Bridging Disciplinary Boundaries (January 11 - 14, 2007)

PURPOSE: Studies examining the association between psychological distress and HIV status among women belonging to populations at elevated risk for HIV infection report a mixture of findings. Some studies with drug-involved women report significantly greater levels of distress among HIV-positive participants compared to HIV-negative participants, while several other studies failed to find significant association between psychological distress and HIV status among drug-involved women. The goal of this study is to shed greater insight into possible explanations for these mixed findings. Specifically, we examine psychological distress as a function of dyadic HIV status (i.e., the combination of a participant and her partner's HIV statuses) among women attending methadone maintenance treatment programs (MMTPs). METHODS: Randomly selected women attending MMTPs in New York City and involved in an intimate relationship provided self-reported data via structured, face-to-face interviews (N=349). Assessment data included sociodemographics (e.g., age, race/ethnicity, marital status, duration of methadone treatment), self-reported HIV statuses of the participant and her “main” intimate partner, and symptoms of psychological distress using the Brief Symptom Inventory. Assessment also included other potential stressors (e.g., intimate partner violence) and buffers of psychological distress (e.g., perceived social support). Multiple linear regression using 3 orthogonal contrast codes constructed from dyadic HIV status was used to test 3 hypotheses simultaneously: (H₁) HIV-positive participants will report greater psychological distress compared to HIV-negative participants. (H₂) Among HIV-negative participants, those with HIV-positive partners will report greater psychological distress compared to those with HIV-negative partners. (H₃) Among HIV-positive participants, those with HIV-positive partners will report lower psychological distress compared to those with HIV-negative partners. RESULTS: The mean age of participants was 40 years, with 30% identifying as African American and 48% as Latino. One-fifth (n=70, 20%) of the sample reported being HIV-positive, and 15% (n=54) of the sample reported that their main partner was HIV-positive. Overall, levels of psychological distress were substantially higher among the entire sample compared to the general population. Hypothesis testing using multivariate analyses with dyadic HIV status indicated the following with respect to hypotheses: (H₁) Levels of psychological distress did not differ significantly between HIV-negative and HIV-positive women. (H₂) HIV-negative women with HIV-positive partners reported significantly greater global levels (p<.01), number of symptoms (p<.01), and symptom severity (p<.01) of psychological distress compared to those with HIV-negative partners. (H₃) HIV-positive participants with HIV-positive partners reported significantly lower global levels (p=.04) and symptom severity (p=.02) of psychological distress compared to those with HIV-negative partners. CONCLUSIONS: Findings support that psychological distress appears to differ as a function of the combination of a woman and her partner's HIV status rather than the woman's HIV status alone. Thus, dyadic HIV status represents an important factor with respect to the mental health needs of women in drug treatment, underscoring the importance of couple- or relationship-based approaches in the development of new and/or innovative interventions for women belonging to populations at elevated risk for HIV. Additional implications for both social work research and practice in drug treatment settings will be discussed.