The objective of this 5 yr program project is to extend findings of our previous NIMH supported studies of responses to psychological stressors and their attenuation by behavioral interventions in HIV-1+ gay men. Our previous research documented that changes in affect, endocrine and/or immune function occur in response to psychological stressors such as anticipation or actual diagnosis of HIV status and that responses to diagnosis in HIV+ men can be attenuated by aerobic exercise of cognitive behavioral stress management (CBSM). Project 1 would analyze cardiovascular, endocrine and immunologic reactivity and recovery from acute stressors by: (a) moving our focus from correlational field observations to controlled laboratory manipulation; and (b) extending our previous observations on HIV- and asymptomatic HIV+ White-American gay men to African- and Hispanic-Americans, to symptomatic HIV-1 infected but pre-AIDS (WHO Stage 3B) individuals and to women. Thus, the project would examine autonomic, neuroendocrine and immune responses to an evaluative speech stressor in 306 subjects using a 3 (ethnicity) x 2 (gender) x 3 (HIV status) design. Project 2 would also extend our previous research by examining the effects of a 10 week CBSM group intervention and 6 month post-maintenance program on 100 Hispanic- and 100 nonHispanic White-American WHO Stage 3B gay men randomized into the CBSM intervention condition or an assessment only control condition. The CBSM intervention is designed to enhance psychological adjustments to symptomatic HIV-1 infection and reduce sexual risk and substance use behaviors by teaching anxiety reduction and self-management techniques, enhancing interpersonal coping skills and increasing social support. The maintenance program combines group support and reinforcement of treatment adherence by using well-documented relapse prevention strategies. Psychological, endocrine and immune measures would be assessed at study entry, immediately after the 10 wk intervention period, and after a 6 month maintenance period. Project 3 would extend our previous research in which we found that moderate aerobic exercise prior to HIV-1 diagnosis lowered self-report levels of distress following news of seropositivity. The proposed project would extend our research conducted on asymptomatic HIV+ gay White men to WHO Stage 3B African- and nonHispanic White- American men and women coping with HIV-1 related symptoms and stressors. Relapse prevention strategies will be used to assess feasibility of aerobic exercise as a long-term intervention in symptomatic HIV-1 infection. The project would randomize 176 men (88 African-American, 88 nonHispanic White-American) and 88 women to either the intervention condition or an assessment-only control condition and would conduct aerobic fitness, psychosocial, endocrine and immune assessments at study entry as well as 3- and 12-months post entry. Cross-project analyses will be conducted on psychosocial, psychiatric, endocrine and immune data.
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