Recent psychoneuroimmunologic findings have suggested that it may be useful to evaluate the influence of behavioral factors on immune functioning and disease progression among human immunodeficiency virus-Type 1 (HIV-1) infected individuals. Behavioral interventions with immunomodulatory capabilities may help restore competence and thereby arrest HIV-1 disease promotion at the earliest stages of the infectious continuum. Evidence describing benefits of behavioral interventions such as aerobic exercise training on both psychological and immunological functioning among high-risk HIV-1 seronegative and very early stage seropositive gay men is presented. The HIV-1 infection is cast as a chronic disease for which early immunomodulatory behavioral interventions may have important physical and psychological impact.
This pilot study was designed as a methodological investigation of the way in which multidimensional scaling of desired objects or prizes might provide knowledge of group values not obtained from a more traditional testing method. Values were examined in four groups of students (female Fine Arts majors, female Business Administration majors, male Fine Arts majors, male Business Administration majors). Separate sets of peer judges interpreted the scaled dimensions. Both multidimensional and traditional test methods yielded interpretable differences among groups. Quantitatively, however, they yielded dissimilar information and could serve as supplementary sources of information in either theoretical comparisons or practical design of incentive, training, or communications programs.
We assessed changes in psychological and immunological functioning during 5-week periods preceding and following notification of serostatus among gay males taking the HIV-1 antibody test. Forty-six asymptomatic homosexual men between the ages of 18 and 40 yrs were recruited from a gay men's organization and through advertisements in a local newspaper. Measures of cell-mediated immunity (lymphocyte phenotypic markers, mitogen responsivity, and natural killer cell cytotoxicity) and psychological functioning (state anxiety, intrusive thoughts, and avoidant behaviors) were obtained at baseline, five weeks later and 72 hr before serostatus notification, and 1 week, 3 weeks and 5 weeks postnotification. Results suggested a dissociation between psychological and immunological phenomena among seropositives wherein lymphocyte proliferative responses to the mitogens phytohemagglutinin (PHA) and pokeweed mitogen (PWM) remained unchanged in the face of significant increases in state anxiety and intrusive thoughts following serostatus notification. These findings suggested that asymptomatic HIV-1 infected individuals, even at the earliest stages of infection, may be unable to mount an immune response to potent psychosocial stressors (i.e., serostatus notification), due perhaps, to the fact that the viral contribution to immune functioning overrides any influence of environmental stimuli. Among the seronegative subjects studied, blastogenic responses to PHA and PWM were depressed at baseline (relative to a group of age and gender-matched controls who were not undergoing HIV-1 antibody testing) but PHA values returned to normal values 5 weeks later. Natural killer (NK) cell cytotoxicity and CD4+CD45R+ inducer cell counts appeared to parallel these changes in seronegatives. Seropositives did display fluctuations in NK cell cytotoxicity that were similar to those noted for seronegatives. Correlational analyses suggested that individual differences in anxiety responses at the time of notification of seropositivity predicted subsequent (1-week lag) declines in NK cell cytotoxicity but not other functional markers. Although most seropositives displayed clinical levels of anxiety, intrusive thoughts and avoidant responses during the week of serostatus notification, these measures returned to their initial nonclinical baseline levels within 5 weeks after notification in both the seropositive and seronegative groups.
A considerable body of evidence, reviewed in this chapter, suggests that psychosocial factors play an important role in progression of HIV infection, its morbidity and mortality. Psychosocial influences relating to faster disease progression include life-event stress, sustained depression, denial/avoidance coping, concealment of gay identity (unless one is rejection-sensitive), and negative expectancies. Conversely, protective psychosocial factors include active coping, finding new meaning, and stress management. In studying long survivors of HIV/AIDS, our group has found protective effects on health of life involvement, collaborative relationship with doctor, emotional expression, depression (conversely), and perceived stress (conversely). Reviewed and discussed are psychoneuroimmunological pathways by which immune and neuroendocrine mechanisms might link psychosocial factors with health and long survival. Finally, biological factors are also a major determinant of disease progression and include genetics and age of the host, viral strain and virulence, medication and several immune response factors on which psychosocial influences could impact.
Our ten-year study examined the association between compassionate love (CL)—other-centered love, as well as compassionate self-love, and spiritual coping (SC)—the use of spirituality (connection to a Higher Presence or God) as a means to cope with trauma, and gender differences in 177 people living with HIV (PLWH). In a secondary data analysis of six-monthly interviews/essays, we coded five criteria of CL and rated the benefit of CL giving, receiving and self for the recipient. Synergistically, we rated longitudinal SC based on coding of 18 coping strategies. Overall, mean CL towards self was very high, followed by CL receiving and giving, while mean SC was moderately high. Women, in comparison to men, perceived higher benefit from SC and giving CL to others. Overall, CL towards self had the strongest association with SC, more pronounced in women than in men. Beyond gender, only CL for the self was a significant predictor of SC. Although there was a moderate association between SC and the perceived benefit from giving CL, after controlling for gender, this association was present in men only. Conversely, receiving CL from others yields a stronger association with SC in women than in men. Women perceived to benefit significantly more from SC and giving CL to others compared to men, whereas no gender differences were found on perceiving benefit from receiving CL from others or oneself. In conclusion, although women perceive more benefit from giving CL to others than men, this does not explain the higher benefit from SC among women. Ultimately, both men and women perceive to benefit more from SC the more they exhibit CL towards self and thus spiritual counseling should keep the importance of the balance between CL towards self and others in mind.
