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PubMed2003

Knowledge and attitudes towards antiretroviral therapy among factory workers participating in a cohort on HIV and AIDS, Addis Ababa, Ethiopia.

This study investigates barriers that may pose a threat to a successful implementation of an antiretroviral treatment (ART) program in Ethiopia. As prelude to the provision of ART among factory workers participating in a cohort study on HIV and AIDS in Ethiopia, we measured knowledge and attitudes towards several aspects of ART and provided an educational intervention. The proportion of participants having good knowledge on issues concerning adherence was found reasonably good (67.7%), concerning the benefit of ART was intermediate (37.7%) and concerning eligibility was very low (16.8%). Knowledge concerning eligibility improved somewhat after the provision of the educational intervention. Only one third of HIV infected persons discloses their HIV status to their partner. Several aspects that could impact adherence to ART will be discussed, such as ART knowledge, social support, willingness to take ART, and disclosure of serostatus, taking the cohort study site into account. Results indicate a tremendous need to educate cohort participants before and during introduction of ART. Efforts to increase knowledge of ART, and especially knowledge of eligibility criteria to start ART, seem warranted, as well as encouragement to identify social support and disclose HIV serostatus, as these factors directly impact the success of an ART program.

Adult↗
PubMed1988

Disclosure of psychosocial concerns of young adults with advanced cystic fibrosis (CF) by a nurse home visiting program.

Twelve patients with advanced cystic fibrosis were enrolled over a 36 month interval in a trial to assess the effect of nocturnal home oxygen therapy. As part of this study, there were repeated home visits by the nurse. Immediately following a visit, the nurse encoded all spontaneous expressions of concern into three general categories: CF management, growth and development and family relations. During the first 6 months, the concerns focused on CF management and over the subsequent year were followed by concerns related to growth and development and, finally to family interactions. This pattern suggests a sequence to the types of interventions accepted by this population.

Adolescent↗
PubMed1998

Managing HIV among serodiscordant heterosexual couples: serostatus, stigma and sex.

A qualitative study was conducted with 28 men and women in HIV-serodiscordant couples to explore the management of HIV in their relationship. Content analysis of the interviews revealed the role of serostatus and stigma in shaping partners' experience of HIV, sex and risk. Partners' differing serostatus often created feelings of alienation within the relationship. Compounding this interpersonal dynamic, the HIV service community was experienced as segregating because they were not funded or prepared to work with seronegative partners. Thus many, particularly seronegative women, felt invisible both within and outside of the relationship. Yet, the uninfected partners shared the burden of a stigmatizing illness because of the serodiscordant relationship. Stigma hindered communication about HIV and sex, disclosure to others and access to services. Many experienced HIV as a loss of their sexuality. Seronegative partners spoke about 'keeping sex alive' and often had to push to continue having sex. Couples used multiple strategies to manage HIV, including developing strict behavioural guidelines, connecting with other couples, accessing scientific information and becoming educators and activists. These altruistic activities, which also included participation in research, helped to transcend external and internalized stigma. Implications for developing interventions for HIV-serodiscordant couples are discussed.

Adult↗
PubMed1998

HIV serostatus disclosure among gay and bisexual men in four American cities: general patterns and relation to sexual practices.

The present study examined patterns of serostatus disclosure among previously untested HIV-seropositive and HIV-seronegative gay and bisexual men recruited from four American cities (n = 701). Six months after learning their HIV serostatus, 97% of study participants had disclosed their test results to at least one other individual. Consistent with earlier studies, test results were most frequently shared with friends and the respondent's primary partner. HIV serostatus was disclosed less frequently to family members, co-workers, and non-primary sex partners. Compared with HIV-seronegative men, HIV-seropositive men were more likely to have disclosed their status to a health care provider and less likely to have shared this information with family members. Of seropositive men, 11% did not disclose their serostatus to their primary partner and 66% did not disclose to a non-primary sex partner. Of HIV-seropositive men with one or more non-primary partners, 16% of those who did not disclose their serostatus reported inconsistent condom use during anal intercourse with these partners. No significant differences in self-reported sexual practices were observed for HIV-seropositive disclosers versus non-disclosers. Compared with HIV-seronegative men who did not disclose, seronegative men who shared information about their serostatus were more likely to have had receptive anal intercourse with their primary partner (p < 0.05) and to have engaged in mutual masturbation (p < 0.005), receptive oral sex (p < 0.005) and insertive anal intercourse (p < 0.05) with non-primary partners. No significant differences were observed between disclosers and non-disclosers with regard to condom use. Implications of the findings for future research and HIV prevention programmes are discussed.

Adolescent↗
PubMed2005

Patients with worry: presentation of concerns and expectations for response.

Patients with the same underlying concern express this with different styles that predict preference for physician responses. One hundred primary care patients imagined having chest pain and selected from a videotape, the most likely response which they would tell their physician: (1) symptoms only--no disclosure of underlying concern; (2) symptoms and a "Clue" to an underlying concern; or (3) symptom with an explicit concern. Depending on their preferred expression, they were presented videotaped doctors responses to that disclosure and ranked their response preferences. Patients stating they would present with symptoms only (17%) preferred a biomedical question response; patients selecting a symptom and a clue (43%) were equally comfortable with a biomedical question, facilitation or, an exploration of the clue. Of patients presenting with an explicit concern (40%), most wanted the physician to acknowledge and explore the origins of that concern.

Adolescent↗
PubMed2006

Depressive affect among health care seekers: how it is related to attachment style, emotional disclosure, and health complaints.

The present cross-sectional questionnaire survey investigated depressive affect among persons visiting their general practitioner (GP). It examined the impact of a number of factors likely to be associated with depressive affect, including demographic variables, severity of medical condition, and personal factors such as ease in disclosing personal information, and attachment style. Results showed that among the sample of patients (N = 198) visiting their GP, depressive affect was generally quite high. In particular, those reporting more depressive affect were the elderly, those with more severe health problems, more psychological problems, and a lower level of emotional disclosure frequency. As expected, attachment style was also related to lack of well-being among patients: those with a less avoidant but more anxious attachment style reported higher levels of depressive affect. In total, 38% of the variance of depressive affect was predicted by this model. Security of attachment was also related to reasons why patients consulted their GP, with avoidant attachment related to physical problems and anxious attachment to mental problems. Theoretical relevance of the findings and implications for medical help-seeking are discussed.

Adolescent↗
PubMed2006

Participant responses to retrospective surveys of child maltreatment: does mode of assessment matter?

This study examines the impact that different methods of assessing child maltreatment history may have on adult participants. A total of 334 female undergraduate students were randomly assigned to complete a retrospective measure of child sexual and physical abuse in one of three conditions: paper-and-pencil questionnaire, face-to-face interview, or computer-administered survey. Disclosure rates of abuse, psychological distress and mood change, preferences for assessment format, and perceptions of confidentiality were examined across the three assessment formats. Although disclosure did not vary by condition, participants with a history of abuse reported more distress and mood change than did nonvictims, particularly in the computer condition. Nevertheless, the computer condition was rated as the most preferred format and was viewed by participants as the most confidential means of assessing maltreatment history. Participants reporting abuse through interviews were more likely than those in other conditions to state a preference for another type of assessment format. The implications of these findings for abuse history research are discussed.

Adult↗
PubMedDate not supplied

For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.

OBJECTIVE: Although written emotional disclosure has potential as a stress management intervention for people with health problems, the main (group) effects of disclosure in medical populations are limited. This study sought to identify individual difference moderators of the effects of written disclosure among women with chronic pelvic pain. METHODS: In a prospective, randomized trial, 48 women with chronic pelvic pain completed 3 individual difference measures and then wrote for 3 days about stressful consequences of their pain (disclosure) or positive events (control). Health status was assessed at baseline and 2 months after writing. RESULTS: Main effect group comparisons indicated that disclosure writing resulted in significantly lower evaluative pain intensity ratings than control writing at follow-up, but there were no main effects on other outcome variables (sensory or affective pain, disability, affect). Three baseline individual difference measures, however, significantly moderated group effects. Compared with control writing, disclosure led to less disability among women with higher baseline ambivalence over emotional expression or higher catastrophizing, and to increased positive affect among women with higher baseline negative affect. Ambivalence, but not catastrophizing, was independent of negative affect in its moderation effect. CONCLUSION: Although the main effects of writing about the stress of pelvic pain are limited, women with higher baseline ambivalence about emotional expression or negative affect appear to respond more positively to this intervention.

Adaptation, Psychological↗
PubMed2006

Bipolar disorder and quality of life: a patient-centered perspective.

OBJECTIVES: Several quantitative studies have now examined the relationship between quality of life (QoL) and bipolar disorder (BD) and have generally indicated that QoL is markedly impaired in patients with BD. However, little qualitative research has been conducted to better describe patients' own experiences of how BD impacts upon life quality. We report here on a series of in-depth qualitative interviews we conducted as part of the item generation phase for a disease-specific scale to assess QoL in BD. METHODS: We conducted 52 interviews with people with BD (n=35), their caregivers (n=5) and health care professionals (n=12) identified by both convenience and purposive sampling. Clinical characteristics of the affected sample ranged widely between individuals who had been clinically stable for several years through to inpatients who were recovering from a severe episode of depression or mania. Interviews were tape recorded, transcribed verbatim and analyzed thematically. RESULTS: Although several interwoven themes emerged from the data, we chose to focus on 6 for the purposes of this paper: routine, independence, stigma and disclosure, identity, social support and spirituality. When asked to prioritize the areas they thought were most important in determining QoL, the majority of participants ranked social support as most important, followed by mental health. CONCLUSIONS: Findings indicate that there is a complex, multifaceted relationship between BD and QoL. Most of the affected individuals we interviewed reported that BD had a profoundly negative effect upon their life quality, particularly in the areas of education, vocation, financial functioning, and social and intimate relationships. However, some people also reported that having BD opened up new doors of opportunity.

Adult↗
PubMed2005

Mothers on the margins: implications for eradicating perinatal HIV.

Tactics aimed at reducing perinatal transmission of HIV are proving ineffective at accomplishing complete eradication: a group of women with HIV remain at very high risk for transmitting the virus to their newborns. This study engaged a uniquely high-risk group of HIV-infected mothers as expert informants on childbearing with HIV to inform strategies to eradicate perinatal HIV transmission. The sample draws from an Illinois Department of Children and Family Services (DCFS) database of 1104 HIV-seropositive women with children in protective services between 1989 and 2001. Of these, 32 women knew their HIV-positive status and gave birth to at least two children after 1997 (zidovudine widely implemented as standard of care). Twelve were accessible and consented to participate. Three others, currently pregnant, also participated. Fifteen interviews were completed. The 15 women had given birth to 78 children (9 HIV-infected), fathered by 62 men. Respondents were severely socioeconomically marginalized. They were aware of their HIV status and the benefits of prophylaxis, most desired healthy babies to parent, and most delivered their babies in hospitals equipped to provide adequate prophylaxis. Yet most received inadequate or no prenatal care and did not disclose their HIV status at delivery. Women indicated that denial and substance use were the primary intrinsic barriers and disrespectful treatment was the primary extrinsic barrier to disclosure and care. Women's recommendations about eradication of perinatal HIV transmission emphasized the problem of substance use, the need for private and thorough communication with medical and DCFS personnel, and the need for positive social relationships to enable HIV positive mothers to engage in care. Attention to potent social and institutional barriers that impair the ability of the most marginalized women to disclose their HIV status and accept care is essential to realize eradication of perinatal transmission.

Adult↗
PubMed2003

Social interactions and cardiovascular reactivity during problem disclosure among friends.

The authors examined the relations of social interactions with cardiovascular response in the context of two friends disclosing a problem. They also examined the relations of the sex composition of the dyad and partner gender-related traits (communion/agency) with social interactions. Same-sex and opposite-sex dyads (N = 79) came to the lab. One friend disclosed a real-life problem while the partner provided support; cardiovascular response was monitored. Women provided more emotional support than men, and this sex difference was due to women's higher levels of communion. Agency was linked with greater advice, whereas unmitigated communion was linked with greater negative interactions. Negative interactions predicted slower diastolic blood pressure (DBP) recovery, whereas advice predicted slower heart rate (HR) recovery. Sex composition of dyad moderated some of these effects.

Analysis of Variance↗
PubMed2006

Language use in imagined dialogue and narrative disclosures of trauma.

Support exists in many populations for the use of written disclosure to express thoughts and emotions about a traumatic experience. The present study examined language use in a variation of the writing task modified to include an imagined dialogue with another person. We hypothesized that this method would increase cognitive, affective, and present-tense word use, all of which are linked with beneficial outcomes from writing. We randomly assigned 169 college students to write in one of three conditions: trauma narrative, trauma dialogue, or control writing. Results suggested that writing about traumatic experiences in the form of a dialogue promotes greater present-oriented, affective experiencing and cognitive processing than does writing in the form of a narrative.

Adolescent↗
PubMed2004

Ambivalent tales of HIV disclosure in San Francisco.

In light of rising levels of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in San Francisco, we sought to understand disclosure practices, the calculus of risk and attitudes about HIV seroconversion. In 2000, 150 MSM participated in interviews pivoting around a detailed narrative of a recent incident of UAI. In order to understand the relationship between individual and community norms, we analyzed the narratives as accounts situated within the respondents' experience of the HIV epidemic and the gay community in San Francisco. In justifying their risky sexual practices, MSM cited a community-wide shift toward non-disclosure and barebacking since the advent of highly active anti-retroviral therapy (HAART). Fearing rejection by HIV-positive partners who refuse to use condoms, HIV-negative men saw little advantage in disclosing to casual partners whom they perceived as overwhelmingly HIV-positive. By contrast, HIV-positive men appeared eager to disclose their positive status to release themselves from responsibility for transmission and facilitate "bareback" or unprotected sex. Disavowal of individual responsibility for safer sex in deference to community norms may contribute to the recent spiraling of risk behavior and HIV incidence. Implications for prevention policy are discussed.

Adult↗
PubMed1999

The effects of traumatic disclosure on physical and mental health: the values of writing and talking about upsetting events.

Directly and indirectly, sudden life transitions can profoundly influence people's social, family, physical, and psychological lives. One traditional goal within psychology has been to understand and develop ways by which to reduce the adverse impact of individual and collective traumas. Four major issues surrounding coping with emotional upheavals are discussed in the current paper. The first concerns the natural sequence of coping that occurs in most disasters. The second focuses on the advantages of talking about upsetting experiences and, conversely, the dangers of not talking about emotional upheavals. The third section, which has been central to our lab's approach, deals with evidence that writing about upsetting experiences is beneficial to health and well-being. The final part of the paper discusses these findings within the context of Critical Incident Stress Management (CISM) debriefing strategies.

Crisis Intervention↗
PubMed2003

The prevalence of domestic violence in pregnant women.

OBJECTIVE: To determine the prevalence of domestic violence in a population of pregnant women. DESIGN: Questionnaire survey. SETTING: Antenatal booking clinic in a north of England hospital. POPULATION: Five hundred consecutive women were included. METHODS: Anonymous confidential questionnaire to women who were not accompanied by their partners. MAIN OUTCOME MEASURES: Disclosure of a past history of physical, emotional or sexual abuse. RESULTS: Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26-30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity. CONCLUSIONS: The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.

Adolescent↗
PubMed1977

The effect of interviewer bias on mental illness questionnaire responses.

The purpose of this study was to investigate how interviewer behavior affects information obtained from a respondent during an interview. The five factors of interviewer behavior that were studied were social reinforcement, interviewer disclosure, verbal modeling, interviewer dress, and seating arrangement. The dependent variable was the number of symptoms reported on the 22-item Mental Health Inventory. A total of 128 male and female adult patients under treatment for mental illness were interviewed under procedures using all combinations of the five factors. Control of patient sex, age, ethnicity, and education was effected through the use of a balanced design. The results demonstrated that the behavior of the interviewer influenced the respondent's report of psychiatric symptoms. The largest number of psychiatric symptoms were reported when the interviewer gave social reinforcement while wearing a lab coat and sitting across a desk from the respondent.

Adult↗
PubMed2001

Calculating number of offenses and victims of juvenile sexual offending: the role of posttreatment disclosures.

This research was designed to compare data obtained from agency records at three treatment programs for juvenile male sex offenders with information available from clinicians once youth and their families had been in treatment for at least 6 months. Results revealed that over the course of treatment, youth and their families disclosed information about additional victims and offenses, physical and sexual abuse of the offenders, and several aspects of a violent and sexualized family environment. Over half the boys reported additional victims or additional offenses or both. There were significant increases in the number of reports of physical abuse, witnessing of domestic violence, living in a sexual environment, maternal sexual victimization, maternal victimization of domestic violence, and fathers being perpetrators of domestic violence. These data clearly support the hypotheses of the study and have important implications for both clinical practice and future research in this area.

Adolescent↗
PubMed2005

Methamphetamine-dependent gay men's disclosure of their HIV status to sexual partners.

Disclosure of one's HIV status to a potential sexual partner has important HIV prevention implications. This paper qualitatively evaluates the social and sexual contexts that influence disclosure of HIV status among methamphetamine-dependent gay men enrolled in an outpatient drug treatment research program. As part of an open-ended, semi-structured interview, 34 HIV-positive and HIV-negative men discussed how, when, to whom and under what circumstances they reveal information about their HIV status. The four factors that influence participants' decision to disclose include: (1) an HIV-negative sexual partner's disclosure; (2) sexual venue (private versus public); (3) primary versus non-primary partner; and (4) the perceived risk of the sexual act. Sexual encounters among the men in this sample often occurred in public environments with non-primary partners, and involved use of illicit substances. In these social and sexual contexts, both HIV-positive and HIV-negative participants believed that it is HIV-negative rather than HIV-positive men who should initiate safer sex dialogue and safer sex practices. Findings are helpful in crafting HIV-prevention interventions targeting substance-using gay men whose sexual practices place them at high-risk for HIV-infection.

Adult↗