The South has experienced the largest proportionate increase in persons with AIDS in recent years; however, there is little psychosocial and prevention research stemming from rural areas in the South where the stigma associated with HIV infection is widespread, resources are limited and community networks are tight. The proposed study seeks to fill the knowledge gap by collecting data on HIV infected individuals in six predominantly rural Southeastern states. The overall objective of the study is to learn more about psychosocial adaptation, utilization of physical, mental and non-traditional health services, attitudes about AIDS, and self-reported adherence to medical regimens of HIV infected individuals in the South. The rate of HIV infection among African-Americans is disproportionately high in the rural South relative to the size of the general population and the rate of HIV infection among women is high in the rural South relative to rates of HIV infection nationally. Therefore the analyses will compare men and women, those living in rural and urban areas, and African-American versus Caucasians on the variables listed above. We further wish to examine cross-sectionally and longitudinally the role of demographics and psychosocial adaptation (e.g., psychological symptoms, coping, social support, past trauma) on health status, quality of life, adherence to HIV treatment, and health care utilization. To address the above-mentioned aims, we propose to study 1000 HIV positive men and women living in rural and urban areas of the south. Patients will be recruited from selected Infectious Disease clinics in six southern states: Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina (11 clinics in all). Questionnaire and interview data will be collected at baseline and every 9 months for 3 years (5 data collection points in total). Baseline, 18 and 36-month data collection will be done in-person in either a private location at the clinic or in the home of the respondent. The 9and 27-month interviews will be done over the telephone. In addition, a yearly chart review will be performed during the 3-year study period to obtain information on disease status and utilization of health services from 1 year prior to study entry to 3 months after the final interview. We will also conduct a brief survey of clinicians who provide medical care for the patient respondents, requesting their demographics, training and experience, and attitudes toward poor individuals. A research survey company, Battelle, will be hired to perform all data collection, including recruiting and interviewing of subjects. The data analysis will result in a minimum of 12 peer reviewed journal articles.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-8 (01))
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Weise, Richard E
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Duke University
Schools of Arts and Sciences
United States
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Pence, Brian Wells; Mugavero, Michael J; Carter, Tandrea J et al. (2012) Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 59:409-16
Whetten, Kathryn; Reif, Susan; Toth, Matthew et al. (2012) Relationship between trauma and high-risk behavior among HIV-positive men who do not have sex with men (MDSM). AIDS Care 24:1453-60
Reif, Susan; Mugavero, Michael; Raper, James et al. (2011) Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South. AIDS Care 23:152-62
Pence, Brian Wells; Raper, James L; Reif, Susan et al. (2010) Incident stressful and traumatic life events and human immunodeficiency virus sexual transmission risk behaviors in a longitudinal, multisite cohort study. Psychosom Med 72:720-6
Mugavero, Michael J; Raper, James L; Reif, Susan et al. (2009) Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study. Psychosom Med 71:920-6
Tsao, Jennie C I; Soto, Tomas (2009) Pain in persons living with HIV and comorbid psychologic and substance use disorders. Clin J Pain 25:307-12
Pence, Brian Wells; Thielman, Nathan M; Whetten, Kathryn et al. (2008) Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast. AIDS Patient Care STDS 22:869-77
Pence, Brian Wells; Ostermann, Jan; Kumar, Virender et al. (2008) The influence of psychosocial characteristics and race/ethnicity on the use, duration, and success of antiretroviral therapy. J Acquir Immune Defic Syndr 47:194-201
Whetten, Kathryn; Reif, Susan; Whetten, Rachel et al. (2008) Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med 70:531-8
Mugavero, Michael J; Pence, Brian Wells; Whetten, Kathryn et al. (2007) Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort. AIDS Patient Care STDS 21:681-90

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