Developing a Resilience Intervention for Older, HIV-Infected Women

摘要 艾滋病毒不再是一种致命的疾病。事实上，美国艾滋病毒感染者现在可以预期 在持续的医疗护理下接近正常的寿命。因此，美国的人口生活在 艾滋病病毒是衰老。感染艾滋病毒的老年妇女的健康状况可能比男子差。比如说， 感染艾滋病毒的老年妇女比她们的男性同行经历更大程度的慢性疼痛和疲劳， 报告与健康有关的生活质量水平低于男性， 健康事件和死亡率高于男性。在心理和行为挑战方面，老年人 感染艾滋病毒的妇女抑郁症的发生率很高， 隔离、污名化和抗逆转录病毒治疗依从性降低。压力会恶化或延续慢性 疾病，如艾滋病。很少有干预措施来管理管理威胁生命的疾病的压力， 针对感染艾滋病毒的老年人开发的;没有一个针对妇女，现有的干预措施也没有使用“优势”， 基于”的方法，如发展技能，导致更大的弹性。为了为这项工作奠定基础， 我们从50岁以上的HIV感染妇女中收集了关于衰老经历的形成性定性数据， 为了了解这一人群特有的压力源和需求，这些数据突出了 老年妇女在面对艾滋病毒时能够有复原力的方式。我们在本森-亨利研究所的同事 马萨诸塞州总医院的身心医学已经开发出一种身心医学弹性 基于40多年的临床工作和研究， 减少医学症状（总体而言，血压，头痛，改善睡眠，减少药物）， 焦虑、痛苦和压力在不同的医疗人群中。此应用程序的目标是细化 调整3RP干预措施，以满足老年艾滋病毒感染妇女的具体需求，并完成试点 研究，将产生关于在这一群体中研究干预措施的可接受性和可行性的信息。 患者我们将分两个阶段研究其可接受性和可行性。在我们完善干预措施后，我们 将在两小群感染艾滋病病毒的老年妇女中测试这种干预措施。在我们做出任何必要的 改变后，我们将进行一个小的随机试点，其中参与者被随机分配到修订后的 3RP干预或对照组。这项研究的数据将为更大规模的研究提供信息，以进一步测试这种效果。 并研究如何最好地提供这种干预，使更多的老年艾滋病毒感染妇女受益。 越好.

Abstract HIV is no longer an acutely fatal disease. In fact, individuals living with HIV in the U.S. can now expect to live close to a normal lifespan with ongoing medical care. As a result, the population of individuals in the U.S. living with HIV is aging. Older, HIV-infected women are at risk for worse health outcomes than men. For example, older HIV-infected women experience greater levels of chronic pain and fatigue than their male counterparts, report lower levels of health related quality of life than men, and experience greater numbers of HIV-related health events and greater mortality than men. With respect to psychological and behavioral challenges, older HIV-infected women experience high rates of depression, challenges negotiating healthy sexuality, social isolation, stigma, and reduced adherence to antiretroviral therapy. Stress can worsen or perpetuate chronic illnesses, such as HIV. Few interventions to manage the stress of managing a life threatening illness have been developed for older adults with HIV; none focus on women, nor do existing interventions use a “strengths based” approach, such as developing skills that lead to greater resilience. To lay the groundwork for this work, we collected formative, qualitative data from HIV-infected women over 50 on the experience of aging as a woman with HIV in order to understand stressors and needs unique to this population. These data highlighted ways in which older women can be resilient in the face of HIV. Our colleagues at the Benson-Henry Institute for Mind-Body Medicine at Massachusetts General Hospital have developed a mind-body medicine resiliency intervention (“3RP intervention”) based on over 40 years of clinical work and research that has shown to decrease medical symptoms (overall, blood pressure, headaches, improved sleep, medication reduction), anxiety, distress, and stress among a variety of medical populations. The goal of this application is to refine and tailor the 3RP intervention to meet the specific needs of older, HIV-infected women and to complete a pilot study that will yield information on the acceptability and feasibility of studying the intervention in this group of patients. We will investigate the acceptability and feasibility in two phases. After we refine the intervention, we will test the intervention among two small groups of older, HIV-infected women. After we make any necessary changes, we will then conduct a small randomized pilot in which participants are randomized to the revised 3RP intervention or a control group. The data from this study will inform a larger study to further test the effect of the intervention and to investigate how to best deliver it so it can benefit as many older, HIV-infected women as possible.