Faculty Bibliography

Psychosocial adjustment to living with HIV/AIDS was examined in a purposive sample of 146 New York City, African-American, Puerto Rican, and White non-Hispanic women using the Psychosocial Adjustment to Illness Scale, self-report version (PAIS-SR). Puerto Rican participants reported significantly more problems than African-Americans on the Summary Scale and the Domestic Environment and Psychological Distress domain subscales and significantly more problems than either Whites or African-Americans on the Social Environment domain subscale. Problematic sexual relationships were found to be significantly associated with race/ethnicity, although scores did not differ significantly between any two groups. On average, women in all three racial/ethnic groups reported high levels of psychosocial adjustment problems to their illness relative to normative data for cancer patients. These findings suggest that, while all HIV-infected women may be at risk for problematic psychosocial adjustment to living with HIV/AIDS, Puerto Rican women may be especially vulnerable

Semistructured interviews were conducted with 63 HIV-infected late middle-age and older adults (i.e., age 50 or older). An analysis of the narrative material revealed a variety of themes that reflected participants' beliefs about how their older age advantaged and/or disadvantaged them in living with this disease. Themes reflective of perceived advantages included (1) with age comes wisdom; (2) older people do not feel as cheated; (3) with age comes greater respect for health and life; (4) with age comes patience, contentment, and moderation; (5) older people are less psychologically threatened by disability and fatigue; and (6) older people can focus more on their own needs. Themes reflective of perceived disadvantages included (1) older people's bodies are more worn down and less resilient, (2) older people are more socially isolated, (3) older people get less sympathy and are judged more harshly, (4) doctors set higher goals when treating younger patients, and (5) older people are too compliant and conservative.

BACKGROUND: As a consequence of advances and changes in the detection and treatment of cancer, increasing demands are being placed on familial caregivers of elderly cancer patients. Understanding the factors that place familial caregivers at risk of poor psychological outcomes and threaten their ability to provide adequate care is important for maintaining chronically ill patients in the community. METHODS: Dyads comprised of 164 cancer outpatients (ages 60-90 years) and their adult caregiving daughter completed structured telephone interviews. Hierarchical regression was used to determine the individual and cumulative effect of five domains of potential predictors on the daughters' depressive symptomatology (Center for Epidemiologic Studies Depression Scale [CES-D]). RESULTS: The domains that were shown to be significantly predictive of a daughter's level of depressive symptomatology were daughter sociodemographics, constraints on/facilitators of caregiving, and caregiver burden. The domains of disease/patient characteristics and the daughter's appraisal of the caregiving situation were not found to be significant. The total model suggests that having a health-limiting condition, a greater sense of filial obligation, and greater caregiver burden were correlated with higher CES-D scores, whereas having graduated college, having other social roles, having favorable attitudes regarding her caregiving experience, and providing care in a greater number of domains of care were correlated with lower scores. CONCLUSIONS: These findings demonstrate the importance of focusing on situational factors that may function to constrain or facilitate caregiving when investigating caregiver depression.

Data from an investigation of HIV-infected African-American, Puerto Rican and non-Hispanic white women's treatment behaviour and decision-making are presented. Findings are based on a thematic analysis of the narrative accounts of 31 women who exhibited significant delay in seeing a physician about their HIV infection after testing positive for HIV antibodies. Analysis of the women's qualitative interview data indicated that a variety of barriers impeded them from actively pursuing treatment. The women's psychological responses to learning their serostatus were the most pervasive factors associated with delaying seeking care. Implications of the analysis for informing the design of secondary prevention efforts to move women into treatment earlier are discussed, such as the need to develop interventions or supportive services designed to assist women in coming to terms with their infected status.

The relationship of race and ethnicity with standardized measures of depressive symptomatology and mental health was examined in a sample of HN-infected African American (n = 48), Puerto Rican (n = 50), and White non-Hispanic (n = 48) women in New York City. Mean scores of women from all three racial and ethnic groups were higher than those reported for normative samples on measures of depressive symptomatology and psychological distress, and mean scores on measures of psychological well-being were lower Puerto Rican women reported significantly higher levels of depressive symptomatology than either African American or White women. Puerto Rican women also reported significantly higher levels of psychological distress and lower levels of psychological well-being than African American women. The findings suggest that while all HIV-infected women are at risk of poor adjustment, Puerto Rican women may be especially vulnerable. They also point to the need for future research to determine what factors in these women's lives are predictive of adjustment, especially those factors amenable to intervention. (C) 1998 John Wiley & Sons, Inc.

Through in-depth interviews the testing experiences of HIV-infected women were examined. The barriers that impeded the women from recognizing their at-risk status and from seeking testing once their vulnerability was acknowledged are discussed. Also described are the pathways that led women into testing. The data reveal that lack of understanding about risk behaviors, ignorance of their partner's risk practices, lack of information about HIV-related symptoms, and perceived invulnerability to infection were the principal barriers to women recognizing their at-risk status. The women's accounts also indicate that psychological factors--fear and denial--are the principal barriers to seeking testing once one acknowledges vulnerability. Finally, the data show that few women made a thoughtful proactive decision to be tested but rather seemed to be led by circumstances to learn their status, sometimes unwittingly.

Findings from a study of the testing and treatment behaviour and experiences of African-American (n = 31), Puerto Rican (n = 30) and non-Hispanic white (n = 23) HIV-infected women are reported. All women were 20-45 years of age and had not yet been diagnosed with AIDS. Data for the analyses presented were gathered through an interviewer-administered questionnaire completed before respondents participated in an unstructured interview. The analyses examine race/ethnic differences in women's delays in seeking testing and medical care, and in sources and types of HIV-treatment. Most significant for primary and secondary prevention efforts, the findings suggest that a significant proportion of women who suspect they are infected may delay being tested, and further, a substantial proportion who learn they are seropositive may delay seeking medical care. Thus important opportunities among HIV-infected women for secondary prevention through timely antiviral and prophylactic treatment, and for primary prevention through risk-reduction counselling may be being missed in many cases.

Data collected as part of a psychosocial study of gay and bisexual men's experiences of living with HIV infection as a chronic illness were examined to investigate the psychological impact of the perceived availability of illness-related support and negative illness-related network interactions in a sample of men from this population. The sample was comprised of 144 HIV-infected non-Hispanic white, African American, and Puerto Rican Men living in the New York City metropolitan area. Analyses found evidence of a conjoint (interactive) effect between perceived support and negative network interactions. There was no evidence of either perceived availability of illness-related network support buffering or negative illness-related network interactions amplifying the effect of HIV/AIDS-related physical symptomatology on depressive symptomatology.

Longitudinal data from a sample of gay men living with AIDS (N = 128) were used to assess the relationship of change in various individual and situational correlates with change in depression. Results of regression analyses suggest that changes in physical symptomatology, in the number of bed days, and in the perceived sufficiency of social support are significantly correlated with concurrent change in depressive symptomatology. There was no evidence of change in the perceived sufficiency of social support buffering or amplifying the relationship of change in physical symptomatology with change in depression. The findings illustrate the need for the use of panel data (i.e., repeated assessments of the same individuals) and the assessment of change in both distress and its correlates among individuals living with AIDS.