Enhancing the health of women living with HIV: the SMART/EST Women's Project

Abstract

Stephen M Weiss1, Jonathan N Tobin2, Michael Antoni1, Gail Ironson1, Mary Ishii1, Anita Vaughn2, Andrea Cassells2, Deborah Jones1, Neil Schneiderman1, Elizabeth Brondolo3, Arthur LaPerriere1, Maria Lopez1, Olga Villar-Loubet1, Joanne Camille2, Mahendra Kumar1, J Bryan Page1, SMART/EST Women's Project Team*1University of Miami, Miami, FL, USA; 2Clinical Directors Network, New York, NY, USA; 3St Johns University, Queens, NY, USA; *The SMART/EST Womens' Project Team: DeVieux J, Jean-Gilles M, Gousse Y, Alexander K, Bustamonte V, Lopez E, Casani J, Stanley H, Asthana D, Van Splunteren F, Goldstein A, Nasajon R, Wiesner Y, Zukerman M, Segal-Isaacson CJ, Romanowsky A, Masheb R, Coma C, Ubiera M, D'Andrea SM, Ittai N.Abstract: The principal objective of these multisite studies (Florida, New York, New Jersey: epicenters for human immunodeficiency virus [HIV] among women) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome (AIDS) epidemic in the United States: poor women of color living with HIV. The two studies enrolled nearly 900 women randomly assigned to “high intensity” (cognitive–behavioral stress management training combined with expressive–supportive therapy [CBSM]+ group) or “low intensity” (individual psychoeducational program) treatment conditions over a period of 9 years. The initial study of the stress management and relaxation training/expressive–supportive therapy (SMART/EST) Women's Project (SWP I) focused on reducing depression and anxiety, as well as improving self-efficacy and overall quality of life for women with case-defined AIDS. Findings from this study demonstrated the utility of CBSM+ in reducing distress (depression, anxiety) and denial, while improving social support, self-efficacy, coping skills, and quality of life. The second study (SWP II), which included all women living with HIV, extended these findings by demonstrating that exposure to CBSM+ significantly improved the ability of the participants to take advantage of a health behavior change program encouraging the adoption and maintenance of healthier lifestyle behaviors (high levels of medication adherence, appropriate nutritional intake and physical activity, safer sexual practices, and reduced alcohol use/abuse) essential for optimal health in the context of living with HIV. SWP II also determined that the intervention program was equally beneficial to less-acculturated segments of the affected population (ie, non-English speaking HIV+ women) through the creation of culturally and linguistically sensitive Spanish and Creole versions of the program. A third study (SWP III) is currently underway to “translate” this evidence-based treatment program into Community Health Centers in Miami, New York City, and metropolitan New Jersey.Keywords: HIV, AIDS, behavior, social support, viral load, quality of life, translating research into practice