This 5-year renewal has 2 components. Study 1 will describe over time emotional distress, psychopathology, and dysfunctional behaviors among a cohort of HIV+ and HIV-adults. Subjects without AIDS and with history of parenteral drug use, males sex with males, and/or unprotected heterosexual intercourse with potentially HIV+ partners will have HIV testing with counseling, then be followed at 3 months, 6 months and every 6 months thereafter with repeated counseling and measures of: a) distress (e.g., anxiety, depression); b) psychopathology (e.g., current DSM-III-R Axis I); and c) HIV-related behaviors (e.g., unsafe sex). We will also assess: a) HIV-related stressors (e.g., physical symptoms, CD4, bereavement); b) resources (e.g., social support, hardiness); and c) vulnerabilities (e.g., lifetime Axis I, Axis II). Analyzed cohort will represent women and minorities and be comprised of an estimated 400 HIV+ and 486 HIV- subjects followed for at least 2 years during 11 years since study began. Structural modelling will examine for interactions within an explanatory model that hypothesizes HIV-related stressors will be associated with distress, current psychopathology and maladaptive behaviors as mediated by subjects' resources and vulnerabilities. Study 2 will test the differential effectiveness of standard counseling alone or an additional 6 weekly individual sessions of stress-prevention training. Subjects will be 80 HIV+ and 80 HIV- with levels of distress associated with psychopathology. The dependent variables will be multiple measures of emotional distress obtained before randomization, then 3 and 6 months later. Preliminary data support feasibility and scientific merit of both the prospective and intervention studies. Results will help characterize responses to AIDS epidemic, identify factors associated with psychiatric and behavioral dysfunction, and test potentially generalizable methods for reducing their emotional distress. The proposal will thereby address issues specifically targeted by NIMH RFAs.
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