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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reports findings from a National Institute on Drug Abuse-funded study designed to test the hypothesis that environmental changes, such as the enactment of laws to increase the accessibility of sterile syringes, including syringe exchange and pharmacy sale of syringes without a prescription, will lower the frequency of HIV risk and the prevalence of HIV among street drug users. Project COPE, a study of AIDS risk and risk prevention, collected longitudinal data on drug use, HIV risk, serostatus, and source of syringes in a sample of 710 out-of-treatment injection drug users in Hartford, CT. Findings support the hypothesis and the growing research-based conclusion that syringe exchange is an effective AIDS risk reduction modality.
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PMID:Changing the environment of AIDS risk: findings on syringe exchange and pharmacy sales of syringes in Hartford, CT. 945 70

AIDS prevention programs directed toward women who exchange sex for money or drugs must address multiple issues, including drug addiction, lack of job opportunities for women, culturally constituted gender relationships, and the power of clients to force unprotected sexual activity. Project COPE II, a collaborative effort on the part of community-based service and research agencies in Hartford, Connecticut (US), conducted street outreach to recruit active heroin injectors and crack cocaine users for AIDS risk assessment and voluntary HIV testing. 46% of the 258 female drug users recruited had exchanged sex for money and 31% had exchanged sex for drugs, but only 21% reported consistent condom use. Of the 128 women who agreed to HIV testing, 19 (15%) were HIV-positive; another 37 women did not undergo testing because they already knew they were infected. There was a positive association between exchanging sex for money and both higher injection rates and crack use, suggesting the former may be a strategy for women to achieve a sufficient income to support an addiction at that level. Open-ended interviews with 22 women who reported engaging in sex for money in the preceding month indicated women's need to acquire drugs and avoid withdrawal symptoms overpowered their determination to insist on condom use. Women tried to reduce their HIV risk by promoting oral sex with clients and sticking with regular clients. Interventions aimed at street-based workers should build on women's existing methods of self-protection and empower them to take greater control over their sexual encounters. Also essential are increased drug treatment availability to reduce the effects of addiction, injection drug use harm reduction techniques for those unwilling to enter treatment, and improved training and employment opportunities for impoverished women.
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PMID:Streets, drugs, and the economy of sex in the age of AIDS. 964 Jun 43

The Association for Voluntary Surgical Contraception's (AVSC) medical director discusses new oversight methods of medical quality of family planning programs. The traditional method of oversight involves outside experts making site visits, which tend to be rather far apart, to observe observations of family planning programs after which they write a final report. Staff rarely refer to the report or incorporate its recommendations. Despite its limitations, this system has set a minimum standards for safety. In Nigeria, AVSC is helping local officials develop a decentralized system that includes quality assurance. Local physicians conduct oversight, resulting in co workers being more responsive than they are with outsiders. AVSC staff in Africa originated the COPE (client-oriented, provider-efficient) program. 12 person helps providers go through a series of exercises to evaluate their family planning services. Each person linked to the delivery of family planning services has a role in preserving quality which, in effect, integrates quality assurance into the system. Teamwork to identify problems and to come up with solutions is important to continuous quality improvement to continuous quality improvement in health care. The invisible threat of AIDS is a key reason for the new emphasis on medical quality. The principles of total quality management comprise part of the continuous quality improvement. In Kenya, a nurse assigned to supervise persons responsible for disposal of medical wastes noted that the wastes were accumulating behind the hospital. She learned that the workers did not have kerosene to burn the wastes and that the instructions on how to handle the wastes were gone. 1 week long discussions led to a safe solution.
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PMID:Medical oversight in family planning programs: helping providers continuously improve quality. 1228 8

The authors examined factors associated with four dimensions of functional quality of life (physical functioning, energy/fatigue, social functioning, and role functioning) in 142 men and women living with HIV/AIDS. Participants completed the Brief COPE inventory and the Medical Outcomes Study Health Survey, with HIV-relevant items added. Greater use of maladaptive coping strategies was associated with lower levels of energy and social functioning. Pain severe enough to interfere with daily living tasks was associated with a lower level of functional quality of life on all four quality of life dimensions. Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.
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PMID:Relationship of functional quality of life to strategies for coping with the stress of living with HIV/AIDS. 1251 38

This Article aims to introduce the translation and the validation of a multidimensional measure of coping strategies: the Brief COPE, in a French population. The coping concept comes from psychological studies that were conducted on stress. In the conceptual analysis of stress by Lazarus and Folkman, coping works with two cognitive appraisals performed by the person concerning the perception of a threatening situation and his or her available resources to deal with it. Coping is defined as "cognitive and behavioural efforts to master, reduce, or tolerate the internal and/or external demands that are created by the stressful transaction". The Brief COPE is the abridged version of the COPE inventory and presents fourteen scales all assessing different coping dimensions: 1) active coping, 2) planning, 3) using instrumental support, 4) using emotional support, 5) venting, 6) behavioural disengagement, 7) self-distraction, 8) self-blame, 9) positive reframing, 10) humor, 11) denial, 12) acceptance, 13) religion, and 14) substance use. Each scale contains two items (28 altogether). This inventory has the advantage of being built from acknowledged theoretical models (Lazarus' transactional model of stress, 1984; behavioral self-regulation model, Carver and Scheier, 1981, 1998). It can be used to assess trait coping (the usual way people cope with stress in everyday life) and state coping (the particular way people cope with a specific stressful situation). As is the COPE inventory, the Brief COPE is a measure used for many health-relevant studies: drugs addiction, ageing, breast cancer, depression, AIDS. Both measures are widely used in Anglophone countries and translated in many Languages. Today, the COPE inventory has been validated among Estonian, Croatian, Chinese, and Italian populations and the Brief COPE is also validated among Spanish people. Thus, the worldwide use of this coping inventory should allow a broad comparison of medical and psychological research for coping strategies regarding every kind of pathologies. Thus, we were led to present the translation and the validation of this measure in a French population. Two studies are presented in this Article: the first one describes the validation of the inventory in a dispositional format (trait coping) and the second one the validation of the inventory in a situational format (state coping). The French version of Brief COPE, which was used for both studies, was back-translated and analysed by the Brief COPE Author: Charles S. Carver. For study 1, 834 first Year university students answered the Brief COPE in its dispositional format. To study the factor structure of the Brief COPE, we used structural equation modeling and the LISREL software. Results show that the expected theoretical structure and the observed one fit adequately (c2=606, p<0,05, RMSEA=0,04, GFI>0,95, AGFI>0,92, RMR<0,03). In order to study convergent and discriminant validity of Brief COPE, self-esteem (SEI, Rosenberg, 1979), perceived stress (PSS, Cohen et al., 1983), and psychological distress (GHQ-12, Goldberg, 1972) measures were used. Results show that functional coping strategies (eg, active coping) are linked to good self-esteem, to lower perceived stress, and to lower psychological distress, whereas less functional strategies (eg, denial or self-blame) are widely linked to poor self-esteem, to a high perceived stress, and to psychological distress. Study 1 shows also several significant gender differences. Study 2 describes the Brief COPE validation in its situational format. 178 additional students answered this version. The method that was used is the same the one developed by Lazarus and his colleagues for the WCC validation. Participants were asked to recall and think about the most stressful event they had experienced during the past two Months. They were also to give an account of how much that situation mattered to them. They had to evaluate their capacity to control the situation and indicated whether they felt the situation was amenable to change. The study includes only peoples only people who labeled an event as "important" or "very important". Here again LISREL was used to study the factor structure of the Brief COPE. The results emphasise - as in study 1 - that the expected theoretical structure and the observed one fit adequately (c2=391, p<0,05, RMSEA<0,05, GFI=0,87, AGFI=0,80, RMR<0,06). Differences among means showed how the perceived control of the situation and how the perception of its favourable evolution influenced the coping strategies used (eg, humour or denial). Results in both studies indicate good psychometric properties for the Brief COPE in its French version, whatever the format (ie, dispositional or situational). Thus French searchers have a relevant tool on hand to measure as accurately as possible the coping strategies someone used in everyday life (strategies interfering on health, on a long scale), or in distressful situations (eg, serious illness, traumas). The fact that this easy-to-use coping measure is worldwide spread among medical and psychological studies allows a better broadcast and comparison of results whatever the pathology.
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PMID:[Multidimensional assessment of coping: validation of the Brief COPE among French population]. 1502 85

There is increasing evidence that major depression impacts the course of HIV infection, yet few studies have explored demographic and clinical predictors of depression in people who with HIV/AIDS. This study investigated predictors of depression (e.g., demographic and clinical variables, negative life events, and coping response) among outpatients with recently diagnosed HIV/AIDS patients in South Africa. One hundred forty-nine recently diagnosed HIV/AIDS patients (44 males and 105 females; mean time since diagnosis = 5.8, standard deviation [SD] 4.1) were evaluated. Subjects were assessed using the Mini International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale, and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviors were assessed. Three variables: gender (odd ratio [OR] = 1.23; 95% confidence interval [CI] 1.56, 1.93), impact of negative life events (OR = 1.13; CI, 1.03, 1.23), and disability (OR = 1.51, CI, 1.28, 1.80) predicted current major depression. It is well known from non-HIV populations that female gender and increased negative life events predict depression. These data also emphasize the importance of these links in HIV.
AIDS Patient Care STDS 2004 Aug
PMID:Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. 1532 Oct 19

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.
AIDS Care 2005 Jul
PMID:Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa. 1603 41

The present study evaluated the efficacy of an individualized psycho-education (PE) program in reducing psychological distress and risky sexual behavior and enhancing self-disclosure associated with an HIV diagnosis among attendees of a walk-in non-governmental voluntary counseling and testing (VCT) center in Nigeria. Ninety-four consecutive individuals were asked to complete a pre-counseling, baseline questionnaire detailing their sociodemographic characteristics, psychopathology, sexual practices, self-disclosure intention and coping behaviors. They were screened for HIV and post-test counseled. Sixty-seven individuals (72.2%) who tested positive were consecutively randomly assigned to one of two groups: a PE program (four 60-minute weekly manual driven sessions) (N=34) and a wait-list (WL) control group (N=33). The major outcome measures used were the Crown Crisp Experiential Index (CCEI), the Beck Depression Inventory (BDI) (Beck et al., (1961), self-report sexual practices in past three months, self-disclosure intention and the brief COPE. At four weeks post-intervention, significant reductions on all measures as well as reduction in risky sexual practices were observed in the treatment group compared with the wait-list group. Treatment group members were also significantly more likely to disclose their serostatus and accept their HIV status as a way of coping, compared with the wait-list group. Overall, support was found for the efficacy of a manual-driven PE program for self-disclosure, reduction of depression and improvement in safe sexual practices.
AIDS Care 2006 Nov
PMID:Improving well-being through psycho-education among voluntary counseling and testing seekers in Nigeria: a controlled outcome study. 1701 95

The relationships between coping strategies, goal adjustment, and symptoms of depression and anxiety were studied in 104 HIV-positive men who have sex with men, in December 2006. The mean age of the respondents was 50 years, and almost were of Dutch nationality. On average people had known about their HIV-positive status for 10 years and the majority was on HIV-medication. The Cognitive Emotion Regulation Questionnaire, COPE, the Goal Obstruction Questionnaire, and the Hospital Anxiety and Depression Scale were filled out at home. Pearson correlations and Hierarchical Regression Analyses were performed. The findings suggested that cognitive coping strategies had a stronger influence on well-being than the behavioral coping strategies: positive refocusing, positive reappraisal, putting into perspective, catastrophizing, and other-blame were all significantly related to symptoms of depression and anxiety. In addition, withdrawing effort and commitment from unattainable goals, and reengaging in alternative meaningful goals, in case that preexisting goals can no longer be reached, seemed to be a fruitful way to cope with being HIV positive. These findings suggest that intervention programs for people with HIV should pay attention to both cognitive coping strategies and goal adjustment.
AIDS Patient Care STDS 2008 May
PMID:Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men. 1843 92

Acute/early HIV infection is a period of high risk for HIV transmission. Better understanding of behavioral aspects during this period could improve interventions to limit further transmission. Thirty-four participants with acute/early HIV infection from six US cities were assessed with the Mini International Diagnostic Interview, Beck Depression Inventory II, State-Trait Anxiety Inventory, Brief COPE, and an in-depth interview. Most had a pre-HIV history of alcohol or substance use disorder (85%); a majority (53%) had a history of major depressive or bipolar disorder. However, post-diagnosis coping was predominantly adaptive, with only mild to moderate elevations of anxious or depressive mood. Respondents described challenges managing HIV in tandem with pre-existing substance abuse problems, depression, and anxiety. Integration into medical and community services was associated with adaptive coping. The psychiatric context of acute/early HIV infection may be a precursor to infection, but not necessarily a barrier to intervention to reduce forward transmission of HIV among persons newly infected.
AIDS Behav 2009 Dec
PMID:Psychiatric context of acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: IV. 1951 25


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