This proposal seeks three years of continued support for the Coping and Change Study (CCS), a prospective study of behavioral and psychosocial issues in a cohort of approximately 650 homosexual men at risk for Acquired Immune Deficiency Syndrome (AIDS). Support from NIAID through the Chicago Multicenter AIDS Cohort Study (MACS) provides biomedical investigations every six months in order to document the natural history of HIV infection. The applicants have received NIMH support since June 1985 for psychosocial investigation of the same cohort. Over 95 percent of those participating in the NIAID-funded study agreed to participate in the CCS. Data are obtained by asking participants to complete a self-administered questionnaire at home two weeks following their biannual MACS studies. The CCS assessment focuses on sexual behavior, psychological and social functioning, concurrent stresses (particularly those idiosyncratic to the AIDS crisis), personal resources, and coping strategies. The simultaneous collection of biomedical and psychosocial data in the same cohort provides a unique opportunity to continue investigating two important research questions: 1) To what extent are behavioral risk reduction and/or relapse occurring and what are the determinants of such behavior in this cohort of homosexual men? Analyses to date suggest that behavioral changes may be relatively unstable in a significant portion of the cohort (approximately one-third) and that long-term predictive models are difficult to identify. Nonetheless, several variables consistently associated with long-term behavioral patterns have been identified and will continue to be investigated as the epidemic evolves. Such prospective data are both theoretically valuable and have important practical implications for designing and implementing preventive interventions. 2) To what extent is psychological or social functioning impaired in response to the threat of AIDS and what are the determinants of such dysfunction? The crisis of AIDS has meant the introduction of previously unanticipated and potentially severe stressors into the lives of all those at risk. Remarkably stable and only moderately elevated levels of psychological distress have been described in the cohort, with the greatest impact on AIDS-specific measures. We will continue to monitor these responses, the psychosocial factors predictive of distress, and the inter-relationships between psychological functioning and behavioral risk-reduction.
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