Developing a Resilience Intervention for Older, HIV-Infected Women

摘要 艾滋病毒不再是一种急性致命的疾病。事实上，美国的艾滋病毒携带者现在可以预期活到 在持续的医疗护理下接近正常寿命。因此，生活在美国的个人人口 艾滋病毒携带者正在变老。感染艾滋病毒的老年女性的健康状况比男性更差。例如, 感染艾滋病毒的老年女性比男性感染艾滋病毒的女性经历更严重的慢性疼痛和疲劳， 报告说，与健康相关的生活质量水平低于男性，而与艾滋病毒相关的患者数量更多 健康事件和比男性更高的死亡率。在心理和行为挑战方面，老年人 感染艾滋病毒的女性经历了高抑郁的比率，挑战谈判健康的性行为，社交 隔离、耻辱和减少对抗逆转录病毒治疗的依从性。压力会恶化或使慢性 疾病，如艾滋病毒。很少有干预措施来管理管理危及生命的疾病的压力 是为感染艾滋病毒的老年人制定的；没有以妇女为重点的干预措施，也没有使用现有的干预措施 以“为本”的方法，例如发展技能，以提高复原力。为这项工作奠定基础， 我们收集了来自50岁以上艾滋病毒感染妇女的关于老龄化经历的形成的、定性的数据 以了解这一人群特有的压力源和需求。这些数据突出显示 老年妇女在面对艾滋病毒时能够保持韧性的方法。我们在本森-亨利研究所的同事 马萨诸塞州总医院的心身医学已经开发出一种心身医学弹性 干预(“3RP干预”)基于40多年的临床工作和研究表明 减少医学症状(总体上，血压，头痛，睡眠改善，药物减少)， 各种医疗人群中的焦虑、痛苦和压力。这个应用程序的目标是改进 并量身定做3RP干预措施，以满足感染艾滋病毒的老年妇女的特定需求，并完成试点 这项研究将提供关于对这一群体进行干预的可接受性和可行性的信息 病人。我们将分两个阶段调查该计划的可接受性和可行性。在我们完善干预措施后，我们 将在两小群感染艾滋病毒的老年妇女中测试干预措施。在我们做出任何必要的决定后 然后，我们将进行一个小型随机试验，参与者被随机分配到修订后的 3RP干预组或对照组。这项研究的数据将为一项更大的研究提供信息，以进一步测试这一效果 并调查如何以最佳方式提供干预，以便使更多感染艾滋病毒的老年妇女受益 尽可能的。

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.