Coping strategies, psychosocial distress, substance use and immune function among symptomatic HIV-1 seropositive gay Hispanic and non-Hispanic white men

This dissertation consisted of four empirical cross-sectional studies designed to evaluate relations among coping, psychological distress, alcohol and drug use, and immunity among symptomatic HIV-1 seropositive Hispanic and non-Hispanic White gay men. Study One evaluated measurement models and a general structural equations model using structural equations modeling (SEM) to derive latent factors for coping, psychological distress, and alcohol and drug use among 211 participants. In Study Two, the same relations were evaluated among a subset of participants (N = 169) for whom immunological data (CD4+CD3+, CD8+CD3+, natural killer cell count and cytotoxicity) were available, while in Study Three, these relations were assessed among 129 participants seropositive to four herpesviruses (HSV-1, HSV-2, EBV, and CMV). Study Four included 60 participants who reported alcohol use in a 30-day period prior to assessment and for whom immunological data was available. It was hypothesized that higher adaptive and lower maladaptive coping strategies would be associated with higher psychological distress, and greater use of alcohol and drugs, while higher psychological distress would be associated with greater alcohol and drug use. Greater use of alcohol and drugs was expected to be associated with decrements in immunity. All four studies evaluated the possible role of ethnicity as a moderator. As expected, higher scores in adaptive coping were associated with lower scores in measures of distress, while greater use of maladaptive coping was associated with higher levels of psychological distress. Distress levels were also associated with the use of alcohol and drugs, and use of alcohol and drugs was associated with decrements in immunity. Results of several general SEMs testing these associations showed that the models fit the data adequately thus statistically supporting hypothesized relations. This study is the first to use SEM to evaluate these relations in this population. These findings underscore the importance of utilizing adequate coping strategies to deal with the chronic stress associated with HIV-1 infection in an effort to reduce psychological distress states, and alcohol and drug use. Several implications such as the emphasis on coping skills training in psychosocial interventions in this population, as well as methodological considerations, are discussed