Many studies have delineated patterns of psychological and social distress among persons living with HIV infection, and there have been several reports of mental health interventions for HIV-infected persons experiencing stress and copping problems. However, this research relies heavily on samples from large metropolitan areas with high HIV seroprevalence. Across a series of preliminary studies conducted over the past 2 years, the investigators have examined, characterized, and determined the prevalence of coping problems, psychosocial distress, and factors that reduce the life quality of persons living with HIV/AIDS in small towns and rural communities. These preliminary studies indicate that HIV-infected rural residents feel very isolated, experience recurrent episodes of AIDS-related discrimination, lack emotional support from family members and friends, and lack access to medical and mental health practitioners. Many of these factors are likely to impede the coping and adjustment efforts of HIV-infected rural residents. The proposed 4-year study will examine the effects of a controlled, telephone-delivered, effective coping group intervention to improve illness-related coping styles, increase quality of life, and reduce psychiatric distress among HIV-infected persons in rural communities in relation to two comparison conditions. Three hundred and sixty HIV- infected rural residents will be randomly assigned to one of three conditions: (1) a standard care condition (SC) in which participants have access to customary life-care services provided by AIDS service organizations; (2) SC plus participation in telephone-delivered, coping effectiveness program based on a widely accepted cognitive-behavioral model of stress coping, or (3) SC plus participation in a telephone- linked group educational intervention in which participants receive information on contemporary topics related to living with HIV/AIDS (serving as an attention control group). Pretest and posttest measures, along with followup assessments collected for 12 months at 6-month intervals after posttest, will assess the relative efficacy of the three conditions. Participants will complete measures assessing daily stressors, illness-related coping strategies clinical depression, measures of global psychiatric distress, health-related quality of life, perceived levels of social support, and substance use. If successful, the planned study will identify strategies to provide mental health intervention to HIV-infected persons in America's rural communities, a group increasing in size and whose life-care needs have not been adequately addressed in the research literature to date.
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