Health Improvement for Baltimore Youth

Preliminary data from the investigators' National Center for Complementary and Alternative Medicine (NCCAM)-funded R21 on mindfulness-based stress reduction (MBSR) in HIV-infected youth suggest an association between mindfulness and improved self-regulation and medication adherence. This 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.

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.

Eligibility Criteria:
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