In order to determine psychological factors that may be protective of health and/or related to survival in AIDS, this study proposes to compare three groups on psychological measures: 1) long-term survivors of AIDS; 2) the rare HIV positive people who have low CD4 counts (less than or equal to 50) and have always been clinically asymptomatic (asymptomatic low CD4 group; no CDC 1993 category B or C symptoms); and 3) an early """"""""numerical"""""""" AIDS group (HIV positive people with CD4 counts between 150-200 at entry to the study who are clinically asymptomatic and have not ever had category C symptoms). Study I compares the groups cross-sectionally in order to discern any psychological differences that the long term survivor group and asymptomatic low CD4 group have, especially as compared with the early numerical AIDS group. Study II follows the early numerical AIDS group longitudinally to determine whether: 1) these psychological characteristics developed as a result of continued survival or asymptomatic status (i.e., the chicken-egg problem); 2) the psychological characteristics predict the development of symptoms and/or death (most of this group are expected to become ill and many to die within 3 years); and 3) the psychological changes precede or are a result of health status changes (related to number 1, also the chicken-egg question). The major psychological variables to be assessed through interview and questionnaire include: coping style, life involvement, communication skills (emotional expression, assertiveness), social support, beliefs (self-efficacy, optimism, fatalism), distress, and approach to health care (doctor-patient relationship, taking responsibility for health, keeping up with medical information, etc.). A model is proposed and will be tested by which the impact of AIDS and stressors may be modulated by resources and individual capacities (""""""""trait"""""""" characteristics such as assertiveness, optimism, emotional expression) and behaviors (such as coping, keeping up with medical information) to affect health care, social isolation, depression, and sense of purpose in life and, thus, have an impact on morbidity and longevity. The study will be conducted at two sites, The University of Miami and the University of California at Los Angeles, to ensure an adequate number of the unusual people who comprise Groups 1 and 2.
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