This is a revised proposal for the project, Disclosure Skills for HIV+ Pregnant and Post-Partum Women. As a result of a recent New York State law mandating newborn HIV testing, an increasing number of women will learn about their HIV status either during pregnancy or immediately post-partum. Disclosure of HIV status constitutes an important, ongoing challenge for these women, who are notified at a particularly vulnerable time. The goals of this study are to implement and evaluate a disclosure decision making intervention for women who receive their HIV diagnosis during pregnancy or immediately post-partum and, through this intervention, to help advance theory on the process of HIV disclosure. This study is a randomized clinical trial, with 264 HIV+ women recruited and assigned to one of two conditions: a Disclosure Decision Making Intervention (DDMI) or a Minimal Monitoring Condition (MMC). Women assigned to both the DDMI and MMC groups will receive one month of crisis management prior to randomization, followed by monthly monitoring contacts over a 9-month period. These provisions will increase womens' ability to participate in the randomized trial, will promote retention, and will reduce variance in access to services and care. Women assigned to DDMI will also receive a 10-session disclosure problem-solving program over this 9-month period. The intervention is based on a social problem-solving skills training model and is designed to help women evaluate the risks and benefits of disclosure decisions, develop strategies and skills for disclosing (or concealing), and cope with the consequences of their decisions and unintended disclosures. All participants will receive three research evaluations to track disclosure decision making and evaluate the intervention: 1) at baseline, one month after recruitment and the initial crisis management; 2) nine months later, immediately post-intervention; and 3) six months later, for follow-up. Measures will focus on problem solving and coping skills, antecedents to disclosure decisions, disclosure decision making, social consequences of disclosure or concealment and coping with those consequences, contextual variables, the primary outcome of psychological adjustment, and secondary outcomes including health behavior and sexual risk. Upon completion, this study will yield 1) a feasible and effective intervention package, which can be tested in larger clinical trials among other populations; 2) a comprehensive measure of the disclosure process; and 3) data on the processes and adaptive consequences of disclosure that can contribute to more effective interventions for HIV- infected women and their families in the future.
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