research in PNI, which can be broadly divided into cross-sectional, longitudinal, and intervention studies, and studies of long-term survivors, reveals that the relationship between stress and HIV progression remains equivocal, because of limitations due to methodological difficulties and to our inadequate understanding of immunology and HIV. A model is proposed for the influence of psychosocial stress on progression in HIV disease, which takes account of some of these difficulties.

Psychosocial vulnerability to stress: a study of HIV-positive homosexual men.

Sixty-one homosexual men with HIV infection participated in a 12-month investigation into the role of stressful life events and mediating variables in the stress process. The results revealed that frequency of stressful life events and psychosocial resilience (a factor indexing levels of support, worry, personal self-esteem, and effective coping efforts) significantly predicted levels of emotional distress in this sample. The combined influence of these variables accounted for 53% (Phase 2) and 55% (Phase 3) of the variance in levels of emotional distress. The data point to a need to incorporate measures of life event frequency and several, rather than single, mediating variables in studies investigating the stress process.

Greater emotional distress is associated with accelerated CD4+ cell decline in HIV infection.

An investigation was conducted to explore the relationship between emotional distress and HIV progression. One hundred twenty-five homosexual, HIV-positive males participated in a 12-month longitudinal investigation. Psychosocial data were collected at 6-month intervals and CD4+ data were collected from diagnosis to the end of the investigation. Principal component analyses were performed initially to identify factors of emotional distress and health status. In addition, CD4+ reliability assessments were performed to ensure the validity of the prognostic assessments made. As a result of these analyses, 47 individuals were eligible for the main analyses. The results from a stepwise regression revealed that disease progression was significantly predicted by CD4+ count at diagnosis (32% of variance) and emotional distress (17% of variance), but was unrelated to subjective perceptions of health. The data suggest that some of the variability in HIV progression can be attributed to emotional distress.

An exploration into occupational stress experienced by HIV health care professionals who work within genitourinary medicine settings.

The present study investigates the occupational stress of health care workers involved with HIV care in genitourinary medicine (GUM) outpatient departments. Sixteen nursing and 14 medical staff completed the P. Gray-Toft and J. G. Anderson (1981) occupational stress inventory. This assesses 7 potential sources of stress (death and dying, uncertainty regarding treatment, inadequate preparation, lack of support, conflict with others, conflict with physicians, and workload). The mean scores obtained revealed a preponderance of low-stress scores for both medical and nursing staff. Analyses of variance and covariance further demonstrated that, in general, levels of stress did not differ within or between the occupational groups. However, sources and characteristics of stress were different between nurses and doctors. In this group of health care professionals, their work with HIV-positive patients within the GUM outpatient setting may be instrumental in limiting levels of stress.

Nature and consequences of stressful life events in homosexual HIV-positive men: a review.

A great deal of research has been conducted into the stressful experiences that befall HIV-infected individuals. In this review we have focused on the work that has been conducted with HIV-positive homosexual males and have examined issues concerning the measurement, nature and consequences of stressful life events. It is apparent that, in consort with most other life events research, the measurement of events in this patient group is affected by methodological difficulties. Such difficulties may have, in particular, led to the observation by some investigators that HIV-positive homosexual men experience greater numbers of such events than their HIV-negative counterparts. It is also evident that, while some of these events are typical of those faced by individuals with other life threatening conditions, others are peculiar to this patient group. Research into the consequences of these events for emotional and behavioural functioning indicate that the effects are far-reaching. Similarly, data on the consequences of stressful events for immune function suggest that they may play a role in the progression of the disease, although these data are equivocal.

The measurement and significance of stressful life events in a cohort of homosexual HIV positive men.

Psychosocial HIV research has contributed greatly to our understanding of the psychosocial impact of the infection. However, assessments of stressful life events in homosexual HIV positive men have been made in the absence of a measurement tool specific to this patient group. This paper presents details of the construction and preliminary validation of such a measure. The inventory, based on the Gay Affect and Life Events Scale (Rosser & Ross, 1989), produces three primary life event values: an index of the overall stress experienced in the previous six months, the number of events experienced and the mean stress value of these events. These measures were highly intercorrelated and were found to be positively associated with measures of emotional distress. Principal components analyses revealed the existence of five event factors and five stress factors. Regression analyses, in which the five stress factors were the predictor variables, revealed that different dimensions of stressful experiences have consequences for emotional functioning (r2 = 0.23), self esteem (r2 = 0.12 & 0.14), social support (r2 = 0.06) and coping (r2 = 0.17 & 0.10). The results suggest that the inventory is a useful and appropriate tool for assessing life experiences in this patient group.

The role of social support in HIV infection.

A study was carried out in a group of 91 HIV positive gay men to investigate the relationship between social support, measures of affect and health; the changing nature of support over time; and the causal direction of this relationship. Overall levels of support for this group were found to be moderately high and consistent over 6 months and were associated with greater psychological well-being. Individuals in receipt of quantitatively different levels of support were found to differ on measures of depression, stress, coping efficacy and self-esteem, while individuals in receipt of deficient levels of support were found to be more depressed. However, initial support levels were found to be the most powerful predictors of subsequent support levels. The implications of these findings are discussed.

The role of disclosure in coping with HIV infection.

A qualitative investigation was conducted to explore the role of disclosure in HIV infection. Forty homosexual and bisexual men completed a short demographic questionnaire and participated in a one-to-one, semi-structured interview. The interview was designed to address a variety of personal, interpersonal and organizational issues related to their HIV status and participants were invited to talk about their personal experiences from immediately prior to their diagnosis to the time of the interview. The results from the interviews are presented in three sections: immediately post-diagnosis, asymptomatic phase and symptomatic/AIDS phases. The data revealed that disclosing one's HIV status was an acute and recurrent stressor. Immediately post-diagnosis, individuals were more likely to adopt a policy of non-disclosure and this provided them with an opportunity to come to terms with their diagnosis before having to contend with the reactions of others. After this phase, there was evidence that individuals increasingly used disclosure as a mechanism for coping with the disease. Disclosure of one's status was used to increase both practical and emotional support, share responsibility for sex and to facilitate self-acceptance of one's condition. The results from this investigation revealed that disclosure has a dual role in HIV infection acting as both a stressor and a mechanism by which individuals contend with their infection.

A technique for accurate use of CD4+ cell counts.

Despite uncertainty over their reliability, CD4+ cell counts are used extensively in both clinical and research settings to document progression in HIV infection. We examined, therefore, whether the performance of a simple statistical test would facilitate greater accuracy in the use of this marker. CD4+ cell count data were collected from a cohort of deceased (N = 60) and living HIV-positive gay men (N = 100). Pearson's product moment correlation coefficients were calculated for each individual in order to examine the association between CD4+ counts and time since diagnosis. Correlations of 0.7 or greater were obtained in approximately 50 percent of cases in each cohort. For these individuals, CD4+ cell counts were deemed to be a reliable indicator of rate of progression. The results suggest that the proposed technique ensures greater precision in the use of CD4+ cell counts and that the technique cna be used in individuals with either complete (deceased patients) or partial (living patients) CD4+ data.