This is a 5-year project to test the experimental effects of a 10-week group cognitive behavioral stress management (CBSM) intervention on distress and adherence to HIV combination antiretroviral therapy (CART) in 210 gay and bisexual men with symptomatic HIV infections (including those with and without Acquired Immunodeficiency Syndrome, AIDS). We will test the effects of CBSM on a set of theoretically-determined variables which are proposed to mediate its psychosocial effects. Furthermore, this project will consider the role of hypothesized moderators (e.g., ethnicity) in our analyses. We will also evaluate the effects of CBSM on health status by measuring changes in HIV viral load. This study is a 2 X 4 randomized experimental design with experimental condition (Standard Care + CBSM versus Standard Care Control) as the between-group factor and time point (pre-treatment, post-treatment, 6-month and 12-month follow-up) as the within-group factor. In several previously published papers on asymptomatic HIV+ gay men, we demonstrated that CBSM buffered the psychological and immune impact of an HIV-seropositive diagnosis, decreased social isolation, and improved adaptive coping strategies. Subsequently, we published a series of papers showing that CBSM in symptomatic pre-AIDS gay men increased psychological adjustment and improved immunologic surveillance of herpes viruses. These effects were found in part to be mediated by changes in cognitive appraisals, improved coping strategies and improved perceptions of social support. In the presently proposed project, we propose to evaluate the effectiveness of CBSM in HIV+ gay men with symptomatic disease who are on CART. We intend to specifically focus on (a) whether this intervention can reduce distress and depressive symptoms; (b) whether CBSM increase medication adherence using MEMs, pill counts, pharmacy records and self-reports as indicators, and (c) whether these behavioral changes, in turn, predict HIV viral load. We shall also attempt to specify the mediators and moderators of these behavioral and psychological effects as well as viral load to address issues of mechanism of action and generalizability, respectively. As secondary aims related to harm induction, we will examine the effects of CBSM on negative health behaviors such as substance use and unsafe sexual behaviors over time. Finally, the proposed project extends our prior studies to examine the generality of the effects of a CBSM intervention in subsamples of Black, Hispanic, and non-Hispanic White gay and bisexual men with symptomatic infection (Centers for Disease Control Stages B and C including AIDS).
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