Brown Monique J, Serovich Julianne M, Laschober Tanja C, Kimberly Judy A, Lescano Celia M
a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.
b South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.
AIDS Care. 2019 Aug;31(8):1001-1010. doi: 10.1080/09540121.2019.1605045. Epub 2019 Apr 12.
Individuals living with HIV/AIDS face several stressors and use varying strategies to cope. Disclosure (or nondisclosure) of HIV serostatus is an important consideration among individuals living with HIV. However, studies examining the association between coping and HIV disclosure are lacking, and more research examining potential mediators and moderators is needed. The transactional model of stress and coping and the theory of planned behavior may help in understanding the mediating relationship between coping, decision self-efficacy, and HIV disclosure. Therefore, the aims of this study were to examine the association between coping and HIV disclosure to sexual partners, assess the mediating role of decision self-efficacy, and examine moderation by sex. Baseline data from 262 individuals living with HIV who participated in a disclosure intervention were used for analysis. Descriptive statistics were used to assess sociodemographic characteristics. Principal component analysis was used to operationalize coping. Path analysis was then used to determine the mediating role of decision self-efficacy in the association between overall, adaptive, distancing, and attack/escape avoidance coping and HIV disclosure to sexual partners. After adjusting for age and time since diagnosis, direct associations between coping and decision self-efficacy, and decision self-efficacy and disclosure behavior varied by sex. Among the overall study population, decision self-efficacy mediated the associations between adaptive coping ( = 0.064, = 0.003), attack/escape avoidance coping ( = -0.052, = 0.009) and disclosure behavior. Disclosure intervention programs geared towards populations living with HIV should include decision self-efficacy and adaptive coping, and attenuate attack/escape avoidance coping.
感染艾滋病毒/艾滋病的个体面临多种压力源，并采用不同的策略来应对。艾滋病毒血清状态的披露（或不披露）是艾滋病毒感染者需要重点考虑的问题。然而，目前缺乏关于应对方式与艾滋病毒披露之间关联的研究，因此需要更多研究来探究潜在的中介因素和调节因素。压力与应对的交互模型以及计划行为理论可能有助于理解应对方式、决策自我效能感和艾滋病毒披露之间的中介关系。因此，本研究的目的是检验应对方式与向性伴侣披露艾滋病毒之间的关联，评估决策自我效能感的中介作用，并考察性别因素的调节作用。对参与披露干预的262名艾滋病毒感染者的基线数据进行了分析。描述性统计用于评估社会人口学特征。主成分分析用于对应对方式进行操作化。然后采用路径分析来确定决策自我效能感在总体应对、适应性应对、疏离性应对以及攻击/逃避性应对与向性伴侣披露艾滋病毒之间的关联中所起的中介作用。在对年龄和确诊时间进行调整后，应对方式与决策自我效能感之间以及决策自我效能感与披露行为之间的直接关联因性别而异。在整个研究人群中，决策自我效能感介导了适应性应对（β = 0.064，p = 0.003）、攻击/逃避性应对（β = -0.052，p = 0.009）与披露行为之间的关联。针对艾滋病毒感染者群体的披露干预项目应纳入决策自我效能感和适应性应对方式，并减少攻击/逃避性应对方式。
