RISK TAKING AND ADJUSTMENT IN WOMEN AFFECTED BY HIV

点击翻译按钮获取中文摘要

Women, particularly women of color, constitute the fastest-growing category of AIDS cases. However, little is known about factors that influence sexual decision-making and drug use in women who are HIV infected, the nature of the stressors they encounter, including the impact of HIV on relationships with their male partners, their coping responses, psychological adjustment, health behaviors, and disease course. Before effective interventions can be developed for women affected by HIV, it is important to understand factors affecting their lives that are gender, ethnically and culturally specific. This will ensure that more expeditiously planned interventions will incorporate women's risk taking and adjustment to HIV. The proposed longitudinal study will examine adjustment, high risk behavior and disease course over 24 months in a multi-ethnic sample of 400 African America, Latina and White heterosexual women of child bearing age (18 to 45 years). The sample will include 200 HIV seropositives at different stages of AIDS who are recruited from a variety of hospitals, clinics and community agencies that serve the health and socio-economic needs of women in Los Angeles County. In addition, a neighborhood control sample of 200 seronegative women matched on ethnicity, age, marital status, presence of children, and neighborhood of residence and a sample of 200 (100/group) male partners of the HIV positive and HIV negative women will be recruited. All participants will be assessed by a trained multi-ethnic, multicultural team of female interviewers using a comprehensive interview battery of psychosocial, behavioral, health, and neuropsychiatric measures. Women will be assessed for four hours at baseline and every 6 months for 2 years at $50.00 per session. Men will be assessed for 2 hours at entry and at 12, and 24 months for 2 years at $25 per session. The frequency of assessments will be increased for participants who seroconvert during the life of the study. All measures will be pretested and revised to insure their appropriateness for use with a multi-ethnic samples. A conceptual model of The Adjustment in Women with HIV (AWWH) has been formulated to answer two primary research questions: 1) What role do socio-cultural and personal factors play in influencing sexual decision making and high risk behaviors? and 2) What effects do life stressors, coping strategies and other risks and resources have on health, psychological well-being and HIV-disease course? A secondary goal will be to explore what effects the relationship with the significant male partner have on women's psychological well being, health behaviors and health status. Both cross-sectional (i.e., multivariate) and longitudinal (i.e., survival analysis, structural equation modeling) analyses will be conducted to examine predictors of high risk behaviors, psychological and physical health status and disease course in women affected by HIV. The results from this prospective study will inform future intervention studies to prevent the heterosexual spread of HIV and to improve the quality of life of HIV-infected women.