Social Support and Patient Adherence to Medical Treatment: A Meta-Analysis.

In a review of the literature from 1948 to 2001, 122 studies were found that correlated structural or functional social support with patient adherence to medical regimens. Meta-analyses establish significant average r-effect sizes between adherence and practical, emotional, and unidimensional social support; family cohesiveness and conflict; marital status; and living arrangement of adults. Substantive and methodological variables moderate these effects. Practical support bears the highest correlation with adherence. Adherence is 1.74 times higher in patients from cohesive families and 1.53 times lower in patients from families in conflict. Marital status and living with another person (for adults) increase adherence modestly. A research agenda is recommended to further examine mediators of the relationship between social support and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Stress and Coping Model of Medication Adherence and Viral Load in HIV-Positive Men and Women on Highly Active Antiretroviral Therapy (HAART).

The authors tested a structural model that incorporated age, time since diagnosis, social support, coping, and negative mood as predictors of medication adherence and HIV viral load on 188 men and 134 women on highly active antiretroviral therapy (HAART). The authors used psychosocial latent factors formed from baseline measures to predict latent factors of adherence, as assessed by electronic monitoring and self-report, and viral load defined by indicators assessed over a 15-month period. Results from the model indicate that greater negative mood and lower social support are related to greater use of avoidance-oriented coping strategies. Use of these coping strategies by patients on HAART is related to poorer medication adherence and, subsequently, higher viral load. This model advances researchers' understanding of the contribution of psychosocial variables in predicting treatment adherence and disease progression in HIV-positive men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women.

Objective: To determine the efficacy of a peer-led social support intervention involving support groups and telephone contacts compared with standard clinical care to enhance antiretroviral medication adherence. Design: Randomized controlled trial with follow-up. Participants were 136 HIV-positive indigent mainly African American and Puerto Rican men and women recruited from an outpatient clinic in the Bronx, New York. The 3-month intervention was delivered by other HIV-positive clinic patients trained in addressing barriers to adherence and sensitively providing appraisal, spiritual, emotional, and informational adherence-related social support. Main outcome measures: Medical chart-abstracted HIV-1 RNA viral load, antiretroviral adherence according to electronic drug monitoring and participant self-report, and social support and depressive symptomatology. All assessments conducted at baseline, 3 months, and 6 months. Results: Intent-to-treat and as-treated analyses indicated no between-conditions intervention effects on the primary outcome of HIV-1 RNA viral load or any of the secondary outcomes at immediate postintervention or follow-up. Post hoc analyses within the intervention condition indicated greater intervention exposure was associated with higher self-reported adherence, higher social support, and lower depressive symptomatology at follow-up, even after controlling for baseline adherence. Conclusion: Null findings, consistent with the limited literature on efficacious highly active antiretroviral therapy (HAART) adherence interventions, may be due to insufficient exposure to the intervention, its low intensity, or the nature of the sample-a heterogeneous HAART-experienced group of patients with high levels of substance use and multiple other competing stressors. Overall, findings highlight the need for more comprehensive and intensive efforts to battle nonadherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalized heterosexism among HIV-positive, gay-identified men: Implications for HIV prevention and care.

Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characterizing and improving HIV/AIDS knowledge among cocaine-dependent outpatients.

The present study was an experimental test of efficacy of a brief education intervention for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. Participants were randomly assigned to an HIV/AIDS education intervention (experimental condition) or a sham intervention (control condition). Control participants were subsequently crossed over to the HIV/AIDS education intervention. Experimental participants had higher scores on tests of HIV/AIDS knowledge after receiving the education intervention than did control participants. Further supporting the intervention's efficacy, control participant scores also increased once participants were crossed over and received the education intervention. Scores at follow-up were lower than at postintervention but remained higher than baseline scores. Results support the intervention's efficacy for increasing HIV/AIDS knowledge among cocaine-dependent outpatients. This intervention is brief, inexpensive, and easily implemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional Distress in Nonmetropolitan Persons Living With HIV Disease Enrolled in a Telephone-Delivered, Coping Improvement Group Intervention.

The study delineated depressive symptoms and modeled emotional distress in persons living with HIV disease in nonmetropolitan areas of 13 U.S. states. Participants (N=329) were enrolled in a randomized clinical trial of a telephone-delivered, coping improvement group intervention, and 60% reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. Structural equation modeling indicated that participants who experienced more severe HIV symptomatology, received less social support, and engaged in more avoidant coping also experienced more emotional distress (a latent construct comprising depressive symptoms and emotional well-being). Greater HIV-related stigma and rejection by family led to more emotional distress, with social support and avoidant coping mediating almost entirely the effects of the former 2 variables. The model accounted for 72% of the variance in emotional distress in nonmetropolitan persons living with HIV disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life in bereaved HIV-positive adults: Relationships between HIV symptoms, grief, social support, and Axis II indication.

Objective: This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support, and years since HIV diagnosis. Design: Structural equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement. Main Outcome Measures: Functional assessment of HIV infection, HIV symptoms. Results: The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL. Conclusion: Personality disorders have a direct negative effect on HIV symptoms and HRQoL and indirect effects through grief severity and social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of employment and disability among people living with HIV/AIDS.

Objective: To explore the relationship between employment/disability and selected demographic, biological, and functionality variables for people living with HIV/AIDS. Study Design: Cross-sectional, correlational analysis. Setting: Outpatient HIV/AIDS immunosupression clinic. Main Outcome Measure: Participant employment and disability status. Results: Results of a forced-entry hierarchical logistic regression analysis indicated that race, age, CD-4, and measures of mental and physical functionality significantly predicted employment/disability among study participants. Conclusions: Demographic, biological, and functionality variables represent important predictors of employment and disability among people living with HIV/AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concordance in Attachment States of Mind and Styles With Respect to Fathers and Mothers.

It is believed that by adulthood, independent attachments to the mother and the father coalesce into a single state of mind with respect to attachment. If true, states of mind with respect to mothers and fathers should be concordant. Fifty-six young adults were administered two versions of the Adult Attachment Interview, each of which asked about their relationship with one parent. State of mind with respect to the father was significantly related to state of mind with respect to the mother, as were attachment styles regarding the two parents. Perceptions of attachment styles were not very related to corresponding states of mind but were related to inferred loving from a parent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV/AIDS communication among adolescents in psychiatric care and their parents.

The authors examined HIV/AIDS communication among 207 parent-adolescent dyads in psychiatric care to better understand the relationship between family communication and sexual risk behavior in an at-risk population. Dyads reported content and rated quality of family HIV/AIDS discussions, and adolescent sexual risk was assessed. Families discussed transmission, prevention, consequences, myths, and compassion. Parent-reported discussion of consequences was associated with greater sexual risk behavior, but only for girls. Higher quality communication reported by adolescents was associated with less sexual risk. Parents may send different messages about HIV/AIDS to sons versus daughters, and messages related to consequences may not effectively reduce risk among daughters. However, for boys and girls in psychiatric care, teaching parents how to discuss HIV/AIDS may promote safer sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medication Adherence and Diabetes Control in Urban African Americans With Type 2 Diabetes.

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A1c, blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A1c. The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: Preliminary results from a community survey.

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information-seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral research in HIV/AIDS primary and secondary prevention: Recent advances and future directions.

Great advances have been made over the past decade in behavioral research on how to help persons avoid contracting HIV infections (primary prevention) and how to reduce or alleviate adverse consequences among persons who are living with HIV disease (secondary prevention). Within the primary prevention areas, research has shown the effectiveness of risk-reduction interventions undertaken with individuals, couples, small groups, communities, and at a social policy/structural level. Advances in HIV medical care have also created important new challenges and roles for behavioral scientists in the area of HIV secondary prevention. This article concludes by identifying key emerging issues in HIV behavioral research that will require attention in the years ahead. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources and Types of Social Support in Youth Physical Activity.

This study examines the influence of sources and types of social support on youth physical activity. The sample comprised 372 youth (mean age = 12.05 years, SD = 1.63). Youth were 76% White and 50.3% female. The annual household income for the sample was 20% under $30,000; 30% $30,000-$49,999; 25% $50,000-$69,999; 13% $70,000-$89,999; and 12% $90,000 and above. Results revealed that friends who support and watch youth engage in activities are significantly and positively related to youth physical activity. Significant correlations existed among the type factors. Future research should examine the sources and nature of support and the mechanisms through which social support influences youth physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimate partner violence and its effects on the health of African American HIV-positive women.

The medical outcomes of women infected with HIV are typically worse than those of HIV-positive men. HIV-positive women report high rates of intimate partner violence, and there is evidence that traumatic events have a negative impact on health status. In addition, African American women make up 1 of the fastest growing groups of HIV-positive individuals. Therefore, this study sought to examine the impact of intimate partner violence on HIV medication adherence, HIV-related physical health outcomes, and health-related quality of life in 40 HIV-positive African American women. The results were that women who had experienced intimate partner violence had worse HIV-related health as indicated by reduced CD4 counts and increased HIV viral load. In addition, posttraumatic stress disorder symptoms were related to both intimate partner violence and health-related quality of life. Lastly, HIV medication adherence mediated the relationships between intimate partner violence and the HIV-related health outcomes. Implications for further work and clinical interventions to address intimate partner violence, medication adherence, and health-related quality of life in this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma, social risk, and health policy: Public attitudes toward HIV surveillance policies and the social construction of illness.

Data from a 1999 national telephone survey with a probability sample of English-speaking US adults (N=1,335) were used to assess how support for HIV surveillance policies is related to AIDS stigma and negative attitudes toward groups disproportionately affected by the epidemic. Anonymous reporting of HIV results to the government was supported by a margin of approximately 2-to-l, but name-based reporting was opposed 3-to-l. Compared with other respondents, supporters of name-based surveillance expressed significantly more negative feelings toward people with AIDS, gay men, lesbians, and injecting drug users. More than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future. Implications for understanding the social construction of illness and for implementing effective HIV surveillance programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adherence to antiretroviral medications in HIV: Differences in data collected via self-report and electronic monitoring.

Controversy remains regarding the reliability of methods used to determine adherence to antiretroviral medication in HIV. In this study the authors compared adherence rates of 119 HIV-positive participants during a 6-month study, as estimated via electronic monitoring (EM) and self-report (SR). Adherence for both short (4-day) and long (4-week, or intervisit) periods was examined, as well as factors that underlie discrepancies between EM and SR. Results showed that intervisit EM estimates were consistently lower than those of SR. SR estimates based on shorter periods (4 days) were closer to those of EM. Higher discrepancies between EM and SR estimates were associated with lower cognitive functioning and externalized locus of control. These findings lend support for using both EM and SR methods; however, study design (e.g., length) and other factors (e.g., cognitive status, cost) should be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research.

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relative Importance of Three Domains of Positive and Negative Social Exchanges: A Longitudinal Model With Comparable Measures.

Researchers have expressed considerable interest in the question of whether positive or negative social exchanges more strongly affect psychological health, but previous studies have been limited by using nonparallel measures of positive and negative social exchanges, by measuring negative affect only, and by relying largely on cross-sectional designs. The independent effects of positive and negative exchanges on both positive and negative affect were examined in a short-term longitudinal study of 277 older adults, using social exchange measures with parallel content and equivalent reliability and validity. In cross-sectional analyses, positive exchanges predicted positive affect, and negative exchanges predicted negative affect. In longitudinal analyses, however, negative exchanges predicted both positive and negative affect, whereas positive exchanges were unrelated to either outcome. The more potent and longer-lasting effects of negative exchanges have important implications for theory and interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)