Substance use and its relationship to depression, anxiety, and isolation among youth living with HIV.

Reductions from lifetime to recent levels of substance use, the time since HIV diagnosis, physical health symptoms, CD4 counts, emotional distress, and social supports were examined among 227 (20% female; 22% African American, 27% Anglo, 35% Latino) youth living with HIV (YLH) ages 13 to 24 years. Substance use pervaded the lives of these youth. Male YLH had used more drugs.

Needed: services research with homeless young people.

Most research has focused on the individual characteristics of homeless young people, yet contextual factors such as service delivery are crucial to understanding this population's pathways in and out of home or stable accommodations. The limited research that has examined service delivery has documented the importance of providing appropriate services. To understand the pathways that enable young people to exit homelessness and become safely housed, we discuss the need for better descriptive and evaluation information that accurately reflects the perspectives of service providers and clients.

Families living with HIV.

Given the historical emergence of the AIDS epidemic first among gay men in the developed world, HIV interventions have primarily focused on individuals rather than families. Typically not part of traditional family structures, HIV-positive gay men in Europe and the US lived primarily in societies providing essential infrastructure for survival needs that highly value individual justice and freedom. Interventions were thus designed to focus on at-risk individuals with programmes that were age and gender segregated.

Psychological distress, substance use, and adjustment among parents living with HIV.

Background: Being a parent, especially a custodial parent, living with HIV was anticipated to increase psychological distress and challenges to self-care.

Methods: Mental health symptoms, substance use, and health care utilization were assessed among 3818 HIV-infected adults, including custodial parents, noncustodial parents, and nonparents, in 4 AIDS epicenters.

Results: Custodial parents demonstrated significantly poorer medication adherence and attendance at medical appointments but were similar to nonparents and noncustodial parents in mental health symptoms and treatment utilization for mental health and substance use problems.

Health and health care among male-to-female transgender persons who are HIV positive.

Recent studies have reported high rates of HIV infection among male-to-female transgender persons, but little research has examined how male-to-female transgender persons manage living with HIV. We compared demographic and health characteristics of 59 male-to-female transgender persons who were HIV positive with 300 nontransgender control subjects who were HIV positive. We found several demographic differences between the groups but no significant differences in HIV-related health status.

Predictors of serostatus disclosure to partners among young people living with HIV in the pre- and post-HAART eras.

Predictors of serostatus disclosure were identified among youth living with HIV pre- and post-introduction of highly active antiretroviral therapy (HAART). Two cohorts of HIV-positive youth, aged 13-24, in 1994-1996 (n = 351) and 1999-2000 (n = 253) in Los Angeles, New York, San Francisco, and Miami were sampled through medical providers and a variety of social service agencies. Data were collected on demographic, social, medical, and behavioral topics.

HIV-related stigma among market workers in China.

HIV-related stigma was examined among 209 employees and owners of stalls in 5 markets in an eastern coastal city in China. Of the participants 53% were women and 47% were men; 100% were Han. Ages ranged from 18 to 49 years (M=35, SD=8.

Predictors of sexual transmission risk behaviors among HIV-positive young men.

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors.

Cost-effectiveness of a behavioral intervention for seropositive youth.

An intervention for young people living with HIV (YPLH) was effective in reducing the number of partners of unknown serostatus and the number of unprotected sexual risk acts. In this article, we outline new methods to assess the cost-effectiveness of this intervention. Over a period of 3 months, the intervention would avert an estimated 2.

Predictors of close family relationships over one year among homeless young people.

Predictors of perceived family bonds were examined among homeless young people who initially left home one year earlier. Newly homeless young people aged 12-20 years who had recently left home were recruited in Los Angeles County, United States (n = 201) and Melbourne, Australia (n = 124) and followed longitudinally at 3, 6, and 12 months (follow-up rates ranging from 72% to 86% overall). These homeless young people varied substantially in their bonds to their families.

The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons.

The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals.

The Effects of Peer Group Network Properties on Drug Use Among Homeless Youth.

The authors examine how the properties of peer networks affect amphetamine, cocaine, and injection drug use over 3 months among newly homeless adolescents, aged 12 to 20 in Los Angeles (n = 217; 83% retention at 3 months) and Melbourne (n = 119; 72% retention at 3 months). Several hypotheses regarding the effects of social network properties on the peer influence process are developed. Multivariate logistic regression analyses show that higher concentrations of homeless peers in networks at recruitment were associated with increased likelihood of amphetamine and cocaine use at 3-month follow-up.

Adolescent adjustment before and after HIV-related parental death.

The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life events, and contact with the criminal justice system than nonbereaved youths; these behaviors did not remain significantly higher after parental death.

Perceived adverse effects of antiretroviral therapy.

Adverse effects from antiretroviral therapy (ARV) for HIV are associated with medication nonadherence. The purposes of this study were to explore group differences in the reporting of adverse effects, identify individual adverse effects that are linked to nonadherence, and to explore the role of coping in the relationship between adverse effects and adherence. Cross-sectional interviews of 2,765 HIV-positive adults on ARV therapies in four U.

Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus.

Background And Objectives: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort.

Methods: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization.

Results: Most participants were insured by Medicaid.

Risk behaviors of youth living with HIV: pre- and post-HAART.

Objective: To examine the transmission behavior among youth living with HIV (YLH), pre- and post-HAART.

Methods: Two cohorts were recruited: (1) 349 YLH during 1994 to 1996 and (2) 175 YLH during 1999 to 2000, after the wide availability of HAART. Differences in sexual and substance-use risk acts and quality of life were examined.

Predictors of substance use frequency and reductions in seriousness of use among persons living with HIV.

Aims: To examine predictors of the current level of substance use and reductions in seriousness of substance use among adults living with HIV.

Design: Cross-sectional survey.

Setting: Four major metropolitan areas of the United States.

Prevention for HIV-seropositive persons: successive approximation toward a new identity.

This article presents a three-module intervention based on social action theory that focuses on health promotion and social identity formation for seropositive youth. The modules are designed to reduce transmission of HIV by reducing sexual and substance abuse acts, increasing healthy acts and adherence to care, and maintaining positive behavioral routines. Components of the modules are described, including examples of how these components are implemented in the actual intervention sessions.

The influence of partner type and risk status on the sexual behavior of young men who have sex with men living with HIV/AIDS.

Objectives: The influence of partner type and risk status on the unprotected sexual behavior of young men living with HIV (YMLH) who have sex with men is examined.

Methods: Sexual behavior and sexual partner characteristics of 217 YMLH recruited from adolescent care clinics in 4 AIDS epicenters (Los Angeles, San Francisco, New York, and Miami) were assessed. YMLH were categorized by sexual behavior pattern, and sexual partners were classified by type and risk status.

The Sonagachi Project: a sustainable community intervention program.

High rates of HIV infection among sex workers in India indicate the importance of understanding the process of establishing a sustainable community intervention program. The Sonagachi Project, based in Calcutta, India, has been associated with lower HIV rates among sex workers as compared to other urban centers in India. The program defined HIV as an occupational health problem and included multifaceted, multilevel interventions addressing community (having a high-status advocate; addressing environmental barriers and resources), group (changing social relationships), and individual factors (improving skills and competencies related to HIV prevention and treatment).

Prevention for substance-using HIV-positive young people: telephone and in-person delivery.

HIV risky behaviors and health practices were examined among young people living with HIV (YPLH) in Los Angeles, San Francisco, and New York over 15 months in response to receiving a preventive intervention. YPLH aged 16 to 29 years (n = 175; 26% black and 42% Latino; 69% gay men) were randomly assigned to a 3-module intervention totaling 18 sessions delivered by telephone, in person, or a delayed-intervention condition. Intention-to-treat analyses found that the in-person intervention resulted in a significantly higher proportion of sexual acts protected by condoms overall and with HIV-seronegative partners.

"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities.

Context: Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased.