There is little empirical information about the physical and mental health of informal caregivers for inner-city persons with HIV/AIDS (PWHAs) (IOM, 1994). Preliminary analysis of data from the SAIL study, a prospective study on support networks of African American PWHAs, suggests that in early symptomatic stages of disease kin are perceived as potential sources of care. Data from our pilot study on caregivers of inner-city PWHAs indicate that supportive kin often have high support demands from others in their networks and are economically strained. The proposed study will examine dynamics of informal care to inner-city PWHAs. The conceptual framework is based on Pearlin, et al.'s (1989, 1990) and Kahana, et al.'s (1994) paradigms of caregiving, and theories of social exchange. Caregiving is conceptualized as a transactional form of social support (Vaux, 1988) and as a stress process. The sample will be comprised of 200 index PWHAs and their primary caregivers, with a matched comparison group of 100 index HIV seronegative individuals and their primary supporters (i.e., potential caregivers). We will use a social network approach to examine social contextual conditions that facilitate informal care, and caregivers' and PWHAs' support/care seeking behavior and its relation to their physical and psychological well-being. Index individuals will be interviewed 2 times, and their caregivers or supporters will be interviewed 3 times, over a 2 year period. For the index cohort we have data from two current studies on individuals' mental health, CD4 count, medical service utilization, risk behaviors, and social networks. This study design will allow us to follow changes in the physical and mental health of caregivers and PWHAs, and major events that may occur in the caregiving relationship, e.g., caregiving role withdrawal, substitution of caregiving role, and possible death of the PWA. The study results on psychosocial aspects of caregiving and caregivers' service utilization will be compared to results from the Epidemiologic Catchment Area (ECA) study.
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