Using novel methods to examine stress among HIV-positive African American men who have sex with men and women

Abstract

Biomarker composites (BCs) that objectively quantify psychosocial stress independent of self report could help to identify those at greatest risk for negative health outcomes and elucidate mechanisms of stress-related processes. Here, BCs are examined in the context of existing disease progression among HIV-positive African American men who have sex with men and women (MSMW) with high stress histories, including childhood sexual abuse. Participants (N = 99) collected 12-h overnight and morning urine samples for assay of cortisol and catecholamines (primary BC) and neopterin (an indicator of HIV disease progression). Data on cumulative psychosocial trauma history (severity, types, frequency, age at first incident), posttraumatic stress disorder (PTSD) symptoms, sexual risk behaviors, and a secondary BC consisting of routine health indicators (heart rate, blood pressure, body mass index, waist-to-hip ratio) were also collected. Lifetime trauma exposure was highly pervasive and significantly greater among those meeting a standard cutoff for PTSD caseness (24 %). After controlling for HIV factors (neopterin levels and years with disease), PTSD was a significant (p <.05) predictor of the primary, but not secondary BC. Those with PTSD also had significantly more sexual partners, sex without a condom, and exchange sex for money or drugs than those without PTSD. Specific trauma characteristics predicted PTSD severity and caseness independently and uniquely in regression models (p’s <.05–.001). A primary BC appears sensitive to cumulative trauma burden and PTSD in HIV-positive African American MSMW, providing support for the use of BCs to quantify psychosocial stress and inform novel methods for examining mechanisms of stress influenced health behaviors and disease outcomes in at-risk populations.

A Sexual Risk and Stress Reduction Intervention Designed for HIV-Positive Bisexual African American Men With Childhood Sexual Abuse Histories

“…A total of 295 men were screened, and 117 met the eligibility criteria ( Figure 1); 99 had complete baseline data (the data for these men were used in an earlier baseline report on this population 40 ). Of these 99 men, 88 participated in either the ES-HIM or the HP condition (i.e., attended at least the first session).…”

“…A baseline analysis of a larger cohort from this same sample 40 showed that severe CSA and a greater number of PTSD symptoms were significantly associated with increased sexual risk behaviors. In addition, clinically meaningful PTSD symptom levels (PDS score above 17) predicted baseline biomarker composite scores.…”

“…40 Nonetheless, replication of this study is needed with a larger sample to increase the probability of effective randomization and provide adequate statistical power to further examine the effectiveness of ES-HIM in improving sexual and mental health outcomes and biomarker composites. Although a number of interventions have targeted people living with HIV/AIDS in an attempt to decrease sexual risk behaviors and improve psychological outcomes and immune functioning, 43,44,47 few have influenced change across all domains.…”

“…Although interventions designed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes, future research is needed to examine factors that influence intervention effects. ( 40 Severe…”

“…As previously reported, CSA severity was positively correlated with frequency of exchanging sex for money or drugs, and PTSD severity was positively correlated with total number of sexual partners. 40 These links between sexual risktaking and trauma-related psychological factors require a holistic approach to intervention (i.e., one that addresses both individual challenges as well as environmental or structural ones), and ES-HIM was developed with this need in mind.…”