Sizemore K Marie, Samrock Steven, Gray Shannon, Marcotte David, Rendina H Jonathon
Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.
Department of Psychology, Fordham University, New York, NY, USA.
Mindfulness (N Y). 2020 May;11(5):1159-1169. doi: 10.1007/s12671-020-01315-8. Epub 2020 Feb 10.
People living with HIV (PLWH) are disproportionately affected by stressful life events. HIV-related stress adds to general life stressors to increase health risks among this population. Stress has not only been associated with HIV progression but it is also linked to HIV transmission risk behavior (e.g., substance use). Older adults living with HIV (OALWH) experience additional age-related stress and are at increased risk for substance use. Mindfulness buffers against stress for PLWH; however, research has yet to examine mindfulness as a buffer between HIV-related stress and substance use for OALWH.
Participants were 130 OALWH ( = 54.65, SD = 4.20) and 74.6% were Black. The majority were male (69.2%), and nearly half identified as heterosexual (48.5%). A hierarchical linear regression examined the main and interactive effects of mindful awareness and two types of HIV-related stress (e.g., stigma and rumination) on alcohol and drug use problems.
In step one of the model, we examined HIV stigma ( = .231, = .015) and found no significant interaction with mindful awareness. In step two, HIV rumination ( = .288, = .001) was added. We found a significant interaction ( = .196, = .020), indicating those with low mindful awareness and high rumination reported the greatest substance use problems. Exploratory analyses revealed an indirect effect of HIV stigma on substance use through HIV rumination as well as a significant effect for second-stage moderated mediation.
These findings support mindful awareness as a buffer against HIV rumination for OALWH. Further, our results have important implications for the utility of mindfulness-based interventions (MBIs) with OALWH and comorbid substance use disorders.
感染艾滋病毒的人（PLWH）受应激性生活事件的影响尤为严重。与艾滋病毒相关的压力叠加在一般生活压力源之上，增加了这一人群的健康风险。压力不仅与艾滋病毒的进展有关，还与艾滋病毒传播风险行为（如药物使用）相关。老年艾滋病毒感染者（OALWH）会经历额外的与年龄相关的压力，且药物使用风险增加。正念可缓解PLWH的压力；然而，尚未有研究探讨正念作为OALWH中艾滋病毒相关压力与药物使用之间的缓冲因素。
参与者为130名OALWH（平均年龄 = 54.65岁，标准差 = 4.20），74.6%为黑人。大多数为男性（69.2%），近一半为异性恋（48.5%）。采用分层线性回归分析正念意识以及两种类型的艾滋病毒相关压力（如耻辱感和反复思考）对酒精和药物使用问题的主效应和交互效应。
在模型的第一步，我们检验了艾滋病毒耻辱感（β = 0.231，p = 0.015），未发现与正念意识有显著交互作用。在第二步，加入了艾滋病毒反复思考（β = 0.288，p = 0.001）。我们发现了显著的交互作用（β = 0.196，p = 0.020），表明正念意识低且反复思考程度高的人报告的药物使用问题最多。探索性分析揭示了艾滋病毒耻辱感通过艾滋病毒反复思考对药物使用的间接效应以及二阶调节中介的显著效应。
这些发现支持正念意识可作为OALWH抵御艾滋病毒反复思考的缓冲因素。此外，我们的结果对于针对OALWH及共病药物使用障碍的正念干预措施（MBIs）的效用具有重要意义。
