This proposal tests a dietary intervention of combined dietary knowledge and behavior change training to reduce the frequency of diarrhea related to malabsorption among HIV positive individuals. Diarrhea is a common symptom of HIV disease affecting 50% to 90% of patients at some point in their illness. Chronic diarrhea related to malabsorption will lead to loss of work, reduction in quality of life (QOL), restriction of personal freedom and malnutrition if uncorrected. To reduce the frequency of diarrhea among HIV infected patients, effective physiologic interventions and theoretically based interventions are needed. Studies that use elemental formula preparations do not address the issue of palatability that supports long-term adherence to the diet needed by patients with HIV that have diarrhea. This study utilizes a diet program based on normal foods, that pilot data suggest is effective at improving the symptom of diarrhea related to malabsorption in HIV patients. This study tests the effectiveness of a dietary intervention using normal food to reduce the frequency of diarrhea episodes and improve stool consistency in a randomized, single blind, parallel groups, controlled clinical trial. The approach to the intervention draws on Ajzen's theory of planned behavior. Subjects in the study are HIV infected person with diarrhea related to malabsorption who are averaging three or more diarrhea episodes per day over a seven day baseline phase. Subjects are enrolled in a 24-week intervention trial located at The Irving Center for Clincal Research at Columbia Presbyterian Medical Center. Subjects are randomized to one of two treatment conditions. Condition 1 receives combined dietary knowledge concerning the effects of various foods on malabsorption diarrhea and cognitive/behavioral skill training which underlie dietary behavior change; Condition 2, the control condition receives an intevention program which focuses on HIV self-care which is neither dietary knowledge nor skill building training. Subjects assigned to conditions 1 or 2 complete daily bowel movement, food and antidiarrheal medication data collection diaries for 24 weeks and attend scheduled protocol sessions at weeks 1,2,3,8,16, and 24. Both conditions are identical in duration and intensity and involve various interractive learning activities. All interventions are implemented by nurses. Nurses are key health professionals in the effort to manage the symptoms of HIV
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