Adaptive demands along the HIV disease continuum

Our knowledge of the problems or adaptive demands associated with HIV infection has largely been derived from clinical history taking and qualitative research of persons with AIDS. This study uses a behaviour-analytic approach to systematically describe and quantify the specific adaptive demands encountered by persons with HIV across the disease continuum. Ninety six HIV-infected gay men and 33 seronegative comparison group participants were interviewed in depth. Participants were divided into three groups representing the disease continuum: seronegative, HIV asymptomatic and HIV symptomatic groups. Responses to a Problem Checklist were statistically and content analysed. Distressing emotions, relationship difficulties and HIV-related symptoms were the three most frequently endorsed problems and were also the three most frequently reported problems of most concern. Overall there was a trend for instrumental difficulties to increase with disease progression, whereas emotional and existential problems did not vary as a function of HIV stage. The behaviour-analytic approach to the specification of problems related to HIV infection has implications for both clinical and research endeavours. The specification of problems provided a means for accurately identifying common problems to target and could, therefore, provide the basis for developing suitably matched interventions for use with HIV-infected persons.