This application seeks to test the effects of behavioral interventions on quality of life, psychosocial, and health status indices in a randomized controlled trail with 432 ethnically representative female AIDS patients. These patients will be recruited from the three largest AIDS epicenters for women: Miami, Florida; Newark, New Jersey; and Bronx, New York. The sample will include African-American, Caribbean, and Hispanic women who have recently (within the past 6 months) been diagnosed with case-defined AIDS. The 10-week cognitive behavioral stress management (CBSM) intervention to be used in the proposed study has been/is being tested by investigators on this research team in several studies with HIV+ women and gay men, with encouraging findings. This application will test the effects of CBSM with African-American, Caribbean, Hispanic, and Caucasian women at a more advanced stage in the HIV/AIDS disease process and will incorporate additional therapeutic strategies found to be effective by other investigators with patients confronting life threatening diseases. This expanded intervention will focus upon enhancing personal control over life stressors, expanding the repertoire of effective coping strategies, and increasing emotional expression and social support to reduce the deleterious affective and behavioral sequelae of AIDS. The objective of this study will be to determine (a) how effective the proposed expanded intervention will be for women who have already progressed to case-defined AIDS at the time of intervention; (b) whether active efforts to help women maintain their intervention-acquired skills will predict improved psychological, behavioral, and symptom status at follow-up; and (c) whether these effects generalize across ethnic boundaries. Thus, the proposed study will test the capacity of the expanded intervention to enhance problem solving coping strategies and perceptions of social support and to reduce the inappropriate use of denial and disengagement with concomitant improvement in quality of life indices and reduction in signs and symptoms associated with disease progression.
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