In the first 2 years of our NIMH-funded 3 year study we have recruited a heterogeneous physically asymptomatic population of over 350 adults at risk for AIDS, assessed their immediate psychological response to HIV antibody testing, randomized them to 3 standardized psychoeducational interventions, and begun comparing entry measures of distress risk behaviors, coping and immune function with scores at 2 and 6 months post- notification. This 5-year renewal will enable us to (1) establish an outreach program to recruit and maintain more intravenous drug users (IVDU); (2) follow our HIV+ and at risk HIV- for longer than 6 months; (3) enter more subjects to achieve adequate sample size for each major risk group and each post-notification intervention; (4) similarly recruit, elsewhere of HIV+ (""""""""known HIV+""""""""); and (5) examine for possible HIV-induced will (Ia); Document the psychobehavioral responses to voluntary HIV antibody testing on physically asymptomatic subjects representing five risk groups: (1) 60 HIV+/ 60 HIV- IVDU. (2) 60 HIV+/60HIV- gay males, (3) 60 HIV+/60HIV- bisexual males (4) 60 HIV+/60 HIV- heterosexuals whose partners are at high risk for HIV-, and (5) 400 heterosexuals whose partners are at relatively lower risk for HIV+; (Ib): Determine for the first 4 risk groups the effectiveness in reducing psychological distress and risk behaviors of 3 post-notification interventions: HIV counseling alone or 6 additional individual weekly stress-prevention training (SPT) sessions or 3 additional weekly SPT sessions imparted by an interactive video program: (II): similarly examine the effectiveness of these 3 interventions for known HIV+' 60 IVDU, 60 gay males, 60 bisexual males and 60 non-IVDU heterosexuals; and (III) longitudinally, compare at 6 month intervals over 3 years the neuropsychological neurological and neurorediographic (MRI) findings of 50 HIV+ and 50 closely-matched HIV- gay/bisexual males enrolled in I or II. Predictor variables assessed at entry on all 720 subjects at high risk for AIDS include (1) HIV serology; (2) clinical ratings of DSM-III-R Axis I/II disorders (SCID/PDE; depression (Hamilton); cognitive capacity (CCSE), and physical symptoms/sighs; and (3) self-report measures of distress (IES, BS1, VAS, STAI); (4) coping, hardiness, attributional styles (ASQ-R), social support (ISEL), life stressors (PERI); (5) risk behaviors, and (6) lymphocyte subsets on 480 HIV+ and 60 comparison HIV-. Outcome variables assessed at 2,6,12,18,24,30 and 36 months alter entry include seroconversion, psychiatric diagnosis, and/or4), psychological distress, coping, risk behaviors, and immunological status (e.g. total T4). This well-established study uniquely, cost-effectively and scientifically addresses critical areas of research targeted by RFPs of the NIMH.
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