This is a 5-year project to test the efficacy of a 12-week group cognitive behavioral stress management (CBSM) intervention--and a monthly maintenance program--on health behaviors, mood and psychological adjustment, quality of life and physical health status and prognosis in 210 women with HIV infection who are using combination antiretroviral therapy (CART) (and who range from asymptomatic, symptomatic without AIDS, to symptomatic with AIDS). The study is a 2x4 randomized experimental design with experimental conditions (CBSM plus CART versus usual care [CART] as a between group factor and time point (pre-treatment, post- treatment, 6- and 12-month follow up) as a within group factor. Preliminary evidence from pilot testing with a group of symptomatic pre- AIDS HIV positive African American women (n=24) is suggestive of a buffering effect for the intervention for both affective distress (depression and avoidant thoughts) and for CD4 decline observed in the control condition over time. This is consistent with our previously published papers on asymptomatic and symptomatic pre-AIDS HIV+ gay men where we demonstrated that CBSM buffered the psychological and immune impact on an HIV-seropositive diagnosis (or dealing with symptoms), decreased social isolation, and improved adaptive coping strategies. In the proposed project we proposed to extend our pilot investigation with women to include women spanning the full range of the HIV continuum. In addition, because of the changing characteristics of the HIV/AIDS epidemic (i.e., successful introduction of protease inhibitors and antiretroviral combination therapies) we intend to focus also on (a) whether a CBSM intervention can be implemented to enhance health behaviors (medication adherence, reduced substance use, and reduced unsafe sexual behaviors) and other aspects of quality of life (vocational, educational independence/empowerment, social/community involvement), (b) whether these behavioral, psychological and immune effects are accompanied by low levels of viral load and decreased disease progression, and (c) how effective CBSM would be in women at various stages along the HIV/AIDS continuum including those who have already progressed to full-blown AIDS at the time of intervention.
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