Spiritual transformation, psychological well-being, health, and survival in people with HIV.
OBJECTIVE
Although Spiritual Transformation (ST) occurs in a sizable proportion of people with HIV (about 39%), there is little research on the potential benefits of ST with respect to psychological well-being, health, and survival in this population. Our study attempts to fill this gap.


METHODS
Using a mixed method approach, we related interviews of 147 people with HIV (identifying the presence/absence of ST) to questionnaires measuring demographics, medical history, treatment adherence, physical symptoms, and psychological well-being (i.e., stress, coping, life attitude, and spirituality), and assessments of CD4-counts and viral load and survival 3 to 5 years later.


RESULTS
At comparable times since HIV-diagnosis and antiretroviral medications prescribed, the presence of ST was significantly associated with better treatment success (undetectable viral loads, higher CD4 counts), better medication adherence, fewer symptoms, less distress, more positive coping, different life attitudes (i.e., existential transcendence, meaning/purpose in life, optimism, death acceptance), more spiritual practices, and increased spirituality. ST was also associated with substance-use recovery and with being African American. Survival up to 5 years was 5.35 times more likely among participants with ST (p(f) = .044). According to a Cox-regression adjusted for baseline CD4-counts, age, race-ethnicity, gender, education, years since HIV-diagnosis, and a history of substance-use problems, ST still reduced the risk of death (HR = 0.07, 95% CI = 0.01-0.53, p = .010).


CONCLUSIONS
ST has associated benefits for psychological well-being, health, and survival.
Ironson
Gail
G
Department of Psychology, University of Miami, Coral Gables, Florida 33124, USA. GIronson@aol.com
Kremer
Heidemarie
H
D000223:Adaptation, Psychological; D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003863:Depression / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D029181:Spirituality; D013315:Stress, Psychological / Q000821:virology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D019562:Viral Load