Health Improvement for Baltimore Youth

Despite remarkable advances in HIV medication effectiveness, adherence to HIV treatment
recommendations is alarmingly poor, resulting in preventable morbidity and mortality. It is
estimated that 26-72% of HIV-infected adolescents are non-adherent to their HIV medications
and 22-33% are non-adherent with scheduled health care visits. HIV treatment non-adherence
puts individuals at markedly increased risk for illness related to HIV itself and a variety
of opportunistic infections, as well as at increased risk of spreading HIV.

Preliminary data from the investigators' NCCAM-funded R21 on mindfulness-based stress
reduction (MBSR) in HIV-infected youth suggest an association between mindfulness and
improved medication adherence, as well as enhanced self-regulatory processes (coping,
psychological function, and cognitive function). This two-armed randomized, controlled trial
will help the investigators to better understand the specific impact of MBSR on HIV
medication and treatment adherence in HIV-infected youth, and the efficacy of MBSR in the
amelioration of stress and improved self-regulation.

The aims of the study are as follows:

Primary Objective

Investigators hypothesize that MBSR vs. active control program (HT) participation will be
associated with:

• (H1) Improved HIV medication adherence (self-report validated by HIV viral load) at 3
months, 6 months, and 12 months

Secondary Objectives

Investigators also hypothesize that MBSR vs. active control program (HT) participation will
be associated with:

- (H2) Improved coping at 3, 6, and 12 months

- (H3) Improved psychological functioning at 3, 6, and 12 months

- (H4) Improved cognitive functioning at 3, 6, and 12 months

Investigators will also explore:

- associations (and potential mediation) among mindfulness, self-regulation, and HIV
medication adherence and

- using qualitative methods, experience with MBSR, HIV treatment adherence, as well as
reasons for non-participation in the study and non-attendance of program sessions to
inform future implementation planning.

- gender differences in the effects of MBSR versus HT on emotion regulation and
physiological responses to stressful stimuli.

Inclusion Criteria:

- 13-24 years of age

- English speaking

- Receiving care at the adolescent outpatient clinics at Johns Hopkins Children's Center
(JHCC/University of Maryland Medical Center (UMMC)/Moore Clinic

- Positive for HIV and aware of his/ her status

- Prescribed anti-retroviral therapy (ART)

- Able to attend and participate in the 9 week program sessions

Exclusion Criteria:

- patient currently exhibits significant psychological, developmental, or behavioral
issues as assessed by the site clinical staff

- participated in a previous MBSR program or studies

Exclusion Criteria for supplement study:

• patient is transgender