This R03 application proposes a secondary data analysis using existing data from the Coping with HIV/AIDS in the Southeast (CHASE) study to investigate the effects of incident stressful and traumatic events on health outcomes in HIV+ individuals. The CHASE project, a 5-year NIMH R01 study, included 611 participants recruited in 2001-2002 from 8 Infectious Diseases clinics in 5 southeastern U.S. states. A consecutive sampling strategy yielded a sample reflective of HIV+ patients in the region in distributions of gender, race/ethnicity, and mode of HIV acquisition. The CHASE study primarily sought to describe the psychosocial characteristics (mental health, substance use, traumatic event history, coping strategies, and social support) of individuals receiving HIV care and to examine the relationships between psychosocial characteristics and health outcomes. Published results from the CHASE study document a high prevalence of childhood (33%) and lifetime (50%) sexual abuse and severe physical abuse and identify associations between history of traumatic events and a range of negative health outcomes (worse overall health, higher health care utilization, higher sexual transmission risk behaviors, lower antiretroviral therapy [ART] adherence, more opportunistic infections [OIs], and higher all-cause and AIDS-related mortality). Beyond their history of traumatic events, a large majority of CHASE participants experienced incident stressful and traumatic events during the 27 month follow-up period including death of a family member (41%) or close friend (37%), a serious non-HIV related illness, injury, or accident (54%), or sexual (1%) or physical (15%) assault. While a high burden of past traumatic events is well documented among HIV+ persons, few longitudinal studies have explored in depth the characteristics of those experiencing incident stressful and traumatic events after HIV infection or the health consequences of incident stressful and traumatic events. The proposed secondary data analysis seeks to fill this knowledge gap by addressing three specific aims with the existing CHASE data: (1) Describe the incidence of stressful and traumatic events, predictors of incident events, and differences in incident events between those with and without a history of past traumatic events;(2) Examine the associations between incident stressful and traumatic events and changes in health- related behaviors (risk behaviors and ART adherence);and (3) Examine the associations between incident stressful and traumatic events and changes in clinical health-related outcomes (general health, HIV viral load, CD4 count, and OI incidence). The detailed stressful and traumatic event inventory in the CHASE dataset will allow us to consider sexual and physical assault separately as well as stressful events more broadly defined. This program of research will help inform policy and clinical care decisions about the implications of recent stressful and traumatic events for health outcomes and the relative importance of assessing lifetime versus recent stressful and traumatic events in HIV clinical care. This project seeks to understand the influence of recent stressful and traumatic experiences such as sexual or physical assault or death of a loved one on HIV-related behaviors (medication adherence, transmission risk behaviors) and health outcomes in HIV-positive individuals. The project will analyze pre-existing data from the Coping with HIV/AIDS in the Southeast (CHASE) Study which includes over 600 HIV-positive individuals who were recruited from HIV clinics in 5 southeastern U.S. states in 2001-2002 and followed for 3 years.
| Pence, Brian Wells; Mugavero, Michael J; Carter, Tandrea J et al. (2012) Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr 59:409-16 |
| Reif, Susan; Mugavero, Michael; Raper, James et al. (2011) Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South. AIDS Care 23:152-62 |
| Pence, Brian Wells; Raper, James L; Reif, Susan et al. (2010) Incident stressful and traumatic life events and human immunodeficiency virus sexual transmission risk behaviors in a longitudinal, multisite cohort study. Psychosom Med 72:720-6 |
| Mugavero, Michael J; Raper, James L; Reif, Susan et al. (2009) Overload: impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multisite human immunodeficiency virus cohort study. Psychosom Med 71:920-6 |
