This revised application is in response to PA-97-069 """"""""AIDS and Aging: Behavioral Sciences Prevention Research"""""""" and requests support to evaluate a Coping Improvement Group Intervention for persons 50 years of age and older living with HIV disease. Through December 2001, more than 90,000 persons living with AIDS in the United States were 50 years of age or older at the time of their AIDS diagnosis (CDC, 2001). Unfortunately, because most AIDS mental health research has focused on younger individuals, geropractitioners know little about the mental health needs of HIV-infected older adults. Across a series of preliminary studies supported by NIH, our study team has characterized levels of psychological distress and coping difficulties in late middle-aged and older adults living with HIV/AIDS. These studies portend that many HIV-infected older adults experience elevated levels of depression and suicidal ideation, confront complex barriers to medical and mental health care services, and lack social support resources. These and other dilemmas not only reduce one's life quality but may also lead to health-compromising behaviors in this group, such as poor adherence to HIV treatment regimens and the continued practice of high HIV-transmission risk behaviors. The proposed three-year study will evaluate the impact of a face-toface Coping Improvement Group Intervention on the adjustment efforts of HIV-infected persons 50-plus years of age in relation to two comparison conditions. Three hundred (N=300) HIV-infected older adults will be randomly assigned to either: (1) a face-to-face, Coping Improvement Group Intervention based on Lazarus and Folkman's (1984) Transactional Model of Stress and Coping; (2) a face-to-face, Information-Support Group Intervention; or (3) a Standard of Care Comparison Condition. Pre- and post-intervention measures, along with follow-up assessments collected 4- and 8-months post-intervention, will assess the relative efficacy of the three conditions. Participants will complete measures assessing comorbid health conditions, cognitive functioning, sources of life stress, ways of coping, psychological distress, social support, health services utilization, treatment adherence, and quality of life. At the current time, there are few--if any--age appropriate mental health interventions for HIV-infected older adults. However, the planned research may yield a culturally-contextualized coping improvement intervention for this vulnerable population, and this innovation would contribute significantly to the AIDS care and gerontological fields.
