Pessimism and emotional repression in the progression of squamous intraepithelial lesions (SIL) and human immunodeficiency virus (HIV)-related immunosuppression and disease in HIV-1 seropositive black women co-infected with human papillomavirus (HPV)

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Michael H. Antoni - Committee Chair


HIV+ women are at increased risk for HIV-related gynecological conditions, such as squamous intraepithelial lesions (SIL), herpes simplex virus (HSV) outbreaks, pelvic inflammatory disease (PID), and vaginal candidiasis. These disease processes may be mediated by deficient host immune response. While it has been demonstrated that psychosocial factors are associated with immune functioning and disease outcome in HIV-negative and HIV-positive individuals, no research to date has addressed the role of psychosocial factors in the progression of HIV-related gynecological conditions and immunosuppression in HIV+ women with HPV. This study was the first to examine prospectively the role of stressful life events, emotional repression, and pessimism on the progression of SIL and HIV-related immunosuppression and disease in low socioeconomic (SES) status, HIV+ women of color. Results indicated that these psychosocial factors were associated with numerous clinical outcomes, cell-mediated immunity, and natural immunity at follow-up. Higher impact of negative life events was associated with higher SIL levels, the progression or persistence of SIL, greater number of HSV outbreaks, and decrements in percentages of T lymphocytes and NK (CD56+CD3--) cells at 1-year. Pessimism did not significantly predict clinical or immune outcomes, which may be due to measurement limitations. Of the emotional repression constructs investigated, greater ambivalence over emotional expression predicted lower SIL levels and the nonprogression or regression of SIL at one year. This latter finding may indicate HIV+ women of color who described themselves as carefully weighing and monitoring the intrapsychic and interpersonal effects of their emotional expression experienced clinical benefits. This may be a gender- and culturally-specific "emotional intelligence" that ensures safety in expressing oneself in order to maintain connections with others for tangible and emotional purposes. Overall, these findings have significant implications for psychosocial group interventions for HIV+ women of color. Interventions should focus heavily on exploring mechanisms of coping with stressors both related and unrelated to HIV. However, the unexpected protective function of ambivalence over emotional expression suggests that these coping mechanisms must be explored within the context of gender, culture, SES, and disease status.


Health Sciences, Obstetrics and Gynecology; Psychology, Clinical

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