Stress Management for HIV-Infected Individuals

Stressors, stress responses, coping strategies, and social resources are related to psychological adjustment, immune system function, and the physical course of HIV infection. Stress-management interventions that modify how individuals process and deal with stressors help to reduce distress and facilitate adjustment and buffer the stressors on the immune system.

We now know from randomized clinical trial that HIV+ people assigned to a time-limited group-based stress management intervention show reductions in negative mood, improved coping (e.g., less denial), and greater social support as well as decreases in stress hormones such as cortisol and NE, greater antiviral immune function against herpes viruses, and greater signs of immune system reconstitution. Greater improvements in mood and reductions in stress hormones predicted the greatest gains in immunity, thus providing support for a PNI model in HIV infection.

Some of these gains appear to be brought about by the ability of these interventions to modify stressor appraisals, improve coping strategies, and enhance social support in HIV-infected people. Psychosocial interventions that provide information, skills, and support to infected people can help normalize neuroendocrine levels and can also facilitate the adoption and maintenance of positive health behaviors, including better adherence to demanding antiretroviral medication protocols.

Because interventions may also decrease denial and depressed affect, they may, in turn, decrease negative health behaviors (e.g., substance use and risky sex) that are associated with immune system decrements. The improvements in immune function that have been associated with these psychosocial interventions raises the interesting question of whether stress management can help reconstitute the immune system once antiretroviral agents have contained HIV.

Although we are now learning much about how stressors and stress management interventions influence HIV disease in gay men, far less is known about other HIV-infected populations that are growing in numbers (e.g., poor minority women and injection-drug users).

Understanding the mechanisms through which stressful experiences and stress management interventions contribute to quality of life and the physical course of HIV infection may help the growing populations of infected people who are attempting to manage this chronic disease.