With the advent of potent combination antiretroviral therapy, persons with HIV or AIDS now face the prospect of living longer with this disease as a chronic condition. In addition to the distress of having this chronic illness, persons with HIV infection have been shown to have high rates of sexual and physical abuse, other life stresses and traumas, and depression. Our previous research and others have documented the detrimental impact of stress, depression, lack of social support and avoidant coping strategies on immune changes and disease progression in HIV infection. Studies in normal adults and those with chronic illness have further documented improvements in medical symptoms and cellular immune response among those who disclose traumatic events through writing. Thus, the goal of the current study is to test the efficacy of emotional disclosure through writing in patients with HIV infection. We will compare two interventions, that is, emotional disclosure through writing about traumatic experiences (experimental) to writing about emotionally neutral topics (control) on the following: HIV disease progression, health status, psychosocial variables, and health behavior. Our study sample of HIV infected men and women will be recruited from South Florida. We will obtain completed data on 200 patients who will be equally randomized to one of two groups: The intervention group (emotional disclosure/processing) will write for four sessions about their stressors. The control group will write for four sessions on trivial topics. All patients will be assessed at baseline, each writing session and at one, six and twelve months post intervention. We hypothesize that subjects who write about traumatic experiences will have greater reductions in HIV RNA viral load, HIV and non-HIV somatic symptoms, urinary and salivary cortisol, psychological distress, passive and self-blaming coping strategies, and risky sexual behaviors, and greater increases in CD4 T-lymphocytes, health related quality of life, self-esteem, well-being, social support, and medication adherence at the followup assessments. Among patients in the emotional disclosure intervention, we will further determine how the efficacy of the intervention varies as a function of race, gender, socio-economic status (SES), abuse/trauma history, recent stressful events, psychological symptoms, coping strategies, social support, and quality of emotional disclosure and depth processing. Confirmation of our hypotheses will have important clinical implications for the treatment of HIV infected men and women in that it will provide a rationale for the use of stress reduction through writing as an adjunct to psychological and biological based treatments.
