This 5 year project examines the effects of psychosocial stressors, social support, coping style and a supportive group intervention on psychological, neuroendocrine, immunological functioning and health status in bereaved HIV-1 seropositive and seronegative gay men. Two hundred and forty men will be randomly assigned to either a supportive group intervention or a minimal contact control condition. We will assess psycological (life stressors, social support and coping style), psychiatric (structured clinical interview, clinician rating of depression and anxiety, cognitive function), neuroendocrine relationships (ACTH, cortisol, catecholamines, beta endorphin), immunological (lymphocytephenotypes, proliferative response to mitogens, natural killer cell activity, immunoglobulin level), and health status (immunological progression, CDC stage, frequency of health care visits) before and after the intervention and at six month intervals over the subsequent 30 months. We will also use controls for nutritional status (general and specific nutrients) and (for those who progress) virological status (viral load and zidovudine resistance). We will enroll gay men who are within 3 months of bereavement of a close friend or lover and are either asymptomatic HIV-1 seropositive (CDC II or III with T4 cell counts >700 cells/mm(3) or HIV-1 seronegative gay men. The group intervention is proposed for 10 weeks, and a half hours for each session with two therapists experienced with HIV-1 infected individuals and terminal illness who are currently conducting such a group. The group is a semi-structured group with topics aimed at working through the grieving process. Intervention is structured to intervene on the basis of a psychosocial model we have noted to have significant association with distress in a natural history study of HIV-1 infected individuals. This model is comprised by 3 domains with their attendant parameters- (1) life stressors (controllability, predictability, and duration), social support (availability and satisfaction), and coping style (dispositional and situational). We have noted that increased life stressors, decreased social support and use of passive coping strategies are associated with increased psychological distress in HIV-1 infected individuals. Group intervention is aimed at each of these domains- (1) stress management, (2) increasing support, and (3) encouraging use of active coping strategies. We will examine (1) the impact of the intervention and (2) the predictive power of the model for level of psychological distress, immunological function and health status both cross- sectionally and longitudinally controlling for quality of the relationship, time since bereavement, number of bereavements, and life style factors. Finally, we propose to quantify serostatus differences in neuroendocrine associations between level of distress and immune function in relationship to the intervention.
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