As treatment for human immunodeficiency virus (HIV) associated disease become increasingly effective in slowing of halting disease progression, large numbers of individuals will be living with infection as a chronic illness. It is important to understand how these individuals manage the many adaptive tasks associated with their HIV seropositive status and to assess the quality of life they are able to maintain. We propose a two stage quasilongitudinal study of the adaptation to living with HIV infection as a chronic condition of men who have sex with men, with a focus on identifying white-black-hispanic differences. Stage 1 will consist of a qualitative study employing in-depth focused interviews with a sample of 45 white, 45 black and 45 Puerto Rican men (total N-135). Men from each group will be equally divided among those who are asymptomatic infected, those who are symptomatic infected (but not qualifying for a diagnosis of AIDS), and those diagnosed with AIDS. The findings of the stage 1 study will be used to design and conduct a large stage 2 survey study. Currently, we are seeking support only for stage 1. Research objectives will: (1) To identify the adaptive tasks that HIV infected men who have sex with men must accomplish to successfully adjust to their condition and how these may or may not vary by disease stage and race/ethnicity; (2) To describe strategies used by HIV infected men who have sex with men to address the adaptive challenges posed by their condition and how these may or may not vary by disease stage and race/ethnicity; (3) To describe and compare adaptations to living with HIV infection as a chronic condition of black, Puerto Rican and white men who have sex with men. More specifically to examine how group differences in health beliefs, perceptions and values influence adaptive strategies and illness behavior influence psychosocial adjustment; (4) to gather data that will inform the design of the stage 2 survey. These will include, for example, information regarding: Appropriate criteria for successful adaptation; the suitability of several existing standardized measures for the survey, and information needed to develop new measures where necessary; and (5) to begin to develop relational propositions describing the nature of the associations among adaptive challenges, strategies used to meet these challenges, psychosocial adjustment to HIV infection, stage of disease and race/ethnicity. Findings from the two stage study will enable us to identify factors that place HIV infected individuals at increased risk for poor psychosocial adjustment to their illness, and also inform the development of preventive interventions to forestall such difficulties.
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