Women and HIV

The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS

Study Question(s): Are changes in self-efficacy -- as a result of participating in a cognitive behavioral intervention -- related to changes in disease status (e.g., HIV viral load and CD4 cell count) and psychological well-being (e.g., depression and anxiety) in women with AIDS?

Study Participants: This substudy is based on data from a subset of 56 women participating in the SMART/EST (Stress Management and Relaxation Training/Expressive Supportive Therapy) project for whom the biological measures were available at the beginning of the study and at various times after the intervention. Women (less than 18 years of age) living with AIDS were recruited from three major areas: Miami-Dade County, New York City and the New Jersey metropolitan area. Data from a larger cohort of 391 women were used for initial analyses about the self-efficacy inventory. Most participants were African American (65%) or Hispanic (11%).

Study Methods: Women were randomly assigned to one of two 10-week interventions:

1) group cognitive behavioral stress management (CBSM+) intervention, which teaches participants a variety of active coping strategies (e.g., cognitive restructuring, relaxation exercises, assertive response) or

2) individual low intensity intervention (educational/entertainment video)

Three components of self-efficacy were identified from an initial analysis of an 8-item Self-Efficacy Inventory in the larger sample:

	AIDS self-efficacy-perceived skills to prevent re-infection and slow down the development of symptoms
	Cognitive behavioral self-efficacy-cognitive stress management and reframing skills
	Adherence self-efficacy-perceived ability to take medications as prescribed.

Intervention participants completed the Self-Efficacy Inventory, the Beck Depression Inventory and the State Trait Anxiety Inventory before and after the intervention period.

Study Findings: At baseline, women in both intervention groups were mildly depressed and anxious and had reported moderate AIDS, cognitive behavioral and adherence self-efficacy skills. After three months, these data indicated that:

	Increased AIDS self-efficacy was related to both decreased viral load and increased CD4 count, but not to changes in depression or anxiety.
	Increases in cognitive behavioral self-efficacy were related to decreases in viral load, depression and anxiety.
	Increased adherence self-efficacy was associated with decreased viral load.

In this pilot substudy of 56 women, self-efficacy changes or changes in biological indicators were not related to the cognitive behavioral intervention.

Limitations: First, this pilot substudy of the association between changes in self-efficacy and health was restricted to a subset of women that had CD4 cell counts and viral loads completed before and after the intervention. In a previous report on the larger sample of participants, there were significant increases in self-efficacy in the intervention group, but not in the individual low intensity comparison condition. Second, the control group was really a low intensity intervention condition where the participants received essentially similar stress management information by videotape.

Lessons Learned: The SMART/EST was designed to respond to the needs of minority women living with AIDS. Studies have shown beneficial health effects of cognitive behavioral interventions in men with HIV/AIDS. This study was the first to examine this approach in minority women living with AIDS. Although this pilot study did not demonstrate an independent effect of the intervention on the outcomes of interest, it shows that improving self-efficacy is related to future improved disease status and well-being in women with AIDS. Thus, people who believe they have the skills to prevent re-infection and the skills to slow down the development of symptoms actually appear to have better biological and psychological outcomes.

Sources: Ironson G, Weiss S, Lydston D, Ishii M, Jones D, Asthana D, Tobin J, Lechner S, Laperriere A, Schneiderman N, Antoni M. The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women's Project. AIDS Care. 2005 Feb; 17(2):222-36.

The process of disclosing HIV status between HIV-positive mothers and their HIV-negative children

Study Question(s): What is the experience of disclosure for HIV-positive mothers and their children?

Study Participants: Participants included 35 women and 19 children 10-18 years of age who were aware of their mother's HIV status. These women and children were enrolled in a larger, longitudinal study of 105 mother-child pairs entitled Living with HIV/AIDS: Mother-Child Coping and Adjustment.

Study Methods: Mothers were interviewed about the experience of being an HIV-positive mother, the role of religion in coping with the diagnosis and issues regarding disclosure of her diagnosis to her child(ren). Children were also interviewed about the experience of having a mother who is HIV-positive and issues regarding disclosure.

Study Findings: These data focused on the decision to disclose the mother's HIV status, the process of disclosure and the impact of disclosure on the mother-child relationship. The child's developmental readiness was a major factor in the decision to disclose as was the need to protect the child. For children, the actual event of disclosure generated shock and fear.

Positive aspects of disclosure from the mother to the child included:

	open, honest communication
	closer relationships between mothers and their children

Common negative aspects included:

	fear
	uncertainty
	forced secrecy for fear of being discriminated against due to disease status
	behavioral changes in the children
	shifting responsibilities between the mother to the child.

Limitations: The study had a small sample size.

Lessons Learned: Disclosure, and all it entails, remains a vital issue for mothers who are HIV-positive. This is evident in the fact that only 54% of the mothers in the larger study had disclosed their HIV status to their children. The effects of disclosure on children may be under-estimated if only a mother is asked how her child is coping. Direct assessment of the child should be an important family-centered component of the holistic care of mother's with HIV.

Source: Vallerand AH, Hough E, Pittiglio L, Marvicsin D. The process of disclosing HIV serostatus between HIV-positive mothers and their HIV-negative children. AIDS Patient Care and STDS. 2005 Feb;19(2):100-9.