This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.DETAILED NARRATIVESPECIFIC AIMS 1. To characterize HIV-related felt stigma in a cohort of Puerto Ricans LWHA. 2. To characterize the lifetime abuse, HIV-related risk behaviors, and adherence to treatment in a cohort of Puerto Rican PLWHA. 3. To explore the relationship between HIV-related felt stigma, lifetime abuse, treatment adherence, and clinical outcomes (viral load).4. To develop and evaluate the effect of an intervention model to reduce the impact of HIV-related felt stigma in a group of Puerto Ricans living with HIV/AIDS.5. To assess the impact of the intervention model on risk behaviors, treatment adherence and clinical outcomes in a group of Puerto Ricans living with HIV/AIDS. ProgressThe data collection for the characterization of HIV-related felt-stigma has been completed and the Data collection for the characterization of Experiences of Abuse with the revised version of the instrument is underway. We have initiated the analysis of the data and are developing an adherence instrument with our consultants. The research team has received two-day training in the development of psychotherapeutic interventions for HIV populations with Dr. Lydia Temoshok.Significance:SignificanceThis study fills a research gap regarding the impact of HIV related felt stigma and a history of abuse on HAART treatment adherence. Furthermore, it will explore the association between HIV related felt stigma and the experience of having been abused and how these may represent a risk factor to become infected with HIV. The development of culturally sensitive and valid instruments to assess HIV related felt stigma and experiences of abuse is a much needed scientific contribution. It will help to identify Puerto Ricans LWHA who perceive themselves as stigmatized because of their serostatus. This study will serve as groundwork for the development of intervention strategies to reduce and/or prevent the impact of HIV felt related stigma and abuse in the lives of PLWHA in Puerto Rico. Through the first phase of the study depression an anxiety have appeared as possible mental health mediating variables for HIV- felt-stigma. There is a scarcity of research exploring such variables and their interaction with treatment adherence in PLWHA in Puerto Rico. Design: A cross sectional survey using the HIV felt stigma and Experiences of Abuse self- administered questionnaires adapted for Puerto Rico. Recruitment of participants:We have recruited 106 participants for this phase of the study. Potential participants were screened through the use of the Spanish version of the Brief Psychiatric Rating Scale (BPRS). Six potential participants who presented psychotic symptoms and/or severe cognitive impairments were not included in the study. The investigators completed an incident report each time a potential participant was found not eligible. Those excluded from the study were referred to community services as needed.Analysis of results: The collected data was sent to the CCHD Data Core Center at the Universidad Central del Caribe (UCC) for statistical analyses. Original documents such as signed consents, completed instruments, and socio-demographic questionnaires are secured in a locked cabinet.InstrumentsBrief Psychiatric Rating Scale (BPRS) PR-CCHD Universal Questionnaire HIV Felt Stigma Scale Adapted Spanish Version (Jim nez, and Puig et al., 2005)History of Abuse Experiences Questionnaire, Adapted Spanish version (Jim nez and Puig et. al.,2005)Beck Depression Inventory - BDI-II (Beck, 1996)Beck Anxiety Inventory Preliminary resultsMost of the participants (n=102) were single (20%) men (55.1%) with high school education (37%). The most frequent age range was 40-49 (n=32). 51 participants (77%) reported alcohol consumption and 38 (57.5%) reported cigarette use. The majority preferred having sex with someone from the opposite gender. The participants' mean age at their first sexual experience was 15 years while the first sexual partner's mean age was 21 years of age. Moreover, 14 participants reported been forced to perform sexual acts at least once in their life (mean age 13.6 years old).Preliminary results show that 58% of the participants felt stigmatized 'almost always' or 'always.' Disclosure concerns (84%) and negative self image (74%) were identified as having a greater impact. Women obtained significantly higher scores in the Personalized Stigma, Negative Self Image, and Public Attitudes Concerns sub-scales than the men. 64% of participants reported experiences of emotional abuse, 72% reported Domestic violence, 28% sexual abuse, and 96% reported physical abuse. More women reported a history of lifetime abuse. Personalized Stigma was significantly related to Negligence and Emotional Abuse. Emotional abuse was also related to a negative self image and concerns about public attitudes toward PLWHA. Domestic violence was significantly correlated with all the HIV- Felt Stigma subscales.
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